Abraham Adunsky, MD, Rami Levi, MD, Aharon Cecic, MD, Marina Arad, MD, Shlomo Noy, MD and Vita Barell, BA
Background: The progressive increase in the number of elderly patients with hip fractures and the particular multidisciplinary needs of this population call for the investigation of other models of orthogeriatric care.
Objectives: To describe the nature and assess the feasibility of a comprehensive orthogeriatric unit attending to patients' surgical, medical and rehabilitation needs in a single setting.
Methods: This retrospective chart review describes consecutive older patients with hip fractures admitted directly from the emergency ward to an orthogeriatric ward.
Results: The mean age of the 116 patients evaluated was 82.4 years. Delay to surgery was 3.6±3.1 days and total length of stay 23.9±11.0 days. No patient was transferred to other acute medical wards of the hospital and 66.4% were able to return to their previous living place. Rates of major complications and mortality were extremely low.
Conclusion: The present model of a comprehensive orthogeriatric ward is a practical, applicable and feasible service for elderly hip fracture patients and can cover the various needs of these patients. The deployment arrangements needed to establish and operate the ward were minimal and there were only a few management and organizational problems. The cost-effectiveness and other comparative benefits of this type of service have yet to be clarified.
Anat Kesler, MD, Ronit Galili-Mosberg, MD and Natan Gadoth, MD
Eyal Meltzer, MD and Shmuel Steinlauf, MD
Background: Lithium has been a part of the psychiatric pharmacopoeia for more than half a century. Its efficacy is marred by a narrow therapeutic index and significant toxicity.
Objectives: To increase physicians’ awareness of the various manifestations of lithium intoxication.
Methods: We reviewed the clinical data of cases of lithium poisoning occurring in a municipal hospital during a 10 year period.
Results: Eight patient records were located. The mortality rate was 12.5%. All patients were women and the mean age was 66.4 years. The most common symptoms were neurological. One illustrative case is described in detail with lithium serum levels showing the usual two-phase decline.
Conclusions: Lithium poisoning can present in many forms. Increased physician awareness and the early use of effective treatment, mainly hemodialysis, will prevent mortality and protracted morbidity associated with this condition.
Tomas Kozak, MD and Ivan Rychlik, MD
Intractable forms of autoimmune diseases follow a rapid course, with a significantly shortened life expectancy sometimes comparable to that of malignant diseases. Immunoablative therapy, including high dose cytotoxic agents and hematopoietic autologous stem cell rescue, was recently introduced as an aggressive approach to treat autoimmune diseases that have a rapid course and are resistant to conventional therapy. The most frequent indication for this type of treatment is multiple sclerosis, seconded by systemic sclerosis. The results of immunoablative treatment with documented responses in both diseases are encouraging. The data are mature enough to begin comparative randomized studies of immunoablative versus conventional treatment to validate the benefit of the aggressive approach. A randomized trial involving SSc was recently launched (ASTIS) and a trial involving MS is under preparation. Considerably less experience with immunoablative treatment has been gained in systemic lupus erythematosus, rheumatoid arthritis, and other disorders with an autoimmune pathophysiology. Autologous hematopoietic stem cell transplantation in humans offers more long-lasting immunosuppression than reeducation of lymphocytes. In fact, allogeneic transplantation may replace the whole immune system. However, this attractive approach is still associated with considerable morbidity and mortality and is not yet justified for treatment of automimmune diseases. Non-myeloablative allogeneic transplantation and sub-myeloblative high dose cyclophosphamide without stem cell support are alternative approaches that could be explored in pilot studies.
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Avichai Shimoni, MD and Arnon Nagler
Eyal Grunebaum, MD, Yair Levy, MD and Yehuda Shoenfeld, MD
Jacob Lavee, MD and Yoav Paz, MD
Gil Siegal, MD, Jacob Braun, MD, Avraham Kuten, MD, Tzahala Tzuk-Shina, MD, Louise M. Lev, MD, Ines Misselevitch, MD and Michal Luntz, MD
Rosalia Smolyakov, MD, Klaris Riesenberg, MD, Francisc Schlaeffer, MD, Abraham Borer, MD, Jacob Gilad, MD, Nechama Peled, MSc and Michael Alkan, MD
Abraham Goldfarb, MD, Menachem Gross, MD, Jean-Yves Sichel, MD and Ron Eliashar, MD
Pnina Romem, MmedSc, RN, Haya Reizer, BN, RN, Yitzhak Romem, MD and Shifra Shvarts, PhD
Southern Sinai, a mountainous desolated arid area, is inhabited by Bedouin nomad tribes composed of Arabic-speaking Moslems. Until the Six Day War between Egypt and Israel in 1967, healthcare services in the region were based on traditional medicine performed by the Darvish, a local healer. Over the course of Israeli rule (1967-1982) an elaborate healthcare service was established and maintained, providing modern, up to date, comprehensive medical services that were available to all free of charge.