1. No category

(2007 ZBGZCV) 'C 'CGI ,146 LZM
FBGVZF
CP\ FPTZM\
QHGBF-\C \JGNCC \GCJ \G\B[ \GR[KF
WVI KCB
CKCB-N\ \JKSZCKRGB ,ZNYBS FBGVZN FJNGYVF ,KYSBZGS KBGVZ HMZP ,ZBGGX-[BZ KIG\KRG D"BB 'IP
NMN NTP G\GFHNG YKGEPC CXTF N[ FKPGJRBF \B ZKMFN [K
BN OKZYPC .IG\KRF \TC GC FTKDVP TRPKFN \RP-NT ,YVS
FC[ FNGTV NMP TRPKFN [KG ,YKGEP GRKB ZGJKRF OKJTP
.ECNC ZGJKRF NT BKF \GMP\SFF
FPGREB N[ \GKGR[KF \\KZM ZIBN FNIPF \GR[KFN QGMKSF
QGMKS OKKY[ ZIBP ,FGCD BGF QHGBF-\C \JGNC N[ \KVZGPGBKNV
QRKBG EK\TC FRTVG\[ \GVSGR \GKVGYSGZYKP \G\B[N FGCD
\PSZV\PF 'CIG QBKZHR N[ O\EGCTC .IG\KRF \TC QKTN \GBZR
ONT\FN [KG ,KEP ZXY CYTPF QPH ,'FBGVZF' N[ KIMGRF QGKNKDC
ZGTK[ \B FRGMR LKZTFN \RP-NT .\GBXG\F IG\KRC FH JCKFP
OKRKKXP[ KVM ,\GIVN OKR[ 10 N[ CYTP [ZER ,FNIPF \GR[KF
.ZPBPF KZCIP
-GBKNV \B[ \\KZM ZIBN FGCDF \GR[KFF ZGTK[ CYT
\GRZYFC NGVKJ NT OKNGIFP YNIC WNPGP ,\KR[R \KVZGP
FE[N \B[ KB\ (Spillage) \VKNE QF \GKZGFF .IG\KRF ZIBN
OZGD .FJGNCF N[ \GR[KR \G\B[ N[ CZ ZVSP \\KZMG IG\KRF
F\KKF FPM ET BGF QKZYFN BN[ FJNIFF NT TKV[FN KG[T[
OB :KRG[BZF IG\KRC \PN[GP \KIJ[F FRGBF \\KZM
FRGBC \BXPR \GR[KFF NM[ BKF FR[RF IG\KRC \GP[Z\FF
\B QKJGNIN UGVI\ \GPN[C F\\KZMG ,FJGNCF N[ \KIJ[F
CGYTNG GH F\KZMC YV\SFN [K KHB { OEGYF IG\KRF FE[ NM
OFC[ OKNGIC ,\BH \PGTN .FRKZYC NGVKJ BNN FNGIF ZIB
NT IGGEG ,ECNC \GRZYFC NVJN Q\KR ,FIK\R FRKB \B[F
NGVKJ KEK-NT \CIZR \B[ OT OKNGIC OD FNIPC FJKN[
.|4~ QGZJGKR \RKZYC
CXTF \B FVKYPF \B[ CYT OKRVF CXT \\KZMN SIKK\FC
FMKZX FCJ \B[ \\KZM LZGXN CXTF \\KZMN FKZGFF {
F[YF FBGNI\F CYT ,FRGZIB FZKZCMG \TE NGYK[C \G[TKFN
YZ \XNPGP CXTF \\KZM .\G\KPXNG ,OGZDN FNGNT GHM F\KZM[
CKZYFN KNCP FBGNPC \B[F \B \GZMN Q\KR BN OFC[ OKNGIC
OKZIBF OKZGHBF NMP ZCM F\ZMR \B[F Z[BMG ,CXTF \B OD
.\B[P QKJGNIN OKKYR F\KZMF \GNGCD \B[ NM GRKKFE ,F\GPN[C
GZP[N QGKSKR ZIBN ,CZGTPF URTF \B \GZMN [K FNB OKNGIC YZ
IYNRF ,Cable graft KEK-NT \ZMR[ TJYF \B ZHI[NG Q\KR[ NMM
QGZIBF FH OD OBG ,LGPSF Greater auricular-FP NNM-LZEC
.NDZC Sural-F CXTP ,\B[C CZGTP
-\C \JGNC N[ \KR[R \KVZGPGBKNV FPGREB \\KZM ,OGMKSN
\TC CMZGP NGYK[G \GRPGKP FMKZXPF ,F[Y FPK[P BKF QHGBF
111
Kew words: Tumor; Parotid gland; Pleomorphic adenoma.
