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Comparison of Surgical Treatment Using Mohs Micrographic Surgery versus Wide Local Excision for the Treatment of Dermatofibrosarcoma Protuberans. 使用莫氏显微外科手术与局部广泛切除术治疗皮纤维肉瘤的比较

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-12-01

Hagai Landov, Sharon Baum, Raneen Mansour, Boaz Liberman, Aviv Barzilai, Joseph Alcalay

{"title":"Comparison of Surgical Treatment Using Mohs Micrographic Surgery versus Wide Local Excision for the Treatment of Dermatofibrosarcoma Protuberans.","authors":"Hagai Landov, Sharon Baum, Raneen Mansour, Boaz Liberman, Aviv Barzilai, Joseph Alcalay","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive, soft-tissue sarcoma. The treatment is surgical and includes wide local excision (WLE) or Mohs micrographic Surgery (MMS). There is no consensus regarding the preferred type of surgery.</p><p><strong>Objectives: </strong>To compare the outcomes of the two types of surgery (WLE and MMS).</p><p><strong>Methods: </strong>This retrospective cohort study was based on the medical records of 59 patients with DFSP treated at Sheba Medical Center (using the WLE method) or Assuta Medical Center (using the MMS method) between 1995 and 2018. The data included demographics, clinical presentations, imaging, types of wound closures, pathological margin status, surgical defect sizes, recurrences, and follow-up.</p><p><strong>Results: </strong>Of the 59 included patients, 18 (30.5%) underwent WLE and 41 (69.5%) underwent MMS. The mean age at diagnosis was 40.1 ± 14.4 years. The male-to-female ratio was 1.5:1. The main tumor location was the trunk (50% for WLE and 41.5% for MMS). The main type of closure for both procedures was primary closure. In 72.2% of WLE and 78.8% of MMS cases, the margins were free. The difference between the final surgical defect and the original tumor size was statistically significantly smaller in patients who underwent MMS. The median duration of follow-up was 6.6 years. There was no significant difference in the rate of recurrence.</p><p><strong>Conclusions: </strong>MMS enables better tissue preservation and results in a minor surgical defect compared to WLE, with no difference in tumor recurrence between the two methods.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 11","pages":"682-687"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Epithelioid Fibrous Papule (Angiofibroma) of the External Auditory Canal: A New Entity? 外耳道上皮样纤维性丘疹（血管纤维瘤）：新实体？

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

Naama Ronel, Oleg Sukmanov, Gil Lahav, Shimrit Sharav, David Kiderman, Ady Yosepovich

引用次数: 0

Allergic Rhinitis in Israel: A Multicenter Study of Allergic Rhinitis Across Three Climate Zones. 以色列的过敏性鼻炎：跨越三个气候带的过敏性鼻炎多中心研究。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

Rachel Eisenberg, Allon Raphael, Matan Risling, Ilan Asher, Ori Toker

{"title":"Allergic Rhinitis in Israel: A Multicenter Study of Allergic Rhinitis Across Three Climate Zones.","authors":"Rachel Eisenberg, Allon Raphael, Matan Risling, Ilan Asher, Ori Toker","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Allergic rhinitis (AR) is a common illness. Worldwide prevalence varies between 5% and 50% depending on self-reported surveys, test-based studies, geographic location, and age. Despite the clinical relevance of AR in the Israeli population, few studies have characterized the sensitization profiles and key pollen aeroallergen.</p><p><strong>Objectives: </strong>To describe the most common aeroallergens eliciting a positive skin prick test (SPT) in AR patients across three different main climate zones in Israel.</p><p><strong>Methods: </strong>We evaluated SPT of aeroallergen sensitization in 1308 AR patients from three topographically and climatically different areas of Israel, describing humidity levels, temperature, and urbanization.</p><p><strong>Results: </strong>The overall prevalence of positive SPT among patients presenting with AR symptoms was 86%. Indoor aeroallergen sensitization was observed in 76% of patients. Monosensitization was noted in 20% of patients, and polysensitization was noted in 65%. Among the 1308 cases of AR, the top four aeroallergens were mites, olive tree pollen, grass pollen, and cat dander. The top aeroallergen in Israel's central district were mites (62%), olive tree pollen (36%), and grass pollen (30%). In the coastal plains, mites (92%), cat dander (36%), and olive tree pollen (33%) were most prevalent, and in the south mites (77%), olive tree pollen (30%), and grass pollens (26%) were most common.</p><p><strong>Conclusions: </strong>The top four aeroallergens eliciting a positive SPT were mites, olive tree pollen, grass pollen, and cat dander. Identification of a major aeroallergen can tailor the allergist's SPT panels and specify which aeroallergen should be used for immunotherapy.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"616-620"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Asymptomatic Testicular Tumor in Patient with Retroperitoneal Fibrosis as Manifestation of IgG4-related Disease Recurrence: A Case Report. 腹膜后纤维化患者无症状睾丸肿瘤是 IgG4 相关疾病复发的表现：病例报告。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

