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        תוצאת חיפוש

        מרץ 1999

        אהוד גולדהמר, ליאוניד חרש ואדוארד אבינדר
        עמ'

        Circadian Fluctuations in Efficacy of Streptokinase Thrombolysis

         

        E. Goldhammer, L.Kharash, E.G. Abinader

         

        Cardiology Dept., Bnei-Zion Medical Center and Technion Faculty of Medicine, Haifa

         

        This study was designed to assess possible diurnal fluctuations in the efficacy of thrombolysis with streptokinase. 156 consecutive patients treated with streptokinase during the period 1.1.95-1.7.96 were studied retrospectively. Success or failure of thrombolysis was determined according to the accepted clinical and angiographic criteria starting at midnight, 12 times at 2-hour intervals, then 8 times at 3-hour intervals, and then 6 times at 4-hour intervals. A definite peak for successful thrombolysis was found in the late afternoon and early evening hours. Between 16:00-20:00 PM, in 30.23% successful thrombolysis were observed, compared to 6.98% between 20:00-24:00 PM (p<0.05) and in 10.53% between 00.00-04:00 AM (p<0.05).

         

        Multiple regression analysis showed that the independent factor with the greatest impact on successful reperfusion was the actual time until thrombolysis (p=0.037); then came the interval from pain onset to streptokinase administration (p=0.020), while age and gender had much lesser impacts (p=0.328 and 0.215, respectively), and individual risk factors even less.

        These findings may have several clinical implications: dose adjustment for the time of day may be required, with larger doses needed during morning hours, or preference for primary coronary angioplasty to avoid increase in bleeding complications due to higher doses of thrombolytic agents.

        רון פלד, גיורא פילר, יוליה ברגר, נוה טוב, ניר פלד ופרץ לביא
        עמ'

        Recording Nocturnal Erections and Insurance Claims: Cost-Effectiveness

         

        Ron Peled, Giora Pillar, Y. Berger, Naveh Tov, Nir Peled, Peretz Lavie

         

        Sleep Lab, Gutwirth Building, Technion Medical School, Haifa

         

        Road accidents, work accidents, or other trauma can cause impotence and are frequently followed by insurance claims. During 1990-97 we examined 230 males with such a complaint. All underwent full polysomnographic recordings in the sleep laboratory for 2 nights, during the course of which NPT (nocturnal penile tumescence) was examined with special equipment. It was assessed by an experienced technician following planned awakenings from REM sleep.

         

        In 75 of the 230 subjects (33%), satisfactory erections were observed. In 100 (43%), who experienced at least 3 periods of REM sleep, no erections occurred. These patients were categorized as suffering from organic impotence. In the remaining 55 (24%), the results were inconclusive, with only partial erections or not enough REM sleep periods.

         

        Since a man recognized as suffering from impotence may be awarded large monthly payments for life, these examinations, in our opinion, are an important tool to prevent unjustified claims, and can save the state unnecessary expenses.
         

        ריפעת ספדי, ירון ריבר, יוסף חביב וירון אילן
        עמ'

        Neurological Manifestations of Non A-G Viral Hepatitis

         

        Rifaat Safadi, Yaron River, Yosef S. Haviv, Yaron Ilan

         

        Liver Unit, Division of Medicine and Neurology Dept., Hadassah University Hospital, Jerusalem

         

        Guillain-Barre and other neurologic syndromes rarely occur as complications of viral hepatitis (A, B and C). Other neurologic syndromes have also been reported in serologically defined viral hepatitis, including mononeuritis, auditory neuritis, and seizures. Chronic hepatitis B and mononeuritis multiplex are found together in 31-54% of patients with periarteritis nodosa. The mechanisms of these associations are unknown, but may include direct cytotoxicity of the virus or immune-mediated damage. Vasculitis of the vasa nervorum plays an intermediate role, at least in some cases. We describe a 36-year-old man with acute non A-G hepatitis complicated by Guillain-Barre syndrome. The neurological manifestation resolved completely without specific therapy within 6 days, as the hepatitis resolved.

