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Breu F.X.,Practice for Vascular Medicine at the Tegernsee | Zelikovski A.,Medical Center | Loberman Z.,Assuta Medical Center | Rauh G.,Practice for Angiology
Phlebologie | Year: 2014

Background: The primary objective of the study was to demonstrate that Intermittent Pneumatic Compression (IPC) with the new ANGIO PRESS™ IPC device can significantly improve the walking distance, i.e. pain free initial intermittent claudication distance (ICD) and the absolute claudication distance (ACD) in patients with stage II peripheral arterial occlusive disease (PAD) compared to control treatment. Patients and methods: A total of 67 patients were screened and randomized into the study in four clinical centers based in Israel and Germany. Patients were randomized to one of the two study groups: 1. Medication treatment with ASS / Clopidogrel and standardized walking exercise with additional IPC treatment, two times per day for 1.5 hours for three months. 2. Medication treatment and standardized walking exercise alone. The safety and efficacy of the ANGIO PRESS™ device was determined for the treatment of symptoms of PAD Fontaine stage IIb by measuring the pain free walking distance, the absolute walking distance, the ankle-brachial-index (ABI) and the walking pain. Additionally the quality of life (QOL) of each subject was assessed according to the SF-36 questionnaire. Subjects were followed up at six weeks and 3 months. Results: No statistical differences were observed in any of the demographic characteristics and baseline scores. A significant difference was found between the treatment and control group in the ACD and the walking pain scale. Subjects in the treatment group improved their total walking distance in 54 meters, an improvement of 40% compared to their baseline distance. The walking pain improved by 1.89 points in the treatment group. Despite the fact that the difference in the ICD between the study groups were not found significantly different, the mean change from baseline in ICD score at the three month visit in the treatment group of 37 m was found statistically significant (p=0.0002), whereas the mean change of 20.7 m in the control group was not found significantly different. No changes were found between the study groups in the ABI and the QOL. The treatment was easy to tolerate and most patients suffered no side-effects, nor complained of any significant discomfort. Two subjects suffered from SAEs which were determined as not related to the study treatment. Conclusion: The ANGIO PRESS™ is a non-invasive, easy to use, home treatment which is safe and moderately effective for the treatment of intermittent claudication. The ability of subjects to improve their absolute walking distance and reduce the walking pain on the same time may offer a significant value for patients at early stages of PAD who are not indicated for an invasive treatment. © Schattauer 2014.


Sharir T.,Assuta Medical Center | Slomka P.J.,Cedars Sinai Medical Center | Hayes S.W.,Cedars Sinai Medical Center | DiCarli M.F.,Brigham and Women's Hospital | And 5 more authors.
Journal of the American College of Cardiology | Year: 2010

Objectives This prospective, multi center trial compared quantitative results of myocardial perfusion imaging and function using a high speed single-photon emission computed tomography (SPECT) system with those obtained with conventional SPECT. Background A novel SPECT camera was shown in a pilot study to detect a similar amount of myocardial perfusion abnormality compared with conventional SPECT in one-seventh of the acquisition time. Methods A total of 238 patients underwent myocardial perfusion imaging with conventional and high-speed SPECT at 4 U.S. centers. An additional 63 patients with a low pre-test likelihood of coronary artery disease underwent myocardial perfusion imaging with both technologies to develop method- and sex-specific normal limits. Rest/stress acquisition times were, respectively, 20/15 min and 4/2 min for conventional and high-speed SPECT. Stress and rest quantitative total perfusion deficit, post-stress left ventricular end-diastolic volume, and ejection fraction were derived for the 238 patients by the 2 methods. Results High-speed stress and rest total perfusion deficit correlated linearly with conventional SPECT total perfusion deficit (r = 0.95 and 0.97, respectively, p < 0.0001), with good concordance in the 3 vascular territories (kappa statistics for the left anterior descending coronary artery, left circumflex coronary artery, and right coronary artery were 0.73, 0.73, and 0.70, respectively; >90% agreement). The percentage of ischemic myocardium by both imaging modalities was significantly larger in patients with a high coronary artery disease likelihood than in those with a low and intermediate likelihood (p < 0.001). The average amount of ischemia was slightly but significantly larger by high-speed SPECT compared with conventional SPECT in high-likelihood patients (4.6 ± 4.6% vs. 3.9 ± 4.0%, respectively; p < 0.05). Post-stress ejection fraction and end-diastolic volume by the 2 methods were linearly correlated (r = 0.89 and 0.97, respectively). Conclusions The high-speed SPECT technology provides quantitative measures of myocardial perfusion and function comparable to those with conventional SPECT in one-seventh of the acquisition time. © 2010 by the American College of Cardiology Foundation.


