תוצאת חיפוש

One-Stage Surgery for Hirschsprung's Disease in Children

Mark Weinberg, Baruch Klin, Itzhak Vinograd

Dept. of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, and Sackler School of Medicine, Tel Aviv University

Traditionally Hirschsprung's disease has been treated by 2-or 3-stage procedures. During the past 6 years a 1-stage Duhamel procedure without stoma has become our treatment of choice for Hirschsprung's disease in neonates and young infants. Over a 6-year period, 15 infants and children with colonic Hirschsprung's disease were treated with the 1-stage Duhamel retro-rectal pull-through procedure without a stoma, with the Lester-Martin modification. All patients had the usual short segment aganglionosis, but 1 had a long segment which included the splenic flexure.

Early complications included wound infection in 1 and minor rectal bleeding in 3. Late complications included constipation in 1 and enterocolitis in 4. Long-term functional results were very good in all those operated except for 1 with rectal achalasia.

We conclude that Hirschsprung's disease can be successfully treated with a 1-stage pull-through operation, the child usually benefitting from the shorter hospital stay and the avoidance of a colostomy.

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.

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.

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.

Severe Transient Neutropenia due to Parvovirus B19

D. Heldenberg

Dept. of Pediatrics, Hillel Yaffe Medical Center, Hadera

A 10-year-old girl was admitted with a 3-day history of fever, cough, abdominal pain and vomiting. Severe neutropenia (total neutrophil count 186/mm³), a mild increase in ALT and AST, and a positive titer of IgM antibodies against parvovirus B19 were found. The neutropenia resolved and liver enzymes became normal as she recovered. We conclude that parvovirus B19 infection should be considered in the evaluation of an acute illness accompanied by severe neutropenia.

Familial Hemiplegic Migraine of Childhood

A. Livne, E. Lahat

Pediatric Division and Pediatric Neurology Unit, Assaf Harofeh Medical Center, and Sackler Faculty of Medicine, Tel Aviv University

Familial hemiplegic migraine is a rare autosomal, dominant, migraine subtype. It is characterized by acute episodes of hemiplegia and hemisensory deficits, and other neurological abnormalities occurring either before or together with severe headache, nausea and vomiting; episodes last several hours and then spontaneously subside. Intervals between episodes are relatively prolonged. Unless there is a relevant family history suggesting this syndrome, the diagnosis is usually delayed. Recently the gene for the syndrome was identified on chromosome 19. We report 3 boys and 1 girl, 11-15 years old with hemiplegic migraine.

Sonographic Demonstration of a Levonorgestrel-Releasing LUD

Yaron Zalel, Doron Kreizer, David Soriano, Reuven Achiron

Ultrasound Unit, Obstetrics and Gynecologic Dept., Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University

Mirena, a new intra-uterine device (IUD) introduced in Israel during the past year, releases 20 mcg/day of levonorgestrel for 5 years. It has the advantages of reduced pregnancy rates and diminished menstrual blood loss, together with a low risk of pelvic inflammatory disease compared with current IUD's.

It has a typical sonographic appearance, differing from that of regular IUD's, which was demonstrated in all 15 women examined in this study. Its sonographic appearance includes both proximal and distal ends of the vertical arm of the device, which extend into the internal cervical os and fundal region, respectively. Acoustic shadowing between both ends defines the location of the device, which should help avoid consultations due to "lost IUD's."

Limited Percutaneous Surgical Drainage in Severe Neonatal Necrotizing Enterocolitis in Low Birth Weight Prematures

Robert Finaly, Zahavi Cohen, Vadim Kapuller, Agneta Golan, Edna Kurtzbart, Abraham Mares

Depts. of Pediatric Surgery and Neonatology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

The usual treatment of complicated neonatal necrotizing enterocolitis (NEC) is resection of the necrotic bowel, lavage of the peritoneal cavity and diversion enterostomy. Low-birth-weight premature neonates with this condition are in special danger if general anesthesia and full exploratory surgery is contemplated.

A relatively simple alternate procedure is percutaneous insertion under local anesthesia of a soft abdominal drain, most often in the right lower quadrant. The procedure is done in the neonatal intensive care unit without moving the whole set-up to the operating room.

4 such cases have been treated within the past year. 3 were discharged home as they did not require additional surgical treatment, not having developed intestinal stenosis or obstruction. 1 recovered from the acute episode, but succumbed to a severe intraventricular hemorrhage and respiratory failure 7 days after the procedure.

Our limited but most gratifying experience, in addition to similar experience of others, encourages us to recommend this simple surgical approach in the very sick low-birth-weight premature with fulminant NEC.

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.

