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hoarding places on this vulnerable population [14].
of elder neglect or abuse and speaks to the severe impairment
Furthermore, hoarding in the elderly is characterized as a form
PERFECTOR
This complicates efforts to characterize and treat the problem.
diagnosed for years (up to a decade) after onset of symptoms.
and hoarding [17-19]. Similar to PTSD, hoarding may not be
Scientists have linked genetic heritability of PTSD [16]
years of age [15].
of the general population, but as high as 6% in people over 55
every 5 years of life. Hoarding incidence is estimated at 2–4%
that hoarding prevalence and severity increases by 20% with
and depression. Furthermore, Cath and colleagues [14] found
age, and is correlated with social isolation, co-morbid anxiety,
begins around 40 years of age, increases in severity after middle
Roane and co-authors [13] concluded that hoarding onset
In a review of literature on hoarding in elderly populations,
nection in this population.
emerging anecdotal reports and related literature suggest a con-
hoarding and PTSD were found to be correlated [12]. However,
assessed PTSD among Jewish Holocaust survivors, although
We did not find any articles in the literature that directly
HOARDIng AMOng JEwISH HOlOCAuST SuRVIVORS
adjustments in diagnosis and treatment approach [11].
largely untreated PTSD symptoms, which are unique, require
contracted as friends died [11]. As Holocaust survivors age,
sions, children became independent adults, and social circles
[3]. However, with aging, individuals retired from their profes-
origin and developed strong social circles with other survivors
responsibilities. Most were disconnected from their families of
with PTSD symptoms by engaging in occupational and family
for treatment [4]. For years, these untreated individuals coped
suggest that the latter diagnosis is insufficient to provide a basis
chopathological symptoms exceed those of PTSD and some
Furthermore, as Jewish Holocaust survivors age, their psy-
productive lives.
Holocaust survivors, despite the fact that most had achieved
research published in the 1970s [10] identified PTSD among
KEY WORDS:
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phenomenon termed: a collusion of silence [4]. However,
#131118-COHANIM - 131118-COHANIM | 2 - B | 18-11-13 | 11:24:13 | SR:-- | Black
131118-COHANIM - 131118-COHANIM | 2 - B | 18-11-13 | 11:24:13 | SR:-- | Yellow
about their experiences and the world did not want to listen – a
131118-COHANIM - 131118-COHANIM | 2 - B | 18-11-13 | 11:24:13 | SR:-- | Magenta
treatment [3,4]. Second, many survivors did not want to talk
ing with symptoms, affected individuals did not get the proper
a distinct diagnosis with a treatment strategy. When present-
ing a time in history when the disorder was not codified into
several reasons. First, these individuals experienced PTSD dur-
Holocaust survivors were not assessed or treated for PTSD for
In the initial years following the end of World War II, Jewish
2
1
pTSD AMOng JEwISH HOlOCAuST SuRVIVORS
certain traumatic events prior to symptom onset [9].
highlighted an important association between hoarding and
nosis, including more instances of physical assault. The authors
#
Case CommuniCations Case CommuniCations Despite antifungal therapy, the patient’s FDG PET/CT images showed intensely change on the corresponding CT images. of many lesions did not show significant baseline PET images. The anatomical size higher FDG uptake compared with the some of the lesions showing significantly of the hepatosplenic fungal infection with PET/CT scans that revealed persistence he underwent a series of follow-up FDG clinical conditi
Pyoderma Gangrenosum and Extensive Aseptic although with the drawbacks of being neither inexpensive nor COnCluSIOnS
Chest Wall Abscess in a Patient with Inflammatory free of morbidity. In more recent years, guided biopsies have Surgical lymph node biopsy, if performed correctly, is likely
to yield an optimal diagnostic result. However, in view of
become the gold standard for tissue sampling since they are
Bowel Disease cost-effective and involve a simple and minimally invasive the invasive nature of the procedure, such biopsies should be
undertaken only in patients with a definitive indication or with
procedure that is associated with low morbidity. These proce-
dures may provide rapid information and direct approach when a high suspicion for lymphoma. The first percutaneous biopsy
Igor Snast MD , Iris Ostfeld MD , Lev Pavlovsky MD PhD , Emmilia Hodak MD and Anat Gafter-Gvili MD 2,3,4 facing a patient presenting with lymphadenopathy. Guided result can be uninformative, especially in patients with a his-
1,4
1
1
2
biopsies can be used on palpable or non-palpable lymph tory of lymphoma; however, occasionally the type of lymphoma
2
1
Departments of Dermatology and Medicine A, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel nodes. In the latter case, different techniques can be used, cannot be accurately determined. In these situations, repeated
3 Institute of Hematology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
4 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel such as endoscopic ultrasound-guided fine-needle aspiration percutaneous biopsies should be avoided and patients should
(EUS-FNA), endobronchial ultrasound-guided transbronchial be referred for surgery.
needle aspiration (EBUS-TBNA), and abdominal or thoracic
CT-guided biopsy. Needle biopsy is quick, does not require a Acknowledgment
general anesthetic, can be performed ambulatory, and has high The authors acknowledge the statistical assistance of Ms. Ronit Leiba
computed tomography (CT) scan depicted the thigh and chest wound revealed a diffuse overall sensitivity and specificity with low false-negative and MA, statistician, Quality of Care Unit, Rambam Health Care Campus,
KEY WORDS: aseptic abscess, inflammatory a large subcutaneous chest wall abscess dermal infiltrate of neutrophils extending false-positive results [13-18]. Haifa, Israel
bowel disease (IBD), neutrophilic extending within the pectoralis muscle into chest wall striated muscles, with focal In our study, 52 patients (44.1%) underwent percutaneous
dermatosis, neutrophils, pyoderma with sternal destruction. An incision was fibrinoid necrosis of blood vessel walls. biopsy prior to surgical consultation. Of these, 33 underwent Correspondence
Dr. y. Kluger
gangrenosum (PG) performed with drainage of purulent fluid. Laboratory evaluation demonstrated core-needle biopsy (FNB) only, 16 both FNA and FNB, and 3 Dept. of General Surgery, Rambam Health Care Campus, Haifa 3109601, Israel
IMAJ 2018; 20: 712–713 Broad-spectrum antibiotics were initiated. elevated inflammatory markers; negative FNA only. Since the most common pathologic diagnosis was fax: (972-4) 777-3527
Near the chest wound, two satellite rapidly serologies for hepatitis B/C, human immu- lymphoma, we decided to review the sensitivity and specificity email: y_kluger@rambam.health.gov.il
enlarging ulcers with undermined viola- nodeficiency virus, cytomegalovirus, and of percutaneous biopsy for detection of lymphoma. Our results References
ceous borders appeared. atypical bacteria; negative Mantoux and contrast the published literature, which reported higher sensi- 1. Zornoza J, Cabanillas FF, Altoff TM, Ordonez N, Cohen MA. Percutaneous needle
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ent, coincident, or subsequent associated nodule appeared, which rapidly underwent A diagnosis of chest wall AA with corresponding to a sensitivity of 89% and a specificity of 97%. 4. Diulus L, Chalikonda S, Pitt T, Rosenblatt S. Efficacy of laparoscopic mesenteric/
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