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        תוצאת חיפוש

        אוקטובר 1998

        יהודה שינפלד
        עמ'

        Kaleidoscopic Autoimmunity

         

        Yehuda Shoenfeld

         

        Unit for Study of Autoimmune Diseases and Medical Dept. B, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University

         

        We describe an 18-year-old girl with idiopathic thrombocytopenic purpura (ITP) who developed chronic active hepatitis following splenectomy that cured the ITP. This is a phenomenon in which an organ belonging to the immune system is resected, which results in cure of one autoimmune disease but in the emergence of another, apparently unrelated, second autoimmune disease. We refer to this phenomenon as kaleidoscopic autoimmunity, explaining that some autoimmune diseases are not induced by autoantigen-driven mechanisms, but rather result from immune dysregulation.

        עדנה פינצ'ובר
        עמ'

        Art Therapy for Hospitalized Children (Inspired by Elizabeth Kuebler-Ross's Approach)

         

        Edna Pinchover*

         

        Pediatric Wards School, Hadassah Hospital (Ein Karem and Mt. Scopus), Jerusalem

         

        This paper presents a combined strategy for coping with the emotional condition of hospitalized children, and reports the results of its implementation in pediatric wards. The strategy combines art therapy methods with the spiritual-psychological approach developed by Elizabeth Kuebler-Ross. Art therapy uses art for therapeutic and diagnostic purposes; in this study it was employed to encourage the child-patients to express their feelings, and lead them to processes of understanding of and adjustment to their conditions. Kuebler-Ross' methods, known for dealing with difficult emotional situations at the bedside of the seriously ill, were enlisted to build a relationship of trust and respect between patient and therapist.

        The population dealt with consisted of children (age 3-13) injured in road accidents, and cardiac and oncological cases. 7 case studies are brought to demonstrate the integrated therapeutic process. The process starts from the child-patient's artwork, which allows the therapist better insight into emotional conditions and to relate closely to issues brought up by the work. Through conversation with the therapist in an atmosphere of empathy and honest consideration, the patient becomes aware of her/his reactions, behavior, intentions and ambitions.

        The belief underlying this study is that the patient derives from these contacts new abilities which moderate anxieties and strengthen healthy energies. Better collaboration and sounder ways of coping with intrusive medical treatment, as well as more trust and hope seem to emerge from the relationships created by these contacts.

         

        * Principal of School.

        ספטמבר 1998

        נגה רייכמן, נתן קאופמן, ראובן מדר ועידית פלטאו
        עמ'

        Purpura - an Unusual Presentation of Takayasu Arteritis

         

        N. Reichman, N. Kaufman, R. Mader, E. Flatau

         

        Dept. of Medicine B and Rheumatic Disease Unit, HaEmek Hospital, Afula and Rappaport Faculty of Medicine, The Technion, Haifa

         

        Takayasu arteritis is an uncommon vasculitis, often referred to as aortic arch syndrome. It is most prevalent in young women. Physical findings such as the combination of pulseless arms and carotid bruits suggest the diagnosis. Associated skin manifestations such as pyoderma gangrenosum and erythema nodosum have been described. We present a 27-year-old woman with diffuse purpuric eruption and Takayasu arteritis. This appears to be the first description of such an association.

        מירי קרן ושמואל טיאנו
        עמ'

        Feeding Disorders in Infancy: Feeding Interaction Concept in Diagnosis and Treatment

         

        Miri Keren, Samuel Tyano

         

        Community-based Mental Health Baby Clinic, Gehah Hospital and Sackler School of Medicine, Tel Aviv University

         

        In infancy clinical manifestations of psychological distress are mainly somatic. Feeding disorders are one of the most common and nonspecific manifestations of different kinds of disturbed parent-child relationships. These disturbances may have their origins in the baby's constitution and physical status, in the parent's personality structure, or both, as has been conceptualized in the transactional model of normal and abnormal development. Among the daily interactions a baby has with parents, feeding has special inherent impact on the early parent-child relationship because of its psychological meanings. Therefore, feeding disorders, with or without failure to thrive, often reflect various disorders of infancy, still not well recognized in the medical community, such as regulatory disorders, attachment disorders, depression of infancy, disorders of separation-individuation, and post-traumatic eating disorder. 3 clinical cases are brought to increase awareness of psychological distress in the infant, and of feeding disorders as 1 of its manifestations. Each illustrates a different kind of feeding disorder in terms of etiology and pathogenesis. Through these cases we emphasize the need for a multidisciplinary, integrative approach in diagnosis and treatment. Our conceptual background is based both on the transactional model of development (infant and parental factors impact on each other) in a very dynamic paradigm, and on psychodynamic premises. Intrapsychic conflicts and past representations impact heavily on the parenting characteristics. We emphasize the psychological significance of disturbed feeding interactions, with or without failure to thrive.

