Rapid enzymatic burn debridement: A review of the paediatric clinical trial experience.

NexoBrid (NXB) has been proven to be an effective selective enzymatic debridement agent in adults. This manuscript presents the combined clinical trial experience with NXB in children. Hundred and ten children aged 0.

A new bromelain-based enzyme for the release of Dupuytren's contracture: Dupuytren's enzymatic bromelain-based release.

Objectives: Injectable Bromelain Solution (IBS) is a modified investigational derivate of the medical grade bromelain-debriding pharmaceutical agent (NexoBrid) studied and approved for a rapid (four-hour single application), eschar-specific, deep burn debridement. We conducted an ex vivo study to determine the ability of IBS to dissolve-disrupt (enzymatic fasciotomy) Dupuytren's cords.

Materials And Methods: Specially prepared medical grade IBS was injected into fresh Dupuytren's cords excised from patients undergoing surgical fasciectomy.

Nail puncture wound through a rubber-soled shoe: a retrospective study of 96 adult patients.

Nail punctures through rubber-soled shoes expose the foot to the possibility of deep infection and foreign body retention. In this article, we describe characteristics of adult patients who sustained nail puncture wounds through a rubber-soled shoe and were treated at our institution from January 1, 2000, to January 8, 2008. Of the 96 patients, 36 (37.

Ponseti management of clubfoot in older infants.

Unlabelled: Treatment of clubfoot with the Ponseti method is successful when performed immediately after birth. We treated 23 infants (36 feet) who presented to us after casting, applied at other institutions, failed or after 3 months of age. Twenty-two infants had serial casting started during the first 2 months, and one infant who was 6 months old at presentation had not received previous treatment.

Splenic and mesenteric emboli in a patient with protruding aortic arch atheroma.

Protruding atheromas in the thoracic aorta are an important cause of embolic disease. Transesophageal echocardiography (TEE) is the modality of choice for diagnosis of these lesions. We present a patient with splenic infarction in whom TEE revealed a large mobile atheroma in the aortic arch.

Pneumococcal sepsis due to functional hyposplenism in a bone marrow transplant patient.

Encapsulated bacteria can cause severe infections following bone marrow transplantation, usually in patients with chronic graft-versus-host disease (GVHD). Presented here is the case of an allogenic bone marrow transplantation recipient with chronic GVHD who developed overwhelming pneumococcal sepsis 3 years following transplantation. One year earlier the male patient had developed non-meningococcal, non-gonococcal neisseria infection.

[Levels of INR in patients admitted to the department of internal medicine].

We reviewed the records of 282 patients admitted to the Department of Internal Medicine who had been treated at home with warfarin. In 181 patients INR was measured on the day of admission. Less than 20% of the 44 patients treated with warfarin for artificial valves had INR levels within the therapeutic range--3-4.

Managing obesity: a survey of attitudes and practices among Israeli primary care physicians.

Objectives: To document and assess Israeli family physicians' (FPs) knowledge, attitudes and practices regarding the management of overweight and obesity.

Methods: Anonymous questionnaires were completed by 510 family physicians (82% compliance rate). The questionnaires were distributed in various continuous medical education sites of FPs in Israel.

[Extensive subcutaneous hemorrhage complicating primary amyloidosis].

Bleeding manifestations are common in patients with primary as well as secondary amyloidosis and have been attributed to different mechanical and metabolic causes. Factor X deficiency has been described in patients with primary amyloidosis, although severe bleeding is not common in these patients. We describe a patient with extensive subcutaneous hematoma, a sign that served as the major indicator assisting us in establishing the diagnosis of primary amyloidosis.

The 'difficult patient' as perceived by family physicians.

Objectives: The aim of this study is to understand in depth the experience of the family physician faced with the patient that he perceives as 'difficult'. This was done by means of the 'long interview' as a method of qualitative research.

Method: We interviewed 15 randomly selected Board-certified family physicians, with five or more years experience as specialists, employed in the northern district of the 'Clalit Health Services', the major sick fund in Israel.

[Propafenone dose for emergency room conversion of paroxysmal atrial fibrillation].

Paroxysmal atrial fibrillation (AF), a frequent cause of repeated hospitalization, is effectively treated with propafenone. The time to conversion to sinus rhythm is a consideration when managing AF in the emergency room. We investigated the conversion rates of paroxysmal AF by 3 different oral propafenone (P) regimens, in terms of time to conversion.

Prevalence of hypothyroidism and diabetes mellitus in elderly kibbutz members.

Unlabelled: The aim of this study was to determine the prevalence of hypothyroidism and diabetes mellitus (DM) in elderly (aged 65-92 years) kibbutz members in Northern Israel.

