Israel Medical Association Journal最新文献

{"title":"Can Video Capsule Endoscopy Replace Biopsy in the Diagnosis of Celiac Disease?","authors":"Yaron Niv","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"196-198"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379392","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}

{"title":"Ruptured Sinus of Valsalva Aneurysm in a Patient with DiGeorge Syndrome: Expanding the Cardiovascular Phenotype.","authors":"David Hochstein, Valentin Belinson, Efrat Mazor, Rafael Kupershtein, Leonid Sternik, Roy Raphael, Ohad Bitan, Yoni Grossman","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"189-190"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379440","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}

{"title":"Policy of Age-related Health Examinations as a Condition of Drivers' License Renewals in OECD Countries: A Systematic Review.","authors":"Yuval Dadon, Francis B Mimouni, Joseph Mendlovic","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"191-195"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379414","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}

{"title":"Gastrointestinal Bleeding in Patients Who Underwent HeartMate 3 Left Ventricular Assist Device Implantation.","authors":"Jonathan Eisenberger, David Koren, Shmuel Somer, Bryan Itkowitz, Eyal Nachum, Alexander Kogan, Leonid Sternik, Jeffrey Morgan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Continuous-flow left ventricular assist devices (CF-LVADs) have yielded improved outcomes compared with pulsatile-flow devices; however, significant rates of gastrointestinal bleeding (GIB) have been observed. The HeartMate 3 left ventricular assist device (HM3-LVAD) (Abbott, Inc., Chicago, IL, USA) includes new features, such as an artificial pulse, which may decrease GIB prevalence compared to the HeartMate 2 left ventricular assist device (HM2-LVAD).</p><p><strong>Objectives: </strong>To evaluate the incidence, predictors, and clinical outcomes of GIB in patients supported by the HM3-LVAD.</p><p><strong>Methods: </strong>From 2016 until 2024, 180 patients with chronic heart failure underwent HM3-LVAD implantation. Records were reviewed to determine the post-implant GIB prevalence, location of the bleeding, and associated morbidity and mortality. Univariate and multivariate analyses were conducted to identify independent predictors of GIB.</p><p><strong>Results: </strong>GIB occurred in 25 patients (14%) with a duration of support ranging from 1 to 1821 days. Sources of GIB included the small bowel and rectum in eight patients each, large bowel in one, and stomach in two. No clear source was identified in 11 patients. Recurrent GIB occurred in 16 patients (64%). There were no deaths attributable to GIB. None of the historical or demographic parameters were found to be independent predictors of GIB.</p><p><strong>Conclusions: </strong>GIB is a frequent source of morbidity for patients on HM3-LVAD support but does not significantly impact survival. As the implantation of CF-LVADs with non-pulsatile flow gains popularity for both bridge-to-transplant and destination therapy, a better understanding of the pathophysiology of GIB in these patients will reduce the prevalence of this complication.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"150-155"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379429","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}

{"title":"Benign Presacral Tumor Mimicking a Pilonidal Abscess: A Diagnostic Pitfall.","authors":"Amram Kupietzky, Yehonatan Bar-Moshe, Ido Mizrahi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Presacral tumors are rare and heterogeneous neoplasms that develop in the space between the rectum and sacrum. Their low prevalence and diverse embryologic origins often complicate diagnosis and management. We present the case of a 43-year-old woman who was initially misdiagnosed with a pilonidal abscess, later identified as a benign presacral tumor. PATIENT DESCRIPTION A 43-year-old woman presented with a gradually enlarging mass in the pilonidal region over the course of several months. She was referred to our colorectal clinic with a presumptive diagnosis of a pilonidal abscess made by her primary care physician. The patient was otherwise healthy, with no complaints of pain, fever, chills, or unintentional weight loss. On physical examination, a non-tender mass was palpated over the coccygeal region. Notably, there were no midline pits or visible hair [Figure 1A]. Given the atypical presentation, a magnetic resonance imaging (MRI) was performed, which revealed a well-defined, large presacral bilobular thin-walled cystic mass, posterior to the rectum, without any post contrast ring-enhancement or intramural solid nodule [Figure 1B]. Due to the low anatomical position of the mass relative to the sacrum, a Kraske approach was selected for surgical excision. Under general anesthesia, the patient was placed in the prone jackknife position. A vertical midline incision was made 7 cm cephalad to the anal verge, over the coccyx. This position exposed a well-encapsulated, large presacral tumor [Figure 1C], which was excised en-bloc along with the tip of the coccyx [Figure 1D, Figure 1E]. The specimen was sent for pathological evaluation, which revealed a retrorectal epidermal cyst. The patient's postoperative course was uneventful, and she was discharged on postoperative day one. Informed consent was obtained from the patient.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"187-188"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379451","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}