[
QKCP \GIKM[F QF \KVZGPGBKNV FPGREB DGSP \GCJ \G\B
FNB OKNGIC NGVKJF .(Parotid) QHGBF-\C \JGNC \G\B[
\JGNC N[ \KIJ[F FRGBF NM \\KZMP YNIM \B[F \\KZM NNGM
\RPGJ (FKXBNYGRB) ECNC [GDF \\KZM[ QGGKMP ,QHGBF-\C
OKHMZPC ,\BH OT .Z\GK OKFGCD \GR[KF KZGTK[N QGMKS FCGIC
FJGNCF N[ YNI G\GB \B YZ \GZMN OGKM NCGYP ONGTC OKCZ
N[ QG\I\F YNIC FKGXP \B[F OB ,FPDGEN .\B[F \B NKMPF
OKVRTN KIJ[ BGF[ YNI G\GB \B \GZMN Q\KR ,FJGNCF
.OKRGKNTF OKVRTF \B QMSN BN LMG ,OKRVF CXT N[ OKRG\I\F
FBKZC FPYKZ BNN ECNC [GDF \\KZMP F\GFPC FRG[ GHM F\KZM
\GR[KFN QGMKSF \B FZKCDP FRKB[ QGGKMP ,(FKXBNYGRB) GCKCS
.\B[F
N[ \KIJ[F FRGBF N[ FBNP F\KZM \TXC\P[M OD
\KR[R OKNGIFP YNIC ,F\GPN[C \B[F \\KZM OT FJGNCF
,GH \B[ N[ \VJTPF FRCP CYT \KVZGPGBKNVF FPGREBF
\GR[KFN QGMKSF \B FZKCDPG (OKEGVGEKSV) \GKGJNC\FP FKGRCF
OGZDN NGNT IG\KRC \B[ KB\ N[ ZGHKV ,QM-GPM .FNIPF
NMC \GTGZHF \GR[R \G\B[ N[ CZ ZVSPC \RKKVGBPF \GR[KFN
,Z\GKC F[Y OK\KTN BKF GNB \G\B[ \\KZM .|1~ IG\KRF FE[
.|3,2~ FGCD BGF \VSGR \GR[KFNG OKRVF CXTC FTKDVN QGMKSFG
N[ KIMGRF QGKNKDC OSZV\PF ,'CIG QBKZHR N[ OZPBPC
OKIG\KR GZCT[ OKNGI 20 N[ FXGCY NT IGGEP ,'FBGVZF'
FZKCS FBGNI\ OT \KVZGPGBKNV FPGREB N[ \GR[KF \\KZMN
\G\KZM EEGTN [K .(OKRVF CXTC FTKDV 10%) IG\KRF \GCYTC
KVM { TGXKCN Q\KR ZCEF Z[BM FNB \G\B[ N[ IG\KRC
NGVKJM BGF FRKZYC NGVKJF N[ GPGYP .GH FZEKSC IGGEP QMB[
OKTDRF NM N[ FBNP F\KZM ZIBN ,ECNC (KJRCG'DEB) USGR
.Q\KR[ NMM ,OKR[RF
NMG CXTF N[ KBEG KGFKH NT FEVYF \PKKY GNB OKIG\KRC
.QMN OEGY FTXGC BN GH OB \KIJ[F FRGBF NM \\ZMRG ,GKVRT
FRGBF \B OD \GZMNP SGRP QKB OKNGIFP NJGCP BN YNIC
\G\B[F \TKZHN TYZYF F\KKF[ ,QHGBF-\C \JGNC N[ FYGPTF
FRGBF NM \\KZM GZCT[ OKNGIC ZYKTC ,KRG[BZF IG\KRC \GR[RF
NM \B EEGCNG \GFHN [K FNB OKNGIC .QG[BZF IG\KRC \KIJ[F
FZKCDPF FNGTV { FYGPTF FRGBF \B \GZMN HBG ,CXTF KVRT
