Rambam Medical Center Research Articles

Extracorporeal Shock Wave Lithotripsy for Large Ureteral Stones Using HM3 Lithotriptor

We assessed the efficacy of extracorporeal shock wave lithotripsy for large (more than 10 mm) ureteral calculi with the unmodified Dornier HM3 lithotriptor. A total of 96 consecutive patients with large ureteral stones were treated with shock wave lithotripsy using an unmodified HM3 lithotriptor. Patients, stone characteristics, preliminary treatment before shock wave lithotripsy, additional procedures after shock wave lithotripsy, complications and clinical outcomes were assessed. Between 2000 and 2003 a total of 96 patients (75 males, 21 females, mean age 51 years [range 16 to 81]) with large ureteral stones underwent shock wave lithotripsy. Average stone size was 14 mm (range 10 to 22), 90 stones were calcified, and 66 stones were located in the upper ureter, 20 in the mid ureter and 10 in the distal ureter. A total of 77 (80.2%) patients underwent a single shock wave lithotripsy session, 18 (18.7%) underwent 2 sessions and 1 (1.1%) patient underwent 3 sessions. The overall stone-free rate was 86.5% (83 patients). Complications occurred in 10 (10.4%) patients. Shock wave lithotripsy failed in 13 (13.5%) patients who were successfully treated with ureteroscopy. Our data show that shock wave lithotripsy for large ureteral stones along the entire ureter with the unmodified HM3 lithotriptor has a high success rate with minimal morbidity. We recommend it as first line treatment.

Fetal paroxysmal supraventricular tachycardia without heart failure leading to ischemic damage

Prenatal DiagnosisVolume 26, Issue 2 p. 187-188 Letter to the Editor Fetal paroxysmal supraventricular tachycardia without heart failure leading to ischemic damage D. Waisman, Corresponding Author D. Waisman Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelDepartment of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorA. Rotschild, A. Rotschild Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorM. Bardicef, M. Bardicef Department of Obstetrics and Gynaecology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorN. Zelnik, N. Zelnik Department of Pediatrics, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorR. Auslander, R. Auslander Department of Obstetrics and Gynaecology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorI. Kessel, I. Kessel Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorA Lorber, A Lorber Pediatric Cardiology Unit, Rambam Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this author D. Waisman, Corresponding Author D. Waisman Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelDepartment of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorA. Rotschild, A. Rotschild Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorM. Bardicef, M. Bardicef Department of Obstetrics and Gynaecology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorN. Zelnik, N. Zelnik Department of Pediatrics, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorR. Auslander, R. Auslander Department of Obstetrics and Gynaecology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorI. Kessel, I. Kessel Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this authorA Lorber, A Lorber Pediatric Cardiology Unit, Rambam Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, IsraelSearch for more papers by this author First published: 07 February 2006 https://doi.org/10.1002/pd.1374Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume26, Issue2February 2006Pages 187-188 RelatedInformation

Absence of HIV-Associated Nephropathy in Ethiopians

Population-based epidemiological surveys in several countries have shown approximately 10- to 15-fold increased susceptibility to human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) for populations of recent African ancestry. Accordingly, we sought to determine whether a similar or different pattern of susceptibility was evident among Ethiopians followed up in an HIV clinic in Israel. One hundred seventy-six consecutive patients (126 Ethiopians, 50 non-Ethiopian Israelis) followed up at the HIV clinic of Rambam Medical Center in northern Israel were examined for the presence of proteinuria and/or decreased glomerular filtration rate. HIV viral load, CD4 count, and treatment modality also were determined. Overall, 73% of patients were treated with highly active antiretroviral therapy, and there was no difference between Ethiopians and non-Ethiopian Israelis in this regard. Mean CD4 count in Ethiopians was 288 +/- 140/microL, significantly less than the corresponding CD4 count of 398 +/- 190/microL for non-Ethiopian Israelis. Mean viral loads were greater in Ethiopians compared with non-Ethiopian Israelis. None of 176 HIV-infected patients fulfilled clinical criteria for HIVAN as delineated in this study. HIV-infected individuals of Ethiopian descent have a level of susceptibility to HIVAN similar to that of non-Ethiopian Israelis, which is strikingly less than that reported for other populations for recent African ancestry. This does not appear to be attributable to differences in HIV infection control or viral subtype and most likely represents population-based differences in host genetic factors. This finding emphasizes the importance of avoiding generalizations with respect to phylogeographic ancestry in disease-susceptibility studies.

