תוצאת חיפוש

Sunscreen Use in an Urban Negev Population

Pesach Shvartzman

Family Medicine Dept., Ben-Gurion University of the Negev, Beer Sheba

The use of sunscreen in the Negev population was assessed. The study population included 1458 subjects, mean age 35.5‏±14.2 years, half born in Israel and 25% in East Europe. Two-thirds were exposed to the sun 1-2 hours a day and 13% 4 hours a day or more. Only about 15% used sunscreen while shopping, 69% used it at the beach, and less than half applied it to children being sent to school. Sunscreen use was greater in women (p<0.000001), especially those with sensitive skin (p<0.0001) and red hair (p<0.0001). No significant association was found with age, education or country of birth.

Compulsory, Ambulatory Psychiatric Treatment

R. Durst, A. Teitelbaum, Y. Bar-El, M. Shlafman, Y. Ginath

Arie Jaros Jerusalem Mental Health Center and Talbieh Mental Health Center (Affiliated with the Hebrew University-Hadassah Medical School, Jerusalem) and Israel Ministry of Health, Jerusalem District

The Treatment of Mentally Sick Persons Law of 1955, was repealed and replaced by the Law of 1991. Under the latter, the Order for Compulsory Ambulatory Treatment (OCAT) was addressed for the first time (Section 11, a-d). According to this law, the district psychiatrist instead of issuing a hospitalization order, may issue an OCAT, under which the required treatment is given within the scope of a clinic which he designates, for up to 6 months and under conditions which he specifies. This is done on the basis of psychiatric examination, or an application in writing from the director of a hospital or clinic, when continued ambulatory treatment is needed after discharge from hospital or instead of compulsory hospitalization. The district psychiatrist may extend the period of treatment for further periods, none of which is to exceed 6 months. Compulsory ambulatory treatment is to enable patients to benefit from the positive aspects of living freely in the community, while receiving prompt treatment under compulsory conditions. The concept offers a partial solution, achieving a balance between civil liberties and clinical needs, between over-confinement and under-treatment which might be dangerous or neglectful. The clinical impression has been that the OCAT has not fulfilled expectations. The purpose of this study was to examine the topic in a systematic way in Jerusalem and the soutern districts for the 4 years since inception of the law. In 44.4% of cases OCAT was proven to be effective, while in 33.1% it was found to be ineffective and did not prevent compulsory hospitalization, one of its main goals. It was partially effective in the rest of the cases. It is recommended that suitable means for the enforcement of the law be allocated and that the subject of forceful hospitalization and OCAT be made a mandatory subject in the residency program of psychiatrists.

Radiotherapy of Localized Prostatic Carcinoma

Eliahu Gez, Yael Netzer-Horowitz, Einat Waiman, Raphael Rubinov, Yoram Cohen, Abraham Kuten

Northern Israel Oncology Center and Oncology Dept., Rambam Medical Center and Lin Medical Center, Haifa; and Soroka Medical Center, Beer Sheba

112 patients with localized prostate cancer, clinical stage A2-C, were treated by definitive radiotherapy between 1982-1988. Radiation volume encompassed the prostate, seminal vesicles and pelvic lymph nodes. The 10-year actuarial survival figures were: overall 51%; stage A2 87%; stage B 50%; stage C 36%; well differential tumors 67%; moderately differentiated 50%; poorly differentiated 32%; patients with local tumor control 55%; and patients with minimal local control 36%. It is concluded that external beam irradiation is effective in localized prostatic cancer. Stage and grade are prognosticators of survival.