May Simshon-Turgeman, Eliahu Rosenberg, Amir Bartal, Carmi Bartal

引用次数: 0

The Efficacy of Echocardiography-guided Cardiac Implantable Electronic Devices Implantation to reduce Device Related Tricuspid Regurgitation: Long-term Follow-up. 超声心动图引导下心脏植入式电子设备植入术对减少与设备相关的三尖瓣反流的疗效：长期随访。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

Tamar Slobodov, Gergana Marincheva, Michael Rahkovich, Andrei Valdman, Yonatan Kogan, Avishag Laish-Farkash

{"title":"The Efficacy of Echocardiography-guided Cardiac Implantable Electronic Devices Implantation to reduce Device Related Tricuspid Regurgitation: Long-term Follow-up.","authors":"Tamar Slobodov, Gergana Marincheva, Michael Rahkovich, Andrei Valdman, Yonatan Kogan, Avishag Laish-Farkash","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cardiac implantable electronic devices (CIEDs) with endocardial leads crossing the tricuspid valve can lead to or worsen tricuspid regurgitation (TR), causing substantial morbidity and mortality. Despite a recent randomized controlled study revealing a low short-term incidence of device-related TR (DRT) post-CIED implantation, uncertainties persist regarding the efficacy of intra-procedural 2-dimensional transthoracic echocardiography (2DTTE) in preventing long-term TR.</p><p><strong>Objectives: </strong>To conduct a long-term follow-up study on patients with CIED implants based on a previous study conducted at our hospital.</p><p><strong>Methods: </strong>In a retrospective study at Assuta Ashdod Medical Center (2018-2019), patients undergoing de-novo CIED implantation with (n=39, group 1) or without (n=51, group 2) intra-procedural 2DTTE were analyzed. Clinical, demographic, and long-term (> 1 year) echocardiographic data were collected and compared.</p><p><strong>Results: </strong>The study included 90 patients (mean age 72.3 ± 11.0 years, 63% male, 23% ICD, 50% active leads, follow-up 32.8 ± 11 months). TR aggravation was found in 25% of patients (13 in group 1, 10 in group 2), with no statistical difference between groups. Multivariate analysis identified a history of atrial fibrillation (AF) as the sole significant factor in long-term TR deterioration (OR=3.44, 95%CI 1.13-10.43, P = 0.029). Other clinical, demographic, echocardiographic, and device-related factors did not significantly contribute to long-term DRT.</p><p><strong>Conclusions: </strong>After one-year post-CIED implantation, the incidence of DRT significantly increases. Intra-procedural 2DTTE does not effectively reduce long-term DRT, suggesting that implantation-related mechanisms are less likely the primary cause. AF likely plays a major role in the pathogenesis of long-term TR in this subset post-CIED implantation.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"621-629"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiac and Pleural Involvement in Systemic Light Chain Amyloidosis: A Case Report. 系统性轻链淀粉样变性的心脏和胸膜受累：病例报告

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

Ela Giladi, Hadas Gilboa-Sagy, Liaz Zilberman, Olga Zyabkin, Abid Assali, Sagee Tal, Osnat Jarchowsky

引用次数: 0

Resilience Unveiled: Myxedema Coma in a Hostage Survivor. 揭开复原能力的面纱：一名人质幸存者的肌水肿昏迷。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

Noa Fried-Regev, Tzachi Slutsky, Amit Frenkel, Moti Klein, Shlomi Codish, Dan Schwarzfuchs