Langier S.,Tel Aviv University | Landsberg R.,Tel Aviv University | Landsberg R.,Assuta Medical Center | Sade K.,Tel Aviv University | Kivity S.,Tel Aviv University
Rhinology | Year: 2011

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a T helper-2 (Th2) inflammatory disease with considerable impact on the quality of life. Staphylococcus aureus enterotoxins (SAEs) can induce and/or amplify inflammation. In this study, we investigated the immunomodulatory effect of SAEs on cytokine production by T cell obtained from nasal polyps (NPs) and examined whether neutralizing interleukin 5 (IL-5) can reverse the immunological effect mediated by those toxins. Methods: NP tissues were obtained from all patients who underwent endoscopic sinus surgery for CRSwNP. NP cells were isolated and stimulated in vitro with SAEs in the presence or absence of anti-IL-5. Flow cytometry (FACS) analyses were performed to measure specific T lymphocyte cytokine production. Results: Seventeen patients (mean age 48 years) were enrolled. SAEs significantly increased the IL-4, IL-5 (Th2) and interferon (INF)-γ (Th1) cytokines released from T lymphocytes of NPs. The addition of anti-IL-5 suppressed IL-4 and INF-γ release, which was most evident on NP tissue with high basal levels of IL-5. Conclusions: Neutralizing IL-5 is a potential therapeutic modality in patients with NPs, the effect of which is dependent on IL-5 levels.


Tenenbaum S.,Sheba Medical Center | Shabshin N.,Assuta Medical Center | Levy A.,Tel Aviv University | Herman A.,Sheba Medical Center | Gefen A.,Tel Aviv University
Journal of Rehabilitation Research and Development | Year: 2013

Heel ulcers (HUs) are the second most common pressure ulcers (PUs). Despite the significant morbidity and economic cost associated with HUs, there remains a lack of understanding of the basic pathophysiology of PUs because of limited basic research. There are only sparse data regarding the efficacy of prevention aids such as heel padding devices, and these data are based mainly on epidemiological research rather than biomechanical models and deformation measurements. This study was designed to explore the effects of foot posture and support stiffness properties on soft tissue deformations using magnetic resonance imaging (MRI). Subjects were scanned with and without weight bearing, in neutral external rotation position and in 90 degrees to supporting surface and with different heel padding devices. Tissue strains were calculated for skin, subcutaneous tissue, and effective (total) soft tissue. We found skin strains with the foot in external rotation to be significantly greater than when the foot was upright. Heel padding devices have a statistically significant effect on reducing the extent of deformations in both skin and subcutaneous tissues. Furthermore, the design features of heel padding devices have substantial influence on tissue deformations. This study demonstrates how MRI provides convenient, accurate, and quantitative comparison of biomechanical performances of heel padding devices.


Merenbakh-Lamin K.,Tel Aviv Sourasky Medical Center | Merenbakh-Lamin K.,Tel Aviv University | Ben-Baruch N.,Kaplan Medical Center | Yeheskel A.,Tel Aviv University | And 14 more authors.
Cancer Research | Year: 2013

