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        תוצאת חיפוש

        אוקטובר 1999

        בני אבידן, בתיה וויס, יהודה חוברס, אניטה יונש, שמעון בר מאיר ונתן קלר
        עמ'

        Sensitivity and Resistance of Helicobacter Pylori to Antibiotic Treatment

         

        Benny Avidan, Batia Weiss, Yeuda Chowers, Anita Younash, Simon Bar-Meir, Nathan Keler

         

        Dept. of Gastroenterology and Microbiology, Sheba Medical Center, Tel Hashomer

         

        Resistance to antibiotics is considered the main reason for failure to eradicate Helicobacter pylori (HP). Resistance rates are different in developed and developing countries and are not known for Israel. We studied HP resistance rates in 40 patients who underwent esophagoduodenoscopy for various indications and were found to have gastric HP colonies.

         

        Sensitivity was determined by E-test, using clarythromycin, amoxycillin, clindamycin, erythromycin and metronidazole. The resistance rate for metronidazole was up to 67% but that for clindamycin was only 10%. HP was very sensitive to both macrolide antibiotics, erythromycin and clarythromycin.

        מרק ויינברג, ברוך קלין ויצחק וינוגרד
        עמ'

        One-Stage Surgery for Hirschsprung's Disease in Children

         

        Mark Weinberg, Baruch Klin, Itzhak Vinograd

         

        Dept. of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, and Sackler School of Medicine, Tel Aviv University

         

        Traditionally Hirschsprung's disease has been treated by 2-or 3-stage procedures. During the past 6 years a 1-stage Duhamel procedure without stoma has become our treatment of choice for Hirschsprung's disease in neonates and young infants. Over a 6-year period, 15 infants and children with colonic Hirschsprung's disease were treated with the 1-stage Duhamel retro-rectal pull-through procedure without a stoma, with the Lester-Martin modification. All patients had the usual short segment aganglionosis, but 1 had a long segment which included the splenic flexure.

        Early complications included wound infection in 1 and minor rectal bleeding in 3. Late complications included constipation in 1 and enterocolitis in 4. Long-term functional results were very good in all those operated except for 1 with rectal achalasia.

         

        We conclude that Hirschsprung's disease can be successfully treated with a 1-stage pull-through operation, the child usually benefitting from the shorter hospital stay and the avoidance of a colostomy.

        אוגוסט 1999

        נועה ברק, רון ישי ואלישבע לב-רן
        עמ'

        Irritable Bowel Syndrome: Biofeedback Treatment

         

        N. Barak, R. Ishai, E. Lev-Ran

         

        Biofeedback Unit, Psychiatric Ward, Sheba Medical Center, Tel Hashomer

         

        Irritable bowel syndrome is a group of heterogenic complaints of functional bowel disorder in the absence of organic pathology. The pathophysiology is unclear. In most cases treatment includes symptomatic remedies, antidepressants, psychotherapy and hypnotherapy.

        Biofeedback has recently been introduced as a therapeutic modality. Treatment also includes relaxation techniques and guided imagery, together with computer-assisted monitoring of sympathetic arousal. Biofeedback requires active participation of patients in their healing progress and leads to symptom reduction in 2/3.

        יוני 1999

        ג' איזיקיאל, ש' ולפיש וי' כהן
        עמ'

        Adjuvant Therapy of Large Bowel Carcinoma

         

        G. Ezekiel, S. Walfisch, Y. Cohen*

         

        Dept. of Oncology and Colorectal Unit, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

         

        The National Institutes of Health (NIH) held a consensus conference which recommended 5-FU and levamisole as adjuvant chemotherapy for colon cancer MAC (Modified Astler Coller) stage C.

        From 1991-1994, 37 such patients diagnosed here were treated with 5-FU (intravenous dose of 450/mg/m²/d for 5 days and from day 29, once a week for 48 weeks) and oral levamisole (50 mg 3 times/d. for 3 days, every 2 weeks for a year), as suggested by NIH guidelines.