        פברואר 1999

        תמי שוחט, נעמי ורסנו, אמנון קירו, גלית גולן, אלה מנדלסון ומיכאל וינגרטן
        עמ'

        Influenza Surveillance through Sentinel Reporting Clinics

         

        T. Shohat, N. Versano, A. Kiro, G. Golan, E. Mendelson, M. Weingarten

         

        For the Influenza Surveillance Network: Israel Center for Disease Control, Israel National Laboratory for Influenza and Central Virology Laboratory; Netka Child Health Center and Dept. of Family Medicine, Rabin Medical Center, Beilinson Campus, Petah Tikva

         

        In a joint effort of the Israel Center for Disease Control, the National Center for Influenza in the Central Virology Laboratory, together with a group of collaborating pediatricians and family physicians, a network for influenza surveillance was established in the winter of 1996-97. Nose and throat swabs were obtained from 571 patients with flu-like illness. 133 (23%) were positive for influenza virus. Both influenza A(H3N2) and B were isolated, predominantly influenza B during the beginning of the season. Both circulating strains were antigenically similar to those included in the vaccine for 1996-1997. Patients from whom influenza virus was isolated were significantly more likely to suffer from cough and myalgia in comparison with patients whose cultures were negative (p=0.02 and 0.003. respectively). Results of the first year of surveillance indicate that sentinel reporting clinics are useful for timely detection and identification of the viral strains circulating in the community, thus allowing prompt intervention in preventing the spread of influenza. Conclusions from the first year of the study were drawn and applied in the winter of 1997-1998.

        ינואר 1999

        חיים בן-עמי ויהודה עדות
        עמ'

        Diagnosis and Treatment of Heart Failure within the Communuity

         

        Haim Ben-Ami, Yehuda Edoute

         

        Dept. of Medicine C, Rambam Medical Center and Technion Faculty of Medicine, Haifa

         

        Congestive heart failure causes substantial morbidity and mortality. Symptoms and physical findings can help in diagnosis, but have limited sensitivity and specificity. Objective measurement of ventricular function is essential in virtually all patients in whom heart failure is suspected; reversible causes of heart failure must be sought.

        Out-patient management includes education and counseling, emphasis on and assessment of compliance with diet, and pharmacological treatment. Angiotensin-converting enzyme inhibitors are the mainstay of treatment but are underused, and maximal doses are not given, apparently because of concern about side-effects. Diuretics should be administered only as needed to manage fluid overload. Calcium channel blockers are relatively contraindicated in patients with impaired ventricular function. Patient follow-up should be guided by results of the medical history and physical examination. Routine serial testing of ventricular function and exercise performance is discouraged.

        סילביה קוטון, דני כהן ומנפרד גרין
        עמ'

        Diarrheal Disease among Care-Givers at Children's Day- Care Centers 


        S. Koton, D. Cohen, M.S. Green

         

        Israel Center for Disease Control, Ministry of Health and Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer; Medical Corps, Israel Defense Forces; Dept. of Epidemiology and Preventive Medicine; Sakler Faculty of Medicine, Tel Aviv University

         

        Diarrheal disease tends to spread from infected children to their families. Due to the increased risk of exposure, children's caregivers in day-care centers may have a higher incidence of diarrhea, particularly when caring for very young children. We therefore examined the incidence of diarrhea and antibodies to Shigella among caregivers in day-care centers, according to age groups of children in their care (<18, 18-34, and >35 months) and in comparison with the general population. 2 studies with a retrospective cohort and seroepidemiological cross-sectional design were carried out. Questionnaires were completed by 401 caregivers in 36% of all WIZO day-care centers. As a measure of past exposure to Shigella, levels of S. sonnei and S. flexneri antibodies were examined in the blood of 110 caregivers (ELISA method).

        There was a higher incidence of diarrhea among young children, increasing the potential exposure to diarrheal agents among their caregivers. Nevertheless, no statistically significant differences in diarrhea incidence were found among caregivers of the various age groups during the previous year (p=0.768) and during the previous month (p=0.319), nor in absenteeism due to diarrhea during the last month (p=0.761). Levels of Shigella antibodies were similar among caregivers in all 3 groups. Diarrheal incidence was higher among women in the population control group than among caregivers during the previous year (p=0.005) and month (p=0.067). No statistically significant differences in levels of S. sonnei and S. flexneri antibodies were found between caregivers and women in the control group.

        There was no evidence that diarrhea is an occupational hazard for caregivers of young children. An explanation may be the development of protective immunity against common diarrheal agents due to recurrent exposure.
         

        דצמבר 1998

        הקבוצה הישראלית לסקרים באוטם חד בשריר הלב
        עמ'

        Characteristics, Management and Prognosis of Acute Myocardial Infarction (Israel 1990-1996)

         

        Israeli Survey Group On Acute Myocardial Infarction

         

        From 1990 to 1996 we conducted consecutive 2-month surveys in all CCUs (n=26) in Israel. The aim was to compare the characteristics, management, and prognosis of patients with acute myocardial infarction (AMI) between the 4 surveys.

         

        Patient characteristics were similar in all surveys. About 75% of patients were males and had a first MI. Mechanical and arrhythmic complications decreased slightly between 1990 and 1996. In contrast, frequency of treatment with thrombolysis, aspirin, beta-blockers and ACE-I, as well as coronary interventional procedures, increased tremendously.

