תוצאת חיפוש

Topical Photodynamic Therapy in Basal and Squamous Cell Carcinoma and Penile Bowen's Disease

Yoram Harth, Bernard Hirshovitz

Photodynamic Therapy Unit, Elisha Medical Center, Haifa

Photodynamic therapy (PDT) is a noninvasive selective therapy for a specific group of skin tumors. 5-aminolevulinic acid 20% in a water-in-oil cream base was applied to the tumors as a photosensitizer and was followed after 12 hours by exposure to a high output light source emitting red (585-720 nm; 150 mW/cm²) and near infrared irradiation (1.25-1.6 mm; 50 mW/cm²) for 10-15 minutes (VersaLight, incoherent filtered light source). Complete responses were achieved after 1-3 treatments in 26/31 lesions of superficial or small nodular basal cell carcinoma (BCC) and 4/5 in superficial, squamous cell carcinoma (SCC) lesions. There was a patient with Bowen's disease of the penis. Follow-up was for 12-24 months. This noninvasive, nearly painless treatment gives excellent therapeutic and cosmetic results. Our data show its efficacy for certain subtypes of BCC, SCC and Bowen's disease. Further studies will determine the exact cure and recurrence rates with this modality and compare it to other modes of skin cancer therapy.

Fine Needle Aspiration Biopsy of Mediastinal Masses Guided by Computed Tomography

M. Sklair-Levy, D. Shaham, I. Sherman, I. Bar-Ziv, I. Libson

Depts. of Radiology and Pathology, Hadassah-University Hospital, Jerusalem

Progress in diagnostic radiology and pathology during the past decade has changed the approach to diagnosis of mediastinal masses. Diagnosis by CT-guided needle biopsy (CTNB) has replaced open biopsy and mediastinoscopy. CTNB of mediastinal masses is accurate, reliable and safe. It is done under local anesthesia, in ambulatory patients and is tolerated well. Between July 1987 and April 1997 we performed 67 biopsies in 63 patients aged 6-86 years; 33 were women (average age 40.8 years) and 30 men (average age 38.3 years). 57 of 67 biopsies were core biopsies for histologic examination and 10 were cytologic biopsies. In this report we concentrate on the 57 core biopsies. 41 of the biopsies were diagnostic; in 3 of them no evidence of malignancy was found. In 38 of the biopsies a tumor, malignant or benign, or an inflammatory process was diagnosed. In 24 of the biopsies the diagnosis was lymphoma. In 16 there was not enough material for diagnosis. We repeated the biopsy in 4 of the latter due to high suspicion of malignancy and reached a diagnosis in all 4 of them. In 6 the diagnosis was reached only by operation. The biopsies were from all compartments of the mediastinum. There were no complications such as pneumothorax or bleeding, except for 1 case of mild hemoptysis. In conclusion, CTNB of mediastinal lesions is accurate, safe and relatively cheap. In 72% a diagnosis was reached in the first attempt and a second attempt raised the diagnostic rate to 79%. We believe that CTNB should be the first step in tissue diagnosis of mediastinal masses, including those with a high suspicion of lymphoma.

Oncogenetic Counseling and Genetic Testing of Those at High Risk for Breast and Ovarian Cancer

Livia Theodor, Ronit Shiri-Sverdlov, Galit Hirsch Yechezkel, Revital Bruchim Bar-Sade, Eva Gak, Irit Friedman, Anna Kruglikova, Gilad Ben-Baruch, Shulamit Risel, Moshe Z. Papa, Boleslav Goldman, Eitan Friedman

Oncogenetics Unit, Dept. of Clinical Epidemiology, Institute of Genetics, and Gynecology, Oncology, and Surgical Depts., Chaim Sheba Medical Center, Tel Hashomer

There is inherited predisposition to breast and ovarian cancer in 5-10% of all women with these diseases. Germline mutations in BRCA1 and BRCA2 presumably account for most of the genetically susceptible individuals. We summarize 2 years of experience in counseling and testing for inherited predisposition to these cancers.

