תוצאת חיפוש

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.

Combined Treatment of Hepatic Tumors by Cryosurgery and Resection

Doron Kopelman, Alexander Beny, Ahmed Assalia, Diana Gaitini, Yoram Klein, Moshe Hashmonai

Depts. of Surgery B, Oncology and Radiology, Rambam Medical Center and Technion Faculty of Medicine, Haifa

Cryosurgery is an old technique which is being used for hepatic tumors as an adjuvant to hepatic resection. We recently treated 7 patients with multiple malignant liver tumors, 5 of whom had colorectal metastases, 1 carcinoid metastases, and 1 multiple hepatic lesions of hepatocellular carcinoma. 6 underwent combined liver resection and cryoablation of lesions in the remaining liver. In the 7th patient, only cryoablation was performed because hepatic resection was rejected and there was an extrahepatic metastasis. The advantages of this treatment are removal or destruction of all liver lesions found by any method, including intraoperative ultrasound examination, maximal preservation of normal liver parenchyma and that it is curative in patients inoperable by standard criteria.

Management of Malignant Bowel Obstruction in Home Care

Menahem Sasson, Pesach Shvartzman

Dept. of Family Medicine, Kupat Holim Klalit and Ben-Gurion University of the Negev, Beer Sheba

Malignant bowel obstruction occurs in about 10% of those with advanced abdominal cancer and in about 25% of those with advanced pelvic cancer. Such patients usually develop nausea, vomiting, constipation, abdominal dilatation and colicky pain. Traditional therapy consists of intravenous fluids and decompression by duodenal tube, gastrostomy or operation but postoperative mortality is high. Treatment requires hospitalization and therefor such patients have not been considered candidates for home care.

Palliative medical techniques can cope with this syndrome and allow home care. Hypodermoclysis, non-prokinetic anti-emetics like haloperidol and scopolamine, octeotride, corticosteroids, and narcotics for severe abdominal pain can alleviate symptoms. Medications can be combined and infused subcutaneously in a syringe driver and patients can remain with their families in their natural environment. Such techniques can give these patients who have short life expectancies reasonable quality of life.

Use of Intranet in the Hospital Setting

David Bregman, Leon Levi

College of Administration, Tel Aviv and Rambam Medical Center, Haifa

In the Intranet system, the organization uses technologies developed and applied in the Internet network world-wide. Hospitals can use Internet technologies to make hospital information systems more efficient by improving use of existing systems and by adding additional possibilities. Furthermore, the hospital can improve its relations with its customers and also bring the organization additional customers. Intranet implementation can be divided into the areas of: communication, managing and distributing information, and application linkage. Implementation must be modular, gradual and planned according to economic, technological and organizational aspects of the hospitals. By the Intranet, organizations can achieve benefits that include: improving communication array, availability of data and information, using existing information systems and their applications, enhancing customer satisfaction and saving costs of manual application systems.

Combinations of Vasoactive Agents by Penile Injection for Erectile Dysfunction

E. Segenreich, S. Israilov, J. Shmueli, D. Simon, J. Baniel, P. Livne

Andrology Unit, Institute of Urology, Rabin Medical Center (Beilinson Campus), Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University

In the past 15 years there has been continuous increase in the use of injections into the corpora cavernosa of different vasoactive drugs for treatment of erectile dysfunction (ED). However, some of these drugs are very expensive, are not available everywhere, and have side effects. We therefore compared the success rate of the most widely used compounds, papaverine and regitine, in 452 patients (age range 26-85) with different types of ED. Each patient received in the clinic injections of papaverine, 6-25 mg, and regitine, 0.05-1.5 mg. When maximal rigidity of the penis (MRP) was >80%, we instructed the patient to self-inject the drug at home, 5-30 minutes before coitus. If after 3 injections MRP was not >80%, prostaglandin E1 (PGE1) in an average dose of 10-25 mcg was added. If there was no response, papaverin+regitine+PGE1 were given in higher dosage, and atropine sulfate, 0.02+0.06 mg, was added if necessary.

Of 452 patients, 305 (67.4%) had MRP >80% after 3 injections of papaverine plus regitine. The other patients received PGE1 in addition. This was helpful in 61 patients (41.5%), while 55 (63.9%) required papaverine + regitine + prostin in higher doses. Of these, only 31 received papaverine + regitine + PGE1 + atropine sulfate. Of these, 20 (64.5%) reached MRP >80%, and 11 (2.4%) MRP <60. For these 11 patients, we recommended a penile prosthesis. Thus in 67.4% of the 452 patients, papaverine + regitine injections were effective; in 41.5%, PGE1; in 63.9%, papaverine + regitine + prostin + atropine sulfate. Only 11 (2.4%) did not react to intracorporeal injection.

