תוצאת חיפוש

Gram-Negative Enteric Bacteremia in Children in the Negev

Michal Maimon-Greenwald, Eugene Leibovitz, Nimrod Maimon, Nechama Peled, Ron Dagan

Pediatric Infectious Disease Unit and Clinical Microbiology Laboratory, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

During 1989-1994, there were 322 episodes of Gram-negative enteric bacteremia in 308 children. The incidence increased from 31/100,000 in children younger than 15 years of age during 1989-1991, to 50/100,000 during 1992-1994. The most common pathogens were Klebsiella, E. Coli, Salmonella and Enterobacter. 39% of episodes were nosocomial and a significant increase was recorded for each species during the last 3 years of the study. Klebsiella represented the most common pathogen causing nosocomial bacteremia, while E. coli and Salmonella were the main pathogens causing community-acquired bacteremia. In this study in southern Israel, the incidence of Gram-negative enteric bacteremia was significantly higher in Bedouin children, with the exception of bacteremia due to Salmonella, which occurred mainly in Jewish children.

Separation of Conjoined Twins: The Anesthesiologist's Perspective

Zvi Grunwald, Yacov Katz

Dept. of Anesthesiology, Rabin Medical Center, Beilinson Campus and Schneider Children's Hospital, Petah Tikva

Managing anesthesia care for separation of conjoined twins poses a special challenge for the anesthesia team. Early preparation, thorough understanding of the anatomical and the physiological consequences of this complex anomaly, as well as careful coordination with the teams of surgeons, nurses and operating room personnel are mandatory to assure successful separation of the conjoined twins. It is recommended that the mother be transferred to and the babies be delivered at a tertiary care medical center, like the Children's Hospital. Special attention is devoted during the surgical procedure to cardiovascular stability, drug disposition, fluid balance and temperature control. The multidisciplinary team approach makes this complex surgery a success. When postoperative survival cannot be guaranteed for both twins, close contact and consultation is mandated with the parents, medical personnel and religious and legal advisors.

Diverticular Disease of the Appendix

R. Greenberg, Shmuel Avital, Hanoch Kashtan, Yehuda Skornik

Dept. of Surgery A, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University

The incidence of appendiceal diverticulosis in pathologic specimens is 0.004-2.1%. Diverticular disease of the appendix is classified as congenital (true) or acquired (false). The clinical presentation differs from that of acute appendicitis. The average age is older, the pain is often intermittent, and while localized in the right lower abdominal quadrant, is of longer duration. No further treatment besides appendectomy is needed. Since a high rate of perforations, peritonitis and lower gastrointestinal bleeding have been reported as complications, it is recommended that in those with an incidental finding of diverticula of the appendix during surgery, that appendectomy be performed. It is not recommended to perform prophylactic appendectomy when diverticula of the appendix are found on barium enema.