         

        16 patients were males and 21 were females, mean age was 62 years and median 64. Cancer locations were: right colon (in 16, 43%), left colon (19, 51%), multiple colon primaries (2, 1%). 25 (68%) had 1-3 positive lymph nodes and 12 (32%) had 4 or more positive lymph nodes.

        Only 20 (54%) finished treatment as prescribed. In the others, 1 or both drugs caused side-effects for which the drugs had to be stopped. 6 patients relapsed while on treatment.

         

        The most common side-effects were diarrhea, stomatitis and bone marrow suppression. 3 were hospitalized due to neutropenic fever. 5-year actuarial survival of all patients was 61%; 5-year relapse-free survival was 61%; 5-year relapse-free survival of right versus left colon was 41% and 82%, respectively (p<0.01). There was no significant difference in 5-year survival of those with 1-3 positive lymph nodes as compared to those with 4 or more (62% and 56%, respectively). 5-year survival in those who finished or did not finish treatment (excluding those who stopped treatment because of progressive disease) was 83% and 70%, respectively (NS).

         

        The 5-year survival of our series was similar to that of patients treated similarly elsewhere. The 5-FU and levamisole treatment was not tolerated well by our study population. It has recently been replaced in our service by a 5-FU and leucovorin regimen given for 6 months.

         

        * Jules E. Harris Chair in Oncology.

        אריה איזנמן ורפאל עינת
        עמ'

        Superficial Skin Necrosis in Short Bowel Syndrome

         

        Arie Eisenman, Rafael Enat

         

        Dept. of Medicine B, Rambam Medical Center and Rappaport Faculty of Medicine, The Technion, Haifa

         

        Short bowel syndrome causes a complex of symptoms due to compromise of small intestinal nutrient absorption. A 60-year-old woman underwent major resection of the small intestine due to a road accident 3 years ago. The sole manifestation of short-bowel-syndrome was superficial skin necrosis due to vitamin K deficiency. She was asymptomatic for a long time, until treatment with antibiotics further intensified initially subclinical malabsorption.

        It is not clear why there had been no other symptoms and why the main impact was on the fibrinolytic system rather than the coagulation system, as is usually the case. It is recommended that patients after major resection of the small intestine be closely monitored for coagulation function if an oral antibiotic is prescribed.

        מאי 1999

        ניר שהם ויחיאל שויד
        עמ'

        Conservative Approach in Abdominal Trauma in Childhood

         

        Nir Shoham, Yechiel Sweed

         

        Dept. of Ophthalmology, HaEmek Medical Center, Afula and Dept. of Pediatric Surgery, Nahariya Medical Center

         

        To determine the results of the conservative approach in the treatment of pediatric abdominal trauma, we retrospectively analyzed data from the files of 95 cases of abdominal trauma in children during a 5-year period.

         

        51 patients (54%) had isolated abdominal injury, while 44 (46%) had multiple trauma. The most common causes of injury were road accidents and falls from heights (74%). CT scans were performed in 61 (64%) with positive results in 90%. Ultrasonography was done in 22 (23%) and was positive in 55%.

         

        The spleen was the most vulnerable intra-abdominal organ (33 patients, 35%), as well as the organ most severely damaged. Other injured organs were: liver (30 cases), kidney (16), stomach (2), large blood vessels (2), and pancreas, duodenum and diaphragm (1 case each).

        83 patients (87%) were treated conservatively, while 11 were operated on for penetrating abdominal trauma (3 cases), hemodynamic instability (3), positive DPL (3), and Scale 4 splenic injury and free intra-abdominal air on CT scan (1 case each). Early and late complications were mild.

         

        It is concluded that CT is an efficient and reliable imaging method for diagnosis and staging of severity of injury in blunt abdominal trauma. Nonoperative management of solid organ injuries under careful observation in a pediatric trauma center is safe and appropriate. Most Scale 4 splenic injuries can be treated successfully without surgical intervention. Using this conservative approach there were no late complications.

