60 years of medical activities in the Jezreel Valley. From the Archives of Central Emek Hospital in Afula.
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Biomedical subjects
Publications and source records attributed to D Kohn.
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Three cases of meningoencephalitis caused by the West Nile virus in young people are described. All patients had high fever, severe headaches, and meningeal irritation. One patient had papillitis and a maculopapular rash. Lymphadenopathy, which is a common finding in West Nile fever, was not found in any of our patients. Duration of the disease was one to two weeks, and recovery was complete. Cerebrospinal fluid examination revealed an increase in protein and pleocytosis (predominantly polymorphonuclears). We believe that West Nile encephalitis is not rare in Israel.
Adult respiratory distress syndrome (ARDS) is a severe disease that carries a poor prognosis (50 to 60% mortality). Although modern ventilatory techniques, especially positive end-expiratory pressure ventilation, have reduced the mortality rate somewhat, they are still far from serving as the ideal solution to this grave condition. High-frequency positive pressure ventilation (HFPPV) is a relatively new technique that enables effective alveolar ventilation without creating high intrapulmonary pressures. HFPPV using a conventional ventilator, Bennett MA-1B (Suffex, England), was tried in a 22-yr-old man with ARDS due to pyocyanea sepsis, who had failed to respond to conventional ventilation. A dramatic improvement was achieved within 60 min of increasing the ventilatory rate from 12 to 80/min, with a concomitant decrease of tidal volume from 12 to between 2 and 23 ml/kg. HFPPV may be a useful alternative method in the treatment of patients with ARDS.
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A case of thrombotic thrombocytopenic purpura with an unusual subacute course is described. Treatment was initiated after the patient had been ill for four weeks. Low-dose plasma exchange (10 ml/kg body weight per day) was associated with a sharp drop in the reticulocyte count and a transient reduction of lactate dehydrogenase activity to within the normal range. The administration of corticosteroids was followed immediately by the disappearance of neurological symptoms, and after high-dose plasma exchange (25 ml/kg body weight per day) all the symptoms of disease remitted. The remission has lasted for 10 months; we suggest that each of the therapeutic measures employed played a role.
Body iron stores and endocrine functions were determined in eight patients with chronic hemolytic anemia who had received only small amounts of blood and no iron preparations. Four patients had beta-thalassemia intermedia (BTI) and four had sickle-cell thalassemia (SCT). Hemoglobin levels and degrees of hemolysis were similar in both groups of patients. The patients with BTI showed clear evidence of iron overload, whereas there was no evidence of iron accumulation in the patients with SCT. The three patients with BTI who had endocrinologic evaluations showed endocrine dysfunctions. Two patients with SCT had no endocrine abnormalities and the other two probably had some degree of primary hypogonadism. Iron overload in patients with thalassemia probably results from excessive intestinal iron absorption and can damage various parenchymal and endocrine organs, even in the absence of an external source of iron.
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A semiquantitative cytochemical evaluation of beta-glucuronidase activity in peripheral lymphocytes in 123 normal sybjects was made. It was found that the enzymatic activity was influenced by age but not by sex. Activity was weak in newborn infants but increased with age and reached maximal values in old subjects. Age should therefore be taken into consideration when the enzyme activity is evaluated.
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