[Neurocysticercosis in Israel].

BACKGROUND: Neurocysticercosis is the most common cause of adult onset seizures in developing countries. In recent years, with the rise in the number of immigrants to developed countries and travelers to endemic areas, neurocysticercosis is increasingly diagnosed in non-endemic countries. AIMS OF THE STUDY: The authors describe the clinical and epidemiologic characteristics of patients diagnosed with neurocysticercosis acquired in Israel or in immigrants to Israel from endemic countries. METHODS: A retrospective national survey of patients diagnosed with neurocysticercosis during 1994-2009 was conducted. Clinical and epidemiologic data were recorded. Case definition consisted of roentgenologic, serologic and pathologic features. RESULTS: In all, 17 cases of neurocysticercosis were diagnosed in Israel during the study period. Nine (53%) cases were diagnosed in travelers to endemic areas, and six (35%) in immigrants from endemic areas. Two cases were native Israelis who had never traveled to an endemic area. Most immigrants suffered from multiple brain lesions. Two immigrants underwent brain biopsy. CONCLUSIONS: This is the first report of the clinical and epidemiologic characteristics of patients diagnosed with neurocysticercosis acquired in Israel or diagnosed in immigrants to Israel. Neurocysticercosis must be included in the differential diagnosis of seizures, headache or neurologic deficit with single or multiple brain lesions, especially in immigrants from endemic countries. Invasive procedures may be obviated by appropriate clinical diagnosis, imaging and serology.

Effects of high-frequency chest wall oscillation on pleural pressure and oscillated flow.

The effectiveness of high-frequency chest wall oscillation (HF-CWO) is directly related to the level of oscillated flow (osc) in the airways. We used the Vest system to investigate the effects of HFCWO on chest wall and pleural pressures and we correlated these pressures to the resultant osc. We also compared the latest HFCWO device with it predecessor. Different combinations of vest inflation pressure (background pressure) and oscillation frequency were randomly applied to 10 healthy volunteers. Chest wall pressure was determined using an air-filled bag under the vest and pleural pressure was estimated using an esophageal balloon. Reverse plethysmography was used to measure osc at the mouth and a spirometer was used to measure changes in end-expired lung volume. We found a significant correlation between chest wall and pleural pressure with approximately one-third of the chest wall pressure transmitted into the pleural space. Mean esophageal pressure remained negative at all background pressure/frequency combinations. There was a significant correlation (p<0.0001) between the esophageal pulse pressure and osc, which was highest at 15Hz regardless of the background pressure. The end-expired lung volume correlated with mean chest wall pressure. There was no significant difference between the two Vest systems. Since osc dictates the effectiveness of HFCWO and since osc is dependent on esophageal pulse pressure, which in turn is dependent on chest wall pulse pressure, it follows that the effectiveness of HFCWO is influenced by the ability to generate an effective chest wall pulse pressure.