This progressive method of treatment enabled us to select the optimal dosage and combinations of compounds in 441/452 patients (97.5%) according to the severity of their dysfunction. During follow-up of 6 months, spontaneous erections without injection were achieved in 115 (26.0%).

Taxol as Second-Line Therapy in Recurrent Breast and Ovarian Cancer

R. Borovik, M. Steiner, J. Atad, B. Sneiderman, T. Rosenberg, S. Palti

Oncology Depts., Lin Medical Center and Carmel Medical Center, Haifa

Results of chemotherapy with Taxol (paclitaxel) in 55 patients with recurrent breast and ovarian cancer were reviewed. Taxol was given as a 3-hour infusion, every 3 weeks, on an outpatient basis. There was complete or partial response in 8 patients (23%) with breast cancer and 10 (50%) with ovarian cancer. Performance status and previous response to adriamycin were important prognostic factors. Toxicity was manageable. Treatment had to be stopped for hypersensitivity reactions in only 2 patients. Taxol given in an ambulatory clinic is safe and effective.

Topical Photodynamic Therapy in Basal and Squamous Cell Carcinoma and Penile Bowen's Disease

Yoram Harth, Bernard Hirshovitz

Photodynamic Therapy Unit, Elisha Medical Center, Haifa

Photodynamic therapy (PDT) is a noninvasive selective therapy for a specific group of skin tumors. 5-aminolevulinic acid 20% in a water-in-oil cream base was applied to the tumors as a photosensitizer and was followed after 12 hours by exposure to a high output light source emitting red (585-720 nm; 150 mW/cm²) and near infrared irradiation (1.25-1.6 mm; 50 mW/cm²) for 10-15 minutes (VersaLight, incoherent filtered light source). Complete responses were achieved after 1-3 treatments in 26/31 lesions of superficial or small nodular basal cell carcinoma (BCC) and 4/5 in superficial, squamous cell carcinoma (SCC) lesions. There was a patient with Bowen's disease of the penis. Follow-up was for 12-24 months. This noninvasive, nearly painless treatment gives excellent therapeutic and cosmetic results. Our data show its efficacy for certain subtypes of BCC, SCC and Bowen's disease. Further studies will determine the exact cure and recurrence rates with this modality and compare it to other modes of skin cancer therapy.

Fine Needle Aspiration Biopsy of Mediastinal Masses Guided by Computed Tomography

M. Sklair-Levy, D. Shaham, I. Sherman, I. Bar-Ziv, I. Libson

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

Progress in diagnostic radiology and pathology during the past decade has changed the approach to diagnosis of mediastinal masses. Diagnosis by CT-guided needle biopsy (CTNB) has replaced open biopsy and mediastinoscopy. CTNB of mediastinal masses is accurate, reliable and safe. It is done under local anesthesia, in ambulatory patients and is tolerated well. Between July 1987 and April 1997 we performed 67 biopsies in 63 patients aged 6-86 years; 33 were women (average age 40.8 years) and 30 men (average age 38.3 years). 57 of 67 biopsies were core biopsies for histologic examination and 10 were cytologic biopsies. In this report we concentrate on the 57 core biopsies. 41 of the biopsies were diagnostic; in 3 of them no evidence of malignancy was found. In 38 of the biopsies a tumor, malignant or benign, or an inflammatory process was diagnosed. In 24 of the biopsies the diagnosis was lymphoma. In 16 there was not enough material for diagnosis. We repeated the biopsy in 4 of the latter due to high suspicion of malignancy and reached a diagnosis in all 4 of them. In 6 the diagnosis was reached only by operation. The biopsies were from all compartments of the mediastinum. There were no complications such as pneumothorax or bleeding, except for 1 case of mild hemoptysis. In conclusion, CTNB of mediastinal lesions is accurate, safe and relatively cheap. In 72% a diagnosis was reached in the first attempt and a second attempt raised the diagnostic rate to 79%. We believe that CTNB should be the first step in tissue diagnosis of mediastinal masses, including those with a high suspicion of lymphoma.

Oncogenetic Counseling and Genetic Testing of Those at High Risk for Breast and Ovarian Cancer

Livia Theodor, Ronit Shiri-Sverdlov, Galit Hirsch Yechezkel, Revital Bruchim Bar-Sade, Eva Gak, Irit Friedman, Anna Kruglikova, Gilad Ben-Baruch, Shulamit Risel, Moshe Z. Papa, Boleslav Goldman, Eitan Friedman

Oncogenetics Unit, Dept. of Clinical Epidemiology, Institute of Genetics, and Gynecology, Oncology, and Surgical Depts., Chaim Sheba Medical Center, Tel Hashomer

There is inherited predisposition to breast and ovarian cancer in 5-10% of all women with these diseases. Germline mutations in BRCA1 and BRCA2 presumably account for most of the genetically susceptible individuals. We summarize 2 years of experience in counseling and testing for inherited predisposition to these cancers.