The Parapharyngeal Space: Tumors and Surgical Approaches

E. Raveh, R. Sadov, B. Nageris, R. Feinmesser

Dept. of Otolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva

The potential parapharyngeal space contains the great vessels of the neck, cranial nerves IX-XII, the sympathetic chain and lymph nodes. Surgical access is difficult and the infrequency of tumors in it make surgery of this part of the head and neck a challenge. 8 women and 2 men (mean age 54.7, range 31-70 years) with tumors of the parapharyngeal space operated on during the past 6 years are presented. The most common surgical approach was the cervical submandibular, used in 6 of our patients with relative ease and minimal complications. Tumors of deep lobe parotid origin should be operated through a transparotid approach. Large benign or malignant tumors have a better prognosis when the transcervical transmandibular approach is used, providing wider access.

Preliminary Experience with Laparoscopic Repair of Inguinal Hernias

Herbert R. Freund, Dan Seror, Dan Eimerl, Oded Zamir

Surgery and Anesthesiology Depts., Hadassah-University Hospital, Mount Scopus, Jerusalem

During 1992-1996 we performed 163 laparoscopic hernia repairs in 100 men and 2 women. The mean age was 50.6; and in 61 the operation was bilateral. 66 were by transabdominal preperitoneal approach and 36 btotal extra-peritoneal approach. There were only a few minor complications and total recurrence rate was only 4.3%, partly attributable to our learning curve. Laparoscopic inguinal herniorrhaphy reduces postoperative incisional and muscular pain and causes less disruption in the postoperative period than open repair. Return to normal activity and work is faster for laparoscopic than for open repair, but operating room costs are higher (time and equipment). However, economic advantages for the national economy should be considered.

Balance Disturbances in Children with Middle Ear Effusions

Avishay Golz, Batia Angel-Yeger, Henri Zvi Joachims, Aviram Netzer, S. Parush

Dept. of Otolaryngology and Head and Neck Surgery, Rambam Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa

Vertigo and dizziness are not common complaints in childhood, but probably present more often than has been thought. These symptoms, caused mainly by otitis media (OM) and middle ear effusion (MEE), are 2 of the most common diseases in children, and until recently had long been neglected in the literature and in practice. We determined objectively the incidence of balance-related symptoms in children with long-lasting MEE, and resolution following insertion of ventilation tubes (VT). 36 children, aged 4-9 years, were studied using electronystagmography (ENG) and the Bruininks-Oseretsky tests for motor proficiency, before and after ventilation of the middle ear. Results were compared to those in 74 healthy children with no history of middle ear disease. Abnormal ENG findings were found in 58%, and 71% had low Bruininks-Oseretsky (BO) test scores. The ENG was abnormal in only 3 of the controls, 1 of whom also had low BO test scores. The symptoms and signs of balance disturbances resolved in 96% following VT insertion. These results indicate that balance-related symptoms often encountered in young children may result from chronic MEE, and that they resolve following evacuation of the effusion and ventilation of the middle ear.

Central Cord Syndrome in the Elderly Who Fall: a Diagnostic Trap

A. Adunsky, H. Semo, S. Levenkrohn

Geriatric Rehabilitation Dept., Chaim Sheba Medical Center, Tel Hashomer

Acute post-traumatic spinal injury is common and usually poses no diagnostic difficulties. Following a low-energy fall, the onset of acute central cord syndrome in the elderly is not common and is frequently misdiagnosed. Men aged 60 and 81, and a woman aged 75 are described, in whom central cord syndrome was overlooked. Awareness of this condition is important to avoid incorrect diagnosis and hazardous management.

Surgical Approach to Benign Cecal Ulcer

J. Haik, A. Judich, I. Barshack, M. Ben-Haim, M. Shabtai, A. Ayalon

Dept. of Surgery B and Pathology Institute, Chaim Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University

Benign cecal ulcer is a rare lesion, usually diagnosed during operation for suspected acute appendicitis or peritonitis of unknown origin. In the past, right hemicolectomy was recommended as the treatment of choice because of the difficulty in differentiating malignant lesions from benign cecal ulcers. However, in recent reports a more conservative approach has been suggested, consisting of selective colectomy followed by frozen section biopsy. This approach is aimed at preventing unnecessary excision of the colon and conserving the ileocecal valve. We present a 47-year-old woman operated for right lower quadrant peritonitis, believed to be due to acute appendicitis. On exploration, a biopsy-proven benign cecal ulcer was found and resected.

