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Enlarged lymph nodes (ELN) pose a great diagnostic challenge. They may represent the first clinical finding of a hematologic disease or other malignancy and may be an indication of a wide range of infectious and non-infectious diseases. Because many patients undergo percutaneous biopsy, surgical excisional biopsy is not often considered.To analyze indications for a patient's referral for surgical biopsy of ELN and diagnostic steps to follow until referral, and to determine the number of ELN.A retrospective study was conducted of prospectively collected data of patients who underwent surgical biopsy of ELN from January 2004 to December 2013.Of 118 patients who underwent surgical biopsy of ELN, only 52 (44%) had needle biopsy (NB) before referral. Lymphoma was diagnosed by NB in 24 (46%) of the referred patients. In patients with a previous diagnosis of lymphoma, NB of ELN yielded a sensitivity of 67% and specificity of 79%. In patients with lymphadenopathy but with no previous history of malignancy, sensitivity for lymphoma was 68% and specificity was 71%. The investigative time period until final diagnosis was 3 months in patients who had NB but only 1.25 months in patients who were referred directly for surgery (P0.0001).Surgical biopsy of ELN still has a place in the clinical evaluation of patients with ELN. Surgery may significantly reduce the length of investigation and prevent unnecessary diagnostics, especially in patients with suspected lymphoma recurrence.

Colon cancer is common, affecting mostly older people. Since age is a risk factor, young patients might not be given the same attention as older ones regarding symptoms that could imply the presence of colon cancer.To investigate whether young patients, i.e., under age 50, complain of symptoms for longer than older patients until the diagnosis of colon cancer is established.In this retrospective cohort study, patients were divided into two groups:50 years old (group 1) andor = 50 (group 2). All had undergone surgery for left or right-colon cancer during the 10 year period of the study from January 2000 through December 2009 at one medical center. Rectal and sigmoid cancers were excluded. Data collected included age, geander, quantity and quality of complaints, duration of complaints, in-hospital versus community diagnosis, pathological staging, the side of colon involved, and overall mortality. The primary outcome was the quality and duration of complaints. Secondary outcomes were the pathological stage at presentation and the mortality rate.The study group comprised 236 patients: 31 (13.1%) were50 years old and 205 (86.9%) wereor = 50. No significant difference was found in the quantity and quality of complaints between the two groups. Patients in group 1 (50 years) complained for a longer period, 5.3 vs.2.4 months (P= 0.002). More younger patients were diagnosed with stage IV disease (38.7% vs. 21.5%, P= 0.035) and fewer had stage I disease (3.2% vs. 15.6%, P= 0.06); the mortality rates were similar (41.9% vs. 39%). Applying a stepwise logistic regression model, the duration of complaints was found to be a predictor of mortality (P= 0.03, OR 1.6, 95% CI 1-3.6), independently of age (P= 0.003) and stage (P0.001).Younger patients are more often diagnosed with colon cancer later, at a more advanced stage. Alertness to patients' complaints, together with evaluation regardless of age but according to symptoms and clinical presentation are crucial. Large-scale population-based studies are needed to confirm this trend.

The proportion of motorcyclists injured in road accidents in Israel is larger than their proportion among road users.To identify factors contributing to the risk of injury motorcyclists as compared to drivers of other motor vehicles.We retrieved and analyzed National Trauma Registry data on drivers, aged 16 and above, who were involved in traffic accidents and hospitalized between 1 January 1997 and 30 June 2003.The study group comprised 10,967 patients: 3,055 (28%) were motorcyclists and 7,912 (72%) were drivers of other motor vehicles. A multiple logistic regression revealed that Tel Aviv, the busiest metropolitan city in Israel, is a risk for motorcycle injury as compared to other regions; males have an increased risk compared to females; and age is a protecting factor since the risk of injury as a motorcyclist decreases as age increases. Nevertheless, the population of injured motorcyclists in Tel Aviv was significantly older (mean age 32.5 years vs. 28.6 elsewhere; t-test P0.0001). Twenty percent (n = 156) of the injured motorcyclists in Tel Aviv were injured while working, compared to 9.5% (n = 217) in other regions (chi-square P0.0001). Motorcycle injuries in Tel Aviv were of lower severity (7.7% vs. 16.4% according to the Injury Severity Scale 16+, chi2 P0.0001), and had lower inpatient death rates (1.2% vs. 2.5%, chi2 P = 0.001).Tel Aviv is a risk for motorcycle injury compared to other regions, males have an increased risk compared to females, and age is a protecting factor. The proportion of motorcyclists in Tel Aviv injured while working is double that in other regions.