         

        משה ויסברוט, גד ולן ודוד הנדל
        עמ'

        Rupture of Pectoralis Major Muscle: Operative Treatment of an Uncommon Sport Injury

         

        Moshe Weisbort, Gad J. Velan, David Hendel

         

        Orthopedics Dept., Rabin Medical Center (Golda Campus), Petah Tikva

         

        Rupture of the pectoralis major muscle in an athlete is rare, but is said to be common in weight lifters. The muscle usually ruptures at the musculotendinous junction during forceful contraction of the muscle in adduction, forward flexion and internal rotation of the arm. We describe an athlete who suffered such a major tear during a rugby game. It was treated surgically and after adequate rehabilitation, athletic activities were resumed.

        שמואל מייזל, ולדיסלב פיינשטיין ושרה קנדל-כצנלסון
        עמ'

        Treating Mother and Baby in Conjoint Hospitalization in a Psychiatric Hospital

         

        Shmuel Maizel, Vladislav Fainstein, Sarah K. Katzenelson

         

        Dept. B, Eitanim Mental Health Center, Jerusalem

         

        Since 1990 we have been admitting mothers with postpartum psychiatric morbidity together with their babies to our open psychiatric ward. The aim of conjoint hospitalization is to maintain and develop the bond between mother and baby while treating the mother's psychiatric disorder. The presence of the infant in the hospital allows both a thorough evaluation of the mothers' maternal ability and to use the infant as a facilitator of the mothers' recovery by engaging maternal functions. It prevents the infants from being placed in a foster home for the duration of the mothers' hospitalization. Readily available in Britain and Australia, such conjoint hospitalization is controversial and rarely available elsewhere. In the past 5 years we hospitalized 10 women with 11 babies (1 woman was hospitalized twice, after different births). All women had received psychiatric treatment prior to childbirth, but this was the first psychiatric hospitalization for 2 of them. Diagnoses (DSM-IIIR) were chronic paranoid schizophrenia (4), disorder (4), schizo-affective schizophrenia (1) and borderline disorder (1). 8 were suffering from active psychotic symptoms on admission. They were treated pharmacologically, received individual and group psychotherapy, and participated in all ward activities. Families were engaged in marital, family and/or individual therapy according to need. All participated in cognitive-behavior treatment tailored to individual need to build and enrich the mother-infant bond. All improved significantly and were able to function independently on discharge, but in 1 case adoption was recommended.

        איון פוקס, לאוניד אומנסקי ויעקב לרנר
        עמ'

        Folic Acid Deficiency in Chronically Hospitalized Mental Patients

         

        Ivan Fuchs, Leonid Omansky, Yaakov Lerner

         

        Eitanim Mental Health Center, Jerusalem (Affiliated with the Hebrew University-Hadassah Medical School)

         

        Studies over the past 30 years have shown a relationship between folic acid deficiency and psychopathology. FA deficiency was observed more often in depressed and in psychotic patients, in alcoholics, in those suffering from organic mental disorders and in the psycho-geriatric population. In a chronic inpatient population of 120 patients, of the 106 in whom FA serum levels were examined, only 1 had a definitely subnormal level. An additional 16 had close to the lower limit of normal (2 ng/ml) and were considered borderline cases. FA-deficient and borderline patients were then compared to matched patients with normal FA levels on the MMSE and PANSS scales by blinded raters. Small differences were found between the 2 groups. The FA-deficient and borderline patients had more organic and psychotic symptoms, but the differences were not statistically significant.

        יונתן רבינוביץ, דינה פלדמן, רויטל גרוס ווינקה בורמה
        עמ'

        Characteristics of Israeli Primary Health Care Physicians who Treat Depression

         

        Jonathan Rabinowitz, Dina Feldman, Revital Gross, Wienka Boerma

         

        Bar Ilan University, Ramat Gan; Israel Ministry of Health; JDC-Brookdale Institute, Jerusalem; and Netherlands Institute of Primary Health Care (NIVEL)

         

        Primary health care physicians have a pivotal role in treating mental health problems. We determined the proportion of primary care physicians in Israel who treat depression and their characteristics. The study was based on a stratified national random sample of primary care physicians (n677, response rate 78%). From these physicians' reports 22% always treat depression, 36.6% usually, 28.6% sometimes, and 12.6% never. Based on a logistic regression model the physicians who always or usually treated depression were distinguished from the other physicians by their treating more medical conditions on their own, seeing themselves as having more first contact for psychosocial problems, having frequent contact with social workers and specializing in family medicine. Primary health care physicians play a major role in treating depression on their own. This raises new questions about how they treat depression themselves, and under what circumstances they treat or refer to a specialist.