        In parallel, 30-day and 1-year mortality decreased significantly, from 16.5% and 22.5%, respectively, to 9.0% and 13.9%. After multiple adjustment for factors associated with mortality, the 30-day relative risk of death for patients hospitalized in 1992, 1994 and 1996 was 0.79 (95% CI 0.59-1.08), 0.75 (95% CI 0.56-1.01) and 0.54 (95% CI 0.39-9.74), respectively, as compared with 1990.

         

        Although there is no direct proof that changes in management of AMI are related to the reduction in mortality seen during the course of the surveys, the association seems likely.

        דורון זמיר, רסמי מג'דלה ופלטיאל וינר
        עמ'

        Normotensive Hydrocephalus Complicating Recurrent E. Coli Meningitis

         

        Doron Zamir, Rasmi Magadle, Paltiel Weiner

         

        Dept. of Medicine A, Hillel Yaffe Medical Center, Hadera

         

        E. coli meningitis is a disease that occurs in predisposed patients, either as a result of trauma or in neonates after neurosurgery. Recurrent E. coli meningitis in an adult without any apparent predisposition is uncommon, and hydrocephalus complicating bacterial meningitis is even more rare. We report a unique case of a 67-year-old alcoholic man who had had 2 consecutive episodes of E. coli meningitis within 2 months. In both episodes there was a favorable response to ceftriaxone. However, normotensive hydrocephalus appeared a few weeks later, with mental and physical deterioration.

        נובמבר 1998

        ארנה גייר
        עמ'

        Nonpenetrating Deep Sclerectomy

         

        Orna Geyer

         

        Ophthalmology Dept., Tel Aviv-Sourasky Medical Center

         

        This is the first report from Israel of nonpenetrating deep sclerectomy (DS), a new operation for the surgical management of glaucoma. It facilitates ocular fluid drainage without entering the eye. It involves performance of a conjunctival flap and creation of a 565 mm superficial scleral flap. A deeper scleral flap is dissected off the scleral bed together with the roof of the canal and corneal stroma, leaving behind the wall of the canal and membrane. Aqueous will flood the dissected area. A collagen device is then sutured to the scleral bed, the superficial scleral flap sutured into position and the conjunctiva closed. With this procedure, the surgeon can avoid the common complications of conventional glaucoma surgery.

         

        We report a 6-month follow-up of 15 patients after DS. Mean preoperative intraocular pressure was 26.7+2.5 mm Hg, which decreased to 15.5+4.7. After 6 months there was no change in visual acuity after surgery. DS is associated with good middle-term intraocular pressure control and a low rate of postoperative complications. It is therefore a good alternative to standard glaucoma surgery.

        מאיר כהן, ערן תמיר, סובחי אבו-עאיד, יאיר גלילי, מיכאל גלעדי, שמואל אביטל, רפאל שפיר ויוסף קלאוזנר
        עמ'

        The Diagnosis and Treatment of Fournier's Gangrene

         

        M. Cohen, E. Tamir, S. Abu-Abid, Y. Galili, M. Giladi, S. Avital, R. Shafir, Y. Klausner

         

        Surgery and Infectious Disease Depts. and Division of Surgery, Tel Aviv-Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University

         

        We treated 2 women and 8 men suffering from Fournier's gangrene during 1990-96. 2 had diabetes, 1 suffered from ulcerative colitis and 1 was an alcoholic. In 8 of them the infection was triggered by a mixture of aerobic and anaerobic bacteria. Treatment consisted of repeated wide debridement and early colostomy. This aggressive approach resulted in relief of the septic signs within 24 hours and permitted early skin grafting of the wounds. 2 patients died due to sepsis that caused multiple organ failure. The 8 who survived were hospitalized for an average of 35 days. On follow-up examination 1-5 years later all patients had undergone closure of the colostomy and were completely rehabilitated.

        Fournier's gangrene is not rare in the geriatric population. We believe that early diagnosis and aggressive wide debridement, combined with early colostomy, are the keys to successful treatment.

        ניר הילזנרט, עידית ליברטי ולונה אבנון
        עמ'

        Spontaneous Internal Jugular Vein Thrombosis Complicating Chronic Pulmonary Disease

         

        Nir Hilzenrat, Edit Liberty, Luna Avnon

         

        Depts. of Medicine B and E, and Pulmonary Disease Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba

         

        Spontaneous internal jugular thrombosis is a rare vascular disorder. It usually occurs as a result of external pressure due to a tumor, infection or as a result of damage to the vessel wall after trauma or central venous catheterization. We report a 35-year-old woman who suffered from severe pulmonary hypertension due to chronic cystic lung disease. She was admitted due to sudden, severe, right-sided neck pain. Internal jugular occlusion by a thrombus was demonstrated by ultrasound and CT-scans but no apparent cause was found. We postulated that the important factors in the development of her thrombosis were stasis due to pulmonary hypertension and high blood viscosity.

