Israel journal of medical sciences最新文献

Human papillomavirus (HPV) has been implicated strongly with human cervical, anal and penile cancers. The polymerase chain reaction (PCR) was used to detect HPV in cervical specimens of 88 women working at the public whorehouse. Using consensus primers which encode the L1 region of the HPV genome, the presence of HPV DNA was demonstrated in 2 specimens. Restriction endonuclease digestion of the amplified products was carried out for accurate typing. Samples which were positive by L1 PCR were digested with Hae III, BstN I and Dde I restriction enzymes. The patterns produced by digestion were identified as HPV types 6b and 16.

The main objective of this study was to investigate mortality differentials in the Israeli population, aged 40 years and above, with regard to major demographic and socio-economic characteristics, in the nine-and-a-half years following the census of 1983. The method of data collection consisted of a linkage of records from the 20% sample of the census with the records of deaths occurring until the end of 1992. The linked file contains the socio-economic and demographic data from the census, and dates and causes of death taken from the death records. This paper focuses on a systematic evaluation of the quality of the linked file, and includes a description of the characteristics of the file. Methods of verification are presented and sources of possible errors are discussed. Results of bivariate analyses of mortality differentials in relation to marital status, ethnic origin, level of education, employment, occupation and income are presented.

The intention of this paper was to review the literature on the use of EEG in headache evaluation and recommend clinical applications of this technique. The consensus of published findings was that EEG can differentiate migraineurs from controls but that it is not justified for routine diagnosis of headache etiology. We conclude that neuroimaging is a superior technique for detecting underlying structural lesions.

Forty-five patients who were referred for surgical resection of large colonic polyps after index colonoscopy were considered for endoscopic polypectomy. Eighteen of these patients were ultimately referred for surgery. Twenty-five patients with 25 large polyps underwent endoscopic polypectomy; there were 9 females and 16 males with a mean age of 69 years. Among the polypectomy patients, polyp size was 3.0-6.0 cm, found mostly in the left colon. There were 21 pedunculated and 4 sessile polyps. Follow-up was carried out for a mean of 48 months (range, 12-171 months). Polypectomy was possible on a single attempt in 12 (48%) cases and in 13 (52%) cases by a piecemeal technique. Pathological examination revealed malignancy in 11 (44%), adenomatous polyp in 11 (44%), and inflammatory, hyperplastic and harmartoma in 1 patient each. Complications included bleeding in 3 (12%) patients and diarrhea and fever in 1 (4%). All complications were successfully treated conservatively without sequellae. Two patients were referred for surgery, 1 with invasion of the base of the polyp and 1 because of a synchronous malignant polyp. During follow-up, 8 metachronous polyps were detected. In 1 of these, a carcinoma was found and treated with endoscopic polypectomy. In conclusion, endoscopic polypectomy of large polyps is safe and can defer surgical treatment. Regular follow-up is required. Endoscopic polypectomy of large polyps should be considered before referral for surgical treatment.

In Israel, as in most other countries, complementary medicine (CM) is gaining in popularity. This article provides a critical review of the field. In particular, it addresses the issues of effectiveness, safety and costs. For none of these fundamental issues is evidence at present sufficient for forming firm conclusions. Research methodologies in CM do not, in principle, differ from those in mainstream medicine. In certain instances they may, however, require some adaptation to fit the special needs of CM. It is concluded that key questions in CM remain unanswered and research efforts to find these answers should be increased.

Open-access endoscopy has recently gained popularity in referring patients for endoscopic procedures. Retrospective (looking into patients' medical files) and prospective studies (using 2 different questionnaires, and evaluating a selection system) were conducted, comparing the efficacy of open-access endoscopy for patients referred by either family practitioners or gastroenterologists. In the retrospective study, 673 patients (mean age 48.8 years, male-58%) underwent upper gastrointestinal endoscopy. The main indications for upper endoscopy were epigastric pain (71%), heartburn (18%) and vomiting (13%). Severe endoscopic findings were not different between the study groups. Normal or mildly abnormal findings were diagnosed in 75% of patients in both groups. In the prospective study, 361 patients were referred for upper endoscopy (mean age 50.2 years, male-58%). Although there were significantly (p < 0.01) fewer normal and more mild endoscopic findings in the patients referred by gastroenterologists, as compared with family practitioners, there was no difference in the clinically significant (severe) endoscopic findings. Previous ulcer, smoking, gender, age and nocturnal pain were predictive for severe endoscopic findings. There was a linear correlation between the severity of the scoring system and the endoscopic findings. The results of the present study, which reveal nonsignificant differences in the indications for and the findings of endoscopies, indicate that selection of patients for endoscopy can be safely done by family practitioners. In order to reduce the number of referred patients with no gastrointestinal pathology, a better scoring system to detect at-risk patients should be developed.