תוצאת חיפוש

Evaluation of a Local Infant Formula Enriched with Polyunsaturated Fatty Acids

Zvi Weizman, Elena Brutman, Drora Leader, Chaim Zegerman

Pediatric Gastroenterology Dept. and Nutrition Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev and Soroka Medical Center, Beer Sheba;

and Ma'abarot Products Industry, Kibbutz Ma'abarot

Polyunsaturated fatty acids (PUFA) are vital for the normal development of the brain and the eye retina in infancy. Breast milk contains significant amounts of PUFA, and compensates for their low production in infancy. Only recently a few companies with worldwide product distribution have started to enrich infant formula with PUFA. We evaluated the safety and clinical efficacy of a locally made PUFA-enriched infant formula, produced for the first time in Israel.

50 normal, full term infants participated in a prospective, randomized double-blind study. Half received a regular whey-predominant infant formula (Materna Plus), and the other half a PUFA-enriched formula (Materna Premium), both produced in Israel, for 30 days. Evaluation included physical examination, growth parameters, stool analysis, daily parental questionnaires regarding infant behavior and defecation, and developmental assessment.

There were no significant differences on comparing growth parameters, infant behavior, attacks of restlessness, gas severity, or stool characteristics in the 2 groups. There were no side effects or abnormal stool findings in either group, and no differences in developmental assessment at 3 months of age.

We conclude that the locally-produced PUFA-enriched infant formula is safe and clinically efficient. We assume that the lack of any effect on developmental indices is due to the relatively short exposure to the PUFA-enriched diet. Nevertheless, based on the recent literature, there is no doubt that PUFA supplementation isvital in improving infant brain and eye development.

Suicidal Calls to a Telephone Emergency Service

Itzchak Gilat, Zvi E. Gil

ERAN (Israel Association for Emotional First Aid)

Suicidal threats and suicidal ideation among callers to the Israeli hot-line (ERAN) were investigated, using 2 methods of analysis. The first, an epidemiological survey based on 8,272 calls received by all 8 ERAN posts during 2 years, reported on their standard form for recording interactions with suicidal callers. The second is content analysis of 42 detailed reports of interactions with such callers. Epidemiological analysis revealed a higher rate of suicidal ideation among callers with a psychiatric history, compared with those without a history. However, the 2 groups did not differ in rate of suicidal threats. In addition, suicidal threats of adolescents were related mainly to problems of identity and self-image, while mental disorders were the main problems among adults. Content analysis identified 2 patterns of terminating the interaction, which represent 2 strategies of intervention to prevent suicide. The first is establishing a contact between the caller and an appropriate individual in the caller's environment who undertakes responsibility to help the caller. The second strategy is reducing the caller's tension, leading to a withdrawal of the suicidal threat. The first pattern is more characteristic of interactions with psychiatric callers, while the second is more frequent among non-psychiatric callers to ERAN. The hot-line makes a unique contribution in helping those threatening suicide, which constitutes a real emergency.

Acute Hyperparathyroidism Caused by Hemorrhage into a Parathyroid Adenoma

I.E. Priel, Rama Katz, E. Dolev

Depts. of Medicine E and Radiology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University

Acute hyperparathyroidism is a rare and dangerous condition. It is supposed to result from transformation of a mild chronic form into an acute and stormy illness. The causes and the mechanism of such a transformation are usually unknown. A case of acute hyperparathyroidism is presented in which hemorrhage into a parathyroid adenoma was recognized and diagnosed as the immediate cause of the transformation from the mild long-standing form of the disease into the severe acute form.

Treating Hospitalized Children in Severe Pain with Oral Methadone

Yoram Shir, Victor Shvelzon, Gila Rosen

Pain Treatment Service, Dept. of Anesthesiology, Hadassah University Hospital, Jerusalem

Pain relief is usually inadequate in hospitalized patients, especially in children, either after surgery or with various medical conditions. Among other reasons, this is due to suboptimal use of available analgesic drugs. In the past 2 years oral methadone has become our opioid of choice for severe pain in hospitalized children who can take oral medication. More than 70 babies and children, aged 8 months to 9 years, who suffered mainly from pain due to burns or cancer, were treated by the in-hospital pain service. They received 0.1% methadone syrup, 0.2-0.4 mg/kg/day, for from a few days to more than a month. In most there was significant pain relief with no serious side-effects. In some, treatment could be changed to parent-controlled analgesia after a few days, with no adverse effects. We describe 5 of the children who present the advantages of oral methadone over other opioids.

Intra-Osseous Ganglion of Scaphoid and Lunate Bones

M. Kligman, M. Roffman

Dept. of Surgery, Carmel Medical Center, Haifa

We present a patient with intra-osseous ganglion of the left scaphoid and lunate bone. These were excised and a bone graft inserted. 1 year after operation the patient was free of pain, without limitation of wrist motion. Intra-osseous ganglion of the carpal bone is not common and lunate and scaphoid intra-osseous ganglion has rarely been reported. Awareness of this condition may lead to earlier diagnosis and treatment, with satisfactory outcome.

