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        תוצאת חיפוש

        דצמבר 2001

        בן-עמי סלע
        עמ'

        בן-עמי סלע

         

        המכון לכימיה פתולוגית, מרכז רפואי שיבא, תל-השומר: החוג לביוכימיה קלינית, הפאקולטה לרפואה סאקלר, אוניברסיטת תל-אביב

         

        טיפול ארוך-טווח ב- L-dopa בחולי פארקינסון כרוך בהשפעות-לווי בלתי רצויות במדדים מוטוריים, ובשנים האחרונות נעשה מאמץ בפיתוח גישות חלופיות לטיפול במחלה זו. אחת השיטות המבטיחות היא של טיפול בגנים (gene therapy), בניסיון למנוע את ניוון התאים יוצרי הדופאמין במערכת הניגרו-סטריאטית במוח. לאחרונה הופנתה תשומת לב מרובה לחלבון הנירוטרופי GDNF (glial cell-line neutrophic factors), בשל יכולתו לשמר ולעודד את פעילות התאים יוצרי הדופאמין. בסקירה זו יסוכמו היבטים שונים של ההחדרה למוח של החומר הגנטי המקודד לחלבון זה.

        אוקטובר 2001

        הרצל שבתאי, עמוס קורצ'ין
        עמ'

        הרצל שבתאי, עמוס קורצ'ין

         

        מח' עצבים, מרכז רפואי תל-אביב והקתדרה לנירולוגיה שיראצקי, אוניברסיטת תל-אביב

         

        מחלת פארקינסון היא אחת המחלות הניווניות השכיחות הפוגעות במערכת העצבים. שכיחות המחלה היא 0.4% מתחת גיל 40, 1% מעל גיל 65 ו-2.6% מעל גיל 80. הגיל הממוצע של הופעת המחלה הוא בין 55-60 שנה. המחלה פוגעת במערכת המוטורית החוץ-פירמידית, ומתאפיינת במישלב סימנים הכוללים איטיות, נוקשות, רעד במנוח, הפרעות ביציבה ובשיווי משקל, וקיפאונות בהליכה (freezings of gait). קיימות גם תופעות שכיחות שאינן מוטוריות, כגון הפרעות אוטונומיות (אורתוסטטיזם, עצירות כרונית), הפרעות נפשיות (דיכאון, חרדה) ופגיעה קוגניטיבית המתבטאת בליקוי בזיכרון עד כדי שיטיון (dementia). הפתולוגיה של המחלה מאופיינת בהרס ובמוות של תאים דופאמינרגיים בחומר השחור (substantia nigra). הפאתופיזולוגיה של המחלה כוללת בעיקר חסר של הפרשת דופאמין בגרעיני הבסיס, והטיפול העיקרי מכוון לתיקון חסר זה. לא ניתן להסתייע בדופאמין עצמו, מאחר שהחומר איננו עובר את מחסום הדם-מוח. כבר למעלה מ-30 שנה לבודופא הוא תכשיר הנחשב ל"מדד הזהב" (gold standard) לטיפול במחלת פארקינסון. לבודופא הוא "קדם-תרופה" (prodrug). החומר עצמו אינו פעיל, אך הוא חודר בקלות יחסית למוח והופך שם לדופאמין.

        ינואר 2001

        בולסלב קנובל ופאול רוזמן
        עמ'

        Cholesterol Pericarditis Associated with Rheumatoid Arthritis

         

        B. Knobel, P. Rosman

         

        Dept. of Medicine B, Edith Wolfson Medical Center, Holon; and Sackler Faculty of Medicine, Tel Aviv University

         

        Cholesterol pericarditis (CP) is a rare and unusual disease characterized by chronic pericardial effusion with high cholesterol concentration. Precipitation of cholesterol crystals may occur and induce inflammation and constrictive pericarditis. CP may be idiopathic, but is usually associated with a systemic disease, such as tuberculosis, myxedema, or as in our case, rheumatoid arthritis (RA).

        We present a 78-year-old woman with RA, typical deformities of the metacarpo- and metatarso-phalangeal joints and subcutaneous rheumatoid nodules. She was hospitalized with increasing dyspnea and weakness and a 2-dimensional transthoracic echocardiogram showed a large pericardial effusion, without tamponade.