        אפריל 1999

        גד שקד ומריו גולוקובסקי
        עמ'

        Management of Pancreatic Trauma in Damage-Control Laparotomy

         

        Gad Shaked, Mario Golocovsky

         

        Dept. of Surgery and Trauma Service, Soroka University Hospital, Beer Sheba and Dept. of Surgery and Trauma Service, Washington Hospital Center, Washington DC

         

        Major pancreatic trauma challenges the trauma surgeon with diagnostic problems and choices of treatment modalities. The most important determinant guiding management is the integrity of the main pancreatic duct. The preoperative and intraoperative assessment and treatment of pancreatic injury may be difficult, especially when concurrent severe injuries are present. There are alternative approaches in the management of the traumatized pancreas when ductal injury is not obvious during initial exploratory laparotomy.

        מרץ 1999

        יהודה לרמן, גבריאל חודיק, חווה אלוני ושי אשכנזי
        עמ'

        Is Official Data on Reported Morbidity Valid? Hepatitis A in Israel as an Example

         

        Yehuda Lerman, Gabriel Chodik, Hava Aloni, Shai Ashkenazi

         

        Occupational Health and Rehabilitation Institute, Ra'anana, Schneider Children's Hospital, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University

         

        Hepatitis A is one of the most frequently reported notifiable infectious diseases in Israel. The annual incidence as reported is around 70/100,000. The physician or the diagnostic laboratory notifies the district health office of the Ministry of Health.

        The purpose of this research was to evaluate the sensitivity of passive surveillance of hepatitis A morbidity among adults, 18 years and over. Methods included study of notifications to the Ministry of Health or hospitalizations of cases of hepatitis A and of positive laboratory tests results (IgM) for hepatitis A. We estimated the extent of under-reporting by 2 different methods of extrapolation.

        Data based on passive surveillance among the adult population, between 1.1.1993-31.12.1994, comprised less than 1/5 of the actual number of cases. Physicians notified about 6.2% of their hepatitis A patients. 5.1% of the notifications to the district health office were sent twice or more, usually both by the physicians and labs.

        The official data on hepatitis A morbidity, based on passive surveillance, are considerably underestimated. Physicians and public health officials should be aware that such data may not accurately reflect the magnitude of the risk or the amount of disease that can be prevented. Efforts should be made to improve this situation.

        פרנקלין גרייף, משה רובין, איתן מור, ישראל נודלמן, ארנולד סיחון, אריה פיגר, אלכס בלינקי ושלמה ללצ'וק
        עמ'

        Liver Surgery - Five Years of Experience

         

        Franklin Greif, Moshe Rubin, Eitan Mor, Israel Nudelman, Arnold Sihon, Arie Figer, Alex Belinki, Shlomo Lelcuk

         

        Hepatobiliary Unit and Depts. of Surgery B, Transplantation, Oncology and Radiology, Rabin Medical Center (Beilinson Campus) and Sackler School of Medicine, Tel Aviv University

         

        Major hepatic resections have been associated with significant morbidity and mortality. In the past decade or so this has changed and such procedures are now done in increasing numbers. In the past 5 years we operated on 129 patients with benign or malignant hepatic lesions (75 females, 54 males; age-range 14-84). the reason for surgery was malignancy in 94 (72.9%) and benign lesions in 35 (27.1%). The most common indication for surgery was liver metastases secondary to colorectal cancer in 45% of all patients or 61.7% of those operated for malignancy. Primary liver cancer was the cause for liver resection in 13.2% of all patients or 18.1% for those with malignancy. Of the 35 patients with benign lesions the leading causes for surgery included: giant cavernous hemangioma, simple liver cysts, echinococcus cysts and focal nodular hyperplasia (11%, 22.8%, 20% and 14.3%, respectively).