Resistance to endocrine therapy occurs in virtually all patients with estrogen receptor α (ERα)-positive metastatic breast cancer, and is attributed to various mechanisms including loss of ERα expression, altered activity of coregulators, and cross-talk between the ERα and growth factor signaling pathways. To our knowledge, acquired mutations of the ERα have not been described as mediating endocrine resistance. Samples of 13 patients with metastatic breast cancer were analyzed for mutations in cancer-related genes. In five patients who developed resistance to hormonal therapy, a mutation of A to G at position 1,613 of ERα, resulting in a substitution of aspartic acid at position 538 to glycine (D538G), was identified in liver metastases. Importantly, the mutation was not detected in the primary tumors obtained prior to endocrine treatment. Structural modeling indicated that D538G substitution leads to a conformational change in the ligand-binding domain, which mimics the conformation of activated ligand-bound receptor and alters binding of tamoxifen. Indeed, experiments in breast cancer cells indicated constitutive, ligand-independent transcriptional activity of the D538G receptor, and overexpression of it enhanced proliferation and conferred resistance to tamoxifen. These data indicate a novel mechanism of acquired endocrine resistance in breast cancer. Further studies are needed to assess the frequency of D538G-ERα among patients with breast cancer and explore ways to inhibit its activity and restore endocrine sensitivity. ©2013 AACR.


Klement A.H.,Meir Medical Center | Koren-Morag N.,Tel Aviv University | Itsykson P.,Assuta Medical Center | Berkovitz A.,Meir Medical Center | Berkovitz A.,Assuta Medical Center
Fertility and Sterility | Year: 2013

Objective: To study the advantage of intracytoplasmic morphologically selected sperm injection (IMSI) versus intracytoplasmic sperm injection (ICSI) in the first artificial reproductive technology (ART) cycle and in consecutive cycles. Design: A cohort study. Setting: Single outpatient fertility center. Patient(s): Couples presenting with male factor infertility, requiring ovum micromanipulation. Intervention(s): The ICSI or IMSI was performed according to the couple's choice. Main Outcome Measure(s): Clinical intrauterine pregnancies and deliveries. Result(s): A total of 1,891 IVF-ICSI cycles and 577 IVF-IMSI cycles were included. In the first IVF treatment, pregnancy rates (PRs) were 46% and 47%, respectively, and delivery rates were 23% versus 30%, respectively. In the second cycle to follow a failed ICSI, PRs and delivery rates were significantly higher for patients who chose to shift to the IMSI technique compared with patients who chose to go through a second IVF-ICSI cycle (56% vs. 38% PRs and 28% vs. 18% delivery rates, respectively). In the following cycles a significant difference was demonstrated in both PR and delivery rates in favor of patients shifting between treatments. In a multivariate analysis an approximate threefold increased chance existed for both pregnancy and delivery only in the case of couples failing an ICSI attempt who shifted to IMSI. Conclusion(s): Our present experience supports refraining from repeated IMSI cycles. In light of improved PRs and delivery rates, we recommend promoting the IMSI method for couples who failed ICSI cycle, once or more.


Hershko-Klement A.,Meir Medical Center | Lipitz S.,Tel Aviv University | Wiser A.,Meir Medical Center | Berkovitz A.,Meir Medical Center | Berkovitz A.,Assuta Medical Center
Fertility and Sterility | Year: 2013

Objective: To describe the obstetric performance of a selected population of twin pregnancies, comparing reduced vs. nonreduced twin pregnancies after the successful completion of the 12th week. Design: Prospective cohort study. Setting: Outpatient fertility center. Patient(s): A cohort of 464 twin pregnancies including both ovulation induction and assisted reproductive technology pregnancies. Intervention(s): Fetal reduction. Main Outcome Measure(s): Pregnancy outcome and prematurity rate. Result(s): The study group included a cohort of 464 twin pregnancies in a single outpatient fertility center: 70 cases of twin pregnancies after a reduction procedure (15.1%) and 394 cases of nonreduced twins (84.9%). Of the nonreduced twin pregnancies, 8.6% went through an abortion, as compared with 4.3% in the reduced group. Mean age at delivery was also comparable between the two groups (35.8 weeks in the reduced group, 35.6 weeks in the nonreduced group), as was the rate of severe prematurity (3.3% in the nonreduced group, 2.9% in the reduced group). Conclusion(s): Our work supports a lack of causative relationship between fetal reduction and pregnancy endpoint. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


