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Invasive fungal sinusitis is becoming increasingly common in patients undergoing BMT. This study was undertaken to evaluate the incidence, presenting symptoms, diagnosis procedures, treatment and outcome of invasive fungal sinusitis. The study population comprised 423 consecutive BMT patients at Hadassah University Hospital from January 1986 to August 1992. Eleven patients (2.6%) developed invasive fungal sinusitis, 8 had underlying hematologic malignancies and 3 severe aplastic anemia (SAA). Median interval between BMT and fungal sinusitis was 22.5 days (range 2-106 days). Eight of 11 patients had protracted neutropenia (median 8 days with median neutrophil count at the time of fungal sinusitis diagnosis of 0.25 x 10(9)/l). Four patients developed GVHD before fungal sinusitis was diagnosed. Presenting symptoms were fever (100%), orbital swelling (63%), facial pain (54%) and nasal congestion (36%). In 8 patients Aspergillus species were isolated (A. flavus in 7, A. quadrilineatus in 1); in 1 patient Candida albicans was isolated and in the other 2 fungal elements were detected histologically (Fusarium and Mucor, respectively). Six of the patients underwent surgical debridement at diagnosis. Three received granulocyte transfusions. All patients received systemic amphotericin B (7 conventional and 4 amphotericin B colloidal dispersion (ABCD)). Only 2 of the 11 patients responded completely to therapy with a follow-up of 15 months. It appears that invasive fungal sinusitis is a potentially fatal complication in immunocompromised patients post-BMT. Current treatment approaches are largely ineffective and new methods of management of this serious problem are needed.

We investigated whether the sexual practices of homosexual and bisexual men attending the Jerusalem AIDS Clinic had changed between 1986/7 and 1990. The responses of a group of 79 homosexual and bisexual men to a questionnaire in 1986/7 were compared to the responses of a group of 37 homosexuals/bisexuals in 1990. Consistent yet statistically insignificant differences in sexual behavior between the 1990 and 1986/7 groups were observed: More individuals were using condoms (53% vs 36% respectively), and at an earlier age. The practice of anal sex was less common (48% vs 67% respectively) and that of oral sex more common (46% vs 27% respectively). These differences were not confounded by the level of education between the two groups. Analyzed separately for homosexuals and bisexuals, the increase in condom use was more noticeable among homosexuals compared with bisexuals, while the decrease in anal sex was greater in bisexuals compared with homosexuals. These results may indicate a trend towards safer sexual behavior in this at risk population, but further studies are needed to support or refute these observations.

The study examined the hypothesis that the use of psychoactive substances is strongly associated with social deviance. Patterns of alcohol and drug use among two samples of deviant adolescents were investigated and compared to patterns of use among a sample of non-deviant youths. The participants were as follows: ninety-seven juvenile delinquents, inmates in institutions, aged twelve through eighteen; 184 detached youth, aged twelve through eighteen, who are in treatment programs of the Departments of Youth Advancement, Ministry of Education & Ministry of Welfare; and a nationwide representative sample of 8151 high school students, aged twelve through eighteen. Substance use was measured by three self-report indices: frequency of use during the last year, use during the last month, and use during the last week. The results clearly indicate that psychoactive substance use is concentrated among Israeli groups of deviant adolescents. These adolescents use all types of substances, licit as well as illicit, at rates considerably exceeding those found among high school students. However, a great similarity was found between the deviant groups of adolescents and the high school students in several personality correlates (sensation seeking, anxiety, depressive mood and learned resourcefulness) of substance use, and to a much lesser degree in its interpersonal correlates (perceived closeness to parents and to peers). The results' implications for prevention are discussed.