Technetium 99-M Sestamibi Bone Scan in Musculo-Skeletal Neoplasms

Dror Robinson, Lena Pinkas, Lilia Mindlin, Nahum Halperin, Tifha Horn

Dept. of Orthopedics and Nuclear Medicine, Assaf Harofeh Medical Center, Zerifin

It is often difficult to assess accurately the nature of a skeletal lesion. Problems include differentiating a malignant from a benign bone tumor, as well as determining the cause of a pathologic fracture. Such fractures may occur through osteoporotic bone as well as through neoplasm-affected bone. Thus, development of an imaging modality capable of distinguishing between such lesions is of importance. During 1996, we ran a prospective study in which results of Tc-99m-methyl-diphosphate (MDP) bone scans were compared with those of sestamibi (MIBI) bone scans and with subsequent biopsy and clinical course. The results of the bone scans were assessed by 2 independent "blinded" observers, and the ratios of counts in lesions to those in normal tissue (L/N ratios) were calculated. In cases of malignant (7) and benign (8) tumors, intensity of uptake in MDP scans were not predictive of degree of aggressiveness. On the other hand, MIBI bone scans demonstrated significant difference in intensity of uptake between benign and malignant bone tumors (L/N ratios 2.05 vs 2.75). In 5 of 8 benign lesions the L/N ratio was 1. In the others, increased uptake was minimal. In 2 patients changes in uptake in MIBI bone scan following chemotherapy appeared to be related to the degree of tumor necrosis achieved. While the MIBI bone scan cannot replace tissue biopsy as a definitive diagnostic modality in bone neoplasms, it does appear to allow better preoperative assessment and prognosis.

Telling the Bad News: do the Elderly Want to Know Their Diagnoses and Participate in Medical Decision Making?

Sara Carmel, Alon Lazar

Sociology of Health Unit, Faculty of Health Sciences, and Dept. of Behavioral Sciences, Ben-Gurion University of the Negev, Beer Sheba

In view of reported changes in western countries in the preferred model of doctor-patient relations, we evaluated the wishes of elderly persons for open doctor-patient communication with regard to terminal disease. Data was collected in 1994 from 987 elderly persons (70+) by structured interviews. Most of respondents wanted open communication and wished to be involved in medical decisions regarding life-sustaining treatment. However, only a minority tell their physicians and/or family members of their wishes. This suggests that most of the elderly expect physicians to be the first to initiate discussions of these issues. The results also indicate that among the elderly, those more educated, less religious, and those living in Israel longer, are more likely to want open communication with their physicians. This is explained by the relationship of these characteristics with the dominant cultural values of this group, and its acceptable models of relations in other areas of life.

Fish Spine Infection

Alexander Nudelman, Gordon Edelson, Amos Linden, Raoul Raz

Orthopedic Dept., Poriya Hospital and Dept. of Infections Diseases, HaEmek Hospital, Afula

Vibrio vulnificus is a Gram-negative bacterium living in warm salty water that produces a spectrum of human disease which may progress to devastating, sometimes fatal infections in susceptible individuals. Such infections have rarely been reported in Israel. However, over the past few months we have been seeing a sharp increase in V. vulnificus infections with a common history of injury to extremities by the sharp spines of Tilapia zillii, ("amnon" or St. Peter's fish). Clinical suspicion and prompt intervention prevent the untoward consequences of misdiagnosis or delay.