Correlation between Success in Specialty Examinations and Learning Methods of Family Medicine Residents

Netta Notzer, Dahlia Megiddo, Ruth Abramowitz, Michael Weingarten

Medical Education Unit, Family Medicine Section, Sackler Faculty of Medicine, Tel Aviv University

Learning methods chosen by residents in family medicine during their residency and the correlation between them and achievement in the written specialty exams (Stage 1) were investigated. The learning patterns studied were: structured learning (certification course, study with a tutor, staff meetings, conferences) and self-learning (textbooks, journals, the Hebrew publication "Update," and audio tapes). Of 184 residents who took the examination in 1994-5, 104 responded to a questionnaire as to preferences for the various learning aids and satisfaction with their use. There was no correlation between use of a given learning method and success in the examination. Significantly more candidates preferred self-learning, especially among those who were successful, but also among some who failed the examination. There was no direct connection between the examination and the high level requirements of the residency program, for which up-to-date, integrated knowledge based on self-learning is needed.

Epidermoid Cyst of the Spleen

Dan Bar-Zohar, Yaniv Sherer, Hana Manor, Amir Peer, Simon Strauss, Ariel Halevy

Dept. of Surgery B and Institute of Radiology, Assaf Harofeh Medical Center, Zerifin, and Sackler Faculty of Medicine, Tel Aviv University

Splenic cysts are rarely found or diagnosed. Excluding cases of trauma, the events preceding their development have not been fully understood. We describe a 22-year-old woman in her 34th week of pregnancy in whom ultrasound revealed a cystic lesion 8610 cm. in diameter in the left upper abdomen. Further imaging tests followed by laparotomy confirmed the splenic origin of the cyst. Splenectomy was performed and the lesion was histopathologically defined as an epidermoid cyst.

Recurrent Tuberculosis in a Psychiatric Hospital

A. Zeenreich, B. Gochstein, A. Grinshpoon, M. Miron, J. Rosenman, I. Ben-Dov

Pulmonary and Radiology Institutes, Chaim Sheba Medical Center, Tel Hashomer and Tel Aviv University; Israel Ministry of Health; and Gan Meged Hospital

During 1987-1996, 39 of 720 patients hospitalized (most for severe schizophrenia) were diagnosed as having active pulmonary tuberculosis (5.4%, 975 per 105 per year). In 1992-1993, after a cluster of 5 cases was found, all patients were screened by PPD skin test and chest X-ray and 16 more cases were identified. Diagnosis was confirmed bacteriologically in only 10 of them but there were typical radiological findings in the others. 39 were treated with a multi-drug regimen. In addition, 333 exposed patients and 21% who had converted their skin tests were given isoniazid preventive therapy. A small increase in levels of liver enzymes was common, but significant abnormality (over 4 times the upper limit of normal) was found in only 7 patients, in whom therapy was therefor stopped or changed. During a follow-up period of 4 years, 2 more developed tuberculosis and 33 converted their PPD reactivity status. We conclude that an outbreak of tuberculosis in a psychiatric hospital can be controlled with a relatively low rate of side-effects by using systematic diagnostic and therapeutic measures. However, single step screening is not sufficient. Routine screening of all new patients, a high index of suspicion and contact investigation are needed.

Traumatic Common Carotid-Internal Jugular Fistula: Positive Aspect

R. Avrahami, M. Liverson, M. Haddad, A. Zelikovsky

Dept. of Vascular Surgery and Anesthesia, Rabin Medical Center, Beilinson Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University

A 42-year-old man presented with a penetrating neck injury from a pellet gun. Physical examination showed an open 1 cm wound on the right side of the neck, hematoma of the right sternocleidomastoid muscle, and carotid artery injury. He was hemodynamically stable and there was no neurological deficit. Arteriogram of the neck disclosed a pseudoaneurysm with an arteriovenous fistula between the common carotid artery and internal jugular vein. At surgery, the tears in the carotid artery and jugular vein were sutured and a vacuum drain was introduced. The postoperative course was uneventful, and the patient was discharged 5 days later. Instead of the expected results of a penetrating carotid artery injury, such as blood loss, airway obstruction or neurological deficit, the arteriovenous fistula caused by the pellet actually saved the patient's life. Blood flow from the artery via the pseudoaneurysm to the jugular vein kept the patient in stable condition.

Glenoid Fossa Fracture

M. Kligman, M. Roffman

Dept. of Orthopedic Surgery, Carmel Medical Center, Haifa

4 patients with displaced intra-articular glenoid fossa were treated either surgically or conservatively. After an average follow-up of 7 years, the clinical and radiographic results were satisfactory in all. The 2 treated surgically required shorter follow-up than those treated conservatively. Conservative treatment should be considered a good option for displaced intra-articular glenoid fossa fracture.

