תוצאת חיפוש

Characteristics of Nasopharyngeal Carriage of Streptococcus Pneumoniae in Children During Acute Respiratory Disease

A. Aran¹, D. Fraser², R. Dagan¹

Pediatric Infectious Disease Unit¹, Epidemiology Department², Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva

Streptococcus pneumoniae is an important cause of pediatric morbidity and its main reservoir is the nasopharynx, from which it can disseminate and cause invasive disease. From November 1997 through March 1998, nasopharyngeal carriage of S. pneumoniae was evaluated in 250 children under the age of 36 months: 123 Jews and 127 Bedouins with acute respiratory disease and in 980 healthy control children (852 Jews and 128 Bedouins).

Carriage rate was higher among sick children. Among Jewish children it was 57% and 35% of sick and healthy children respectively (p<0.01), and among Bedouin children it figured as 80% and 67% respectively (p=0.01). The difference in carriage rate was most prominent in infants under the age of 5 months: among Jewish children it was 60% and 27% of sick and healthy children respectively (p<0.001) and among Bedouins it was 82% and 65% respectively (p=0.05).

Higher carriage rate of penicillin resistant pneumococci (PRP) was also detected in sick children, with no relation to antibiotic treatment in the month prior to sampling. In Jewish children PRP was detected in 12%, 28% (p<0.001) and 36% (p<0.001) of healthy children, sick children with previous antibiotic treatment and sick children with no treatment, respectively.

The seroypes included in the newly developed 7-valent conjugate vaccine: 4, 6B, 9V, 14, 18C, 19F, 23F, that are highly pathogenic and often antibiotic resistant contributed 74% of isolates in sick Jewish children who had previous antibiotic treatment and 39% of isolates in healthy children (p<0.001). In Bedouin children vaccine types carriers rate among the sick children was not higher than in healthy children.

Acute respiratory disease increases the risk of pneumococcal carriage in general and carriage of resistant pneumococci in particular. Previous antibiotic treatment increases the risk of carring one of the pathogenic serotypes included in the 7-valent vaccine. The impact of disease is most prominent in infants under 5 months, since they are usually less exposed to S. pneumoniae carriers than older children.

Since the increase in carriage rate during illness is mostly due to the serotypes included in the newly developed conjugate vaccine, future immunization programme may decrease not only morbidity rate but also nasopharyngeal carriage rate of pneumococci in general and of antibiotic-resistant pneumococci in particular.

Laparoscopic Approach in Treating Hepatic Cysts 

P. Schachter, V. Sorin, M. Shimonov, A. Rosen, A. Czerniak

Dept. of Surgery A, Wolfson Medical Center, Holon

Solitary and multiple hepatic cysts are now more commonly found because of advances in imaging techniques. Most hepatic cysts are asymptomatic, but when they do cause symptoms they require surgical intervention. The advent of laparoscopy and of laparoscopic ultrasonography allow comprehensive evaluation and treatment of the cysts.

12 patients with hepatic cysts were treated laparoscopically. 8 with single cysts underwent successful subtotal cyst resection without signs of recurrence (up to 20 years of follow-up). 4 with polycystic liver disease underwent sub-total resection of superficial cysts. Deep cysts were unroofed and drained under laparoscopic ultrasound guidance. In this group, 1 experienced recurrence of symptoms and required partial hepatectomy of the involved segment. In another, a connection between a deep cyst and bile ducts was demonstrated and cystojejunostomy was performed.

The laparoscopic approach in the management of patients with liver cysts is effective and safe, and we recommend it as the procedure of choice for single hepatic cysts. In polycystic liver disease the procedure is much less successful.

Cortical Blindness Following Coronary Angiography 

Addie Ron, Simcha Meisel, Myra Shapiro-Feinberg,Herman O. Klein

Depts. of Medicine, Cardiology and Diagnostic Imaging,Meir Medical Center, Kfar Saba

Cortical blindness has been occasionally reported as a complication after cerebral angiography, but is rare after coronary angiography. The contrast agent is believed to be responsible for the sudden development of blindness. Although the exact mechanism is unknown, it appears that the contrast agent disrupts the blood brain barrier, mostly in the occipital areas.

We report a 77-year-old man who suddenly developed transient, bilateral cortical blindness 4 hours after coronary angiography. Using contrast enhancement, the CT scan showed typical, symmetrical involvement of both occipital lobes. There were no other neurological deficits. Vision and CT findings returned to normal within 48 hours.

Anaphylactic Shock after Diclofenac Sodium 

Amnon Hadar, Gershon Holcberg, Moshe Mazor

Division of Obstetrics and Gynecology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

Anaphylaxis due to diclofenac sodium (Voltaren) is rare. We describe a 39-year-old woman who received a suppository of diclofenac for analgesia 6-hours after cesarean section. She developed severe angioedema and profound hemodynamic shock 10 minutes after the diclofenac, to which she had been exposed in the past without any side-effects. There are few reports of such an acute, life-threatening, multisystem reaction to this drug in the English literature.