         

        76 patients underwent anatomical resection and 63 had either a nonanatomical resection or a different operation. Among the former the most common procedure was right hepatectomy (36) and among the later a nonanatomical resection equal to 1-3 Couinod segments (44). Operating time ranged from 55 min. to 8:41 hours with a mean of 3:31‏1:37. Mean hospital stay was 8.7‏5.8 days and 86.8% received between 0-2 units of blood. Overall mortality was 6.2% and 31.2% of the fatalities had cirrhosis. Overall mortality in noncirrhotic patients was 2.6%. The complication rate was 16.3% and only 7 patients (4.4%) were hospitalized in the intensive care unit. This indicates that major liver resections can be done safely, with morbidity and mortality similar to that of other major abdominal operations. 

        ריפעת ספדי, ירון ריבר, יוסף חביב וירון אילן
        עמ'

        Neurological Manifestations of Non A-G Viral Hepatitis

         

        Rifaat Safadi, Yaron River, Yosef S. Haviv, Yaron Ilan

         

        Liver Unit, Division of Medicine and Neurology Dept., Hadassah University Hospital, Jerusalem

         

        Guillain-Barre and other neurologic syndromes rarely occur as complications of viral hepatitis (A, B and C). Other neurologic syndromes have also been reported in serologically defined viral hepatitis, including mononeuritis, auditory neuritis, and seizures. Chronic hepatitis B and mononeuritis multiplex are found together in 31-54% of patients with periarteritis nodosa. The mechanisms of these associations are unknown, but may include direct cytotoxicity of the virus or immune-mediated damage. Vasculitis of the vasa nervorum plays an intermediate role, at least in some cases. We describe a 36-year-old man with acute non A-G hepatitis complicated by Guillain-Barre syndrome. The neurological manifestation resolved completely without specific therapy within 6 days, as the hepatitis resolved.

        פברואר 1999

        איתן מור, משה רובין וירון ניב
        עמ'

        Intestinal Transplantation: World Experience and Future Perspective

         

        Eytan Mor, Moshe Rubin, Yaron Niv

         

        Depts. of Transplantation, Surgery B and Gastroenterology Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva

         

        Intestinal transplantation, which until recently has been considered an experimental procedure, is now undergoing considerable change and becoming a standard treatment for patient with intestinal failure. The major improvement in results is due to the introduction of new immunosuppressive agents that have led to significant reduction in acute rejection. Nevertheless, reduction in severe infectious complications, which are the main cause of mortality after transplant, as well as improved techniques for early diagnosis of rejection are needed before intestinal transplantation can be widely used.

        We describe our experience in post-transplant follow-up of a woman, aged 32-years, who had undergone intestinal transplantation for short bowel syndrome after extensive bowel resection.

        אוקטובר 1998

        ניר הילזנרט ועידית ליברטי
        עמ'

        Multiple Angiodysplastic Lesions of the Colon - a Therapeutic Challenge

         

        Nir Hilzenrat, Edit Liberty

         

        Division of Gastroenterology and Dept. of Medicine E, Soroka Medical Center and Ben-Gurion University, Beer Sheba

         

        Colonic angiodysplasia is one of the most frequent causes of recurrent lower gastrointestinal tract bleeding, mainly in the elderly. In 50% of patients multiple angiodysplastic lesions were reported when they were the cause of rectal bleeding. Bleeding from angiodysplasia is more severe and less responsive to treatment in those with coagulation disorders. A 74-year-old woman with an artificial mitral valve who was treated with coumadine is reported. A few years after operation she began to develop severe recurrent rectal bleeding because of multiple angiodysplastic lesions along the right colon, proven by colonoscopy. She was frequently hospitalized for blood transfusions; endoscopic treatment was not feasible and the surgical risk of colectomy was very high. Treatwith estrogen and progesterone significantly decreased recurrent episodes of bleeding.