Tauman R.,Tel Aviv University | DeRowe A.,Tel Aviv University | Ophir O.,Assuta Medical Center | Greenfeld M.,Tel Aviv University | Sivan Y.,Tel Aviv University
Sleep Medicine | Year: 2010

Objective: Eustachian tube dysfunction and sleep-disordered breathing (SDB) share common pathophysiologic mechanisms. Our objective was to investigate whether children referred for isolated TTI (tympanostomy tube insertion) are at increased risk for snoring and upper airway procedures. Methods: Telephone interviews to parents of children who underwent isolated TTI and to age- and gender-matched controls were conducted. Results: Four hundred fifty-seven children were included in the study; 352 had isolated TTI (study group) and 105 children were controls. Twenty-two percent of children in the study group were reported to snore compared with 7.6% in the controls (p = 0.001). Eighteen percent of children in the study group were reported to have undergone adenotonsillectomy compared with 4.8% in the controls (p = 0.0005). Future SDB, i.e., either snoring or adenotonsillectomy following TTI, was found in 34% of children in the study group compared with 11% in the controls (p = 0.0004). Children who underwent isolated TTI were at increased risk for future snoring (OR = 3.4, CI: 1.6-7.2) and future adenotonsillectomy (OR = 4.4, CI: 1.7-11.2). Conclusions: Children who undergo isolated TTI are at increased risk for snoring and for adenotonsillectomy. We suggest that these children be followed for symptoms of SDB on a scheduled basis to allow for early diagnosis and intervention. © 2009 Elsevier B.V. All rights reserved.


Outsourcing is a method that enables an organization to focus on its expertise by transferring its other services to professionals who can fulfill them. In recent years, research has repeatedly shown that health services use a variety of outsourcing companies. To describe the experience acquired using outsourcing in public and private hospitals in Israel, and to present the factors, budgetary parameters, opportunities and problems affecting outsourcing. The questionnaire was sent to 36 hospitals in Israel, constituting 88.2% of all hospitals in Israel--private, public, H.M.O ("Clalit") and governmental. The response to the questionnaire reached 97.2% and revealed the following: 94% of the hospitals use outsourcing services in the following fields: security, cleaning, Laundry service, cafeterias, and I.T.; 42% of the hospitals assign 0-5% of their annual budget for outsourcing contracts. Private hospitals use more outsourcing services than public hospitals. The factors driving outsourcing are: cost restrictions (82.8%), operational flexibility (77%), and focus on the core business (74.2%). The potential advantages of outsourcing are: improvement in services 180.5%), customer satisfaction (72.2%), and cost reduction (69.4%). Difficulties affecting outsourcing are: dependence on external resources (83.3%] and internal organizational resistance (69.4%). The results of the outsourcing are lower costs, reduced number of personnel by 1-10% and high level of satisfaction. It seems that in recent years outsourcing is being used in hospitals and is central to the areas of infrastructure and logistics, as well as legal and medical services. Using outsourcing in hospitals provides opportunities for improved customer satisfaction, better focus for the hospital on its core activities and cost reduction. HospitaLs that succeed in synergetically integrating the external and the internal service providers will flourish. INNOVATION/VALUE: This research exposes, for the first time, the scope of contractual outsourcing in hospitals in Israel, and presents the dilemmas of utilizing this form of provision of services.


Gervasi E.,Latisana Civil Hospital | Cautero E.,Latisana Civil Hospital | Dekel A.,Assuta Medical Center
Arthroscopy Techniques | Year: 2014

Treatment of massive rotator cuff tears can be challenging, especially when tears are considered irreparable or, when repaired, at significant risk of retear. A surgical technique is described using a biodegradable subacromial balloon-shaped spacer (InSpace; Ortho-Space, Caesarea, Israel) that, when implanted between the humeral head and acromion, permits smooth, frictionless gliding, supporting shoulder biomechanics. The specific insertion technique described herein is a simple procedure that can be performed in a day-care or outpatient setting with patients under local anesthesia, thus providing a treatment option for patients with multiple comorbidities complicating or contraindicating surgery, such as reverse arthroplasty under general anesthesia. © 2014 Arthroscopy Association of North America.

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