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.

Advances in Ophthalmological Photodynamic Therapy

Yoram Solberg, Michael Belkin

Goldschleger Eye Research Institute, Tel Aviv University and Chaim Sheba Medical Center, Tel Hashomer

Photodynamic therapy is a new experimental therapeutic technique which is attracting increasing attention. Its biopharmacological basis of action is the specific interaction of a photosensitizing compound with the cellular elements of pathological lesions. The photosensitizer is thought to enter specifically into the pathologic cells, where it accumulates. The lesion is then irradiated with a sensitizing laser-beam of specific wave-length to activate the photosensitizer, which then becomes a generator of free oxygen radicals. These radicals destroy the sensitizer-harboring pathological cells. The advantage of specifically destroying pathological lesions without affecting surrounding normal tissue is obvious. Recently, many experimental studies have been conducted to test the usefulness of photodynamic therapy for ocular disorders, mainly advanced age-related macular degeneration and uveal melanoma. Results so far are encouraging.

Quality of Life in Younger Adults after First Stroke

Shenka Alfassa, Revital Ronen, Haim Ring, Aida Dynia, Ada Tamir, Reuben Eldar

Fleischman Unit for Study of Disability, Neurological Ward, Loewenstein Hospital, Ra'anana

To study the effect of stroke on the quality of life in younger adults, 199 patients 17-49 years of age who had sustained a first stroke between 1.11.92 and 31.10.93 were followed up. They were interviewed by telephone at 3, 6, 12 and 24 months after the event. 2 died during the first year of follow-up, and 8 had recurrent strokes. After 2 years, 8 additional patients had died and 4 had sustained recurrent events. Gradual improvement was reported within all age groups and in all areas. During the 3-6 months period, a mean of 4% improvement occurred in functional capability, 15% in social and recreational activity and 8% in return-to-work. The 6-12 month period showed an increase of 3% in improvement in mean functional capability, 10% in social and recreational activity and 2% in return-to-work. 1 year after the stroke 27% remained with moderate to severe disability, but over 86% were functionally independent in their daily living activities. There were no significant changes during the second year of follow-up in these statistics. 67% of those employed prior to their stroke returned to work and approximately 70% reported a return to prestroke social and recreational activity. These results demonstrate that the relatively high recovery rate and functional improvement during a year of follow-up were not accompanied by similar rates of improvement in emplyment and in social integration. They indicate the need for increased emphasis on long-term psychosocial rehabilitation services within the community.

Capgras' Syndrome

I. Z. Ben-Zion, K. Levine, A. Shiber

Psychiatry Dept., Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheba

We present 3 cases of Capgras' syndrome- a delusional disorder in which the patient believes that 1 (or more) of his acquaintances has been replaced by an imposter who appears as a double. 2 were schizophrenics and 1 had depression with psychotic features. This syndrome is rare in our practice, but we do not know if this is due to lack of awareness of the condition, or to the possibility that it is a culture-related syndrome. We suggest that although the syndrome has lost some of it's significance, it is still worth making the diagnosis because of the medical and psychological implications this condition carries.

Hospitalization of the Elderly for Stroke Rehabilitation

D. Gottlieb, M. Kipnis, E. Sister, N. Lipkin, M. Medvedev, S. Brill

Stroke Rehabilitation Unit, Neurogeriatric Dept., Beit Rivka Geriatric Hospital, Petah Tikva

This is a descriptive, longitudinal study of 400 elderly patients admitted for stroke rehabilitation to a geriatric department dedicated to this purpose. We present the demographic, medical, and impairment and disability characteristics on admission, and the outcome of rehabilitation. Mean stay was 54 days and 2/3 became independent and returned home. Functional score on admission was the best predictor of outcome, but age and social support were also significant.

Gynecologic Problems of the Lower Genital Tract in Children and Young Adolescents

Giulia Barda, Dino Bernstein, Sagit Arbel-Alon, Haim Zakut, Joseph Menczer

Dept of Gynecology and Obstetrics, Edith Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University

Hospital records of 46 girls under the age of 17 years, hospitalized for lower genital tract problems in 1986-95 were reviewed. The most common conditions were results of unintentional injuries (43.5%), imperforate hymen (28.2%) and infections (19.6%). The median age for unintentional injuries was significantly lower than for other conditions (7.0 vs 11.4; p<0.001). Most injuries were external and occurred during outdoor activities. Mean volume of estimated bloody fluid drained in those with imperforate hymen was greater when the diagnosis was made after the age of 12 (783 vs 433; not significant). It has been suggested that hematocolpos and hematometra should be prevented, but the possible unfavorable sequelae have not been documented. The relative order of frequency of the various diagnostic groupings and the diagnoses of labial adhesions and imperforate hymen are specific for the age of the study group.