597 women (from 320 families) have been evaluated since August 1995. 242 were evaluated for inherited predisposition to breast and ovarian cancer. One-third had clear-cut evidence of familial background. 74 families were of Ashkenazi origin; the age range of breast cancer was 30-35, of ovarian cancer 40-45. In 80% of families other cancers were also noted in first degree family members, including lung, colon, and prostate cancer and leukemia.

Genetic testing revealed that 45% of affected and 25% of unaffected women were carriers of a mutation in BRCA1 or BRCA2: 67/90 185delAG (BRCA1), 12/90 6174delT (BRCA2), and 4/90 of 5382insC (BRCA1). In addition, a novel mutation in exon 11 of BRCA1 was detected, carried by 7/90 women. The experience gained in oncogenetic counseling and genetic testing for inherited cancer predisposition will eventually enable determining an optimal, rational therapeutic regimen in carriers of mutations.

Screening Tests for Detecting Breast Cancer: Performance Rates and Characteristics of Patients

Netta Bentur, Revital Gross, Ayelet Berg

JDC-Brookdale Institute of Gerontology and Human Development, Jerusalem

Screening tests including mammograms for early detection of breast cancer are in the basket of services provided under the National Health Insurance Law. The law also defines the population groups entitled to mammograms, and sets the frequency of the test as once every 2 years. The aim of this study was to examine the screening rates for early detection of breast cancer at the inception of the law, in order to monitor future changes in performance rates, and identify the characteristics of those unlikely to undergo these tests, in order to promote the use of screening tests by them. This study is part of a comprehensive survey examining the effect of the National Health Insurance Law on the Israeli population.

The survey, carried out in the summer of 1995, included a sample of 1,400 Israeli residents aged 22 and over. To determine performance rates for clinical breast examinations a subgroup of 515 women aged 30 and over was sampled. To determine performance rates for mammograms, 173 women were aged 50-74 (the entitlement ages under the law), were sampled. 54% of women aged 30+ reported having had at least 1 clinical breast examination during their lifetime, and 56% of women aged 50-74 reported having had a mammogram during the past 2 years. Variables with an independent effect on the likelihood of having had a clinical breast examination by a physician during the past 2 years were: being over the age of 50, having at least 9 years of education, being a veteran resident of Israel (as opposed to a new immigrant), and being Jewish. Variables with an independent effect on the likelihood of having a mammogram during the past 2 years were: being a veteran resident of Israel, and having a high income צ which was found to have a borderline effect. The findings of the survey emphasize the importance of changing the behavior patterns of both women and physicians, informing women about their entitlement to the tests, and raising consciousness of the importance of having repeated clinical examinations by a physician, as well as mammograms.

Perisacral Angiosarcoma after Irradiation of Carcinoma of the Sigmoid

J. Zidan, C. Stayerman, H. Turani

Oncology Unit and Pathology Institute, Rebecca Sieff Hospital, Safed

Secondary malignancy is a well-recognized complication of radiation therapy. The risk of postirradiation sarcoma in long-term follow-up is 0.03-0.8%. We report a case of radiation-induced perisacral angiosarcoma 6 years after pelvic irradiation for sigmoid cancer in a 77-year-old man. The tumor was diagnosed postmortem and was locally advanced and metastatic. He died 6 months after onset of symptoms. This case demonstrates the importance of long-term follow-up in those given radiotherapy.

Screening for Transitional Cell Carcinoma of the Bladder with Trophoblastic Differentiation

M. Moldavsy, A. Sazbon, N. Kuchersky, H. Turani

Division of Cytology and Depts. of Urology and of Pathology, Rebecca Sieff Government Hospital, Safed

Urinary bladder carcinoma with trophoblastic differentiation (TD) is a variant of urothelial (transitional cell) carcinoma (TCC) which secretes placental proteins, predominantly beta-human chorionic gonadotropin (HCG). An aggressive clinical course and a poor prognosis are characteristic of this tumor. We evaluated the frequency and clinical and pathological appearance of TCC-TD in the Upper Galilee and Golan Heights between 1988 and 1995 inclusive. Beta HCG, human placental lactogen (HPL), pregnancy specific beta-1 glycoprotein (SP-1) and placental alkaline phosphatase were determined immunohistochemically in paraffin-embedded TCC of urinary bladder. Tumor grade, stage and patient survival were also determined. There was beta-HCG immunostaining in 13 of 62 cases (20.9%). TD was correlated with higher grades of TCC and with advanced stages of disease. No cases of TCC-TD were found in grade 1, stage 0. Co-expression of beta-HCG and HPL was displayed in 2 cases, beta-HCG and SP-1 in 9, and beta-HCG, HPL and SP-1 in 2. Disease-free survival and overall survival were shorter in TCC-TD.