Type I Gaucher Disease and Parkinsonism: Prevalence of Parkinson Disease among Ashkenazi Family Members Who Are Carriers of Gaucher Disease.

Background: An association between patients suffering from Parkinson Disease (PD) and type I Gaucher disease (GD) was previously described (N Engl J Med, 2004). The goals of the present study were to report the frequency of Parkinson disease among the clinically unaffected family members of Ashkenazi GD patients who are obligate or known glucocerebrosidase (GBA) mutations carriers, and evaluate the clinical course in Type I GD carriers with concomitant manifestations of Parkinson disease (PD).Methods: A cohort of forty three consecutive unrelated Ashkenazi Type I GD patients followed at the hematology department in the Rambam medical center in Haifa, Israel were evaluated for a family history of PD.Results: Among forty-three families of Ashkenazi GD patients twelve had one or more relatives with PD. All these subjects were known obligate or identified as (GBA) mutation carriers for one of the common mutations among the Ashkenazi Jewish population namely N370S, 1604 or 84GG. The age of PD onset among GD family members carriers of GBA mutation ranged from 40 to 67 years with a mean of 53 years.Conclusions: A high rate of relatives with PD was found among GD patient's families. These results reinforce the association between GD carrier state and PD and suggest that glucocerebrosidase mutations might predispose to PD.PD in family members of Ashkenazi GD patientsAgeGenotypePD family historyAge onset1884GG/1604mother & 2 GF*50;552084GG/1226grandfather50591226/12262 uncles55311226/1226/nosister46181226/1226grandmother65271226/1226mother52181226/1226father & aunt70321226/12262 aunts (identical twins)55;67401226/1226/noaunt65611226/1226mother4081226/1226grandfather70131226/1226mother & aunt60;64* GF - Grandfather

Further Clinical Experience with Synthetic Mesh for the Entire Abdominal Wall after TRAM Flap Breast Reconstruction

Haifa, Israel From the Department of Plastic and Reconstructive Surgery, Rambam Medical Center. Received for publication July 8, 2004; revised November 16, 2004. Follow-up to Moscona, R. A., Ramon, Y., Toledano, H., and Barzilay, G. Use of synthetic mesh for the entire abdominal wall after TRAM flap transfer. Plast. Reconstr. Surg. 101: 706, 1998. Rony A. Moscona, M.D., Department of Plastic and Reconstructive Surgery, Rambam Medical Center, Ha'Aliya St. 8, Haifa 31096, Israel, [email protected]

Tolerability and feasibility of eptifibatide in acute coronary syndrome in patients at high risk for cardiovascular disease: A retrospective analysis

Background: Despite the beneficial effects of glycoprotein (GP) IIb/IIIa antagonists in patients with unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI), GP IIb/IIIa antagonists are rarely administered in general internal medicine wards in Israel, where most patients with UA/ NSTEMI are admitted, due to lack of adequate monitoring and safety concerns. Objective: The aims of this study were to compare the prevalence of bleeding complications in patients with UA/NSTEMI receiving combination treatment with eptifibatide (a GP IIb/IIIa antagonist), the low-molecular-weight heparin enoxaparin, and acetylsalicylic acid (ASA) versus that in patients receiving enoxaparin and ASA in internal medicine wards in Israel, and to identify risk factors for bleeding complications. Methods: This retrospective analysis included information from the database at Rambam Medical Center, Haifa, Israel. The database provided information from 4 of the 5 wards (the ward from which data were unavailable did not routinely use eptifibatide). Data were included from patients aged ≥l.8 years who were admitted to the center with a diagnosis of UA/NSTEMI, were at high risk for death and/or nonfatal ischemic events based on American College of Cardiology/American Heart Association guidelines, were to undergo coronary intervention, and who had a Thrombosis in Myocardial Infarction risk score ≥3 (moderate to high risk). Patients in the eptifibatide group received eptifibatide IV (180-μg/kg bolus followed by a continuous infusion of 2 μg/kg · min up to 72 hours), enoxaparin SC (2 mg/kg · d), and ASA (100 mg/d). Patients in the control group received enoxaparin SC (2 mg/kg - d up to 96 hours) and ASA (100 mg/d). The prevalence of bleeding events was assessed using data up to 24 hours after the end of study drug administration. Major bleeding was defined as life-threatening bleeding at any site, intracranial hemorrhage, or bleeding accompanied by a decrease in plasma hemoglobin concentration of 5 g/dL or more. Otherwise, bleeding was considered minor. The risk for bleeding events was assessed using multivariate regression analysis. Results: Data from 105 patients (64 men, 41 women) were included in the analysis. In the eptifibatide and control groups, the mean (SD) ages were 68.7 (11.1) and 74.8 (11.0) years, respectively. These characteristics were statistically similar between the 2 groups. The rates of major bleeding were similar between the eptifibatide and control groups (2 [3.8%] vs 0 patients). The rate of minor bleeding was significantly higher in the eptifibatide group compared with that in controls (11 [21.2%] vs 4 [7.5%] patients; P = 0.03). The incidence of thrombocytopenia was statistically similar between the eptifibatide and control groups (0 vs 2 [3.8%] patients). The risk for bleeding was found to be associated with eptifibatide use (odds ratio, 4.8; 95% CI, 1.29–17.80), whereas an association with treatment was not found in the control group. Conclusion: The results of this retrospective analysis suggest that the risk for bleeding complications is higher with combination treatment with eptifibatide, enoxaparin, and ASA compared with that with enoxaparin and ASA in high-risk patients with UA/NSTEMI admitted to internal medicine wards in Israel.