引用次数: 0

Does This Image Reveal a Fourth Cranial Nerve Palsy? 这张图片是否显示第四颅神经麻痹？

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

Daniel M Gelfman

引用次数: 0

The Challenges of Forensic Medicine in Victim Identification in the Wake of the October 7th (2023) Mass Casualty Event. 10 月 7 日（2023 年）大规模伤亡事件发生后，法医学在鉴定受害者身份方面面临的挑战。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

Chen Kugel, Ricardo P Nachman, Itai Katz, Arad Dotan, Gisele Zandman-Goddard, Yehuda Shoenfeld

{"title":"The Challenges of Forensic Medicine in Victim Identification in the Wake of the October 7th (2023) Mass Casualty Event.","authors":"Chen Kugel, Ricardo P Nachman, Itai Katz, Arad Dotan, Gisele Zandman-Goddard, Yehuda Shoenfeld","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The massive terrorist attack on a mixed population of civilians, soldiers, and foreigners on October 7, 2023, resulted in 1200 casualties and led to many major personal identification issues. At the Israel National Center for Forensic Medicine (INCFM), addressing the mass casualty incidents required precision that included technical, ethical, and humanitarian dimensions. Many obstacles arose that were attributable to the vast number and diversity of victims and the heavy workload in the setting of a small forensic team.</p><p><strong>Objectives: </strong>To define the various methods utilized for victim identification.</p><p><strong>Methods: </strong>The different types of identification were visual, primary, and circumstantial. Primary methods compared unique and stable characters of the human body, including fingerprints, comparisons of dental data, X-rays, and medical databases. We implemented other methods (anthropology, genetics) and novel creative strategies (digital photography taken by random individuals using mobile phones) and computed tomography (CT) scan at another designated site other than at the INCFM.</p><p><strong>Results: </strong>Often, visual recognition and extraction of DNA were impossible because of burnt human remains. Hence, a comparison method of antemortem and postmortem CT findings became imperative for many unidentified victims. The more complex cases included the finding of body parts of more than one individual in different body bags (comingled remains). In such situations, we matched the body parts by utilizing DNA methods. We present seven case challenges.</p><p><strong>Conclusions: </strong>We utilized various known and novel methods for victim identification in the aftermath of the events of 7 October 2023 while addressing ethical issues in a case series.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"603-607"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Using Urine Output Trending for the Management of Acute Cardiorenal Syndrome. 利用尿量趋势来管理急性心肾综合征。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-11-01

Anna Rozenfeld, Aliza Goldman, Tal Stern, Shmuel Banai, Yacov Shacham

{"title":"Using Urine Output Trending for the Management of Acute Cardiorenal Syndrome.","authors":"Anna Rozenfeld, Aliza Goldman, Tal Stern, Shmuel Banai, Yacov Shacham","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>One-third of patients with acute decompensated heart failure (ADHF) develop worsening kidney function, known as type I cardiorenal syndrome (CRS). CRS is linked to higher mortality rates, prolonged hospital stays, and increased readmissions.</p><p><strong>Objectives: </strong>To explore the impact of real-time monitoring of urinary output (UO) trends on personalized pharmacologic management, fluid balance, and clinical outcomes of patients with ADHF admitted to a cardiac intensive care unit.</p><p><strong>Methods: </strong>Our study comprised 35 patients who were hospitalized with ADHF and continuously monitored for UO (UOelec). Standard diuretic and fluid protocols were implemented after 2 hours of oliguria, and patient outcomes were compared to a historical matched control (HMC) group. Patients were assessed for daily and cumulative fluid balance (over 72 hours) as well as for the occurrence of acute kidney injury (AKI).</p><p><strong>Results: </strong>Significantly more patients in the UOelec group demonstrated negative fluid balance daily and cumulatively over time in the intensive care unit compared to the HMC group: 91% vs. 20%, respectively (P < 0.0001 for 72-hour cumulative fluid balance). The incidence of AKI was significantly lower in the UOelec monitoring cohort compared to the HMC: 23% vs. 57%, respectively (P = 0.003). Moreover, higher AKI resolution, and lower peak serum creatinine levels were demonstrated in the UOelec group vs. the HMC group.</p><p><strong>Conclusions: </strong>Implementing real-time monitoring of UO in ADHF patients allowed for early response to oliguria and goal-directed adjustment to treatment. This finding ultimately led to reduced congestion and contributed to early resolution of AKI.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"643-649"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

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