597 women (from 320 families) have been evaluated since August 1995. 242 were evaluated for inherited predisposition to breast and ovarian cancer. One-third had clear-cut evidence of familial background. 74 families were of Ashkenazi origin; the age range of breast cancer was 30-35, of ovarian cancer 40-45. In 80% of families other cancers were also noted in first degree family members, including lung, colon, and prostate cancer and leukemia.

Genetic testing revealed that 45% of affected and 25% of unaffected women were carriers of a mutation in BRCA1 or BRCA2: 67/90 185delAG (BRCA1), 12/90 6174delT (BRCA2), and 4/90 of 5382insC (BRCA1). In addition, a novel mutation in exon 11 of BRCA1 was detected, carried by 7/90 women. The experience gained in oncogenetic counseling and genetic testing for inherited cancer predisposition will eventually enable determining an optimal, rational therapeutic regimen in carriers of mutations.

Drowning in Israel: 1990-1992

R. Goldman, G. Kaplan, R. Gurvich, V. Barell

Pediatric Division, Sheba Medical Center, Tel Hashomer; and Health Services Research Unit, Israel Ministry of Health

There are no epidemiolostudies of drowning in Israel in the scientific literature, despite prominent reports in the media. We analthe extent of mortality from drowning in Israel during 1990-92, attempting to identify and characterize groups at high risk, and to determine trends and differences between Israel and other countries. Computerized death certificate files were provided by the Israel government Central Bureau of Statistics; deaths from drowning were included among external causes codes E-830, 832, E-910, E-954, E-964, E-984.

In Israel, as in the United States, mortality from drowning is the fourth cause of death among all unintentional causes, and the second cause in age-groups 1-24, ranking after transport accidents. During 1990-92 there were 1.2 drownings a year/100,000 population. The highest rates were found among young non-Jews 15-24 years old (7.8/100,000) and among elderly Jews (3.5/100,000). Unintentional drowning accounted for 89% of all deaths; while about 10% were defined as suicides. Males had a rate almost 3 times greater than females, and the among Arabs was 2.4 times greater than among Jews. The 1990-92 drowning rate was slightly lower than in previous years.

Drowning rates in Israel are lower than in the United States, except in the elderly. Apparently the principal reason for this difference is difference in sites of drowning. In Israel most drownings occur in the sea, so site data are unavailable for international comparisons. Careful consideration of the categories (E-codes) included in the rates, and of local registration procedures, is necessary for international comparisons.

Foreign workers, tourists and other nonresidents are not included in national vital statistics. But estimations based on Ministry of Interior sources show that foreign workers (most, recent arrivals) during the last few years are an extremely high risk group. Population-based drowning rates are not an accurate estimation of drowning risk, since universal exposure to the "opportunity to drown" is assumed.

Ketogenic Diet for Intractable Epilepsy in Adults

Yaffa Schiff, Tally Lerman-Sagie

Nutrition and Diet Unit, Tel Aviv Medical Center; and Pediatric Neurology Unit, Wolfson Medical Center, Holon; and Sackler Faculty of Medicine, Tel Aviv University

The ketogenic diet is an accepted alternative for children with intractable generalized or multi-focal seizures not amenable to surgery. It is not commonly used in adults because of the impression that the diet is less effective after childhood, when it is more difficult both to achieve ketosis and to change dietary habits. We present a 20-year-old man with intractable epilepsy since early childhood who is being treated with great success by a medium-chain triglyceride ketogenic diet. It has not only controlled the seizures but has also improved quality of life. We recommend a therapeutic trial of the ketogenic diet in intractable epilepsy for all ages.

Suicidal Calls to a Telephone Emergency Service

Itzchak Gilat, Zvi E. Gil

ERAN (Israel Association for Emotional First Aid)

Suicidal threats and suicidal ideation among callers to the Israeli hot-line (ERAN) were investigated, using 2 methods of analysis. The first, an epidemiological survey based on 8,272 calls received by all 8 ERAN posts during 2 years, reported on their standard form for recording interactions with suicidal callers. The second is content analysis of 42 detailed reports of interactions with such callers. Epidemiological analysis revealed a higher rate of suicidal ideation among callers with a psychiatric history, compared with those without a history. However, the 2 groups did not differ in rate of suicidal threats. In addition, suicidal threats of adolescents were related mainly to problems of identity and self-image, while mental disorders were the main problems among adults. Content analysis identified 2 patterns of terminating the interaction, which represent 2 strategies of intervention to prevent suicide. The first is establishing a contact between the caller and an appropriate individual in the caller's environment who undertakes responsibility to help the caller. The second strategy is reducing the caller's tension, leading to a withdrawal of the suicidal threat. The first pattern is more characteristic of interactions with psychiatric callers, while the second is more frequent among non-psychiatric callers to ERAN. The hot-line makes a unique contribution in helping those threatening suicide, which constitutes a real emergency.