        Blood cholesterol was 208 mg/dl, triglycerides 169 mg/dl, LDH 37 u/L and rheumatoid factor 2560 u; glucose, kidney, and thyroid function tests were normal and PPD test negative. Pericardiocentesis yielded 800 ml of opaque, cloudy fluid, with glucose 19 mg/dl, cholesterol 264 mg/dl (normal 20-40 mg/dl), triglycerides 169 mg/dl, LDH 5820 u/L and rheumatoid factor 40 u; viral titers and cultures for bacterial, mycobacterial and fungal infections were negative. The pericardial fluid had a distinctive scintillating, gold-paint appearance and many cholesterol crystals were evident microscopically.

        The patient responded to treatment with methotrexate and steroids. Factors responsible for increase in pericardial fluid cholesterol may be its liberation from injured pericardial cells and rheumatoid nodules, lysis of red cells, or lymphatic obstruction and impairment of the absorptive capacity of the pericardium.

         
         

        מרץ 2000

        דרור רובינסון, חנה אש, דויד אביעזר, גבריאל אגר, נחום הלפרין וצבי נבו
        עמ'

        Autologous Chondrocyte Transplantation - from Science Fiction to Routine Clinical Practice

         

        Dror Robinson, Hana Ash, David Aviezer, Gabriel Agar, Nahum Halperin, Zvi Nevo

         

        Dept. of Clinical Biochemistry, Sackler Medical School, Tel Aviv University, Ramat Aviv; Dept. of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin; and CTI Ltd., Science Park, Kiriat Weizmann, Nes Ziona

         

        Adult articular cartilage lacks the capacity for self-repair. The limiting factor appears to be the inability of chondrocytes to proliferate while embedded in the extracellular matrix typical of hyaline cartilage. Cartilage defects larger than 1 cm2 change articular biomechanics and lead to eventual osteoarth-ritis and joint destruction.

        During the past decade, several competing techniques have evolved to stimulate articular cartilage repair. Small lesions can be successfully treated by either micro-fracture or osteochondral cylinder grafting. The latter technique allows immediate weight bearing but leads to damage of previously uninvolved areas of articular cartilage, which limits its application to lesions of less than 2 cm2.

        When the damaged area is more extensive, grafting of autologous chondrocytes should be considered. First a diagnostic arthroscopy is performed to assess the damaged area and a small cartilage biopsy is taken. 6 weeks later, arthrotomy and chondrocyte transplantation are performed. In the interval, the antologous chondrocytes have expanded by 2 to 3 orders of magnitude. Our experience to date includes 10 cases with follow-up of 6 months to 5 years. Preoperative complaints of crepitation and locking disappear. There is functional improvement and pain reduction of approximately 50%. This procedure, currently limited to patients under 55 years of age with limited damage to an articular surface, for the first time allows reconstruction of damaged articular areas without resorting to allografts.

        דצמבר 1999

        אנדרה מטלון ועמוס ינון
        עמ'

        Malaria in Travelers Returning from Endemic Areas

         

        Andre Matalon, Amos Yinnon

         

        Kupat Cholim Klalit, Dan-Petah Tikva District, and Dept. of Family Medicine, Tel Aviv University; and Infectious Disease Unit, Shaare Zedek Hospital and Hebrew University-Hadassah Medical School, Jerusalem

         

        2 cases of malaria in family practice are described in a 26- and a 50-year-old woman. Both probably could have been prevented had common chemoprophylactic drugs been taken. The risk of malaria is greater than the risk of possible side-effects of the drugs commonly used by travelers for prevention. Family physicians must be aware of the possibility of malaria in young people with fever, especially those who have travelled to equatorial areas and special attention should be given to encourage chemoprophylaxis.

        נובמבר 1999

        יוסף זולדן, דורון מרימס, אריה קוריצקי, אילן זיו ואלדד מלמד
        עמ'

        Apomorphine for "Off-Periods" in Parkinson's Disease

         

        J. Zoldan, D. Merims, A. Kuritzky, I. Ziv, E. Melamed

         

        Dept. of Neurology, Rabin Medical Center, Beilinson Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University

         

        After 3-5 years of continuous use of 1-dopa preparations for Parkinson's disease, 25%-50% of patients develop side-effects such as the "on-off" phenomenon and involuntary movements that markedly impair function. One cause of these manifestations is evidently a disturbance in the absorption of 1-dopa.