Nasopharyngeal Carcinoma in the Pediatric Age Group

Nasopharyngeal carcinoma (NPC) is rare in children, accounting for less than 1% of all malignancies. Radiation therapy has been the mainstay of treatment of many years, but to improve survival, the use of chemotherapy has been advocated. This is a retrospective analysis of 13 patients less than 20 years of age treated for NPC the Rambam Medical Center during 1989 to 2004. Eight boys and five girls with a median age of 14.5 years (range 10-19) were included. Median follow up (including patients who died) was 6.15 years (range 1-15 years). Duration of symptoms was 1 to 24 months (median 5 months). Of the 13 patients, one patient had stage I, 6 had stage III, 5 had stage IV-A, and 1 had stage IV-B disease. Ten patients (77%) had undifferentiated carcinoma (WHO type III) and three patients (23%) had nonkeratinizing carcinoma (WHO type II). Most of the children received two or three courses of neoadjuvant multiagent chemotherapy consisting of cisplatin and 5-FU, followed by radiotherapy with doses in excess of 60 Gy. One child received concomitant chemoradiation. Ten of the 13 patients (77%) are alive without disease 6 years after diagnosis (range 1-15 years). One patient developed local and distant metastases 1 year after diagnosis and is currently receiving combined radiochemotherapy. Two patients died. Overall survival was 84%; event-free survival was 77%. Nine patients (69%) developed moderate to severe long-term complications. Pediatric NPC is curable by combined radiation and chemotherapy, with doses of radiation in excess of 60 Gy. Long-term follow-up is important for early detection of second malignancies as well as for radiation-induced endocrinologic deficiencies and other normal tissue complications.

Percutaneous Tracheotomy in Bone Marrow Transplant Patients With Severe Thrombocytopenia

Evaluation of percutaneous tracheotomy in bone marrow transplant patients with severe thrombocytopenia. A retrospective outcome study. A retrospective study of 26 percutaneous tracheotomies was performed at the Bone Marrow Transplant Unit, Rambam Medical Center, Haifa, Israel. Age, sex, underlying disease, reason for intubation, complete blood count, coagulation profile, and the incidence of renal failure were collected. All patients received 6 units of platelets one hour prior to the procedure. The mean platelets count was 14,300 +/- 5500. Twenty-five of the 26 percutaneous tracheotomies were completed successfully, without any intraoperative complications. One patient suffered from moderate bleeding during the procedure, which was immediately stopped and converted to open tracheotomy. In the postoperative period 4 patients suffered from mild bleeding around the stoma, which was managed conservatively. No other late complications were encountered. Percutaneous tracheotomy can be safely performed in patients with severe thrombocytopenia when the surgeon and anesthesiologist are experienced in the procedure, and platelets are given perioperatively.