Chemical Synovectomy in Arthritis by Intra-Articular Injection of Osmic Acid

D. Markovits, M. Rozenbaum, I. Rosner, E. Rottenstriech

Dept. of Medicine A, Carmel Hospital; Rheumatology Unit, Bnai Zion Hospital; and Zevulun Medical Clinic, Haifa

18 patients suffering from persistent synovitis despite medical therapy were treated with an intra-articular injection of osmic acid. After 1 year of follow-up, 68% had good results and there were no complications nor detectable radiographic evidence of disease progression. Because osmic acid is almost as effective as surgical synovectomy and is cheap and easy to administer, it can be recommended as the first choice for treatment of corticosteroid-resistant arthritis in the early stages of the disease.

Acute Hyperparathyroidism Caused by Hemorrhage into a Parathyroid Adenoma

I.E. Priel, Rama Katz, E. Dolev

Depts. of Medicine E and Radiology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University

Acute hyperparathyroidism is a rare and dangerous condition. It is supposed to result from transformation of a mild chronic form into an acute and stormy illness. The causes and the mechanism of such a transformation are usually unknown. A case of acute hyperparathyroidism is presented in which hemorrhage into a parathyroid adenoma was recognized and diagnosed as the immediate cause of the transformation from the mild long-standing form of the disease into the severe acute form.

Nursing Home-Acquired Pneumonia: Guidelines for Hospitalization

A. Yaretzky, C. Vigder, I. Feldman

Geriatric Dept., Meir Hospital, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University

To determine if there are any specific features of nursing-home acquired pneumonia we carried out a retrospective study in a nursing home between 1995-1996, based on clinical and laboratory data. We found no correlation between these findings and the severity of pneumonia, so it would be hazardous to determine rigid guidelines. These patients should be treated in the nursing home as long as conditions allow, in order to avoid hospitalization.

Delirium Tremens in Israel

G.-Z. Ezrielev

Mental Health Center, Beer Sheba

We discuss pathogenetic aspects (biochemical, pharmacological) of delirium tremens (DT) in accordance with the acute clinical processes, the development of psychosis, and preventive treatment used in the various stages. A typical patient, a 33-year-old man, and the difficulties in diagnosis and treatment are presented and conclusions from the dangerous behavior of the patient are drawn.

Living-Related Liver Transplantation

N. Bar-Nathan, Z. Shapira, E. Shaharabani, A. Yussim, Y. Ben-Ari, T. Sheinfeld, I. Zehavi, R. Shapira, G. Dinari, Z. Ben-Ari, R. Tur-Kaspa, E. Mor

Dept. of Transplantation and Liver Institute, Rabin Medical Center (Beilinson Campus), and Pediatric Intensive Care and Pediatric Gastroenterology Units, Schneider Children's Medical Center, Petah Tikva

Our experience with living-related liver transplantation is described. In 2 boys and 1 girl, aged 4-4.5 years with acute, fulminating hepatitis A, the presence of very severe jaundice (bilirubin levels > 18 mg%) associated with severe coagulopathy (INR>10) and encephalopathy indicated the need for urgent liver transplantation. In all 3 cases the left lateral hepatic segment of a matched blood type parent was transplanted. None of the donors suffered a serious complication postoperatively and all returned to full activity in 6-16 weeks. The post-transplantation course was uneventful in 1 child, but in the other 2 there was hepatic arterial thrombosis in 1 at 1 day and in the other at 8 days post-transplantation. Early detection of arterial thrombosis by Doppler sonography permitted salvage of the 2 hepatic grafts after thrombectomy and re-anastomosis. In 1 of these 2 children an anastomotic biliary stricture was found 2 months after transplantation. It was corrected at surgery and a percutaneous stent was inserted. All 3 children are alive with normal graft function at 2, 7 and 8 months post-transplantation, respectively. This initial experience indicates that living-related liver transplantation is feasible in Israel. The technique might help to solve our severe organ shortage for children awaiting liver transplantation.