EBV-Related Post-Transplantation Lymphoproliferative Disorder

D. Doron, O. Papo, O. Portnoy, E. Granot

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

We describe a 4.5-year-old girl in whom post transplantation lymphoproliferative disorder was diagnosed 1 year after liver transplantation. She ran a complicated course with multiple organ involvement: respiratory failure which required mechanical ventilation, renal failure, bone marrow depression and severe protein-losing enteropathy.

Clinical, Social and Economic Aspects of Comprehensive Geriatric Assessment

Jacob Feldman, Liora Peleg, Abraham Yaretzky

Geriatric Dept., Sapir Medical Center, Kfar Saba, and Sackler Faculty of Medicine, Tel Aviv University

It is well known that maelderly patients are referred to nursing homes because of "functional decline" without being thoroughly in. We studied 9 elderly patients, all referred to hospital due to functional decline and diagnosed as follows: spinal stenosis - 2 cases, depression - 3, thyrotoxicosis -1, Parkinson -1, polypharmacy and congestive heart failure -1 patient each. Proper diagnosis and appropriate treatment prevent unnecessary hospitalization in nursing homes. Our study is meant to draw attention to this crucial aspect of geriatric medicine.

Rehospitalization of Children

U. Brook, Y. Buyanover

Pediatrics Dept., Wolfson Medical Center, Holon, and Sackler Medical School, Tel Aviv University

The aims of the study were to determine the rate of rehospitalization in 1997 a month after the end of initial hospitalization. 72 of 1174 children (6.1%) were rehospitalized. The mean age was 4.6±3.6 years (range 1 month-16 years). The average duration of the initial hospitalization of the 72 children was 8.3±6.0 (range 1-50) days, but only 3.6 days for all hospitalized children. The duration of the rehospitalization was 4.1±2.1 days (range 1-10 days). the interval between the 2 hospitalizations was 11.1±9.6 days (range 1-30 days). Among the diseases of the rehospitalized children in decreasing order were: respiratory diseases (including ORL) (40.9%), gastrointestinal diseases (27.7%), nervous system diseases, and bacteremia and septicemia (5.6%). Second hospitalizations in connection with these conditions were: gastrointestinal disease (34.7%); respiratory disease (29%); and bacteremia and septicemia (11.1%). Our recommendations are for attending physicians to follow-up regularly and periodically children who suffer from chronic diseases and are prone to develop exacerbations. This should be done in cooperation with hospital specialists so that the cooperation may reduce the rehospitalization of these children.

Pediatric Research in an Office-Setting Network

Zahi Grossman, Ernesto Kahan, Samuel Gross, Shai Ashkenazi, Itamar Shalit

Kupat Holim Maccabi, Tel Aviv; Israel Ambulatory Pediatric Association; Dept. of Family Medicine, Tel Aviv University; and Schneider Children's Medical Center, Petah Tikva

Pediatric care in the community is gradually replacing traditional care in hospitals. Despite that, research activity in the community setting is minimal due to objective difficulties. These are mainly constraints of time, office work and lack of research-supporting logistics. In the past decade, throughout the world, primary physicians interested in research have grouped together and formed research networks. The aim of such networks is to support and promote research in the community.

An Israel Pediatric Research in Office-Setting network (IPROS) was established 2 years ago by the Israel Ambulatory Pediatric Association (IAPA). Today, there are over 140 pediatricians listed in IPROS, representing the heterogeneous composition of pediatricians in Israel. The network's policy is defined by a joint steering committee. The committee is composed of IAPA representatives, senior network members and Schneider Hospital senior investigators. The research subjects are diverse, and represent common practical issues.

Effective intra-net communication is vital to the existence of the network, and is accomplished by 3 modalities: 1) semiannual updates by mail, 2) e-mail, using an electronic mailing list to facilitate connection between members, 3) semi-annual meetings. Research budgets are derived from public sources like the Ministry of Health and IAPA, and private sources such as pharmaceutical companies. The administration of the network is supported by Schneider Children's Medical Center, and financed by IAPA.

Sacral Insufficiency Fractures - A Frequent Cause of Low Back Pain in Elderly Women

H. Semo, Z. Zwas, A. Goshen, S. Levenkrohn, A. Adunsky

Depts. of Geriatric Medicine and Nuclear Medicine, Sheba Medical Center, Tel Hashomer

Sudden low back pain is common in elderly women. It causes physical and mental stress, and results in deterioration of functional movement and in activities of daily living. Awareness of possible sacral insufficiency fracture is important; they may be demonstrated by imaging modalities, mainly radionuclide bone scan. Prognosis is good and accurate diagnosis serves to exclude malignancy and relieve fear of chronic pain and disability. We describe 4 women, aged 84, 82, 71 and 77 who illustrating the clinical and imaging findings of this disorder.