A Cognitive User Centered Redesign of a Radiotherapy Chart

We describe the human factors analysis and redesign of the radiotherapy paper chart used at the radiotherapy unit of Rambam Medical Center. The chart is a paper form used by multiple team members. It is the main record of relevant information and treatment orders. It also serves as the major follow up and quality control tool. As such, the chart is a major communication, reference and decision making aid, which has a direct influence on the treatment quality and patients safety and health. Analysis of the existing chart revealed multiple content and format design problems, which raise the probability of errors. The new design of the chart attempts to resolve these problems. At present, it has been adopted by the unit and hospital and is in the process of being produced and introduced to the unit.

Burying Trauma Memories May Reduce PTSD Risk

Back to table of contents Previous article Next article Professional NewsFull AccessBurying Trauma Memories May Reduce PTSD RiskJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:3 Jun 2005https://doi.org/10.1176/pn.40.11.00400008Although society may take a dim view of forgetting, doing so could have a“ silver lining”—helping shield a person traumatized by an event from developing posttraumatic stress disorder (PTSD).This notion is suggested by a study conducted by Israeli researchers and published in the May American Journal of Psychiatry.When a person experiences a traumatic event, he or she is known to be more likely to develop PTSD if certain risk factors are present, for example, preexisting psychiatric illness or physical injury. Several studies have also suggested that recalling the distressing event might be a risk factor for the disorder as well. So Ehud Klein, M.D., chair of psychiatry at Rambam Medical Center in Haifa, Israel, and colleagues conducted a study to determine whether this is the case.They enrolled 120 individuals who had sustained head injuries and were treated for their injuries at the Rambam Medical Center. Most of the injuries were mild and occurred in traffic accidents.Each subject was evaluated within 24 hours of the injury with the Memory of Traumatic Event Questionnaire, which these researchers had developed, they noted, since no such tool was available at the time of the study. This nine-item, self-report instrument asked about a subject's memory of the event; where the event took place; who was involved; when it occurred; sights, sounds, and odors associated with the event; things the subject remembered saying during or after the event; and things other people said during or after it.After the initial assessment, subjects were then assessed one week, four weeks, and six months later for PTSD symptoms. Two instruments were used in the follow-ups—the Clinician-Administered PTSD Scale and the Posttraumatic Stress Scale.The investigators then used the results to determine how well subjects recalled the excruciating events they had experienced and whether their recall could be linked with their subsequent development of PTSD.Within 24 hours after injury, the researchers found, 62 (52 percent) of the subjects had no memory of the event; 47 (39 percent) had a very good memory of the event, and 11 (9 percent) had a vague memory of the event. Thus, a bimodal distribution was evident (see chart). Consequently, a categorical approach was taken, with participants divided into two groups, with the median of the questionnaire scale used as the cutoff point. Thus, the subjects were referred to as either “having memory of the traumatic event” or“ having no memory of the traumatic event.” Accordingly, 55 (45 percent) subjects had memory of the traumatic event, and 65 (55 percent) subjects had no memory of it.Moreover, of the 65 subjects who had no memory of the event, four developed PTSD, compared with 13 of the 55 subjects with memory of the event—a highly significant difference.“The central finding of our study,” the researchers concluded,“ is that memory of a traumatic event is positively associated with the risk for development of PTSD, while lack of memory of a traumatic event decreases the risk and might, in fact, play a protective role. Thus, along with other factors, such as history of previous trauma, previous psychiatric morbidity, and physical injury, memory of a traumatic event appears to be another risk factor for PTSD.”Their finding also has a practical implication, the scientists pointed out in their report. Asking patients whether they can recall the event that traumatized them may help identify those at risk for PTSD.Their results, they added, likewise imply that “`deliberate' disruption of the memory of the traumatic event might prove therapeutically beneficial.” In fact, he and his team are now investigating whether it is possible to facilitate abolition of troubling memories by pharmacological means, Klein told Psychiatric News. And if it is possible, he said,“ we will then study the potential therapeutic benefit of such interventions.”In view of their finding that recall of a traumatic event may promote development of PTSD, Klein and his colleagues question whether therapies that“ elicit traumatic memories as part of the recovery process”—such as exposure therapy—may be counterproductive in some cases. Nonetheless, a number of studies have found that exposure therapy can help patients with PTSD.The study was funded by an internal grant from the Rambam Medical Center.The report, “Does Memory of a Traumatic Event Increase the Risk for Posttraumatic Stress Disorder in Patients With Traumatic Brain Injury? A Prospective Study,” is posted online at<http://ajp.psychiatryonline.org/cgi/content/full/162/5/963>.▪ Am J Psychiatry 2005 162 963 ISSUES NewArchived