Primary Care Physicians in Israel Compared with European Countries

P. Shvartzman, R. Gross, H. Tabenkin, D. Yuval, M. Grinshtein, B. Wienka

Dept. of Family Medicine, Ben-Gurion University of the Negev, Beer Sheba;

Brookdale Institute, Jerusalem; and Nivel Institute, Maastricht, the Netherlands

This study compares Israeli primary care physicians with those of European countries. In Israel a larger proportion of those in primary care are women. The Israeli physicians see many patients a day, but almost never make home visits. They also report for work the fewest hours a day, but spend 21 hours a month in continuous medical education. (more than Europeans?) The Israeli primary care physician scores high in screening for breast cancer and blood cholesterol level, but very low in the fields of minor surgery and alcohol and smoking prevention, contraception, nutrition counseling and normal pregnancy follow-up. Residency training and education may be inadequate, and more emphasis has to be put on the health system and recognizing environmental influences.

Chylothorax following Penetrating Injury

Y. Kluger, B. Sagie, Y. Chemo, A. Ravid, Y. Paz, J. Klausner

Dept. of Surgery, Rabin Trauma Center and Sourasky-Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv

We describe a 19-year-old man with 9 stab wounds of the chest. Initial evaluation revealed paraplegia at the D-10 level and bilateral hemothorax. 2 days after admission right-sided chylothorax was diagnosed. Fasting and total parenteral nutrition resulted in complete clearance. Chylothorax can cause major metabolic consequences, but prompt treatment results in full recovery.

Cardiac Failure following Sting of Yellow Scorpion in an Adult

C. Kristal, I.Y. Shemesh, Y. Mishal, A. Bourvin

Intensive Care Unit, Dept. of Anesthesia and Medical Dept., Barzilai Medical Center, Ashkelon

3 men, aged 18, 29, and 47 had severe cardiovascular disturbances following the sting of the yellow scorpion (Leiurus quinquestriatus hebraeus), which is considered the most dangerous scorpion in Israel. Cardiovascular complications are common in children after scorpion sting, but are rare in adults. Pulmonary edema developed in 1 of those being reported and hypertension and arrhythmias in the other 2. Severe deterioration in left ventricle function was confirmed by echocardiographic measurement of diminished ejection fraction. All patients recovered completely. This is the first report of severe cardiac involvement in adults following scorpion sting. We therefor recommend that even adults who develop cardiac symptoms after scorpion sting, particularly those with chronic cardiac disease, be monitored and treated in an intensive care unit.

Effect of Alpha-Alpha Esterol on Plasma Cholesterol and Antioxidants

Y. Levy, E. Paster, G. Dankner, A. Ben-Amotz, J.G. Brook

Lipid Research Unit, Medical Dept. D, Rambam Medical Center; Rappaport Faculty of Medicine, The Technion; and Israel National Oceanographic Research Institute, Haifa

16 patients with hypercholesterolemia were treated with an extract of alpha-alpha leaves (esterol) while on a low-fat, low-cholesterol diet. Esterol is believed to inhibit the absorption of cholesterol and bile acids and may interfere with the absorption of essential nutrients. As oxidative modification of lipoproteins is required for the process of atherosclerosis, plasma antioxidant vitamins were followed. After 4 months of treatment, plasma cholesterol decreased by 10% from 282 to 250 mg/dl (p<0.001) and LDL cholesterol by 13%, from 203 to 177 mg/dl (p<0.001). Plasma antioxidant vitamins E, A and β-carotene were unchanged. Thus, esterol has a cholesterol-lowering effect but apparently does not lower fat-soluble, plasma antioxidant vitamins. Both cholesterol-lowering and plasma antioxidant vitamins are important for the primary prevention of coronary artery disease in hypercholesterolemia.