The Homeless and the Health System: Profile of the Homeless Patient

J. Posen, N. Tanai, S. Spiro, D. Frumer

Social Work Dept., Ichilov Hospital, Tel Aviv and Faculty of Social Work, Tel Aviv University

The homeless population is mobile and does not use ambulatory health care services. Thus the major contact between the homeless and the medical establishment occurs primarily when they are treated for acute symptoms in hospital. We describe the clinical and sociodemographic profile of the homeless who require hospital services. The research population included 50 homeless treated in the emergency room and various departments of our medical center between October 1994 and August 1995. Social workers used a questionnaire relating to clinical, sociodemographic and social factors. Most patients were men, 76% under the age of 50. The most common diagnosis was alcoholism; other diagnoses included back, limb and joint injuries, infections, skin diseases, and general exhaustion. There were subgroups with differing needs within this homeless population for which appropriate rehabilitation programs are proposed.

Surgical Repair of Fractures of the Clavicle

O. Safran, R. Mosheiff, Y. Mattan, M. Liebergall

Orthopedic Dept., Hadassah-University Hospital, Jerusalem

Clavicular fractures make up 45% of shoulder girdle fractures. The clavicle's susceptibility to injury is due to its subcutaneous position and its role as the bony connection between the thorax and the shoulder. In 95% of cases the mechanism of injury is a direct blow to the shoulder. These fractures are usually treated conservatively without surgery. But there are a few such fractures that require surgical repair in order to unite well. 9 patients were operated on for clavicular fractures during 1991-1995. The indications for surgical repair were lateral-third fracture, floating shoulder, neurovascular deficit or nonunion. The methods used were open reduction and fixation with either plate and screws, Kirchner wires, cerclage or a combination. All fractures united well, with no infections or new neurovascular deficits. Good range of shoulder motion and acceptable cosmetic results were achieved in all. 1 patient had functional limitation due to brachial neuritis caused by brachial damage at the time of injury. Indications for surgical repair and the methods used in these cases are similar to those described in the literature. The high rate of union and absence of complications support surgical repair for the few clavicular fractures that are not likely to unite properly.

Surgical Approach to Benign Extradural Lesions of the Thoracic Spine

Ely Ashkenazi, Stephen T. Onesti, W.J. Michelsen

Depts. of Neurosurgery, Hadassah University Hospital, Jerusalem and Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, The Bronx, New York

A benign epidural lesion in the thoracic spine is rare, and usually the result of intervertebral disc herniation or infection. Not long ago patients were diagnosed late in the course of their disease and the surgical results of the standard laminectomy usually performed were grave. The development of newer imaging techniques (CT and MRI) has made diagnosis much easier, so diagnosis is often earlier, when neurological deficit is minimal. Newer neurosurgical techniques and approaches to the thoracic spoine have been developed to treat these lesions, which we describe. Clinical data on 16 patients operated from January 1996 to January 1997 are presented.

Embolic Splenic Infarction: A Rare Complication of Atrial Fibrillation

Doron Merims, Doron Zilberman, Liliana Lupu, Emanuel Sikuler

Depts. of Medicine B and Radiology, Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheba

Splenic infarction is a rare disorder. The typical clinical presentation is sudden pain in the left upper quadrant of the abdomen, and awareness to this possibility is the major clue for diagnosis. We describe a 49-year-old man with chronic atrial fibrillation and splenomegaly who was treated with anticoagulants. Because of hematuria, the regular dose of anticoagulant therapy was reduced. The hematuria stopped but he complained of sudden onset of pain in the left upper quadrant. Computerized tomography and isotope scan of the spleen confirmed the clinical suspicion of splenic infarction. Treatment with anticoagulants and analgesics was followed by clinical improvement.

Inhaled Budesonide for Chronic Obstructive Pulmonary Disease

Paltiel Weiner, Doron Zamir, Marinella Beckerman

Medical Dept A, Hillel Yaffe Medical Center, Hadera

A significant, large minority of patients with chronic obstructive pulmonary disease (COPD) respond favorably to corticosteroid treatment; but the benefit may be outweighed by its side effects. Long-term administration of inhaled steroids is a safe means of treatment. We hypothesized that treatment with inhaled budesonide would improve clinical symptoms and pulmonary function in subjects with COPD, and that the response to an inhaled B2-agonist would individualize steroid responders. In 44 patients with stable COPD in a double- blind crossover trial, we compared a 6-week course of inhalations of 800 mg/d budesonide with a placebo, separated by a 4-week interval when no medication was taken. In 33 out of 42 responders to the B2-agonist who remained in the study, there was a significant improvement in FEV1 of greater than 20% following budesonide inhalation, as compared to placebo. There was also a significant difference between the 2 periods of treatment as to the mean number of B2-agonist inhalations. We conclude that about 1/4 of patients with stable COPD respond to bronchodilators, and treatment with inhaled steroids improves spirometry data and inhaled B2-agonist consumption in about 3/4.