GNB OKIG\KRC .IG\KRF ZIBN CXTF EGYVK\C FTKDVN QGMKSF \B
\VSGR FEKP YKRTPF ,OKRVF CXT ZGJKRC \GCGZY OK\KTN OKZHTR
:Z\GKC \RMGSP BKF ECNC ZGJKRF NT \GMP\SF LB ,QGIJKC N[
.\KVZGPGBKNV FPGREB ;QHGBF-\C \JGNC ;\B[ :I\VP \GNKP
(2007 ZBGZCV) 'C 'CGI ,146 LZM
Glas AS, Vermey A, Hollema H & al, Surgical treatment of
4.
Douglas JG, Einck J, Austin-Sevmour M & al, Neutron radio-
recurrent pleomorphic adenoma of the parotic gland: clinical
analysis of 52 patients. H & N, 2001; 23: 311-16.
therapy for recurrent pleomorphic adenomas of major salivary
glands. H&N, 2001; 23: 1037-42.
,ZBGGX-[BZ KIG\KRG D"BB \YNIP ,WVI KCB :C\GMP ZCIP
64239 CKCB-N\ ,6 QPXKG CGIZ ,KYSBZGS KBGVZ HMZP
;03=6973544 :QGVNJ
03=6974840 :SYV
khafif@tasmc.health.gov.il :N"BGE
OT GNB \G[Y \G\B[ \GZMN Q\KR \GRGMRF \GKZGFC .IG\KRF
N[ 'FBGVZF' QGKNKDC GH FZEKSC IGGEP[ KVM ,FZKCS FBGNI\
.'CIG QBKZHR
FKVZDGKNCKC
1.
2.
Koral K, Savre J, Bhuta S & al, Recurrent pleomorphic adenoma
of the parotid gland in pediatric and adult patients: value of
multiple lesions as a diagnostic indicator. AJR, 2003; 180 (11711174).
Carew JF, Spiro RH, Singh B & al, Treatment of recurrent
pleomorphic adenoma of the parotid gland. Otol H&N Surg,
1999; 539-542.
FYKRGZM
OKB\N \TV[ UKDR \ZKEI TRGP EKJVV
NGVKJ .OKZCMTF \GP \B QKJGNIN TRP \TV[ UKDRC FYCEF
ETGP \B FIEG FNIPF KRKPS\ \B Q\KP FYCEFF ZIBN
-DBPFF Z\BN Z[YR ZPGIF KM ,OKRKKXP OKZYGIF .F\GP\F
G\ZKEIG G\GZ[Y\F \B TRGP FH QVGBCG ,UKDRF N[ QKRKJGN
.(J Virol, 2006; 80: 11969) B\N
K"B
NT OKIGGEP ,'CIG KZ'X-WNG[ ,QKSRGYSKGGP OKZYGI \XGCY
.OKB\N \TV[F UKDR N[ FZKEIG FEPXF TRGPF ZPGI IG\KV
\B[ OZGDP YVGF[ EKJVV ,ZPGIF \B OKRMP OKZYGIF
\KCZ\C OKKGSKRC GPKDEFG ,"FSKRM TRGP" ,4 KJSNCGZCKV
\BG OKB\C UKDRF \GCZ\F \B QKJGNIN TRP BGF[ OKB\
KRVN FH ZPGIC NGVKJ ,OKZCMTC GMZTR[ OKKGSKRC .O\GP
CP\ FPTZM\
3.