        מאי 1998

        טוביה וינברגר, טוני חאיק ושלמה קידר
        עמ'

        Acute Gastroenteritis caused by Enterohemorrhagic E. Coli O157:H7

         

        Tuvia Weinberger, Tony Hayek, Shlomo Keidar

         

        Dept. of Medicine E, Rambam Medical Center, and Dept. of Family Care, Haifa and West Galilee, and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

         

        We report a 48-year-old man admitted for watery diarrhea, high fever, chills and abdominal cramps. Entero-hemorrhagic E. coli O157:H7 was isolated. This new, dangerous pathogen causes dysentery and complications such as hemolytic uremic syndrome and thrombotic thrombo-cytopenic purpura. These complications can cause renal failure, neurological deficit and death. Recognition of E. coli O157:H7 infection is important since it causes a rare and dangerous condition. To the best of our knowledge this is the first case reported in Israel.

        צבי ויצמן, ילנה ברוטמן, דרורה לידר וחיים זגרמן
        עמ'

        Evaluation of a Local Infant Formula Enriched with Polyunsaturated Fatty Acids

         

        Zvi Weizman, Elena Brutman, Drora Leader, Chaim Zegerman

         

        Pediatric Gastroenterology Dept. and Nutrition Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheba;

        and Ma'abarot Products Industry, Kibbutz Ma'abarot

         

        Polyunsaturated fatty acids (PUFA) are vital for the normal development of the brain and the eye retina in infancy. Breast milk contains significant amounts of PUFA, and compensates for their low production in infancy. Only recently a few companies with worldwide product distribution have started to enrich infant formula with PUFA. We evaluated the safety and clinical efficacy of a locally made PUFA-enriched infant formula, produced for the first time in Israel.

        50 normal, full term infants participated in a prospective, randomized double-blind study. Half received a regular whey-predominant infant formula (Materna Plus), and the other half a PUFA-enriched formula (Materna Premium), both produced in Israel, for 30 days. Evaluation included physical examination, growth parameters, stool analysis, daily parental questionnaires regarding infant behavior and defecation, and developmental assessment.

        There were no significant differences on comparing growth parameters, infant behavior, attacks of restlessness, gas severity, or stool characteristics in the 2 groups. There were no side effects or abnormal stool findings in either group, and no differences in developmental assessment at 3 months of age.

        We conclude that the locally-produced PUFA-enriched infant formula is safe and clinically efficient. We assume that the lack of any effect on developmental indices is due to the relatively short exposure to the PUFA-enriched diet. Nevertheless, based on the recent literature, there is no doubt that PUFA supplementation isvital in improving infant brain and eye development.

        אפריל 1998

        גלית בן אמיתי, יורם נבו, דבורה ליברמן, רוברטו מסטר ושאול הראל
        עמ'

        Cyclic Vomiting Syndrome in Children

         

        G. Ben-Amitay, Y. Nevo, D. Lieberman, R. Mester, S. Harel

         

        Ness Ziona Mental Health Center, Institute for Child Development and Pediatric Neurology Unit, Tel Aviv-Sourasky Medical Center, and Tel Aviv University Medical School

         

        Cyclic vomiting syndrome in children is a manifestation of various etiologies, including gastroenterological and renal disorders, central and autonomic nervous system abnormalities, as well as metabolic and endocrine dysfunction. Frequently no organic cause is found. Personality profiles of children with cyclic vomiting reveal perfectionism, competitiveness, and aggressive behavior. Vomiting attacks have been induced by anxiety and excitement in patients with cyclic vomiting. We describe an 8-year-old girl with cyclic vomiting, frequently associated with occipital headaches, photophobia or dizziness. Psychiatric evaluation indicated a generalized anxiety disorder.

        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
        כתובתנו: ז'בוטינסקי 35 רמת גן, בניין התאומים 2 קומות 10-11, ת.ד. 3566, מיקוד 5213604. טלפון: 03-6100444, פקס: 03-5753303