Kleptomania: Phenomenological, Clinical and Legal Aspects

R. Durst, G. Katz, K. Jabotinsky-Rubin, H.Y. Knobler

Kfar Shaul Mental Health Center, Jerusalem

Kleptomania is currently classified in psychiatric nomenclature as one of the impulse control disorders (DSM-IV, 1994). It is characterized by repeated failure to resist impulses to steal objects, not for personal use or monetary gain. The objects are therefore discarded, given away, or hoarded (ICD-10, 1992). This disorder is known since the early 18th century from the phenomenological and clinical viewpoints, yet is still debated with regard to therapeutic strategies and criminal liability. Although there are usually complications associated with the legal consequences of being caught and arrested, subjects continue to violate the law despite repeated arrests and convictions. In a 28-year old man suffering from kleptomania, years of psychodynamic psychotherapy were ineffective. Only when he was treated as suffering from an impulse control disorder or a variant of obsessive-compulsive disorder, was there significant improvement. The positive response to buspirone (5-HT1A) augmentation of fluvoxamine (SSRI) suggested that disturbed central serotonergic neurotransmission might play an important role in the pathogenesis of kleptomania. This concept is strengthened by the comorbidity of the syndrome with depression and by its compulsive traits. We stress that although kleptomaniacs cannot differentiate between right and wrong, testing shows that their sense of reality is intact, but they act under the influence of drives they cannot resist.

Choanal Atresia: 13 Years of Experience

U. Cinamon, J. Kronenberg

Depts. of Otolaryngology and Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer

Choanal atresia is uncommon and consists of congenital blockage between the nasal cavity and the nasopharynx. The anomaly presents either immediately after birth as respiratory distress, or as a coincidental finding at an older age. Treatment is usually surgical. The approaches are transnasal, transseptal, transpalatal and transantral. Different types of stents are used and for various periods after each type of correction. Between 1983-1996, 20 patients with choanal atresia were operated on, in 12 of whom it was bilateral. The youngest was 3 days old and the oldest 22 years (average 6 years). The 20 patients underwent a total of 29 operations of which all were transnasal except for 2 corrected through a transseptal approach; 3 had their primary operation elsewhere. In all cases the atresia was bony or combined bony and membranous, except for 2 in whom there was combined atresia on 1 side and membranous on the other. The success rate was 75% in those first operated on here, in whom stents were employed. In our last 5 cases we used the endonasal approach and a rigid endoscope, a safe technique that has the advantage of direct unobscured vision.

Analgesia in Breast Surgery with Interpleural Bupivacaine

Z. Crystal, Y. Katz

Dept. of Anesthesiology, HaEmek Medical Center, Afula and B. Rappaport Faculty of Medicine, Technion, Haifa

A control group of 15 patients undergoing breast surgery was given general anesthesia. In 15 other patients an interpleural block with 0.4 ml/kg bupivacaine, 0.5%, was performed 20 minutes before induction of general anesthesia for pre-emptive analgesia. This was extended further by continuous administration of bupivacaine 0.25%, 0.125 ml/kg/hr by automatic infusion pump, with supplements of opiates for postoperative pain management. The combined technique was associated with significantly reduced perioperative opiate requirement with better emergence from anesthesia, fewer side effects, a prolonged pain-free period, and overall better quality of postoperative recovery.

Identification of Sentinel and Axillary Node Involvement in Breast Cancer

M.Z. Papa, D. Bersuk, M. Koler, E. Klein, M. Sareli, G. Ben-Ari

Dept. of Surgical Oncology and Breast Unit, Chaim Sheba Medical Center, Tel Hashomer

Axillary node dissection for breast cancer is important for staging and prognosis. "Sentinel nodes" are the first nodes into which primary cancer drains. Identification, removal and pathological examination of those nodes indicates whether completion of axillary lymphadenectomy is required. The sentinel nodes are identified using a vital dye injected at the primary tumor site. With this technique we were able to identify sentinel nodes in 46 of 48 (95%) women examined. An average of 2.7‏1.2 nodes were identified as sentinel nodes. In 81% of cases there was a correlation between involvement of sentinel nodes and of other axillary nodes as well. In 10% of patients sentinel nodes were involved with tumor while other axillary nodes were negative. The major problem in routine application of this is relationship in surgical decisions is reliable real time pathological identification of lymph node involvement by tumor.