FBGVZF
FYKRGZM
1918 \ R [ N [ \ T V [ F U K D R \ G P K N B
UKDRF ,\BH \PGTN .ZKCS QPHC FPKK\SFG \GPYZC UKDRF
NMN J[V\FG OKFGCD OKHGMKZN FCZ\F 1918 N[ ZHIG[PF
F\KKF F\ND\F[ FRGP\FG ,FBKZF \GKEBR NNGM ,FBKZF KZGHB
{ QGSKIF \MZTP KB\ N[ OKRKRS\G OGPKE ,OKB\ SZF N[
.G\GCZ\F BK[N TKDF UKDRF[ ZIBN OD FM[PR[ FTVG\
OKEEYPF OKRD NGTVK[N FPZD KGG[MT H1N1 UKDRC FYCEF
GHG ,OKVKDR KEDGRM OKTGEKF ,BVNB SGVKJP OKRGZVZRKB ZVSPN
UKDR N[ NGTVK[F \GNKTV ,\BH \PGTN .FRG\PF FNIPN FCKSF
.(Selective) \KRZKZCG FMGPR F\KKF FNB OKRD KCDN 1918
QGSKIF \MZTP N[ GH \PHDGP FCGD\[ ,OKTKXP OKZCIPF
FPZD[ BKF ,OKZKTX OKZDGC OEB-KRCC FBK[C FNKTVF ,FEKNP
FKKSGNMGB \XGCYC ZYKTC ,FVKDPC OKFGCDF F\GP\F KZGTK[N
.GH
GTCGF[ B[GRC \GPGE \GZT[F \GYHIP GH FEGCT \GBXG\
QG'D N[ GZVSC \RKKRTP FZGXC GDXGF UBG ,\GPEGY \GEGCTC
.250=248 'PT The Great Influenza KZBC
K"B
OKNB QH FKF 1918 \R[C \KPNGTF FVKDPF N[ \TV[F UKDR
OKKPERV OKRHP 25 KV OKFGCD F\GP\ KZGTK[N OZD[ ,EIGKPC
.ONGTF KCIZC [KB QGKNKP 40-P FNTPN NJYG OKZIB
\B GDKXF (Nature, 2007; 445: 319) 'CIG FSCGY
OKKGSKRC 1918 \R[P ZHIG[PF \TV[F UKDR N[ G\GNKTV
QGSKIF \MZTP FCKDP ,\TV[ UKDRC FYCEF \TC .OKVGYC
OKZGPBF OKZPGI { OKRKYGPMG OKRKYGJKX \ZKXKC FEKNP
OKRKYKNZJRKB QMG ,OKRGZVZJRKB GPM ,UKDRF \GCZ\F \B OGNCN
\NTVGP GH \MZTP .QGSKIF \MZTP KB\ \B NTV[N OKZGPBF
\[ZVFNG \YNEN \PZGD ,FYCEFFP \GT[ ET \GYE LG\
FNGNT GH \MZTP N[ \PHDGP \GNKTV .OKVKDR KEDGR OKZPGI
KB\ SZFN ,\GBKZC OKNHGR \GZCJXFNG \GPYZN OKYHRN OGZDN
.\GBKZC OE \VKNENG N\KVBF
SGVKJP \TV[ N[ KGG[MT QHC OKVGY GYKCEF 'CIG FSCGY
.SGVKJ G\GBP BGF UB[ 1918 \R[ N[ ZHIG[PF QHCG H1N1
N[ FRG\P FCGD\C KGVXM GCKDF ,FNKDZF \TV[C GNI[ OKVGYF
HGMKZN OB\FC F\KKF[ (Innate immunity) FEKNP \MZTPF
112