תוצאת חיפוש

Liver Allografts from Donors older than 60: Benefits and Risks

Eytan Mor, Dan Shmueli, Ziv Ben-Ari, Nathan Bar-Nathan, Ezra Sharabani, Alexander Yussim, Boris Dorfman, Ran Tur-Kaspa, Zaki Shapira

Transplantation Dept. and Institute of Liver Diseases, Rabin Medical Center, Beilinson Campus; and Sackler School of Medicine, Tel Aviv University

With limited organ resources and an increasing number of candidates for liver transplantation, the world-wide trend is towards using liver allografts from donors older than 60 years. This strategy, however, may be hazardous because of the known correlation between advanced donor age and graft dysfunction. Since January 1996, each of 5 patients received a liver allograft from a donor older than 60 years. Preservation time in these cases was shortened as much as possible and liver allografts were used only if there were no other potential risk factors for primary nonfunction. Mean cold ischemic time was significantly shorter in this donor group (7.8 hrs) than for livers from 28 younger donors (10.2 hour; p<0.01). 3 of the 5 grafts from older donors had normal function immediately. The other 2 initially had biochemical features of preservation injury, but graft function returned to normal within the first week after transplantation. All 5 patients currently have normal graft function, with follow-up ranging from 3-8 months. There was no difference between the 5 recipients of grafts from older donors and 28 adult recipients of grafts from younger donors in extent of preservation injury and in immediate graft function. We conclude that in countries with limited organ resources, such as Israel, liver allografts from older donors can be used within defined limits and minimal preservation time.

Attention Deficit Hyperactivity Disorder, Facilitating Alcohol and Drug Abuse in an Adult

R. Durst, P. Rebaudengo-Rosca

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

Attention-deficit hyperactivity disorder (ADHD) has been considered a mental and behavioral disorder of childhood and adolescence. It is being increasingly recognized in adults, who may have psychiatric co-morbidity with secondary depression, or a tendency to drug and alcohol abuse. We describe a 32-year-old woman known for years as suffering from borderline personality disorder and drug dependence (including hasshish, marijuana, LSD and "exstasy'") and alcohol abuse that did not respond to treatment. Only when correctly diagnosed as ADHD and appropriately treated with the psychotropic stimulant, methylphenidate (Ritalin), was there significant improvement. She succeeded academically, which had not been possible previously, the craving for drugs diminished and a drug-free state was reached. Although administration of psychostimulants to drug abusers is controversial, as they are addictive, in cases of ADHD they have promoted drug abstinence.

Seminiferous Tubule Cytological Pattern in Infertile, Azoospermic Men in Diagnosis and Therapy

David B. Weiss, Shoshana Gottschalk-Sabag, Elchanan Bar-On, Zvi Zukerman, Yigal Gat, Benjamin Bartoov

Male Infertility and Cytology Units, Shaare Zedek Medical Center, Jerusalem; Andrology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva and Male Infertility Laboratory, Dept. of Life Sciences, Bar-Illan University, Ramat Gan

We determined spermatogenic patterns of seminiferous tubules in azoospermic infertile men and evaluated the prevalence of bilateral testicular homogeneity. 185 azoospermic men underwent bilateral testicular fine-needle aspiration (TFNA) in which each testis was punctured at 3 different positions. Aspirated material was stained and classified according to the most mature spermatogenic cell type present or whether only Sertoli cells were present. 35.7% had spermatozoa in their testes, 36.2% had spermatogenic maturation arrest, and 28.1% had only Sertoli cells in their seminiferous tubules. In 15.6% of all patients, the diagnosis in 1 testis differed from that in the other. In only 73.2% of those with testicular spermatozoa was it bilateral. In the remaining 26.9%, only Sertoli cells, spermatocytes or spermatids were found as the most mature cell type in the other testis. The study definitely indicates that fertilization with retrieved testicular spermatozoa should not be offered to azoospermic patients without prior evaluation of the seminiferous tubue spermatogenic pattern in both testes.