Diabetic Ketoacidosis during the Ramadan Fast 

I. Friedrich, Y. Levy

Dept. of Medicine A, HaEmek Medical Center, Afula, and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

We report a 15-year-old Muslim boy with insulin-dependent diabetes mellitus (IDDM) who presented with diabetic ketoacidosis (DKA) during the Muslim Ramadan month of day-time fasting. DKA apparently occurred due to omitting pre-lunch insulin combined with dehydration and overeating during the permitted sunset-to-sunrise meals.

It is well-known that fasting accelerates development of lipolysis and ketosis and increases glucagon levels. Thus, these pathophysiological aberrations related to fasting in ketosis-prone patients, in conjunction with fasting, endanger metabolic control in IDDM.

Hemophagocytic Syndrome

I. Morag, M. Goldman, T. Bistrizer, C. Kaplinsky

Pediatric Division, Assaf Harofeh Medical Center, Zerifin and Pediatric Hematology-Oncology Dept., Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

Hemophagocytic syndrome is a rare, fulminant disease characterized by generalized histiocytic proliferation associated with phagocytosis of erythrocytes, platelets, and to a lesser extent, of white blood cells. We report a 2-year-old boy admitted with high fever and irritability, with a rash, marked hepatomegaly and generalized lymphadenopathy. Liver function tests were abnormal and there was thrombocytopenia and hyperlipidemia. Bone marrow aspiration revealed hemophagocytosis. Despite intensive treatment with steroids, intravenous immunoglobulin and cytotoxic drugs, he died within 10 weeks.

Control of Brucellosis in Taibe: Intersectoral Collaboration

Lutfi Jaber, Shmuel Dahan, Ilana Harari

Bridge-to-Peace Community Pediatric Center, Taibe; Community Pediatrics Unit, Schneider Children's Medical Center, Petah Tikva; Sackler Faculty of M, Tel Aviv University; and Israel Ministry of Health, Sharon District

Brucellosis is contracted from domestic animals. Poor hygiene, primitive animal breeding methods and traditional food preparation are the main contributory factors. We describe an intersectoral program for controlling brucellosis in Taibe, an Arab town in Israel, which had a particularly high incidence of the disease in 1992 and 1993.

At the beginning of 1994 the Israel Ministry of Health and the Community Pediatric Center of Taibe established a community-based program for controlling brucellosis in Taibe. It included an intensive public health education campaign and periodic examination and vaccination of animals. Physicians, veterinarians, nurses, school officials and health inspectors were recruited for this purpose. Residents' awareness of brucellosis was determined before and after the study.

After intervention, the incidence of the disease sharply declined from 176.6 and 175.0/100,000 in 1992 and 1993 respectively, to 5.7, 10.4 and 2.5/100,000 in 1994, 1995 and 1996, respectively, (odds-ratio 24.44; p<00000). Residents' awareness of brucellosis and preventive measures were significantly increased by the end of the study. We conclude that intersectoral collaboration is an important tool for controlling brucellosis.

Knowledge, Attitudes and Training of Family Physicians with Regard to Addiction to Illicit Drugs

Aya Peleg, Roni Peleg, Pesach Shvartzman

Health Promotion and Disease Prevention Unit, and Dept. of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

Substance abuse is one of the most serious problems in Israel. Recent studies show the situation is getting worse. The deleterious outcomes of psychoactive substance abuse include crime, car accidents, physical and mental illness, violence and work injuries.

48 family physicians in the Negev completed a questionnaire which included training, diagnostic and treatment skills, attitudes, knowledge and need for training in this field. 38 family physicians (81%) had had no training, most (96%) indicated the importance of such training. 34 (71%) said that their medical skills could not cope with the problems of addiction, and 29 (64.5%) claimed that the quality of care of addict patients is reduced because of lack of knowledge and diagnostic skills. These findings support the conclusion that efforts should be invested in training family physicians in the field of psychoactive drugs, licit and illicit.

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.

Malignant Eccrine Poroma

R. Silfen, A. Amir, M. Feinmesser, D.J. Hauben

Dept. of Plastic and Reconstructive Surgery, and Pathology Dept., Rabin Medical Center (Beilinson Campus), Petah Tikva

Malignant eccrine poroma (MEP) is rare and both clinical and histologic diagnosis is often difficult. Therefore, diagnosis is sometimes delayed or even incorrect. We report a case in a 70-year old man with MEP of the leg. He demonstrated typical MEP behavior and the problems of differential diagnosis.

Plication of Diaphragm for Postoperative, Phrenic Nerve Injury in Infants and Young Children

Yael Refaely, David A. Simansky, Michael Paley, Alon Yellin

Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University

Paralysis of the diaphragm may cause life-threatening respiratory distress in infants and young children because of paradoxical motion of the affected diaphragm and contralateral shift of the mediastinum during expiration. Phrenic nerve injury (PNI) may follow chest operations.

10 children with diaphragmatic paralysis and severe respiratory distress underwent plication of the diaphragm. Ages ranged from 14 days to 5 years. 9 had PNI after operations for congenital heart disease and 1 after resection of an intraspinal cervical lipoma. The right side was affected in 7, the left in 3.