{"title":"Identifying Risk Factors for Suicide Attempts in Adolescents and Building a Model Using Neural Networks for Predicting Teens at Risk: A Retrospective Epidemiological Study.","authors":"Alon Lalezari, Antoni Skripai, Karam Wattad, Nechama Sharon","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Adolescent suicide attempts have well-established risk factors. The increased number of cases at Laniado Hospital's pediatric department over the past decade prompted our evaluation of the relative importance of these factors.</p><p><strong>Objectives: </strong>To characterize adolescents presenting after suicide attempts and to use these features to develop a neural network for early identification of at-risk youth.</p><p><strong>Methods: </strong>We conducted a retrospective study of suicide attempts among adolescents (11-18 years) admitted to Laniado Hospital's pediatric department (2015-2021). The study included 82 patients with a matched control group (n=82). We analyzed epidemiological, medical, and psychosocial characteristics, identifying statistically significant factors associated with suicide attempts. We then built a predictive model using neural networks.</p><p><strong>Results: </strong>Significant risk factors for suicide attempts included living outside original home (odds ratio [OR] 6.71, P = 0.0002), female gender (OR 12.67, P = 0.0502), unmarried parents (OR=98.51, P < 0.0001), advanced age (95% confidence interval [95%CI] 0.477-1.583, P = 0.0001), higher hemoglobin (95%CI 0.689-1.81, P = 6.30 × 10-6), higher mean corpuscular volume (MCV) (95%CI 3.61-8.07, P = 0.014), and prior psychiatric diagnosis (OR 71.82, P < 0.0001). Non-Ashkenazi background was more common but not significant (P = 0.074). Our neural network model achieved 99.85% predictive accuracy.</p><p><strong>Conclusions: </strong>Psychiatric history, unmarried parents, female gender, and living outside the home were the strongest risk factors for adolescent suicide attempts. We observed higher hemoglobin levels and MCV among affected individuals. Our neural network showed high accuracy (99.85%) in distinguishing between adolescents with suicide attempts from matched controls.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"141-145"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379418","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}

{"title":"Frequency of Bacteremia and the Preventive Effect of Prophylactic Antibiotics in Direct Peroral Cholangioscopy During Endoscopic Retrograde Cholangiopancreatography: A Real-life Retrospective Analysis.","authors":"Fadi Younis, Erez Scapa, Mati Shnell, Iddo Bar Yishay, Einat Ritter, Niv Zmora, Nir Bar, Nathaniel Aviv Cohen, Erwin Santo, Oren Shibolet, Adam Philips, Dana Ben-Ami Shor","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic intravenous antibiotics are not routinely administered prior to direct peroral cholangiopancreatoscopy. The frequency of post-procedure bacteremia has not been well studied.</p><p><strong>Objectives: </strong>To evaluate the risk of bacteremia following endoscopic retrograde cholangiopancreatography (ERCP) with cholangiopancreatoscopy. To assess the prevalence of other infectious complications and the effect of real-life practices regarding prophylactic antibiotic administration.</p><p><strong>Methods: </strong>We conducted a retrospective analysis on consecutive patients (2016-2022) who underwent cholangiopancreatoscopy using the single-operator SpyGlass System (Boston Scientific Corporation, USA). Prophylactic antibiotic treatment was administered based on clinical discretion. Demographic and clinical data, including procedure indication, procedure reports, blood culture results, pre- and post-procedure antibiotic treatment, hospital length, mortality, and infectious and non-infectious complications, were collected.</p><p><strong>Results: </strong>Our single-center cohort included 75 patients who underwent ERCP with direct cholangiopancreatoscopy. We involved 63 patients in the analysis. In 17/63 patients (27%), post-procedural blood cultures were drawn based on clinical suspicion of infection. Positive cultures were found in 4/17 (23.5%) of all cultures and 4/63 (6.3%) of the entire cohort; 2/63 (3.2%) had clinically significant bacteremia. Antibiotic prophylaxis was administered to 35 patients (55.6%), with no evidence of significant reduction in bacteremia, cholangitis, hospitalization length, or mortality rates when compared to patients who did not receive prophylactic antibiotics (P > 0.05). Post-procedural cholangitis was observed in 5/63 patients (7.9%). There were no cases of acute cholecystitis or liver abscess.</p><p><strong>Conclusions: </strong>The prevalence of bacteremia and cholangitis following ERCP with direct cholangiopancreatoscopy was 6.3% and 7.9%, respectively. Prophylactic antibiotics did not reduce post-procedural infectious adverse events.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"174-179"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379379","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}

