Dror Ashkenazi

Ha'Emek Medical Center, Naẕerat, Northern District, Israel

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Publications (6)4.58 Total impact

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    ABSTRACT: Foreign body aspiration is common in children, but there are no clinical clues that can determine or rule out the diagnosis before entering the operating room for bronchoscopy. The purposes of our study were to define the clinical characteristics of foreign body aspiration in the pediatric population and to evaluate the significance of delay in its diagnosis and treatment. The study used a retrospective review of 136 charts of children up to the age of 16 who underwent bronchoscopy for foreign body removal for 10 years in Ha'Emek Medical Center (Afula, Israel). An adult witness of an aspiration episode (most frequent presenting symptom), a child younger than 2 years, and an abnormal plain chest radiography were found to be significant predictors of foreign body aspiration. Estimated risk for foreign body aspiration was significantly higher in children who were younger than 2 years with an eyewitness for the aspiration episode and abnormal chest radiography (odds ratio, 5.6, with confidence interval from 2.0 to 15.6). The rate of complication was 2-fold higher in patients who arrived at the hospital 2 days or more after the aspiration compared with patients who arrived earlier. The rate of complication was 2-fold higher in patients who underwent bronchoscopy 24 hours or more after arrival at the emergency department compared with patients who underwent bronchoscopy within the first 24 hours. Delayed arrival of a child with a suspected foreign body aspiration at the hospital and delayed bronchoscopy were found to be related to a higher rate of complication.
    American journal of otolaryngology 04/2009; 31(5):320-4. · 0.77 Impact Factor
  • Dror Ashkenazi, Salim Mazzawi, Yoseph Rakover
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    ABSTRACT: Intraoperative bleeding during thyroidectomy can cause hemodynamic shock and even death. Efforts to control bleeding may prolong the operation and put at risk adjacent organs. Postoperative bleeding sometimes requires reoperation, and may prolong the hospitalization and the recovery period. There are different ways of achieving hemostasis-ligations, sutures, clips and coagulation methods. Ligasure is an electrothermal sealer, which seals vessels using physical pressure and electric bipolar coagulation. The device has been used in thyroid surgery in recent years. To describe the advantages and disadvantages in the use of Ligasure in the light of our experience and in the literature. (1) Retrospective review of 317 patients who underwent thyroidectomy, using Ligasure, in the period 2002-2005. (2) Summary of research results in which Ligasure was used. In the 317 operations there were no bleeding events nor was there any thermal damage to the recurrent laryngeal nerve. The use of Ligasure did not extend the operative duration or the rate of complications of recurrent laryngeal nerve palsy or hypo-parathyroidism. The use of Ligasure is effective in the prevention of operative bleeding in thyroid surgery, and it does not prolong the operative time nor raise the rate of complications. In comparison with other sealing methods we found Ligasure to be the most effective. The main disadvantage of Ligasure is its cost. We recommend the use of Ligasure in thyroid surgery.
    Harefuah 09/2006; 145(8):561-4, 632, 631.
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    ABSTRACT: Foreign body aspiration is common in young children. Delay in treatment may lead to complications and an emergency bronchoscopy must be performed in suspicious cases. Prevention is the most critical element needed to reduce this morbidity. To examine the demographic data of children at high risk of foreign body aspiration in order to develop precautionary measures oriented to this population. A retrospective review was prepared of all the charts of children under 16 years old who underwent bronchoscopy for suspected foreign body aspiration in Ha'Emek Medical Center during the period 1994-2004. The review presented a total of 136 children who had undergone bronchoscopy. Foreign bodies were found in 73% of the cases. Two thirds of the patients were male and two thirds were children less then two years old. The incidence of bronchoscopies that were positive for foreign bodies was higher in children less then two years old (82.6%) compared with older children (57.1%), p = 0.001. The incidence of Arab children was higher when compared to Jewish children and significantly higher than their percentage in the general child population (p = 0.001). The rate of bronchoscopies was 11 procedures per 100,000 children per year. In the majority of cases food was aspirated (82%) especially nuts and seeds. We found that children under the age of two years, male children and Arab children were at the highest risk of foreign body aspiration. Nuts and seeds are particularly dangerous and it is recommended to prevent young children from eating them. Well-defined public education programs should achieve prevention.
    Harefuah 09/2006; 145(8):569-71, 631.
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    ABSTRACT: Acute otitis media (AOM) in the neonatal period can be difficult to diagnose. This infection can be isolated and localized, or it may be associated with serious bacterial infections or other illnesses. The objectives of this study were to determine the clinical presentation, etiology, susceptibility pattern, and frequency of bacteremia, meningitis and other serious bacterial infections associated with the first episode of AOM in young infants. From July 2002 to August 2004, infants less than 12 weeks of age with confirmed AOM underwent tympanocentesis with culture of the middle ear fluid. Sepsis work-up was performed in all infants, and they were admitted to the pediatric department. Parenteral antibiotic therapy with a combination of ampicillin and gentamicin was initiated. Sixty-eight infants were diagnosed with AOM. The median age was 43+/-17 days, 17 infants (25%) were less than 4 weeks of age. Fever was present in 45 (66%) of the patients. Meningitis or bacteremia was not diagnosed in any of the cases. Concomitant urinary tract infection was diagnosed in six (8.8%) cases and broncholitis in seven (10.4%). Forty-seven bacterial pathogens were isolated from the middle-ear fluid. Streptococcus pneumoniae was the leading pathogen with 18 isolates (38%), followed by non-typable Haemophilus influenzae with nine (19%). Fourteen of the S. pneumoniae (78%) isolates were susceptible to penicillin and the other four (22%) were intermediately resistant. Three (33%) of the nine H. influenzae isolates were beta-lactamase producers. In our study, AOM in infants less than 3 months of age is a localized infection and it is not associated with severe bacterial infections. S. pneumoniae and H. influenzae are the leading pathogens. In our region, most of S. pneumoniae strains are still susceptible to penicillin. Although only small number of patients were under 4 weeks of age, the results of the present study raise the question of whether the current policy of a full sepsis work-up in neonates with AOM is relevant.
    International Journal of Pediatric Otorhinolaryngology 05/2006; 70(4):613-7. · 1.35 Impact Factor
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    ABSTRACT: Parathyroid carcinoma is a rare etiology of primary hyperparathyroidism characterized by severe clinical symptoms of hypercalcemia and markedly elevated serum parathormone levels. Nonfunctioning parathyroid carcinoma is an inactive form of the disease. There are less than 30 reports of nonfunctioning parathyroid carcinoma in the English literature and the association with parathyroid adenoma has not been described. This report describes a patient with concurrent nonfunctioning parathyroid carcinoma and a functioning parathyroid adenoma.
    American Journal of Otolaryngology 01/2006; 27(3):204-6. · 1.23 Impact Factor
  • Lev Shlizerman, Dror Ashkenazi
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    ABSTRACT: Peritonsillar infiltration of a local anesthetic solution for reduction of posttonsillectomy pain is commonly used although the benefit and complications of this technique have not yet been well established. We report a case of a 4-year-old boy who developed peripheral facial nerve paralysis after perioperative infiltration of bupivacaine and uneventful tonsillectomy. The paralysis was noticed a few minutes after extubation and resolved completely after 8 hours. We assumed this to be caused by the direct action of the local anesthetic agent on the facial nerve.
    American Journal of Otolaryngology 01/2005; 26(6):406-7. · 1.23 Impact Factor