Characteristics of Hospitalized Alcoholics

Sergio Marchevsky, Shoshana Weiss

Residential Center for Alcoholics and Israel Society for the Prevention of Alcoholism, Ramat Gan

The background characteristics of 1,173 alcoholics hospitalized for 3 months in this center during December 1982 to December 1994 were reviewed. Socio-demographic variables and termination-of-treatment data, are described. The profile of the typical hospitalized alcoholic was that of a Jewish, urban, married, unemployed man, born in Asia-Africa (or in Israel) who had been living for many years in Israel and had many children and a low educational level. They usually start drinking in adolescence and come to the center after more than 15 years of drinking, mainly at home and alone, and also have family relatives who drink. Implications of the data for treatment and for family physicians are presented.

Use of Student Feedback by Pre-Clinical and Clinical Course Directors

Ruth Abramowitz, Netta Notzer

Medical Education Unit, Sackler Faculty of Medicine, Tel Aviv University

We examined the conceptual and instrumental uses of student feedback on teaching by 2 preclinical and clinical course directors with authority to change structure and content of the courses, assess suitability of instructors and to change methods of student feedback questionnaires have been collected systematically for over 2 decades. A report based on this feedback is sent to course directors, the dean, his assistants and the head of the curriculum committee. Course directors from both groups made broad use of the feedback but made greater use of the report than preclinical course directors. Students had greater regard for individual teaching by clinical course directors than by preclinical course coordinators. No relationship was found between the degree of use of feedback by members of either group and their level of teaching. We conclude that senior faculty use student feedback in their decisions regarding the structure and teaching methods of their courses and are not influenced by individual assessments, positive or negative, by their students.

Pediatric Flexible Bronchoscopy

Haim Bibi, David Shoseyov, Michael Armoni, Melly Ohali, Shlomo Pollak, Menachem Schlesinger

Pediatric Dept., Pediatric Emergency Room, Pediatric Day Care Hospital and Immunology and Clinical Allergy Unit, Barzilai Medical Center, Ashkelon; and Bikur Holim Hospital, Jerusalem (Affiliated with the Faculty of Health Sciences, Ben-Gurion University of the Negev)

Between 1993-1996, 200 pediatric flexible bronchoscopies were performed. Indications were: chronic cough (158 children), persistent pulmonary infiltrates (89), recurrent stridor (28), suspected tracheobronchial foreign body (20), suspected tuberculosis (17) and hemoptysis (3). Some children had more than 1 indication. 124 patients were boys (mean 4.18+2.86 years; range 1 month-15 years) and 76 were girls (mean 4.39+2.7 years; range 4 months-15 years). The procedure included direct vision recorded by video-camera and broncho-alveolar lavage; the lavage fluid was sent for culture, Gram and Ziehl-Nielsen stains and for cytology. There were a few minor side effects: mild stridor which resolved within a few hours (10 children) and transient fever (3). This simple, flexible instrument was effective and helpful in the diagnosis and treatment of children with respiratory symptoms in a secondary hospital facility.

Ct-Guided Core Needle Biopsy Of Abdominal, Pelvic And Retroperitoneal Masses

M. Sklair-Levy, A.I. Bloom, Y. Sherman, S. Fields, J. Bar-Ziv, Y. Libson

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

CT-guided core needle biopsy of abdominal, pelvic and retroperitoneal masses is accurate and safe and can be performed on an outpatient basis. Between 1987 and 1995, 809 patients (age range 1-87 years) underwent 851 biopsies (minimal lesion diameter 1 cm). Cutting needles were always used, facilitating both cytological and histological diagnosis while minimizing risk of complications. A positive result (malignant, inflammatory or infectious) was obtained in 69% of the 809 and a negative result (normal tissue) in 17.4%, while in 13.6%, material for diagnosis was insufficient. Biopsy was repeated in 42 of them in whom radiological or clinical suspicion of malignancy was high. In 24 (60%) a positive result was obtained after the second biopsy.