Congenitally Missing Teeth in the Israeli Cleft Population

The purpose of the study was to determine the prevalence of congenitally missing teeth in a group of Israeli children with various types of clefts. Prevalence of congenitally missing teeth was determined for 179 children with cleft lip, cleft lip and alveolar ridge, cleft lip and palate, and cleft palate. Subgroupings were assessed according to patient sex, origin, cleft type, tooth type, and the side of hypodontia. The diagnosis of congenitally missing teeth (CMT) was based on initial and follow-up panoramic roentgenograms. In case of doubt, occlusal or periapical roentgenograms as well as clinical dental photographs were also used. Data collection was conducted at the Rambam Medical Center, Orthodontic and Craniofacial Unit, Haifa, Israel. In the total cleft group, 67.6% of the patients presented with hypodontia, totaling 246 missing teeth. A statistically significant difference was found in the distribution of patients with CMT of Jewish and minority origin according to sex. Cleft lip and palate was the most frequently affected group in which 195 teeth were missing. The most frequently missing tooth among the cleft population was the maxillary incisor. The order of frequency of the other missing teeth was the same as in the normal population. Hypodontia and malformations of permanent teeth were most common on the cleft side. The frequency of CMT in the Israeli cleft population studied was higher than in the intact population. This confirms findings in other populations worldwide.

81 Transperineal I-125 implants for early prostate cancer: Rambam Medical Center, Israel

81 Transperineal I-125 implants for early prostate cancer: Rambam Medical Center, Israel

An outbreak of Q fever in an urban area in Israel

Reported here is an outbreak of 21 cases of Q fever that were diagnosed during 5 months in the spring and summer of 2001 at Rambam Medical Center, Haifa, Israel. An epidemiological investigation and a case-control study were conducted to identify risk factors associated with acquisition of the disease in this outbreak. Patients were more likely than controls to live in Krayot (a large suburb of Haifa) (76.2% vs. 41.5%; p=0.005), to have more contact with animals (usually pets) (66.7% vs. 26.9%; p=0.007), and to consume more unpasteurized dairy products (23.8% vs. 0%; p=0.01). The Krayot suburb is an entirely urban area, but several livestock facilities are located in its close vicinity, and some of them have been reported to harbor Q fever. Although the patients did not recall having had direct contact with farm animals, the results suggest the presence of livestock facilities in such close proximity to a residential area may cause urban outbreaks of Q fever.

Improving the pattern of work towards emergency medicine at the Emergency Department in Rambam Medical Centre

Rambam Medical Centre is a 950-bed referral hospital, containing 34 beds in the Emergency Department (ED). The arrangement of the ED was based on two separate units: trauma and medical. Patient evaluation lasted many hours, with an abuse of consultants, laboratory and imaging services. To describe the improvement of patient management in our ED by changing working patterns according to emergency medicine guidelines. The trauma and medical units were combined into a one-unit ED, managed by one director and two specialists in emergency medicine. The goal of the ED was defined as the treatment and triage of patients towards discharge or admission in the minimal time needed. New protocols for clinical evaluation, blood and imaging tests, consultation facilities and pain management were implemented according to emergency medicine practice. Once a decision for admission is made, a computerized program assigns the patient to the appropriate ward. There was a dramatic reduction (44%) in the time needed for patient evaluation. The number of patients waiting more than 4 h and 8 h for admission was reduced significantly (11 versus 38% and 1 versus 24%, respectively). The total number of blood tests was reduced by 45%, and the number of blood and urine cultures by 81 and 87%, respectively. Two years after the change, the ED won first place in patient satisfaction screening. By changing work methods according to emergency medicine guidelines, and by using protocols written for emergency medicine, a significant improvement in our duties as an ED was achieved. The backing of the hospital management helped to implement the changes, which led to the functional improvement.