This study tests a multidimensional model of adolescent drug use. The model incorporates sociodemographic variables, personality variables (state and trait anxiety, depressive mood, and sensation seeking), cognitive variables (knowledge, attitudes, and intentions), interpersonal factors (relationships with peers and parents), and the availability of drugs. The model was tested in a longitudinal study, comprising two phases. A total of 1446 high school students served as subjects. The role of cognitive (attitudinal) and interpersonal factors (relationships with parents and peers) was confirmed. In addition, sensation seeking proved to have significant predictive power. Anxiety, depression, and sociodemographic factors, by contrast, had virtually no influence. Availability had a minor effect. The multidimensional explanation was validated longitudinally. The factors related to drug use at the first phase predicted use at the second. This multidimensional explanation accounted for the use of various substances, suggesting that different substances-whether legal or illegal-share a common multidimensional explanation.

We report a patient with diabetes mellitus who suffered severe falciparum malaria complicated by profound and persistent hypoglycaemia. The hypoglycaemia evolved before therapy with quinine was begun and resolved with eradication of the parasitaemia. The patient reverted to her baseline hyperglycaemia despite continuation of quinine. This case illustrates the critical role of falciparum malaria in the pathogenesis of malaria-associated hypoglycaemia, rather than quinine-mediated mechanisms. Anticipation of hypoglycaemia in falciparum malaria and its vigorous treatment may improve the poor prognosis associated with this complication.

We describe a case of a young adult who had chronic recurrent multifocal osteomyelitis that was diagnosed by exclusion and review the distinct clinical course of this disease. It is important to make a correct diagnosis so that unnecessary repeated invasive diagnostic procedures and prolonged use of antibiotics, steroids, or other chemotherapeutic agents can be avoided.

Epidemiological and sociodemographic findings on alcohol (wine, beer, hard liquor) consumption among the Israeli youth are presented. Three samples of adolescents, aged 12-18, were studied by means of an anonymous self-report questionnaire: a nationwide representative sample of high school students; a sample of detached youth; and a sample of inmates in institutions for juvenile delinquents. Alcohol consumption was assessed by three indices: frequency of use during the last year, use during the last month and use during the last week. Since alcohol is imbibed ceremonially in the Jewish tradition, only non-ritualistic consumption of alcoholic beverages was considered. Prevalence of drinking during the last year was 58%, during the last month 42% and during the last week 25%. Thus, it appears that Israeli youth are approaching the drinking prevalence of European adolescents. The results clearly indicate that alcohol consumption is concentrated among groups of deviant adolescents. These adolescents consume all types of alcoholic beverages at rates considerably exceeding those found among high school students. As for the effect of sociodemographic variables, the results strongly support previous findings showing that the patterns and contexts of alcohol use among Israeli youth are similar to those found among youth in other cultures.

Zidovudine has become the standard therapy for patients with AIDS and for asymptomatic HIV infected patients with low helper-T-cell levels. As experience with the drug has grown, knowledge of the range of side effects has increased. We describe progressive pigmentation of finger and toe nails in a white patient due to zidovudine therapy, a phenomenon not often described. Nail pigmentation occurs primarily in black patients. It appears to be reversible and relatively dose dependent. The mechanism responsible for the discoloration is unknown. It is important to alert patients to this side effect and to prevent unnecessary investigations and treatment for other diagnoses, such as cyanosis.

Streptococcus pneumoniae is an uncommon cause of infection in the female genital tract. An unusual case of postmenopausal pneumococcal tubo-ovarian abscess is presented. The pathogenesis of this infection probably entailed the ascent of bacteria from the vagina to the internal genitalia; there was no evidence of infection of the bloodstream or gastrointestinal tract.

Help-seeking preferences of parents of children with mental retardation were examined. A specially constructed Acceptance of Retardation Scale was administered to 25 fathers and 25 mothers. Respondents were asked to consider a number of need situations associated with their child's retardation and rate the likelihood that they would try to help themselves or seek external help from various sources. Results showed that mothers and fathers may have different help-seeking patterns. The fathers' help-seeking behavior seems to be instrumental, whereas mothers seem to be affected by ego considerations. Several demographic correlates of help-seeking behavior were also collected. Implications were discussed.

A sensitive method allowing the detection of mycobacteria by DNA probing has been developed. Besides the choice of a relevant probe encoding for part of the ribosomal RNA genes, the critical step allowing this high sensitivity was the method by which mycobacteria were lysed. Sonication of mycobacteria in the presence of chloroform followed by dot blot by this lysate gave the highest sensitivity in the detection of sequences homologous to the DNA probes.

