Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed signific...Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed significant worsening stridor after a successful intubation for a hernia repair. After 4 intubation attempts, with easy visualization of the vocal cords and unsuccessful placement of the endotracheal tube, the patient was emergently brought to the operating room for evaluation.展开更多
The results of a 7-year retrospective study(1998-2004)frompatch testing with the European Standard Series(ESS)establishingthe frequency of sensitization in a contact dermatitisclinic in Israel are presented.23 allerge...The results of a 7-year retrospective study(1998-2004)frompatch testing with the European Standard Series(ESS)establishingthe frequency of sensitization in a contact dermatitisclinic in Israel are presented.23 allergens were patch tested on 2156 patients,1462 females(67.8%)and 694 males(32.2%)-.Atopy and asthma were present in 21.9%of the patients.One or more allergic reactions were observed in 937 patients(43.5%).The highest yield of patch test positives from the 1076 positive reactions were obtained from nickel sulfate(13.9%),fragrance mix(7.1%),potassium dichromate(3.8%),Balsam of Peru(3.6%),CL +Me-isothiazolinone(3.4%)and cobaltchloride(3.4%).Allergens which produced the least amount of positive results were primin and clioquinol.Allergic contact dermatitis(ACD)was established in 32.8%,whereas occupationally related allergic(8.0)and irritant contact dermatitis(5.6%)affected a total of 13.6%of the cases studied.The most common clinical forms of dermatitis were chronic dermatitis(47.7%)followed by acute dermatitis(22.8%),and lichenification and hyperkeratosis(7.9%).The hands(30.7%),face and neck(23.9%)and extremities(11.3%)were the most frequently affected areas.Four allergens in our study differed from the top 10 allergens in Europe namely:Cl +Me-isothiazolinone,formaldehyde,4-tert-butylphenol formaldehyde resin and sesquiterpene lactone mix reflecting an existing difference in environmental exposure.Our study is the first to provide data on the frequency of sensitization and important allergens in the aetiology of ACD in Israel.In spite of the existing differences with Europe,we conclude that ESS is an appropriate screening system for the diagnosis of ACD in Israel.展开更多
The role of computed tomography in the evaluation of patients with small bowel obstruction has been extensively described in the current literature. We report a rare case of small bowel obstruction related to a surgic...The role of computed tomography in the evaluation of patients with small bowel obstruction has been extensively described in the current literature. We report a rare case of small bowel obstruction related to a surgically proved left-side paraduodenal hernia detected on abdominal computed tomography.展开更多
Background: Although head trauma is considered a common cause of benign paroxy smal positional vertigo (BPPV), clinical presentation and outcome of traumatic B PPV (t BPPV) have not been systematically evaluated. Obje...Background: Although head trauma is considered a common cause of benign paroxy smal positional vertigo (BPPV), clinical presentation and outcome of traumatic B PPV (t BPPV) have not been systematically evaluated. Objectives: To compare the clinical presentation, patients response to physical treatment, and outcome o f patients with t BPPV with those with the idiopathic form (i BBPV). Setting: Tertiary referral neuro otology outpatient clinic. Methods: We reviewed the cli nical records of 247 consecutive patients with posterior canal BPPV during the y ears 1997 to 2000. All patients were diagnosed using the Dix Hallpike test and treated using the particle repositioning maneuver. Patients with an onset of pos itional vertigo within 3 days of well documented head trauma were included in t he t BPPV group. The outcome was compared with the outcome of 42 patients with i BPPV who were similarly treated and followed up. Results: Twenty one (8.5%) of the 247 patients with BPPV fulfilled the diagnostic criteria for t BPPV. Th e most common cause of head trauma was motor vehicle crash, documented in 57%of the cases; half of the patients additionally suffered from a whiplash injury. W hile the other causes were diverse, common falls were predominant. Only 2 of the patients involved in motor vehicle crashes experienced brief loss of consciousn ess. Sixty seven percent of patients with t BPPV required repeated physical tr eatments for complete resolution of signs and symptoms in comparison to 14%of p atients with i BPPV (P<.0 01). During a mean ±SD follow up of 21.7±9.7 months, 57%of t BPPV patients and 19%of i BPPV controls had recurrent attacks (P<.004). Conclusions: The nat ure and severity of the traumas causing t BPPV are diverse, ranging from minor head injuries to more severe head and neck trauma with brief loss of consciousne ss. It appears that t BPPV is more difficult to treat than i BPPV, and also ha s a greater tendency to recur.展开更多
Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive disorder of bile acid synthesis, caused by impaired hydroxylation of cholesterol side chains due to deficiency of the mitochondrial enzyme sterol 27-h...Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive disorder of bile acid synthesis, caused by impaired hydroxylation of cholesterol side chains due to deficiency of the mitochondrial enzyme sterol 27-hydroxylase (CYP27A1), leading to accumulation of cholestanol and cholesterol in brain and other tissues. Elevated plasma cholestanol serves as a key marker for the clinical diagnosis of CTX. In the present report we describe a young man with CTX who was on high dose steroids for a misdiagnosed chronic inflammatory demyelinating polyneuropathy (CIDP) and had normal level of serum cholestanol. When steroids were discontinued, markedly elevated serum cholestanol was measured concomitant with marked clinical worsening. This observation may imply that steroids can lower plasma cholestanol, possibly by directly inducing residual CYP27A1 activity or by inducing alternative pathways for cholestanol elimination.展开更多
The diagnosis of subacute angle closure glaucoma is suspected in patients with narrow angles of the anterior chamber of the eye, presenting with periodic ocul ar, or periocular pain. However, some patients may present...The diagnosis of subacute angle closure glaucoma is suspected in patients with narrow angles of the anterior chamber of the eye, presenting with periodic ocul ar, or periocular pain. However, some patients may present with headaches in the absence of significant ocular discomfort, which often leads to misdiagnosis and delay in specific therapy. The clinical features of 9 such patients are describ ed. Subacute angle closure glaucoma should always be considered in the different ial diagnosis of adultonset headaches.展开更多
文摘Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed significant worsening stridor after a successful intubation for a hernia repair. After 4 intubation attempts, with easy visualization of the vocal cords and unsuccessful placement of the endotracheal tube, the patient was emergently brought to the operating room for evaluation.
