A retrospective study aimed to analyze our experience in 46 patients with blunt traumatic diaphragmatic rupture (BTDR) admitted to our tertiary hospital from 1995 to 2007. Charts, chest roentgenograms (CXR), and computed tomography (CT) scans were carefully reviewed. The mean age was 36.5+/-10.1 years, 36 (78.3%) were males. The etiology was a traffic accident in 36 (78.3%) patients. BTDR was left-sided in 34 (73.9%) and right-sided in 12 (26.1%) patients. CXR was diagnostic in 26 (56.5%) and CT in 12 (26.1%) patients. Associated injuries included lung 12 (26.1%), liver 10 (21.7%), spleen 24 (52.2%) and bowel 2 (4.2%) patients. BTDR was approached through thoracotomy 26 (56.5%), laparotomy 16 (34.8%), and combined approach 4 (8.7%) patients. The repair was primarily with interrupted non-absorbable sutures in 42 (91.3%) and by prosthetic mesh in four patients. Complications developed in 20 patients. Mortality was observed in 2 (4.3%) patients. We concluded that BTDR is a common lesion in young adult males on the left side caused by a traffic accident. A high index of suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis. Associated injuries represent the main prognostic factor affecting morbidity and mortality. Thoracotomy and primary repair is adequate surgical treatment.
A comparison is made of the characteristics of female breast cancer patients, their diseases, and treatment practices in medical centers in Israel and the West Bank of the Jordan River. This experience is further compared with tumor registry data from a major medical center in the United States. Differences are found in the age distributions of patients, marital status, parity, stage of disease at diagnosis, delay between onset of symptoms and diagnosis as well as between diagnosis and treatment. Some of these observations reflect differences in population characteristics, sociocultural practices and local attitudes toward disease, its diagnosis and management.
This paper describes the demographic experience on 373 young cancer patients (less than 20 years of age) at two oncology centers initiated in Israel by one medical team in 1975-1977. These units are the Assaf Harofeh Medical Center (AHMC), which predominantly serves a Jewish population (103 cases); and the West Bank Cancer Unit (WBCU), which provides similar care services to the Arab population of the West Bank (270 cases). The two centers have the unique feature of serving two populations residing in close relationship but still differing in many cultural and socioeconomic characteristics. The Arab patients at WBCU tended to be younger than the Jewish children at AHMC. The five most common diagnostic sites for both AHMC and WBCU included hematopoietic system, bones and joints, soft tissue, urinary tract, and brain and nervous system, although not in the same order of occurrence. These tumor sites accounted for approximately 80% of the cases at each center. The experience with WBCU patients was also compared with data for all Jews in Israel. This comparison identified for both sexes combined statistically significant differences in relative frequency of tumors of soft tissue, eye and orbit, brain and nervous system, and thyroid gland. If confirmed by additional data, reasons for the suggested excess risks should be pursued through more definitive epidemiological studies.
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