Does Testicular Volume Reflect Spermatogenic Pattern in Azoospermia?

David B. Weiss, Elchanan Bar-On, Shoshana Gottschalk-Sabag, Zvi Zukerman

Kupat Holim Mehuhedet and Male Infertility and Cytology Units, Shaare Zedek Medical Center, Jerusalem; and Andrology Unit, Rabin Medical Center (Beilinson Campus) Petah Tikva

The aim of this study was to determine whether testicular volume can serve to predict patterns of spermatogenesis in azoospermia. In 27 tests of azoospermic infertile men, cytological specimens from several sites from each testis were obtained by fine needle aspiration. Testes were classified according to the most mature spermatogenic cell type. Classifications were testes with spermatozoa, with arrested spermatogenic development, and with only Sertoli cells. Prior to fine needle aspiration the 3 dimensions of each testis were determined ultrasonically and its volume calculated. Mean testicular volume (±‏SD) was 7.71 (±5.95) ml for testes with spermatozoa and 7.55 (±2.35) and 7.31 (±4.42) ml for testes with spermatogenic maturation arrest and with only Sertoli cells, respectively (differences not significant). It is concluded that testicular volume can not be used as a predictive parameter, neither for the presence of spermatozoa nor for the cytological pattern of the testes of azoospermic infertile men.

Are Testes in Oligo/Azoospermia Homogenous or Heterogenous?

David B. Weiss, Shoshana Gottschalk-Sabag, Elchanan Bar-On, Zvi Zukerman

Kupat Cholim Meuhedet, Jerusalem; Male Infertility and Cytology Units, Shaare Zedek Medical Center, Jerusalem; and Andrology Unit, Rabin (Beilinson) Medical Center, Petah Tikva

We determined whether a single testicular specimen is sufficient to represent qualitatively the spermatogenic process within the testes of azoospermic or severely oligospermic infertile men. In 191 testes of azoospermic patients and in 26 of those with severe oligospermia, fine needle aspirations at 3 different sites of each testis were performed. Aspirated material from each puncture was stained and in each smear all spermatogenic cells, as well as Sertoli cells, were identified. Testes were classified according to the most mature spermatogenic cell type present, or the presence of only Sertoli cells. The homogeneity of the testicular spermatogenic process was then evaluated. There was an overall intratesticular difference between aspirates in 14.1% of azoospermic testes and in 26.9% of severely oligospermic testes with regard to the most mature spermatogenic cell type. When spermatozoa were the most mature cell type, they were detected in all of the 3 aspirates in 71.4% of the testes. In 18.4% or 10.2% of this group of testes they were retrieved in only 1 or 2 of the aspirates, respectively. In testes in which spermatids or spermatocytes were the most mature spermatogenic stage, these cell types were detected in all 3 aspirates in only 36.4% and 68.0%, respectively. In azoospermic patients with full testicular spermatogenesis, the likelihood of retrieving spermatozoa from the testes was 84.3%, 92.7% and 100% in 1, 2 and 3 specimens, respectively. The following conclusions were drawn: There is a wide range of testicular heterogeneity in azoospermia or very severe oligospermia for diagnosing the testicular spermatogenic pattern. In azoospermia, specimens from several testicular sites are required. It is strongly recommended that no assisted fertilization be offered to azoospermic patients unless prior evaluation of the spermatogenic pattern in the seminiferous tubules is determined.

Mixed Uterine Mesodermal Tumors: Clinical and Pathological Characteristics

Samuel Ariad, Alexander Rabinovitz, Ilana Yanai-Inbar, Benjamin Piura

Depts. of Oncology and of Pathology, and Gynecology-Oncology Unit, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba

During 1971-1996, 17 patients with mixed mesodermal uterine tumors were treated. Average age at diagnosis was 67.3 years, 12/17 were of European and 5/17 of Afro-Asian extraction. The overall 5-year survival was 21%. 10/17 patients had mixed mesodermal tumors with a heterologous mesenchy-mal element, and 7/17 had a homologous mesenchymal element (carcinosarcoma). 6/17 had another primary malignancy, including breast cancer (3/17), bilateral metachronous breast tumor (2/17), and malignant lymphoma of the neck region (2/17). All 3 with breast cancer had previously been treated with tamoxifen. 1 had simultaneous mesodermal tumor and ovarian thecoma. Simultaneous autoimmune manifestations occurred in 2/17, including thrombocytopenic purpura in 1, and myasthenia gravis in another. Mesodermal tumor of the uterus is a relatively rare malignancy with aggressive behavior and poor prognosis. It also had unusual associations with other primary tumors, hormonal treatment, and autoimmune manifestations.