Effect of the 2013 AHA/ASA guidelines on TPA use in acute ischemic stroke at Assaf Harofeh Medical Center in Israel.

Background: Use of TPA to treat patients with acute ischemic stroke was introduced in Assaf Harofeh Medical Center (AHMC) in Israel in November 2007 initially with strict adherence to the inclusion/exclusion criteria of the pivotal NINDS TPA studies published in 1995. The treatment window was expanded in 2010 to 4.5h following the results of ECASS-III.

Multimodal treatment of hemorrhagic pituitary metastasis as first manifestation of renal cell carcinoma.

Background: Metastatic tumors involving the pituitary gland are very rare, with only few cases reported so far in the literature.

Case Description: We report a case of a man who presented with an extremely vascular hemorrhagic pituitary metastasis as the first manifestation of renal cell carcinoma. The patient was successfully treated with staged procedures, including preoperative tumor vasculature embolization followed by transsphenoidal tumor resection.

Treatment of intra-cranial aneurysms with the SILK flow diverter: 2 years' experience with 28 patients at a single center.

Background: Flow diverters are recently developed stent-like endovascular devices developed to treat complex and non-coilable aneurysms. SILK is a type of flow diverter that has been used for nearly 3 years. Only sparse data about it are available.

Return to flight with multiple sclerosis: aeromedical considerations.

Multiple sclerosis (MS) is the most frequent demyelinating disease of the central nervous system, with versatile manifestations--relapsing-remitting or progressive--and an unpredictable course, with prognoses ranging from minimal neurological impairment to severely disabled. Disease modifying agents can minimize relapse rate and slow disease progression. Yet most patients suffer relapses and progression despite use of these agents.

Myasthenia gravis and return to flying status.

Introduction: Myasthenia gravis (MG) is a common primary disorder of neuromuscular transmission. Although MG was once a fatal disease, today treatment with immunomodulating agents and cholinomimetic medications with good supportive care have improved the prognosis and the ability of patients to adapt to their workplaces, including the flight environment.

Cases: The diagnosis of MG in two aircrew members illustrates the range of severity for MG from isolated ocular symptoms to relentlessly progressive generalized disease, as well as the unpredictability of the disease and difficulty in treatment.

Tuberous sclerosis in a military pilot.

Tuberous sclerosis (TS) is a multisystem disorder characterized by hamartomas in various organs. It usually manifests itself during infancy or childhood with neurological features, including mental retardation and seizures. We present the case of a military pilot who was diagnosed with TS at 22 yr.

Cultural methods and environmental conditions affecting gray mold and its management in lisianthus.

Gray mold, caused by Botrytis cinerea, severely affects the base of the stems of lisianthus (Eustoma grandiflorum) plants as well as the cut stems left after flowers are harvested. This study examined infection of lisianthus plants by B. cinerea under laboratory and commercial greenhouse production conditions typical for Israel and evaluated cultural methods for manipulating disease development in commercial greenhouses.

Is intraocular pressure in myotonic dystrophy patients spuriously low?

Background: Ocular hypotony is a common unexplained feature of myotonic dystrophy type 1. Spuriously low applanation tonometric readings can be caused by thin corneas, flat corneal curvature and corneal edema.

Objectives: To determine whether structure abnormalities of the cornea cause spuriously low readings in applanation tonometry.

Mechanisms of vestibulo-ocular reflex (VOR) cancellation in spinocerebellar ataxia type 3 (SCA-3) and episodic ataxia type 2 (EA-2).

The vestibulo-ocular reflex (VOR) mechanism triggers eye movements as a result of head motion in order to keep gaze stationary relative to the world. However, in order to shift the direction of the gaze along with head motion, the VOR mechanism must be overridden ("cancelled"). Two mechanisms have been proposed to explain this cancellation: a reduction of the VOR gain or activation of smooth pursuit (SP) eye movements in the opposite direction.

Physician versus paramedic in the setting of ground forces operations: are they interchangeable?

Background: The setting of military ground force operations can be demanding and requires a matched medical assistance plan. A major consideration is the type of medical caregiver that is assigned to the mission. We studied the similarities, differences, advantages, and disadvantages of physicians versus paramedics in this scenario.

Is posttraumatic benign paroxysmal positional vertigo different from the idiopathic form?

Background: Although head trauma is considered a common cause of benign paroxysmal positional vertigo (BPPV), clinical presentation and outcome of traumatic BPPV (t-BPPV) have not been systematically evaluated.

Objectives: To compare the clinical presentation, patient's response to physical treatment, and outcome of patients with t-BPPV with those with the idiopathic form (i-BBPV).

Setting: Tertiary referral neuro-otology outpatient clinic.

[Traumatic benign paroxysmal positional vertigo: diagnosis and treatment].

Although head trauma is the cause of Benign Paroxysmal Positional Vertigo (BPPV) in about 15% of cases, the clinical features and response to treatment in this particular group of patients was not previously evaluated. We present 20 cases of traumatic BPPV: 12 cases identified from 150 consecutive BPPV patients diagnosed in our Dizziness Clinic; and 8 cases diagnosed from 75 consecutive head trauma patients seen in the Emergency Room. In all patients the clinical diagnosis was confirmed by the Dix-Hallpike maneuver and all were treated by the Epley procedure.

Paraneoplastic cerebellar degeneration heralding fallopian tube adenocarcinoma.

The objective of this paper is to describe an 81-year-old woman with subacute cerebellar degeneration due to fallopian tube adenocarcinoma. Serum anti-Yo antibodies were used to screen for pelvic malignancy. Their presence led to a meticulous search, which included bilateral salpingoophorectomy.

Bipolar affective disorder heralding cerebral demyelination in adreno-myelo-leukodystrophy.

A young male with adrenomyeloleukodystrophy (AMLD), diagnosed at the age of 25 years, presented with signs of bipolar affective disorder (BPD) concomitant with radiological findings of central demyelination. There was a marked deterioration of the earlier relatively benign neurological dysfunction, leading to fatal bulbar syndrome. The association of BPD with central demyelination in AMLD is in agreement with previously reported cases of this and other types of multifocal central demyelination diseases.

Survey of cardiovascular risk factors in newly arrived Yemenites to Israel.

Blood pressure (BP), glucose and lipid profile were examined in 108 adult Yemenite immigrants within a few weeks after their arrival in Israel. Mean systolic BP was 105.8 +/- 15.