Sleep Problems May Cause, Worsen Children's Psychiatric Ills

Sleep Problems May Cause, Worsen Children's Psychiatric Ills

Reply

Diabetic MedicineVolume 22, Issue 4 p. 509-509 Reply D. Aronson, D. Aronson Department of CardiologySearch for more papers by this authorY. Levy, Y. Levy Department of Internal Medicine, Rambam Medical Center and Rappaport Faculty of Medicine, Haifa, IsraelSearch for more papers by this author D. Aronson, D. Aronson Department of CardiologySearch for more papers by this authorY. Levy, Y. Levy Department of Internal Medicine, Rambam Medical Center and Rappaport Faculty of Medicine, Haifa, IsraelSearch for more papers by this author First published: 21 March 2005 https://doi.org/10.1111/j.1464-5491.2005.1436b.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume22, Issue4April 2005Pages 509-509 RelatedInformation

Anxiety as a Predictor of Pain Magnitude Following Termination of First-Trimester Pregnancy

The purpose of the study was to investigate anxiety and other factors that may predict pain magnitude following termination of pregnancy (TOP) during the first trimester. Prospective, nonrandomized study. Department of Obstetrics and Gynecology, Rambam Medical Center in Haifa, Israel. Forty consecutive women undergoing TOP. Women undergoing a TOP were asked to fill out the State-Trait Anxiety Inventory. Pain magnitude was measured by using a visual analog scale (VAS) at 15, 30, and 60 minutes following the procedure. Correlations between state anxiety, trait anxiety, age, parity, number of TOP, gestational age, and pain magnitude were measured. State anxiety was able to predict pain magnitude on VAS 15 minutes after TOP (P = 0.023), and trait anxiety was able to predict pain magnitude on VAS 30 minutes after TOP (P = 0.013). Other variables failed to show significant results. Preoperative assessment of anxiety levels may lead to appropriate treatment in order to alleviate discomfort and ensure pain control outcome.

Developing the Role of the Social Worker as Coordinator of Services at the Surrogate Parenting Center

A law permitting couples to conceive biological children through surrogacy was legislated in Israel in March 1996. The Rambam Medical Center has established the only nonprofit Surrogate Parenting Center at a public hospital in Israel. The multidisciplinary teamwork at the Center is case managed by a social worker. An important role of the social work intervention is consultation and support for the couple and the surrogate at all stages of the process. The case study presented in the article illustrates the need for sensitive and professional intervention due to the complexity of the surrogacy process and the crisis it involves for both the surrogate and the couple. In light of the growing parenting surrogacy cases in the United States, Europe, and Israel, a structured social work intervention model is described, which may be implemented at public or private surrogate parenting centers.

Alginate composites containing vascular growth factors enhance scaffolds angiogenesis as a first step before hepatocyte transplantation: Felix Weisbuch, Rambam medical center, Haifa, IL Israel; Anat Peretz, Smadar Cohen, Ben Gurion Univ, Beer Sheva Israel; Larissa Shenkar, Gideon Shoshani, Rambam medical center, Haifa, IL Israel; Gera Neufeld, Technion inst of Technology, Haifa Israel; Yaacov Baruch, Rambam medical center, Haifa, IL Israel

Alginate composites containing vascular growth factors enhance scaffolds angiogenesis as a first step before hepatocyte transplantation: Felix Weisbuch, Rambam medical center, Haifa, IL Israel; Anat Peretz, Smadar Cohen, Ben Gurion Univ, Beer Sheva Israel; Larissa Shenkar, Gideon Shoshani, Rambam medical center, Haifa, IL Israel; Gera Neufeld, Technion inst of Technology, Haifa Israel; Yaacov Baruch, Rambam medical center, Haifa, IL Israel

Interferon treatment in children with chronic hepatitis B. 5MU/M 2 vs. 10MU/M 2: Hanoch Hager, Pediatric Gastroenterology Unit HaEmek Medical Center, Afula Israel; Corina Hartman, Drora Berkowitz, Rambam Medical Center, Bruce Rappaport school of medicine, Haifa Israel; Philippe Trougouboff, Department of Pathology HaEmek Medical center, Afula Israel; Nurit Rimon, Laboratory of Virology, Rambam Medical Center, Haifa Israel; Raanan Shamir, Rambam

Interferon treatment in children with chronic hepatitis B. 5MU/M 2 vs. 10MU/M 2: Hanoch Hager, Pediatric Gastroenterology Unit HaEmek Medical Center, Afula Israel; Corina Hartman, Drora Berkowitz, Rambam Medical Center, Bruce Rappaport school of medicine, Haifa Israel; Philippe Trougouboff, Department of Pathology HaEmek Medical center, Afula Israel; Nurit Rimon, Laboratory of Virology, Rambam Medical Center, Haifa Israel; Raanan Shamir, Rambam