        We attempted to avoid this problem by using subcutaneous injections. Apomorphine is a rapid-acting dopamine agonist which causes a return from "off" to "on" within minutes.

        We present the results of a trial of subcutaneous injections of apomorphine in 22 Parkinsonian patients (12 males, 10 females) with severe motor fluctuations. During 5 days prior to the apomorphine all received Motilium (domperidone, 60 mg/d) to prevent nausea and vomiting. All were hospitalized initially to determine optimal dosage and to teach them the technique of self-injection.

        2 to 4 mg of apomorphine were injected 1 to 3 times daily for 2 to 12 months. In 17 patients (80%) "off" periods were reduced without significant side-effects. Apomorphine seems to be effective, tolerable treatment for shortening 1-dopa induced "off" periods.

        ספטמבר 1999

        אברהם ירצקי, יעקב פלדמן וקרולה ויגדר
        עמ'

        Infective Endocarditis Presenting as Polyarticular Septic Arthritis

         

        Abraham Yaretzky, Jacob Feldman, Carola Vigder

         

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

         

        We report acute polyarthritis in an 86-year-old man which was initially considered to be an exacerbation of osteoarthritis. After a delay of a few days a diagnosis of septic polyarthritis as an initial symptom of infective endocarditis was made. Although rheumatic manifestations in infective endocarditis are common, septic polyarthritis is rarely seen. In our patient the course of the disease was rapidly fatal.

        מנחם נוימן, בוריס צוקרמן, משה זילברמן, עמיצור פרקש ועוזי בלר
        עמ'

        Tension-Free Vaginal Tape: A New Surgical Treatment of Female Urinary Stress Incontinence

         

        M. Neuman, B. Zuckerman, M. Zilberman, A. Farkash, U. Beller

         

        Division of Gynecologic Surgery and Oncology, Shaare Zedek Medical Center, Jerusalem

         

        Female urinary stress incontinence diminishes the quality of life of about 5% of women. It is usually dealt with by surgery to correct the relaxed pelvic floor, the cause of the incontinence.

        Tension-free vaginal tape is used in a newly described procedure. It consists of the vaginal introduction of a prolene needle-guided mid-urethral sling. The procedure is easy to perform under local anesthesia, recovery is rapid, and results are similar to those of other effective operations.

        We report 44 patients who underwent this type of surgery. There were no significant complications. The early results were good and although the follow-up has been short, we believe that experience with this operation will play an important role in the treatment of urinary stress incontinence.

        אוגוסט 1999

        מיכאל אהרנפלד, פנינה לנגביץ ויהודה שינפלד. עמ' 120-124
        עמ'

        מיכאל אהרנפלד1, פנינה לנגביץ2, יהודה שינפלד3

        מחלקות לרפואה פנימית ג1, ו2 ו- ב3 והיחידה למחלות מיפרקים, המרכז הרפואי שיבא, תל-השומר

        דורון זמיר, יוסף ויצמן, נחום ארליך, מרי עמר ופלטיאל ויינר
        עמ'

        Severe Hypercalcemia Due to Renal Transitional Cell Carcinoma

         

        D. Zamir, J. Weizman, N. Erlich, M. Amar, P. Weiner

         

        Depts. of Medicine A, Urology and Pathology, Hillel Yaffe Medical Center, Hadera

         

        Hypercalcemia is a common metabolic disorder, especially in the elderly. The most common etioloare hyperparathy-roidism or malignancy, most often of the lung, breast, kidney or hematological system. Because hypercalcemia is an uncommon manifestation in urinary tract epithelial tumors, especially those of the renal pelvis, we present a man aged 62 years with hypercalcemia due to renal transitional cell carcinoma.

        ינואר 1999

        אהוד לבל ומנחם יצחקי
        עמ'

        Lymphoma of the Knee Joint Simulating Patellar Fracture

         

        E. Lebel, M. Itzchaki

         

        Orthopedics Dept., Shaare Zedek Medical Center, Jerusalem

         

        Fracture of the patella is not uncommon after direct anterior knee trauma. However, there are other medical situations that resemble it radiologicaly. We present a patient mistakenly diagnosed as having a patellar fracture who had primary, solitary, malignant B-cell lymphoma of the knee space eroding the lower pole of the patella. We have found no reports of such a lesion in the literature. Another commbenign condition that might erode adjacent bone is chronic synovitis. Our patient was treated withchemo- and radiotherapy and the lesion fully regressed with no evidence of local or systemic recurrence 1.5 years after diagnosis.
         