        רון מימון, אריה הרמן, אלי דרייזין, מתי גלסנר וצבי וינראוב
        עמ'

        Trisomy 18 Anomalies on Sonography and Calculated Risk of Chromosomal Abnormalities During First Trimester

         

        Ron Maymon, Arie Herman, Eli Dreazen, Mati Glasner, Zvi Weinraub

         

        Ultrasound Unit, Dept. of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zrifin, and Sackler School of Medicine, Tel Aviv University; and Women's Health Center, Kupat Holim, Holon Branch, Tel Aviv-Jaffa District

         

        Trisomy 18 is a chromosomal disorder giving multiple anomalies. Its frequency depends on maternal age. We report a 28-year-old woman in her first pregnancy, who underwent first trimester scanning for screening. Due to increased nuchal translucency and exomphalos, chorionic villous sampling was performed. Cytogenetic diagnosis was trisomy 18 and termination of pregnancy was carried out immediately.

        לימור גורצק-אוזן, דרורה פרייזר ורון דגן
        עמ'

        Epidemiology of Invasive Hemophilus Influenzae B Infections in Bedouins and Jews; Conjugate Hib Vaccines

         

        Limor Gortzak-Uzan*, Drora Fraser, Ron Dagan

         

        Pediatric Infectious Disease Unit and Dept. of Epidemiology, Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheba

         

        From 1989 to 1996, 139 cases of invasive Hemophilus influenzae B (Hib) infections were identified in children in the Negev, 110 of which occurred before introduction of the conjugate vaccine (1989-92). At that time there were 60.5 cases of Hib per 100,000 in the Negev among children under 5 years of age. During 1995-1996, when Hib conjugate vaccine was part of the regular immunization program, Hib decreased to 6.5 cases per 100,000 in that age group. The effectiveness of PRP-OMP vaccine was 96.5% among Jews and 89% among Bedouins, and the efficacy of the immunization program was 99.99%. This degree of success exceeded all expectations based on the literature. During the whole study period, Hib infections were more frequent among Bedouins than Jews. There was no significant difference in the occurrence of Hib among Jews in the Negev before and after the vaccine was introduced. Hib among Bedouins in the Negev was significantly more frequent than in the Israeli population as a whole before the vaccine was introduced. That gap narrowed after the vaccine was introduced because of the decrease in morbidity among the 2 groups.

        * Medical student.

        דוד ב' ויס, שושנה גוטשלק-סבג, צבי צוקרמן, אלחנן בר-און וצבי כהנא
        עמ'

        Follicle-Stimulating Hormone in Azoospermia in Prediction of Spermatogenic Patterns

         

        David B. Weiss, Shoshana Gottschalk-Sabag, Zvi Zukerman, Elchanan Bar-On, Zvi Kahana

         

        Kupat Holim Me'uhedet; and Dept. of Pathology and Cytology and Male Infertility Unit, Shaare Zedek Medical Center, Jerusalem; Andrology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva; and Paper Research Consultant Institute, Jerusalem

         

        Follicle-stimulating hormone (FSH) is considered to be the most important plasma hormone correlated with spermatogenesis. Elevated FSH plasma levels were shown to be associated with complete damage to testicular seminiferous tubule germinal epithelium. Recently, there have been conflicting reports with regard to the value of FSH plasma levels in predicting seminiferous tubule histology in the azoospermic patient and hence, as a guide for therapy in assisted reproduction using testicular sperm retrieval. The aim of this study was to evaluate whether FSH plasma levels can predict spermatogenic pattern in the testes of the azoospermic infertile patient. 69 infertile men with non-obstructive azoospermia and 18 with very severe oligospermia were studied. In all, plasma levels of testosterone, free testosterone, prolactin, luteinizing hormone and follicle-stimulating hormone were measured by enzyme immunoassay. In the azoospermic patients the seminiferous tubule spermatogenic pattern was determined in testicular aspirates obtained by multiple fine needle aspiration and categorized according to the most mature spermatogenic cell type in the aspirates: Sertoli cells only, spermatogenic maturation arrest or full spermatogenesis. There were no significant differences in plasma levels of any hormone measured except in very severely oligospermic and azoospermic patients. Both normal and elevated levels were detected in all, regardless of seminiferous tubule cytological pattern or plasma FSH in azoospermic patients. It is concluded that plasma levels of FSH can not be used as a predictive parameter, neither for the presence of spermatozoa nor for any other seminiferous tubule cytological pattern in azoospermic infertile men. They cannot serve as guides for selection of azoospermic men for trials of testicular sperm retrieval in assisted reproduction.