Significant complications occurred in 7 (0.8%). 1 hemo-rrhaged following liver biopsy and required blood transfusion. Pancreatitis occurred in 6 (2.6%) following pancreatic biopsy. An intra-abdominal fluid collection in 1 necessitated percutaneous drainage. There was no mortality following the procedure and no documented case of needle-tract seeding of tumor. All outpatients were discharged within 3 hours of completion of the biopsy, without ill effects.

An In-Hospital Pain Service: Present Activity and Future Trends

Y. Shir, V. Shavelzon, G. Rosen, S. Cotev

Anesthesia Dept. and Intensive Care Unit, Hadassah Hospital, Jerusalem

Although significant progress has been made in the past 2 decades in our understanding of pain pathophysiology and in the development of new analgesic drugs and techniques, many patients still experience considerable pain during hospitalization. Unrelieved pain is common not only among patients undergoing surgery, but also in those with a variety of other medical problems. These findings led to the development of our in-hospital acute pain service. This in-hospital pain service has been active since the late eighties, treating both postoperative pain and non-surgical pain in hospitalized patients. During 1995, 2140 patients were treated totaling 8717 treatment days in 18 different medical units and departments. Overall success was more than 75%. We review our experience in treating in-patients who suffer from pain and discuss future trends and need for such a specialized service.

Cyclosporin for Severe Ulcerative Colitis

Z. Symon, R. Stalnikowich, R. Eliakim, Z. Ackerman, D. Rachmilewitz

Dept. of Medicine, Hadassah University Hospital, Mount Scopus and Hebrew University-Hadassah Medical School, Jerusalem

In recent years there have been numerous reports of successful treatment of resistant ulcerative colitis with cyclosporin. A series of 9 patients with moderate to severe active ulcerative colitis was treated with cyclosporin between September 1993 and October 1994. All 9 had failed to respond to conventional therapy, including salazopyrine and intravenous corticosteroids. They underwent colonoscopy and after contraindications to therapy were ruled out, received intravenous cyclosporin, 4 mg/kg/day for 7-10 days. They were discharged on oral cyclosporin with average serum levels maintained at 200 ng/ml. Response was assessed using the clinical score system of Schroeder et al. 2 out of 9 patients (22%) responded with full clinical remissions lasting more than 6 months. 6 patients had partial responses to the intravenous therapy, but symptoms resumed shortly after its cessation. Factors predicting favorable response to cyclosporin therapy were a shorter duration of disease with a fulminant clinical course. The success rate was less than that reported in the literature, possibly because of comparatively low serum cyclosporin levels. Potential complications of therapy and high cost preclude the routine use of cyclosporin in ulcerative colitis. Larger controlled studies are required to assess its efficacy and safety. Until such studies are available, cyclosporin may be tried in poor surgical risks or those not yet ready psychologically for total colectomy.

Volume Reduction Surgery in Emphysema

M.R. Kramer, I. Bar, I. Eidelman, M. Bublil, I. Nitzan, C. Sprung, S. Godfrey, G. Merin

Depts. of Cardiothoracic Surgery and Anesthesiology, and Institute of Pulmonology, Hadassah-University Hospital and Hebrew University-Hadassah Medical School, Jerusalem

Volume reduction surgery (VRS) is a new procedure based on the concept that relieving hyperinflation in emphysema improves diaphragmatic and chest wall mechanics and ventilation perfusion mismatch. We present our early experience with 16 patients who underwent VRS from August 1995 to June 1996. Patient selection was based on: PFT, CT scan, V/Q scan, ABG's and 6-min walk. After pulmonary rehabilitation, operation was by median sternotomy and bilateral lung shaving. Pulmonary function improved significantly. FEV1 increased from 0.68 ± 0.2 to 1.0 ± 0.2 L (p<0.01) and FVC increased from 1.7 ± 0.5 to 2.7 ± 0.5 L (p<0.017). Total lung capacity decreased from 129% ± 24% to 108% ± 20% (p<0.03). 6-min walk increased from 221 ± 90 to 404 ± 123 meters (p<0.001). Complications included 1 death, prolonged air leak in 7 cases and infection in 2. Quality of life improved substantially in 12 of the 16 cases; in 3 cases there was only slight improvement and in 1 the condition became worse. Volume reduction surgery is a promising surgical solution in selected patients with advanced emphysema.