文摘The results of a 7-year retrospective study(1998-2004)frompatch testing with the European Standard Series(ESS)establishingthe frequency of sensitization in a contact dermatitisclinic in Israel are presented.23 allergens were patch tested on 2156 patients,1462 females(67.8%)and 694 males(32.2%)-.Atopy and asthma were present in 21.9%of the patients.One or more allergic reactions were observed in 937 patients(43.5%).The highest yield of patch test positives from the 1076 positive reactions were obtained from nickel sulfate(13.9%),fragrance mix(7.1%),potassium dichromate(3.8%),Balsam of Peru(3.6%),CL +Me-isothiazolinone(3.4%)and cobaltchloride(3.4%).Allergens which produced the least amount of positive results were primin and clioquinol.Allergic contact dermatitis(ACD)was established in 32.8%,whereas occupationally related allergic(8.0)and irritant contact dermatitis(5.6%)affected a total of 13.6%of the cases studied.The most common clinical forms of dermatitis were chronic dermatitis(47.7%)followed by acute dermatitis(22.8%),and lichenification and hyperkeratosis(7.9%).The hands(30.7%),face and neck(23.9%)and extremities(11.3%)were the most frequently affected areas.Four allergens in our study differed from the top 10 allergens in Europe namely:Cl +Me-isothiazolinone,formaldehyde,4-tert-butylphenol formaldehyde resin and sesquiterpene lactone mix reflecting an existing difference in environmental exposure.Our study is the first to provide data on the frequency of sensitization and important allergens in the aetiology of ACD in Israel.In spite of the existing differences with Europe,we conclude that ESS is an appropriate screening system for the diagnosis of ACD in Israel.
文摘The role of computed tomography in the evaluation of patients with small bowel obstruction has been extensively described in the current literature. We report a rare case of small bowel obstruction related to a surgically proved left-side paraduodenal hernia detected on abdominal computed tomography.
文摘Background: Although head trauma is considered a common cause of benign paroxy smal positional vertigo (BPPV), clinical presentation and outcome of traumatic B PPV (t BPPV) have not been systematically evaluated. Objectives: To compare the clinical presentation, patients response to physical treatment, and outcome o f patients with t BPPV with those with the idiopathic form (i BBPV). Setting: Tertiary referral neuro otology outpatient clinic. Methods: We reviewed the cli nical records of 247 consecutive patients with posterior canal BPPV during the y ears 1997 to 2000. All patients were diagnosed using the Dix Hallpike test and treated using the particle repositioning maneuver. Patients with an onset of pos itional vertigo within 3 days of well documented head trauma were included in t he t BPPV group. The outcome was compared with the outcome of 42 patients with i BPPV who were similarly treated and followed up. Results: Twenty one (8.5%) of the 247 patients with BPPV fulfilled the diagnostic criteria for t BPPV. Th e most common cause of head trauma was motor vehicle crash, documented in 57%of the cases; half of the patients additionally suffered from a whiplash injury. W hile the other causes were diverse, common falls were predominant. Only 2 of the patients involved in motor vehicle crashes experienced brief loss of consciousn ess. Sixty seven percent of patients with t BPPV required repeated physical tr eatments for complete resolution of signs and symptoms in comparison to 14%of p atients with i BPPV (P<.0 01). During a mean ±SD follow up of 21.7±9.7 months, 57%of t BPPV patients and 19%of i BPPV controls had recurrent attacks (P<.004). Conclusions: The nat ure and severity of the traumas causing t BPPV are diverse, ranging from minor head injuries to more severe head and neck trauma with brief loss of consciousne ss. It appears that t BPPV is more difficult to treat than i BPPV, and also ha s a greater tendency to recur.
文摘Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive disorder of bile acid synthesis, caused by impaired hydroxylation of cholesterol side chains due to deficiency of the mitochondrial enzyme sterol 27-hydroxylase (CYP27A1), leading to accumulation of cholestanol and cholesterol in brain and other tissues. Elevated plasma cholestanol serves as a key marker for the clinical diagnosis of CTX. In the present report we describe a young man with CTX who was on high dose steroids for a misdiagnosed chronic inflammatory demyelinating polyneuropathy (CIDP) and had normal level of serum cholestanol. When steroids were discontinued, markedly elevated serum cholestanol was measured concomitant with marked clinical worsening. This observation may imply that steroids can lower plasma cholestanol, possibly by directly inducing residual CYP27A1 activity or by inducing alternative pathways for cholestanol elimination.
文摘The diagnosis of subacute angle closure glaucoma is suspected in patients with narrow angles of the anterior chamber of the eye, presenting with periodic ocul ar, or periocular pain. However, some patients may present with headaches in the absence of significant ocular discomfort, which often leads to misdiagnosis and delay in specific therapy. The clinical features of 9 such patients are describ ed. Subacute angle closure glaucoma should always be considered in the different ial diagnosis of adultonset headaches.
