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Berger T.,Israel Defense Forces | Berger T.,Rabin Medical Center | Kassirer M.,Israel Defense Forces | Aran A.A.,Israel Defense Forces | Aran A.A.,The Chaim Sheba Medical Center
Eurosurveillance | Year: 2014

Bacillus anthracis infection (anthrax) has three distinct clinical presentations depending on the route of exposure: cutaneous, gastrointestinal and inhalational anthrax. Each of these can lead to secondary bacteraemia and anthrax meningitis. Since 2009, anthrax has emerged among heroin users in Europe, presenting a novel clinical manifestation, ’injectional anthrax’, which has been attributed to contaminated heroin distributed throughout Europe; before 2009 only one case was reported. During 2012 and 2013, new cases of injectional anthrax were diagnosed in Denmark, France, Germany, and the United Kingdom. Here we present a comprehensive review of the literature and information derived from different reporting systems until 31 December 2013. Overall 70 confirmed cases were reported, with 26 fatalities (37% case fatality rate).The latest two confirmed cases occurred in March 2013. Thirteen case reports have been published, describing 18 confirmed cases. Sixteen of these presented as a severe soft tissue infection that differed clinically from cutaneous anthrax, lacked the characteristic epidemiological history of animal contact and ten cases required complimentary surgical debridement. These unfamiliar characteristics have led to delays of three to 12 days in diagnosis, inadequate treatment and a high fatality rate. Clinicians’ awareness of this recently described clinical entity is key for early and successful management of patients. © 2007-2013. All rights reserved.

Silverberg D.,The Chaim Sheba Medical Center
Vascular and endovascular surgery | Year: 2010

We report a single-center experience with the endovascular management of mycotic aortic aneurysms. Four cases of mycotic aortic aneurysms are described; all treated with endovascular stent graft with variable configurations. All patients underwent successful placement of stent grafts for their aneurysms. No 30-day perioperative mortality was observed. One patient died during the follow-up period from a cause unrelated to the aneurysm. Repair of mycotic aneurysms can be accomplished with endovascular repair. This may be a valid alternative to open repair particularly in patients who are not candidates for conventional open repair.

Shemesh D.,Shaare Zedek Medical Center | Raikhinstein Y.,Shaare Zedek Medical Center | Orkin D.,The Chaim Sheba Medical Center | Goldin I.,Shaare Zedek Medical Center | Olsha O.,Shaare Zedek Medical Center
Journal of Vascular Access | Year: 2014

The type of anesthesia chosen is an integral part of the decision-making process for arteriovenous access construction. We discuss the different types of anesthesia used, with emphasis on brachial plexus block, which is potentially safer than general anesthesia in this fragile patient population with end-stage renal disease. Brachial plexus block is superior to local anesthesia and enables the use of a tourniquet to minimize potential damage to the blood vessels during anastomosis using microsurgery techniques, and does not lead to the vasospasm that may be seen with local anesthesia. Regional anesthesia has a beneficial sympathectomy-like effect that causes vasodilation with increased blood flow during surgery and in the fistula postoperatively that may prevent early thrombosis and potentially improve outcome. © 2014 Wichtig Publishing.

Latzer Y.,Haifa University | Latzer Y.,Rambam Medical Center | Latzer Y.,The Chaim Sheba Medical Center | Stein D.,Tel Aviv University
Journal of Eating Disorders | Year: 2013

Childhood obesity is on the rise in both industrialized and developing countries. The investigation of the psychosocial aspects of childhood obesity has been the focus of long- standing theoretical and empirical endeavor. Overweight in children and adolescents is associated with a host of psychological and social problems such as reduced school and social performance, less favorable quality of life, societal victimization and peer teasing, lower self-and body-esteem, and neuropsychological dysfunctioning. Whereas community samples of obese youngsters usually do not show elevated psychopathology, clinically-referred overweight children show elevated depression, anxiety, behavior problems, attention deficit hyperactivity disorder and disordered eating. Parents' perceptions of their child's overweight highly influence the well-being of obese children and the way in which they perceive themselves. The present review paper aims to broaden the scope of knowledge of clinicians about several important psychosocial and familial dimensions of childhood obesity: the psychosocial functioning, self and body esteem and psychopathology of overweight youngsters, the influence of children's perceptions of overweight, including those of the obese children themselves on their well being, and the influence of parental attitudes about weight and eating on the psychological condition of the obese child. © 2013 Latzer and Stein; licensee BioMed Central Ltd.

Otahal J.,Academy of Sciences of the Czech Republic | Folbergrova J.,Academy of Sciences of the Czech Republic | Kovacs R.,Charite - Medical University of Berlin | Kunz W.S.,University of Bonn | And 2 more authors.
International Review of Neurobiology | Year: 2014

Epilepsy is one of the most common neurologic disorders affecting a substantial part of the population worldwide. Epileptic seizures represent the situation of increased neuronal activity associated with the enhanced demands for sufficient energy supply. For that purpose, very efficient regulatory mechanisms have to operate to ensure that cerebral blood flow, delivery of oxygen, and nutrients are continuously adapted to the local metabolic needs. The sophisticated regulation has to function in concert at several levels (systemic, tissue, cellular, and subcellular). Particularly, mitochondria play a key role not only in the energy production, but they are also central to many other processes including those leading to neuronal death. Impairment of any of the involved pathways can result in serious functional alterations, neurodegeneration, and potentially in epileptogenesis. The present review will address some of the important issues concerning vascular and metabolic changes in pathophysiology of epilepsy. © 2014 Elsevier Inc.

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