We report two cases of pulmonary edema due to scorpion sting. Radionuclide ventriculography (MUGA scan) showed localized cardiac dysfunction. The cardiac injury induced by the scorpion venom persisted for a prolonged period.

We examined 122 patients with inflammatory bowel disease treated with salicylazosulfapyridine. Forty-two (34.5%) had adverse effects that led to discontinuation of therapy in 14 (11.5%). In 33 patients the effects appeared to be dose dependent. The plasma sulfapyridine levels in patients exhibiting gastrointestinal side effects were significantly higher than in patients with no adverse effects (41.0 +/- 20.3 and 23.8 +/- 14.8 micrograms/ml respectively, P less than 0.001). Plasma sulfapyridine levels were significantly higher in slow than in fast acetylators (31.5 +/- 17.1 vs. 22.2 +/- 17.1 micrograms/ml). Slow acetylators had three times as many side effects as fast acetylators; however this difference was not statistically significant.

This is the third report of an epidemiological study dealing with drugs, cigarettes, and now alcohol, amongst secondary school students in Israel. In the present report we describe general trends of alcohol use, draw socioeconomic profiles of alcohol drinkers, and investigate the relationship with cannabis use and cigarette smoking. Drinking patterns of the research population were studied during the 30 days prior to the administration of a questionnaire in order to devise a scale of their quantity of drinking in relation to a time sequence. Measures were also constructed for the drinking patterns of the family and friends of the research population. One of the overall conclusions is that a higher alcohol consumption is indicated amongst youngsters with a profile of delinquency, involvement with youth activities, personal problems and low parental control.

The following hypothesis has been tested: sensation seeking, A-state and A-trait, and depressive mood should positively affect adolescent substance use. The personality variables and alcohol and drug use were assessed among 1,900 Israel adolescents, 14 to 19 years old. The major findings were as follows: (a) Sensation seeking and availability significantly affected the "ever" and "current" substance use among adolescents. On the other hand, contrary to our hypothesis, neither A-trait nor depressive mood significantly affected substance use. (b) A-State affected the use of alcoholic beverages and nonprescribed medications. (c) The data emphasized the significant role of availability of drugs in the understanding of adolescents' substance use. The implications of these findings for interventions among adolescents are discussed.

The predisposing factors lined to drug involvement may be different for various types of youth, although the outcome is the same. In this sense a bimodal curve of drug involvement would indicate two types of highly involved youth: on the one hand, those from high social status families where low parental control implies a tendency to seek involvement with their peers and solve their personal adjustment problems within the peer group. On the other hand, those from the lower social strata for whom low parental control also implies association with outside peer groups as an alternative to shaky and diffuse families and lack of involvement in school life. This study on the cannabis involvement of 776 boys and girls (aged 14-18), drawn from eight schools, is an attempt to identify and describe these polar types of drug-involved youth in more detail.

We describe a patient who displayed the classic features of acute febrile neutrophilic dermatosis (Sweet's syndrome): sudden onset of erythematous plaques, fever, arthritis, and characteristic histologic findings. Unusual findings in her case were the localization of the lesions mainly on the legs, absence of leukocytosis and preceding illness, and marked neutrophilic infiltration in the subcutis. In addition, the fever and eruption subsided on the day the results of pathologic examination were available, making any treatment unnecessary. The short course of the disease in this patient suggests the possibility of postponing steroid treatment for one week in all patients with acute febrile neutrophilic dermatosis.