        אוגוסט 1998

        סורין דניאל יורדאש, אהוד ראט, דן עטר ואלכס וינדזברג
        עמ'

        Vacuum Phenomenon in the Hip Joint: Diagnostic Value

         

        S. Iordache, E. Rath, D. Atar, A. Vindzberg

         

        Orthopedics Dept., Soroka Medical Center, Beer Sheba

         

        Vacuum phenomenon is well known in degenerative spinal disease in the elderly, but is seldom seen in other joints, especially in children. The phenomenon does not represent a pathological finding, and can be used for imaging of the articular facets, mainly in the hip and knee joints. We report a patient with this phenomenon in the hip joint.

        סמיח בדארנה, ניר גלעדי וסילביה הוניגמן
        עמ'

        Botulinum Toxin Injection Effective for Post-Peripheral Facial Nerve Palsy Synkinesis

         

        Samih Badarny, Nir Giladi, Silvia Honigman

         

        Dept. of Neurology, Carmel Medical Center, Haifa; and Movement Disorders Unit, Dept. of Neurology, Tel Aviv Medical Center

         

        Facial synkinesis is an involuntary activation of muscles innervated by the zygomatic or mandibular branche of the facial nerve in conjunction with voluntary activation of the other branch. It appears frequently after recovery from peripheral facial nerve paralysis. We report 10 patients with facial synkinesis following Bell's palsy with a mean duration of synkinesis of 7±4 years before treatment with periorbital injections of Botulinum toxin type A. 9 had marked subjective and objective improvement starting a few days after injection andlasting 4-9 months. The results suggest a useful treatment option for post-Bell's palsy facsynkinesis with Botulinum toxin type A.

        י' שפירא, ילנה צוקרמן, תאופיק זועבי ועודד זורים
        עמ'

        Pheochromocytoma Multi-Organ Crisis: Nonseptic Hyperthermia and Shock

         

        Michael Y. Shapira, Elena Zuckerman, Taufic Zuebi, Oded Jurim

         

        Divisions of Medicine and Surgery, Hadassah-University Hospital; Geriatrics Dept.; Herzog Hospital, Jerusalem; and Dept. of Medicine, Yoseftal Hospital, Eilat

         

        Pheochromocytoma usually presents with nonspecific symptoms such as headache, palpitation, chest pain and hypertension. We present a 48-year-old woman hospitalized due to a pheochromocytoma multi-organ crisis (PMC). It consists of a tetrad of symptoms: multi-organ failure, hyperthermia, encephalopathy and unstable blood pressure. Distinguishing PMC from septic shock may be difficult, and requires needs a high clinical index of suspicion.

        עמירם שראל, ג'ף בורקן, רפאל ל' קרסו, יהודית ברנשטיין ואורי רוזובסקי
        עמ'

        Attitudes of Family Physicians to Alternative Medicine

         

        Amiram Sarel, Jef Borkan, Ralph L. Carasso, Judith Bernstein, Uri Rozovsky

         

        Brull-Tel Aviv Community Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba; and Dept. of Neurology, Hillel Yaffe Medical Center, Hadera

         

        80 Israeli family physicians (51.25% men and 48.75% women) participated in a telephone survey concerning attitudes, practices and experience with alternative medicine. 23.75% reported practicing 1 or more alternative techniques, most commonly acupuncture28%) and hypnotherapy (24%). 55% had referred at least 1 patient to an alternative practitioner during the preceding month. Physicians who studied in Israel or Western countries referred more patients than graduates of medical schools of Eastern Europe. Specialists referred patients more often than residents. The most common reason for referral was back pain.

        הבהרה משפטית: כל נושא המופיע באתר זה נועד להשכלה בלבד ואין לראות בו ייעוץ רפואי או משפטי. אין הר"י אחראית לתוכן המתפרסם באתר זה ולכל נזק שעלול להיגרם. כל הזכויות על המידע באתר שייכות להסתדרות הרפואית בישראל. מדיניות פרטיות
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