        פטר יעקובי, אורלי גולדשטיק, רנטו פינקלשטיין ויוסף איצקוביץ-אלדור
        עמ'

        Empirical Treatment of Urinary Tract Infections in the Delivery Room

         

        Peter Jakobi, Orly Goldstick, Renato Finkelstein, Joseph Itzkovitz-Eldor

         

        Obstetrics and Gynecology Dept. and Infectious Disease Unit, Rambam Medical Center, Haifa

         

        Urinary tract infection (UTI) is the most common bacterial infection during pregnancy. In prenatal and delivery wards treatment is usually started at once in pregnant women with symptoms suggesting UTI, but there is no uniformity as to treatment. We surveyed such treatment in the delivery rooms throughout Israel, and whether the treatment differed in simple cystitis as opposed to pyelonephritis. Results of positive urine cultures from symptomatic parturients admitted here during 1995-1996 were examined.


        There were 17 different empiric treatment protocols in 28 delivery rooms, whose daily cost ranged from 1-119 NIS. We present the antimicrobial sensitivity of 156 bacteria isolated from the urinary cultures from pregnant women in our prenatal ward. Based upon urinary flora, sensitivity and daily cost, we suggest a protocol for empiric treatment. We recommend first and second generation cephalosporins for treatment of simple lower (UTIs), while gentamicin is suggested for treatment of clinical pyelonephritis during pregnancy. There is no medical nor economic justification for the multiplicity of empiric treatment protocols currently used. Considering our results, our protocol is cost-effective for the empiric treatment of UTI in hospitalized parturients and in the community as well.

        אוקטובר 1998

        יהודה שינפלד
        עמ'

        Kaleidoscopic Autoimmunity

         

        Yehuda Shoenfeld

         

        Unit for Study of Autoimmune Diseases and Medical Dept. B, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University

         

        We describe an 18-year-old girl with idiopathic thrombocytopenic purpura (ITP) who developed chronic active hepatitis following splenectomy that cured the ITP. This is a phenomenon in which an organ belonging to the immune system is resected, which results in cure of one autoimmune disease but in the emergence of another, apparently unrelated, second autoimmune disease. We refer to this phenomenon as kaleidoscopic autoimmunity, explaining that some autoimmune diseases are not induced by autoantigen-driven mechanisms, but rather result from immune dysregulation.

        יולי 1998

        מרק וייזר, רעיה לפידוס, יהודה אברמוביץ ומיכאל דוידזון
        עמ'

        The Electroencephalogram in Psychiatric Patients

         

        Mark Weiser, Raya Lapidus, Yehuda Abramowitch, Michael Davidson

         

        Psychiatric Division, Sheba Medical Center and Beer Yaakov Mental Health Center

         

        270 consecutive electroencephalograms (EEGs) performed in a psychiatric hospital were reviewed. 194 (75%) were within normal limits but 66 (25%) showed diffuse generalized slowing. The contribution of the abnormal EEGs to diagnosis and treatment was evaluated by retrospective file review. In none of the cases with abnormal EEGs was there a relationship to diagnosis or treatment.

        יוני 1998

        אלי אשכנזי וסטיבן ט' אונסטי
        עמ'

        Early Results with Threaded Spinal Cage Fusion Systems

         

        Ely Ashkenazi, Stephen T. Onesti

         

        Neurosurgery Depts. of Hadassah-University Hospital, Jerusalem and Montefiore Medical Center, New York

         

        Lumbar interbody fusion is a surgical technique used to treat symptomatic lumbar disc disease. Low back disorders are the most common of the musculoskeletal disorders causing a tremendous burden of disability. One of the causes of low back pain and radiculopathy is spinal instability, which can be treated by spinal fusion. In the past year, threaded cage systems have become available for segmental lumbar fusion for degenerative disc disease. These systems offer several biomechanical advantages over traditional lumbar fusion and instrumentation techniques, and are better tolerated.

        From December 1996 until June 1997 we operated and fused spines of 17 patients, using 2 different fusion systems (anterior and posterior approaches). We present our early results.

        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
        כתובתנו: ז'בוטינסקי 35 רמת גן, בניין התאומים 2 קומות 10-11, ת.ד. 3566, מיקוד 5213604. טלפון: 03-6100444, פקס: 03-5753303