Bi-lateral eosinophilic ulcers in an infant treated with propolis.

BACKGROUND: Propolis is a natural substance, produced by the honey bee, containing amino acids, flavanoids, terpenes and cinnamic acid. It has long been used in folk-medicine for topical inflammatory conditions including ulcerative lesions of different aetiologies. METHODS: A 13-month-old female infant developed bilateral eosinophilic ulcers of the mouth, becoming the youngest patient in the literature so far reported to have done so. Following a protracted 4-month course, during which time the lesions remained unchanged despite various treatments, the ulcers were treated locally with a lanolin-based propolis ointment. RESULTS: Application of the propolis ointment was associated with the rapid resolution of the ulcers within 3 weeks and they did not subsequently recur. CONCLUSIONS: Although inevitably circumstantial, the abrupt healing of this child's chronic eosinophilic ulcers suggests that, in the light of its previously known therapeutic associations, propolis deserves further evaluation in the treatment of this condition, and perhaps in other forms of oral ulceration as well.

Breast lumps in men: four case reports and a literature review.

Four cases of men who consulted their family physicians because of breast lumps are reported. Their final diagnoses were as follows: intraductal carcinoma, gynecomastia, seminoma, and lipoma. A review of the literature revealed a lack of data on the prevalence of breast lumps among male adults, considerable ambiguity in clinical definitions of the term "gynecomastia," and a general uncertainty about the prevalence of malignancy in such lesions. Further epidemiologic studies are needed to determine the true prevalence and nature of breast lumps in men.

Methodological issues associated with an audit of stillbirth in a family medicine practice in Israel.

An audit of 'deficient outcome' involves the step-by-step analysis of every event preceding the occurrence of a preventable medical outcome in order to determine exactly what went wrong. This paper describes methodological problems and related issues associated with a deficient outcome audit undertaken on five stillbirths which occurred in a rural family medical practice in Israel between 1985 and 1987. Problems included initial official disinterest towards the audit, and the high levels of suspicion and antagonism which it aroused in hospital staff approached for information. The problematic aspect of such audits needs more attention. The importance of this type of audit for establishing the precise reasons for perinatal deaths, and thus for maintaining antenatal care standards is discussed. In view of the small numbers of such events likely to occur within any one family practice it is not only feasible but also desirable for more family doctors to carry out such audits routinely, despite the difficulties which are involved.

[A process audit of stillbirths in a rural family medical practice].

A process audit was undertaken of 5 stillbirths recorded in a rural family medical practice between 1985-1987. The stillbirth rate for this practice was 81/1000, as opposed to a national rate of only 4.5/1000 (p less than 0.015). The clinic records of the women, both before and during the affected pregnancies were reviewed in detail. In each case the family and hospital physicians involved were interviewed, as were 3 of the 5 patients. In 2 cases fetal death was recorded when the women were admitted to hospital after fetal movements had already been absent for more than 48 hours. The other 3 women were admitted while the fetus was still alive. The stillbirth occurred in the first of them at 38 weeks of a pregnancy complicated by maternal viral hepatitis A (no fetal monitoring for technical reasons), in the second at 39 weeks after continual fetal monitoring for 48 hours, and in the third at 41 weeks in a pregnancy complicated by pre-eclamptic toxemia. It was concluded that probably all 5 fetal deaths could have been prevented had there been more intensive instruction of the women in the correct interpretation of fetal movements, or if management after admission to hospital had been different.

Elective mutism: report of a case successfully treated by a family doctor.

Elective mutism is a rare psychological disorder of multiple etiology, wherein intellectually normal, nonpsychotic children, who can talk, remain silent with all individuals except a small group of intimate relatives and peers. Certain characteristics and relationship patterns are typically found in the family of the affected child. This report details elective mutism in a young girl in the author's family medicine practice and the treatment attempted by different therapists over a period of several years. Only when all other treatment had failed did the author, by default, accept responsibility for the case. Based on his special relationship as the child's family doctor, and one hypothetically valid interpretation of the function played by the girl's silence, the child's speech was unblocked within a short time and is the first reported case of elective mutism successfully treated by a family doctor.

A rural primary health care service in Israel--some measures of utilization and satisfaction.

Measures of use and satisfaction within a rural health service in Israel were surveyed in a study of the anonymous responses to a questionnaire from 110 mothers of children 14 years of age and younger in two agricultural villages. The majority of mothers expressed satisfaction with the health service, although there were notable reservations about the availability of certain services. Differences were detected between the reasons mothers recorded for initiating contacts with the medical team and the actual day-to-day experience of the health team members. Satisfaction with the service was associated with the length of the waiting time to see the physician, the perceived sufficiency of time the physician spent on the examination, and awareness that the physician was on call after clinic hours for the survey population. It was also found that the combined hospital use for the populations of 10 surrounding villages was almost twice that of the study villages. The findings are discussed in the context of both the immediate impact on the health service studied and the wider implications for primary health care in Israel. These include an identification of the health service with the physician and the potential medical and economic benefits of continued responsibility for care after clinic hours.

Circumplex model of family function in practice.

The recent dramatic resurgence in Israel of family medicine as a medical specialty has stimulated interest in concepts that view family function and dysfunction from the standpoint of family relationships and interaction, and in which the family is seen as a unit rather than as a collection of individuals. One model of family functioning, the circumplex model, is explained. This is based upon two dimensions, cohesion and adaptability. The potential relevance of this model to family medicine in Israel is discussed, along with a brief account of the author's initial steps in developing it for use as a tool in practice.

Drug hoarding in a rural community in Israel. Results of a pilot epidemiologic investigation.

The total quantity of drugs hoarded in a rural village in Israel was established as a result of a comprehensive house-to-house search. In 43 of the 44 houses in the village, hoarded drugs were found. The average number of different drugs found per household was 15.5 and the median number, 9.5. Analgesic and antipyretic drugs, topical skin preparations and antibiotics were found most frequently among a total of 166 identifiable medicines. The drugs found included 5,998 tablets and capsules, 3,327 ml of liquid preparations, 1,290 g of creams and powders and 369 suppositories and pessaries. These findings are discussed in relation to the drug expenditure of the largest Israel health insurance fund, the serious health hazards which they present, and their possible relevance to the total Israel population. The possibility of a "hoarding-prone" personality is raised.