Indication for surgery was inability to wean from mechanical ventilation, which had ranged from 11 to 152 days (median 35). 8 underwent plication via a thoracic approach and 2 via an abdominal approach. There were no complications directly related to the operation.

The interval from plication to weaning from mechanical ventilation ranged from 2 to 140 days (median 4). 1 patient died 2 hours after plication due to severe heart failure and 2 after prolonged hospitalization due to sepsis and multi-organ failure. 6 were extubated 2-8 days (median 4) after plication and 1 only after 40 days.

Early diaphragmatic plication is simple and avoids more serious surgery. While effective in ventilator-dependent infants and young children, it should not be used in those with multi-organ failure. Early plication may prevent the complications of prolonged mechanical ventilation.

Severe Pneumonia Caused by Bordetella Bronchiseptica

Taufik Zuabi, Adir Faivisevitz, Michael L. Alkan

Yoseftal Hospital, Eilat; Soroka Medical Center, Tel Hashomer; and Ben Gurion University Center for Health Sciences, Beer Sheba

Bordetella bronchiseptica rarely causes disease in man, and is an unusual pathogen in animals. It causes a pertussis-like syndrome, but pneumonia and sepsis have been described in the immunocompromised as well as in the immunocompetent. A 53-year-old man with adult-onset diabetes and healed pulmonary tuberculosis presented with lobar pneumonia and rapidly developed septic shock with adult respiratory distress syndrome. He responded well to the combination of piperacillin-tazobactam.

Burns in Children in Israel: Epidemiology, Prevention and Treatment

Arieh Eldad

Medical Corps, Israel Defense Forces and Burns Unit, Hadassah University Hospital, Ein Kerem, Jerusalem

45% of all hospitalized burn casualties in Israel are children younger than 16 years old. In various hospitals they make up 30-60% of all burn casualties, depending on the proportion of children in the area of hospital intake, social and economic factors and the type of hospital. Length of hospitalization of children is shorter than that of the general population (7.3 vs 9.0 days). Scalding is the main cause of thermal injuries among babies and infants (70%), while fire burns are the most common causes among adolescents (56.5%); 90% of babies are injured at home; only 40% of adolescents are burned in home accidents.

In Israel, burned children are treated in 25 different hospitals and in departments of pediatric surgery, plastic surgery, general surgery, pediatrics or burn departments. There is no pediatric burn unit in Israel.

Multilocular Cystic Mass of the Kidney: A Diagnostic Challenge

Judy Kleinmann, Simon Negelev

Urology Dept., Assaf Harofeh Medical Center, Zerifin

Multilocular cystic masses of the kidney present a diagnostic challenge because they may be malignant. Renal cell carcinoma with multilocular cysts has been reported. We present 4 cases in which the preoperative differential diagnosis was between a benign and a malignant multilocular cystic kidney mass.

Our results, combined with those of 33 previously reported cases, reveal that only 32% of cases were diagnosed correctly preoperatively. In 21% of these patients the preoperative clinical evaluation did not correctly diagnose malignancy: 24% of them yielded false negative and 21% false positive results. Angiography was more accurate than CT, US or aspiration of cysts. Frozen section was inaccurate in 55% of cases.

There is no reliable diagnostic test to distinguish between a malignant and a benign multilocular cystic mass. Invasive angiography is more accurate than other modalities. A therapeutic decision has to be made between nephron-sparing and radical surgery in each case. When nephron-sparing surgery is considered, the possible need to perform radical nephrectomy in second-look surgery must be taken into account.

Prevalence of Medical Complaints in the Community-Dwelling Elderly

J. Gindin, M. Geitzn, M. Dushenat, H. Siboni, D. Goldstein, Z. Shapira, N. Konstantin, A. Wurm, A. Goldsmid, E. Hay-Am

Geriatric Institute of Education and Research, Kaplan Medical Center, Rehovot; Pharmacology Dept., Kupat Holim Klalit, Tel Aviv and Central District; and Kupat Holim Klalit, Rishon LeZion

We assessed the prevalence of self-reported medical complaints among the community-dwelling elderly receiving regular medication, and determined associations between health and sociodemographic variables, and the prevalence of complaints.

The study included 170 patients, 60-90 years of age, living at home. Participants were recruited from the 3 main primary care clinics in Rishon LeZion. All were receiving chronic medication and were followed-up utilizing a long-term medication card. Data were gathered in interviews held in patients' homes using a structured questionnaire which included sociodemographics, diseases and medication, mental state assessment by Katzman's score, and a list of 15 medical complaints common among the aged. Relations to age, gender, education, living arrangements, number of diseases and number of medications per patient were determined.

Mean age of participants was 73.2±6.0 years and they suffered an average of 4.07±2.16 diseases and took 5.10±2.83 types of drugs. The most prevalent complaints were: weakness and fatigue (65.0%), agitation and restlessness (56.4%), dry mouth (45.6%), constipation (43.6%) and dizziness (43.2%). The number of diseases, gender, education and age had the strongest associations with the prevalence of specific complaints, as well as their total number. The association between number of medications and mean number of complaints was of borderline significance.