Hyperbaric Oxygen for Carbon Monoxide Poisoning

A. Abramovich, A. Shupak, Y. Ramon, O. Shoshani, Y. Bentur, G. Bar-Josef, U. Taitelman

Israel Naval Medical Institute, Israel Defense Forces Medical Corps, Haifa and Israel Poison Information Center, Intensive Care Unit and Pediatric Intensive Care Unit, Rambam Medical Center, Haifa

Severe cases of carbon monoxide (CO) poisoning from all over Israel are treated at the Israel Naval Medical Institute with hyperbaric oxygen (HBO). Between 1.11.94 and 15.2.95, 24 cases of CO poisoning were treated. Poisoning was usually due to domestic gas-fired heating systems, CO being the only toxin involved. Since delay between termination of CO exposure and arrival at the emergency department averaged 55 minutes, the level of carboxyhemoglobin measured on presentation did not always reflect the true severity of the poisoning. Poisoning was defined as severe and requiring HBO treatment when 1 or more of the following indications was present: evidence of neurological involvement, cardiographic signs of acute ischemic injury, metabolic acidosis, carboxyhemoglobin level greater than 25%, and pregnancy. 20 (84%) recovered consciousness during the course of 1 session (90 min.) of HBO treatment (p2 2.8 ATA) or immediately thereafter, with resolution of other signs of CO poisoning. 3 required a second treatment session before their symptoms resolved. A patient who arrived in deep coma with severe cerebral edema died. HBO is an important element in the combined treatment of severe CO poisoning. There should be greater awareness of the danger of CO poisoning and the means of preventing it, both among medical staff and the population as a whole, mainly in areas in which cold weather requires use of heating systems, which may be gas-fired.

Prognostic Factors And Surgical Results In Traumatic Cataract

Yuval Gelfand, Joseph Pikkel, Benjamin Miller

Ophthalmology Dept., Rambam Medical Center and Bruce Rappoport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

The visual outcome in 23 men and 2 women with traumatic cataracts was analyzed retrospectively. Their average age was 33 and they ranged from 10 to 69 years. Surgical results were either very good or very poor. Associated retinal injuries significantly decreased final visual acuity (p = 0.001). Those with initial visual acuity restricted to finger counting had better visual results than those with initial visual acuity restricted to light perception (p = 0.01) and hand motions (p = 0.02). Usually the lens was removed via the pars plana; the most common mode of optical correction was contact lenses.

Motor Vehicle Accidents And Eye Injuries

J. Pikkel, Y. Gelfand, E. Mezer, B. Miller

Dept. of Ophthalmology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

The medical records of 24,632 patients treated in our surgical emergency service over a 3-year period were reviewed to determine the frequency and characteristics of ocular trauma caused by motor vehicle accidents (MVA). MVA-related injuries accounted for 13.9% of all visits to the service and involved 1106 of the patients (33%), of whom 77% were young males. At least 1 pathological finding was found in 858 (77.6%) and 169 (15.2%) were admitted. 16 patients sustained very severe ocular injuries which resulted in poor vision.

Rheumatoid Arthritis in the Elderly

A. Yaretzky, J. Feldman, P. Alterman, B. Finkeltov

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

Opinions differ as to whether late onset rheumatoid arthritis (RA) represents a clinical subset and whether age at onset involves differences in therapy and prognosis. In this retrospective study we compared 23 patients with early onset RA (average onset 52.8 years; 91.3% of them women), with 36 with late onset (average onset 70.3 years; 67% of them women). No statistically significant differences were found as to demographic, clinical, laboratory or radiographic characteristics.