{"title":"Trichosporon Fungemia in a Tertiary Pediatric Hospital: A Case Series.","authors":"Elad Steiner, Ori Snapiri, Salvador Fischer, Efraim Bilavsky, Nimrod Sachs","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Trichosporon asahii is an opportunistic fungal pathogen increasingly recognized in immunocompromised patients, including children. Although rare, T. asahii fungemia carries significant morbidity and mortality, particularly in those with hematologic malignancies or prolonged immunosuppression.</p><p><strong>Objectives: </strong>This case series aimed to describe the clinical characteristics, risk factors, microbiological profiles, and treatment outcomes of pediatric patients diagnosed with T. asahii fungemia over a 13-year period at a tertiary care children's hospital.</p><p><strong>Methods: </strong>A retrospective review was conducted of all cases of T. asahii fungemia diagnosed between 2010 and 2023 in patients under 18 years of age. Data collected included patient demographics, underlying conditions, immunosuppressive status, presence of central venous catheters (CVCs), neutrophil counts, antifungal susceptibility profiles, treatments administered, and clinical outcomes.</p><p><strong>Results: </strong>Most cases occurred in immunocompromised patients, mainly those with neutropenia and a CVC. Half of the patients died. T. asahii isolates were generally susceptible to voriconazole and other azoles but showed partial resistance to amphotericin B. Clinical improvement was mainly associated with early antifungal treatment (particularly voriconazole) and supportive measures, including immunosuppression reduction, neutrophil recovery, and CVC removal.</p><p><strong>Conclusions: </strong>Voriconazole appears to be a reasonable empiric treatment option for pediatric T. asahii fungemia, a condition associated with a very poor prognosis. Successful management may also require early recognition of risk factors and interventions aimed at reversing immunosuppression and eliminating potential sources of infection such as CVCs.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"146-149"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379412","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}

{"title":"Clinical Predictors of Positive Computed Tomography Findings in Patients with Nasal Obstruction: A Retrospective Cohort Study.","authors":"Eyal Yosefof, Yoav Horev, Eitan Yaniv, Collin F Mulcahy, Dan Yaniv","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Nasal obstruction is one of the most common symptoms encountered in the otorhinolaryngology clinic, with diverse etiology including deviated nasal septum (DNS) and sinusitis. When surgical intervention is considered, the referring surgeon must decide whether preoperative imaging is indicated.</p><p><strong>Objectives: </strong>To identify clinical and physical examination predictors associated with significant sinus findings on computed tomography (CT) imaging in patients with nasal obstruction. To define specific factors in the medical history and physical examination of patients with nasal obstruction, which are associated with positive CT findings.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients presenting with nasal obstruction. We collected demographic data, clinical and physical examination findings, CT imaging results, and surgical outcomes.</p><p><strong>Results: </strong>A total of 242 patients were included (mean age 38.5 ± 16.8 years, 65.7% male), all of whom underwent CT imaging prior to surgery. On univariate analysis, nasal edema, ostiomeatal complex (OMC) blockage, or edema, were all associated with positive findings from the CT (defined as Lund-Mackay > 3). On multivariate analysis, OMC obstruction or edema were associated with positive CT findings.</p><p><strong>Conclusions: </strong>A thorough patient history and detailed physical examination are essential for evaluating nasal obstruction and identifying patients who may benefit from preoperative CT imaging. Specific clinical symptoms can indicate chronic sinusitis, thus guiding surgeons to perform preoperative imaging for accurate diagnosis and targeted treatment beyond deviated nasal septum management.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"168-173"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379417","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}

{"title":"Ninety Second Nation: Sleep Fragmentation as a Public Health Hypothesis in Prolonged Conflict.","authors":"Noam Shomron, Dmytro Martsenkovskyi","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"28 3","pages":"201-202"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379455","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}