Epidemiologic Characteristics of Pediatric Emergency Room Referral and Hospitalization for Diarrhea in the Negev

Moni Benifla, Drora Fraser, Zvi Weizman, Amalia Levy, Ron Dagan

Dept. of Epidemiology and Health Services Evaluation and S. Daniel International Center for Health and Nutrition, Ben-Gurion University of the Negev, and Pediatric Dept. and Pediatric Infectious Disease Unit, Soroka Medical Center and Ben-Gurion University of the Negev

Diarrheal diseases weigh heavily on the health of children, especially in developing countries, but also impose burdens on health care services worldwide. This study was performed to determine whether patterns of referrals in the Negev to the pediatric emergency room (PER) for diarrhea differ between the Jewish and Bedouin populations of the Negev, and the extent of the burden imposed on the PER and in-hospital services in the Negev. Characteristics of referrals and hospitalizations were examined from March 1994 to February 1995. Of the 27,834 referrals to the PER for children under 16, 2518 (9%) had diarrhea and there were 5,169 hospital admissions, 701 (13.6%). The annual rates of referral were 146 per 10,000 in Jews and 225 in Bedouin, giving an odds ratio (OR) of 1.5 (p<0.001). for Bedouin. The rates of hospitalization were 23 per 10,000 in Jews and 99 in Bedouin (OR 4.4, p<0.001). 1380 (54.8%) of the PER referrals were of infants under a year of age. For hospitalization, the annual rates were 164 per 10,000 in Jews and 756 in Bedouins (OR 4.9, p<0.001). During June to August referrals and hospitalizations for diarrhea were significantly higher, and from December to February significantly lower than during the remaining months. These differences arise from the marked seasonal pattern in the Bedouin population, whereas in the Jewish population there was no seasonal variation. Even in the 90's the burden on health services in the Negev as a result of diarrheal illness is considerable and the Bedouin population still contributes to that burden disproportionately. There is need both to reduce the gap in referrals and hospitalization between the populations, as well as to reduce the rates, using currently available means such as education, while developing new technologies, such as vaccines.

Solid Organ Retransplantation

Yaron Ilan, Dan Admon, Michael Friedlander

Division of Medicine, Dept. of Cardiology and Nephrology Unit, Hadassah Medical Center, Jerusalem

The need for solid organ retransplantation is a major factor in the shortage of available organs. Between 1972 and 1992, 56 out of 309 kidney transplants and 2 out of 20 liver transplants performed in our hospital were retransplantations. The present study evaluates local and world experience with organ retransplantations in terms of the medical and ethical issues.

Osteoid Osteoma of the Patella

I. Cohen, A. Aner, V. Rzetelny

Dept. of Orthopedics, Edith Wolfson Medical Center, Holon

Osteoid osteoma is a primary, benign, bone tumor with a typical X- ray appearance. The diagnosis is usually straightforward when it involves the long bones of the leg. However it may occur in unusual locations, such as in flat and cancellous bones. The following case demonstrates the difficulty in diagnosing it in an extremely rare site. A 25-year-old woman with long-standing anterior, right knee pain had had 3 interventions: 2 diagnostic arthroscopies and a distal, femoral biopsy. Since there had been no improvement in her condition, the diagnosis of osteoid osteoma of the patella was suggested, supported by recent X-ray and scintigraphicfindings. This rare condition was confirmed by biopsy of the upper pole of the patella, a procedure that was followed by complete recovery. 6 years later, she is now completely free of pain and has no clinical or X-ray evidence of recurrence.Review of the literature revealed only 5 previously reported cases of osteoid osteoma of the patella. All were diagnosed relatively late and in 1 the tumor was diagnosed only after total patellectomy. Diagnosis of these rare cases that mimic much more common causes of patello-femoral pain demands a high index of suspicion.

Patterns of Injuries and Preventive Measures for Motorcycle Accidents

D. Soffer, Y. Galili, N. Nasralla, D. Aladgem, O. Ablai, Y. Kluger

Depts. of Surgery B and C, Trauma Services, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University

Retrospective analysis of a series of 32 motorcyclists admitted after road accidents was performed. 62% were injured on scooters with 50 cc engine capacity and most of the combined injuries occurred in this group. Most crashes occurred at road junctions.Riders of scooters with larger engine capacities tended to wear protective garments as opposed to riders with smaller engines. There was no correlation between engine capacity and severity of injury. We conclude that motorcyclists should receive special education, especially as to behavior on entering road junctions. We recommend that taxes on protective garments should be lowered in order to encourage motorcyclists to use them.

Quinidine-Induced Rheumatic Toxicity

D. Almoznino-Sarafian, N. Cohen, R. Zaidenstein, V. Dishi, E. Zeckler

Depts. of Medicine C, A and F, Assaf Harofeh Medical Center, Zerifin (Affiliated with the Sackler Faculty of Medicine, Tel Aviv University)

2 women with quinidine-induced lupus are presented. This condition is rare; only about 30 cases have been reported in the English literature. Both our patients had arthritis of the wrist, antinuclear antibodies with homogenous pattern and elevated ESR. Anti-double stranded DNA antibodies were present in 1 patient, and a petechial rash in the other. Complete resolution of arthritis occurred within a few days after quinidine withdrawal, but antinuclear antibodies persisted for several months.