        דצמבר 1998

        ריבה בריק
        עמ'

        Methotrexate Treatment in Refractory Juvenile Rheumatoid Arthritis

         

        R. Brik

         

        Pediatrics B Dept., Rambam Medical Center, Haifa

         

        The mean time from initiation of methotrexate (MTX) treatment of juvenile rheumatoid arthritis (JRA) to partial remission of clinical symptoms and total clinical remission was assessed. 9 girls and 8 boys, from 3 to 18 years of age (mean 11.4±5.4) with active JRA by American College of Rheumatology (ACR) criteria (5 systemic, 8 polyarticular and 4 pauciarticular disease onset), who failed to respond to adequate courses of non-steroidal anti-inflammatory drugs (NSAID), steroids or disease-modidrugs were studied.

         

        Clinic visits were scheduled at monthly intervals for physical and laboratory assessment disease activity and drug safety. Partial response to MTX was defined a 25% reduction of the active joint count and/or articular severity score. Total clinical remission was defined as in adult rheumatoid arthritis. The duration of disease activity until enrollment ranged from 6 months to 14 years (4.5±3.7 yr); duration of therapy was 3 months to 3 years (14.6±9.3mo) and dosage ranged from 5 to 15 mg/m²/week. Prednisone in doses below 10 mg/day and NSAID were permitted.

        14 of 17 patients (82%) had a 25% reduction in joint activity after 6 weeks to 4 months (9.2±3.2 weeks); 10 (59%) went into full clinical remission after 5 to 26 months (14.3±9 months); 3 relapsed after an initial response to treatment, and 4 (23%) did not respond to MTX. The non-responders were males who required higher doses of prednisone (p<0.0001).

        MTX appears to be effective therapy for children with JRA. An initial response can be expected in most patients after 9 weeks of treatment, and full clinical remission occurs after a mean of 14 months.

        אוגוסט 1998

        סורין דניאל יורדאש, אהוד ראט, דן עטר ואלכס וינדזברג
        עמ'

        Vacuum Phenomenon in the Hip Joint: Diagnostic Value

         

        S. Iordache, E. Rath, D. Atar, A. Vindzberg

         

        Orthopedics Dept., Soroka Medical Center, Beer Sheba

         

        Vacuum phenomenon is well known in degenerative spinal disease in the elderly, but is seldom seen in other joints, especially in children. The phenomenon does not represent a pathological finding, and can be used for imaging of the articular facets, mainly in the hip and knee joints. We report a patient with this phenomenon in the hip joint.

        מאי 1998

        דניאל לוין וחיים צינמן
        עמ'

        Importance of Internal Fixation for Talar Neck Fractures

         

        Daniel Levin, Chaim Zinman

         

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

         

        Fracture of the talus, which articulates with 4 other bones in the ankle and foot, must be properly diagnosed, classified and treated to avoid the common complications of post-traumatic osteoarthritis and avascular necrosis. Knowledge of blood supply and anatomy is imperative, since the surgical approach must not damage the few vascular structures that remain intact after the trauma. We present 5 cases of fractures at the neck of the talus. All underwent internal fixation, 1 after closed reduction and 4 after open reduction. In all the results were satisfactory, although 1 patient developed avascular necrosis of the talar body.

        מ' קליגמן ומ' רופמן
        עמ'

        Conversion Total Hip Replaceafter Failed Internal Fixation of Intertrochantric Fracture

         

        M. Kligman, M. Roffman

         

        Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa

         

        Between 1933-1995, 16 patients underwent conversion-total hip replacement after internal fixation of an intertrochanteric fracture failed. Clinical results were unsatisfactory compared to primary total hip replacement. There was a high incidence of intra- and postoperative complications, including femoral fracture, wound infection, and aseptic loosening. This study should increase the surgeon's awareness of the difficulties encountered in conversion of failed intertrochanteric fractures to total hip replacement.

        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
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