Method: The medical records of 1096 elderly (642 females and 454 males) residing in 11 kibbutzim were reviewed for data regarding thyroid function tests (TSH and FT4) and fasting blood glucose. Fasting blood glucose levels above 7.

A case-control study of malignant melanoma in Israeli kibbutzim.

Background: Incidence rates for malignant melanoma in Israel are rising steadily, and the kibbutz population is at increased risk for this malignancy.

Objectives: To assess the risk factors for malignant melanoma among kibbutz members compared to matched healthy controls.

Methods: We conducted a case-control study of 168 malignant melanoma patients and 325 healthy controls, matched by age and gender.

Implantation of permanent dual chamber pacemaker in a pregnant woman by transesophageal echocardiographic guidance.

A 37-year-old woman complained of fatigue and dizziness because of intermittent sinus arrest and asystole up to 5.2 seconds. She was 3 months into her pregnancy and a dual chamber permanent pacemaker was implanted by transesophageal echocardiographic guidance.

The use of systemic antibiotics in seven community hospitals in Northern Israel.

This study evaluated and compared the usage and costs of antibiotics in seven hospitals in the North of Israel and was the first of its kind. We also attempted to determine whether the presence of an Infectious Diseases Unit or Consultant affects antibiotic usage and costs.

Familial pattern of infection with hepatitis B virus among immigrating Ethiopian Jews in Israel.

Seventy-eight families (506 members) of recently immigrating Ethiopian Jews to Israel, were tested for the presence of HBV serological markers to evaluate the intrafamilial horizontal transmission of the virus. Eighty-four members (16.6%) were carriers and 20.

Insulation lead failure: is it a matter of insulation coating, venous approach, or both?

Lead insulation material and implant route have a major impact on lead reliability and durability. We compare the incidence of lead insulation failure resulting from both the venous approach and insulation type. Two hundred ninety consecutive leads were followed for a mean period of 57 +/- 30 months; leads with < 1 year follow-up were excluded.

Empiric antibiotic treatment and the misuse of culture results and antibiotic sensitivities in patients with community-acquired bacteraemia due to urinary tract infection.

Recent data suggests that culture isolations and susceptibility profiles are overlooked, misinterpreted and are not a major determinant in the process of selecting anti-bacterial therapy. Compliance with empiric antibiotic protocols, relationship between blood culture results, change and selection of secondary antibiotic regimens and effect on outcome and length of hospitalization were assessed prospectively in 134 episodes of community-acquired bacteraemia due to urinary tract infection in adults. Empiric antibiotic protocols were correct in 112 episodes (83.

Pheochromocytoma due to unilateral adrenal medullary hyperplasia.

We describe two male patients, aged 17 and 47 years, with clinical and biochemical features of pheochromocytoma. Both patients had normal-sized adrenal glands on abdominal CT scan and abnormal unilateral uptake of I-123 metaiodobenzylguanidine (MIBG) on scintigraphy. The surgical adrenalectomy revealed normal macroscopic glands in both patients.

Changes in the management of pediatric blunt splenic and hepatic injuries.

Background/purpose: Intensive care monitoring, blood replacement, and nonoperative treatment of splenic and hepatic injuries in stable patients is the standard practice in pediatric surgery with a success rate of 90% in children's trauma centers.

Methods: During the past 5 years, 55 children under 14 years of age have been treated for laceration of spleen, liver, or both, proven by computed tomography.

Results: In 34 (62%), other injuries were identified, and only 21 (38%) presented with isolated injuries.

Fractured clavicle and Erb's palsy unrelated to birth trauma.

Objectives: Our purpose was to determine the perinatal factors associated with clavicular fracture or Erb's palsy in neonates and to document the percentage of cases where no risk factors were involved.

Study Design: We reviewed the medical records of all live-born singleton infants admitted to the newborn nurseries between 1992 and 1995. Mothers and infants with clavicular fracture or Erb's palsy were compared with those without these birth injuries.

Deglutition syncope associated with carotid sinus hypersensitivity.

A 78-year-old patient complained of syncope, near syncope, and dizziness when eating; complete atrioventricular block, with ventricular asystole for 3.6 seconds, was recorded on continuous electrocardiographic monitoring. Left and right carotid sinus massage produces sinus arrest and ventricular asystole lasting 6.

The risk of postoperative haemorrhage in tonsillectomy as an outpatient procedure in children.

The safety of performing tonsillectomy as an outpatient procedure is still questionable. This study determined whether there was an increased risk of postoperative bleeding by performing tonsillectomy as an outpatient procedure. A six years' retrospective chart review was made of 363 children who underwent tonsillectomy.