Oral Anticoagulation Therapy in the Primary Care Setting

Shlomo Vinker, Sasson Nakar, Sergei Finkel, Emanuel Nir, Eitan Hyam

Family Medicine Dept., Sackler Faculty of Medicine, Tel Aviv University; and Shaaraim Clinic, General Sick Fund, Rehovot; Central Cinical Laboratories, and District Medical Director, Central District of the General Sick Fund

The use of oral anticoagulant therapy (OAT) to prevent thromboembolism has been widespread in recent years. The concept of high- and low-intensity regimens has facilitated treatment for many, and has lowered the hazards of overly intense anticoagulation. However, a significant proportion of patients suited to the low intensity regimen are not being treated. It is not clear whether its wider use is limited by continued debate, lack of resources, lack of expertise, or other causes. We retrospectively reviewed the medical records of 32 patients treated with OAT administered in the primary care setting. The average age was 66±11 years (range 34-84). 9 were treated with high-intensity OAT: 8 due to artificial heart valves, and 1 due to a hypercoagulable syndrome with recurrent thromboembolism. 23 were treated with low-intensity OAT, 17 of whom had atrial fibrillation. 11 were also being treated continuously with other medication which interacted with OAT or interfered with other coagulation pathways. Such medication included: aspirin, dipyridamole, amiodarone, bezafibrate and allopurinol. Of 414 coagulation tests, 57% and 65% were in the therapeutic range in the high- and low-intensity OAT groups, respectively. There was no major bleeding event, but in 2 of 8 who bled, gastrointestinal bleeding led to hospitalization. Treatment was discontinued in 1 patient because of difficulties in achieving target INR, and in the 2 hospitalized for bleeding. The percentages of test results in, above and below the therapeutic range were similar to those in other large series, for both intensity regimens. We found that a significant proportion of patients were under chronic treatment with other medication which interacted with OAT. To estimate the rate of complications in primary care OAT, larger series are needed. We conclude that OAT can be given and monitored by the family physician, and that awareness of long and short term drug interactions with OAT is mandatory.

Reporting Maternal Behavior during Diarrhea in Bedouin Children

Natalya Bilenko, Amalia Levy, Drora Fraser

Epidemiology and Health Services Evaluation Unit, S. D. Abraham International Center for Health and Nutrition, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

Diarrhea is still a major cause of morbidity and mortality among children in developing countries. The Bedouin population of southern Israel is in transition from a nomadic to a settled life-style. We examined maternal knowledge and reported behavior when their children had diarrhea. Mothers defined diarrhea as the passing of 4-5 stools per day. The most frequent signs of the illness were an increased number of watery stools with changes in either color or form. The most frequent symptom that prompted mothers to seek medical aid was blood in the stool. All mothers reported increasing fluid intake in their children during diarrhea, and most reported giving herbal tea. About half of the women avoided milk products and used special for the treatment of diarrhea. A quarter of the women reported stopping or decreasing the frequency of breast feeding during diarrhea. Reported cessation of breast feeding during diarrhea was associated with changing to special foods, and failure to note the onset of diarrhea or to recognize signs of dehydration. The withdrawal of breast feeding during episodes of illness and diarrhea is related to lack of knowledge regarding diarrhea. These data indicate that even in this population, with free access to preventive and curative medical care, there should be greater efforts to educate mothers to detect diarrheal disease and to maintain breast feeding during the diarrhea.

Salbutamol Intoxication

Haim D. Danenberg

Division of Medicine, Hadassah University Hospital, Jerusalem

A 20-year-old asthmatic woman who ingested 300 mg of salbutamol (Albuterol) and 30 g of paracetamol is presented. She had sinus tachycardia up to 160/min, hypotension (80/50 mmHg), tremor, hypokalemia (2.1 mEq/l) and hyperglycemia (12.1 mEq/l). Treatment was by gastric lavage, fluids, potassium and N-acetylcysteine. Symptoms resolved in 24 hours.

Superficial Dorsal Penile Vein Thrombosis (Mondor's Disease)

Ran Katz, Arye Blachar

Depts. of Urology and Radiology, Hadassah Medical Center, Hebrew University of Jerusalem

Superficial venous thrombosis of the chest wall was first described by Mondor in 1939. Braun-Falco reported in 1955 superficial penile vein involvement in diffuse thrombophlebitis of the abdominal wall and in 1958 Helm and Hodge first described isolated superficial dorsal penile vein thrombosis. Since then, fewer than 50 cases have been reported. The clinical presentation is usually redness and swelling of the dorsum of the penis, accompanied by a palpable, tender thrombotic vein. This acute and painful disease frightens the patient, who is concerned about his fertility and sexual function. The main cause of this disease is frequent sexual intercourse. Diagnosis is based upon anamnesis, physical examination and penile sonography with color Doppler imaging. It is usually a benign disease which resolves quickly under appropriate medical therapy. We present a man who was admitted for this condition and was successfully treated.