The aim of this study is to investigate the possible link between Shoham's personality-core theory [1] and addiction to hard drugs. Basing ourselves on Kleinean premises, that the oral stage is critical in the formation of behavioural patterns, which are influential throughout life, we hypothesize that in the oral stage two opposing vectors, 'separation' and 'participation' are initiated. By 'participation' we refer to the identification of ego with an external object or symbol, and continuous tendency to lose the personal identity by fusion with this object or symbol. 'Separation' is the opposite vector and expresses ego's tendency to incorporate the external object or symbol. These vectors form two multidimensional personality axes, on which the different personality types and behavioral patterns can be anchored. This study aims at investigating the connection between these two vectors and drug addiction. We view drug addiction as a functional behaviour pattern, which brings the individual to a state of internal balance. Shoham's personality theory hypothesizes the derivation of behavioural patterns of different personality 'types', according to the strength of the two vector - the 'separant' and 'participant' types. It is hypothesized that the drug use and the experience gained by using the specific drug by different personality types will vary according to the prominence of the core personality vector. The potency of these vectors is related to an early oral (participant) or a later oral (separant) fixation.(ABSTRACT TRUNCATED AT 250 WORDS)

The present study tries to link some demographic, social, psycholoogical and attitudinal variables of drug abuse. The findings were centred around the readiness of secondary school youth in Israel to be involved in drugs and their active searching for drug involvement. A dependent variable based on five indices of drug involvement was constructed. It was then related to parental control, peer involvement in drugs, sex differentiation and membership in youth movements. A bi-modal high involvement curve was found, the first mode consisting of youth of low socio-economic strata who are drop-outs, who associate with outside peer groups as an alternative to their shaky and diffused families and lack of involvement in school life. The other mode consists of youth with a higher socio-economic background who are involved with drugs due to their desire for new hedonistic and emotional experiences. Their openness to experiment with drugs is a corollary to their involvement within a peer group which condones and legitimizes narcotics as well as any experiences which irrespective of their source, provide "a good high". There is a sub-group within this group which would be involved with drugs as a partial escape from personal problems.

A 31-year-old patient presenting with fever of unknown origin, night sweats and weight loss, associated later with pulmonary nodules, is described. Multiple invasive diagnostic procedures, including exploratory laparotomy and open-lung biopsy, suggested a benign inflammatory granulomatous disease. Metastatic epithelioid sarcoma was ultimately diagnosed after biopsy of an enlarging groin mass. Epithelioid sarcoma should be considered in the differential diagnosis of prolonged fever, associated with granulomas of obscure etiology.

We investigated the relationship between the subjective perception of external stress and suicidal behavior, using a stress model which indicated that the probability of suicide and attempted suicide, as a reaction to stress, increases when social support systems fail or malfunction. We conceived the subjective perception of social stress as expressions of worry or dissatisfaction regarding cardinal life domains such as economic, security, or political situations. We defined support systems in terms of national solidarity expressed as positive (or improved) attitudes regarding the relations between various segments of the population, and we derived the data regarding the subjective indicators from continuing surveys of representative samples of urban Israeli population during the years 1967 through 1979. Eight stress indicators and three solidarity indicators were included, and our findings generally supported the theoretical model. However, the findings regarding men conformed best in relation to suicide, whereas those regarding women confirmed the theoretical model mainly in relation to attempted suicide. Contrary to the model, female suicide rates decreased in times of stress. Feelings of social solidarity in the population were found to reduce suicidal behavior of both men and women.

A 26-yr-old woman with chronic myeloid leukemia developed busulfan-induced ovarian failure. The ovarian failure was manifested by amenorrhea and climacteric symptoms and was verified by elevated plasma levels of luteinizing and follicle-stimulating hormones concomitant with low 17 beta-estradiol levels. The amenorrhea proved to be reversible when, during hematological relapse one year later, the patient was found to be four months pregnant. The busulfan which she was receiving at that time was stopped and amniocentesis revealed a normal karyotype. The remainder of the pregnancy was unremarkable and was terminated by the normal delivery of a healthy child.

One thousand nine hundred Israeli adolescents--51.8% males and 48.2% females--aged 15 to 18, were questioned twice about their current and "ever" substance use. The first study was undertaken during September-October 1982 and the second about a year later. The findings clearly indicated a slight rise in the incidence and a moderate growth of the prevalence of substance use among Israeli adolescents. The relationships between substance use and several background sociodemographic variables that were studied are discussed.