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Weiniger C.F.,Hebrew University of Jerusalem | Weiniger C.F.,Stanford University | Spencer P.S.,University of California at Berkeley | Weiss Y.,Hadassah Hebrew University Medical Center | And 2 more authors.
Israel Journal of Health Policy Research | Year: 2014

Background: External cephalic version (ECV) is infrequently performed and 98% of breech presenting fetuses are delivered surgically. Neuraxial analgesia can increase the success rate of ECV significantly, potentially reducing cesarean delivery rates for breech presentation. The current study aims to determine whether the additional cost to the hospital of spinal anesthesia for ECV is offset by cost savings generated by reduced cesarean delivery.Methods: In our tertiary hospital, three variables manpower, disposables, and fixed costs were calculated for ECV, ECV plus anesthetic doses of spinal block, vaginal delivery and cesarean delivery. Total procedure costs were compared for possible delivery pathways. Manpower data were obtained from management payroll, fixed costs by calculating cost/lifetime usage rate and disposables were micro-costed in 2008, expressed in 2013 NIS.Results: Cesarean delivery is the most expensive option, 11670.54 NIS and vaginal delivery following successful ECV under spinal block costs 5497.2 NIS. ECV alone costs 960.21 NIS, ECV plus spinal anesthesia costs 1386.97 NIS. The highest individual cost items for vaginal, cesarean delivery and ECV were for manpower. Expensive fixed costs for cesarean delivery included operating room trays and postnatal hospitalization (minimum 3 days). ECV with spinal block is cheaper due to lower expected cesarean delivery rate and its lower associated costs.Conclusions: The additional cost of the spinal anesthesia is offset by increased success rates for the ECV procedure resulting in reduction in the cesarean delivery rate. © 2014 Weiniger et al.; licensee BioMed Central Ltd. Source


Keidar A.,Hadassah Hebrew University Medical Center | Hecht L.,Hebrew University of Jerusalem | Weiss R.,Hebrew University of Jerusalem
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2011

Purpose of review: Bariatric surgery is gaining acceptance as an effective and well tolerated treatment of morbid obesity in adults yet experience in obese children is still lacking. The purpose of this review is to highlight recent findings in this exciting field and identify the knowledge gaps. Recent findings: One randomized controlled trial and several case series have been published in the last 2 years regarding bariatric surgery for obese adolescents. These studies demonstrate relative safety along with significant weight loss. In addition, the vast majority of obesity-related comorbidities are resolved following these procedures. Adverse psychological effects of these procedures are probably more common than those in adults and need to be addressed. Summary: These publications indicate that bariatric surgical procedures, mainly gastric banding and gastric bypass, when performed on the right patients by skilled surgeons along with the appropriate ancillary staff, show positive metabolic effects and are well tolerated. Precise patient selection criteria, choice of the procedure and the extent of the multidisciplinary preoperative and postoperative care, are yet to be defined. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source


Kukuy O.,Institute of Nephrology and Hypertension | Livneh A.,Tel Aviv University | Ben-David A.,Institute of Nephrology and Hypertension | Kopolovic J.,Hadassah Hebrew University Medical Center | And 6 more authors.
Journal of Rheumatology | Year: 2013

Objective. Reactive (AA) amyloidosis may complicate familial Mediterranean fever (FMF), the prototype of autoinflammatory diseases. Thus, proteinuria in FMF is commonly viewed as resulting from amyloidosis, and kidney biopsy is deemed superfluous. However, nephropathy other than amyloidosis has been described in FMF, but its rate and distinctive characteristics are unknown. Our aim was to determine the rate and underlying pathology of FMF-related nonamyloidotic proteinuria and compare its clinical course, demographic, and genetic features to those of FMF-amyloid nephropathy. Methods. This study is a retrospective analysis of data from patients with FMF undergoing kidney biopsy for proteinuria above 0.5 g/24 h, over 10 years (2001-2011). Clinical, laboratory, genetic, and pathology data were abstracted from patient files. Biopsies were viewed by an experienced pathologist, as necessary. Results. Of the 25 patients referred for kidney biopsy, only 15 (60%) were diagnosed with amyloid kidney disease (AKD), and 10 were diagnosed with another nephropathy. The AKD and nonamyloid kidney disease (NAKD) groups were comparable on most variables, but showed distinct characteristics with regard to the degree of proteinuria (6.45 ± 4.3 g vs 2.14 ± 1.6 g, p = 0.006), rate of severe FMF (14 vs 5 patients, p = 0.022), and rate of development of end stage renal disease (73.3% vs 20%, p = 0.015), respectively. Conclusion. NAKD is common in FMF and, compared to amyloidosis, it is featured with milder course and better prognosis. Contrary to common practice, it is highly recommended to obtain a kidney biopsy from patients with FMF and proteinuria more than 0.5 g/24 h. The Journal of Rheumatology Copyright © 2013. All rights reserved. Source


Berkun Y.,Hadassah Hebrew University Medical Center | Eisenstein E.,Hadassah Hebrew University Medical Center | Ben-Chetrit E.,Hebrew University of Jerusalem
Clinical and Experimental Rheumatology | Year: 2012

The last two years have been marked by many studies trying to better characterise the clinical features of FMF in children and proposal of new treatment for those who are resistant to colchicine. In addition, many studies tried to address the potential effect of genetic modifiers on FMF and the potential effect of MEFV mutations on other inflammatory diseases. The main points arose from these studies include a breakthrough in the therapeutic approach for FMF and the lack of consistency regarding the reciprocal effect of MEFV mutations on other diseases and the effect of genetic modifiers on FMF. The highlights of these studies, their potential clinical implications and the unmet needs, which are still to be addressed, are summarised in this review. © Clinical and experimental rheumatology 2012. Source


Drenger B.,Hebrew University of Jerusalem | Drenger B.,New York University | Ostrovsky I.A.,Hebrew University of Jerusalem | Barak M.,Rambam Health Care Campus | And 3 more authors.
Anesthesiology | Year: 2011

Background: The possibility of restoring sevoflurane postconditioning (sevo-postC) cardioprotection in diabetic animals is uncertain. We hypothesized that attenuation of myocardial injury by sevo-postC might be hindered by inhibition of signal transducer and activator of transcription (STAT) 3-regulated activity of phosphatidylinositol 3-kinase (PI3K) in diabetic animals. To determine whether postC cardioprotection can be restored by normoglycemia, we treated rats with insulin. Methods: Diabetic or nondiabetic rats were randomly subjected to 30-min ischemia/reperfusion, with ischemic postC or sevo-postC, with and without mitochondrial adenosine triphosphate-dependent potassium channel blocker 5-hydroxy decanoate sodium and PI3K antagonist wortmannin. The infarct area, phosphorylated STAT3, and apoptosis were examined. Studies were repeated after insulin treatment. Results: Ischemic postC and sevo-postC significantly reduced infarct size by 50% in the nondiabetic rats (P < 0.002), a phenomenon completely reversed by 5-hydroxy decanoate sodium and wortmannin. Diabetes mellitus blocked the protective effect of postC, and insulin treatment to achieve normoglycemia did not restore cardioprotection. Phosphorylated STAT3 nuclear retention was significantly increased after ischemia-reperfusion and was further enhanced in response to ischemic postC (P < 0.05) but was significantly reduced in diabetic rats (by 43%; P < 0.01). Conclusions: The effective reduction in infarct size and apoptosis in the nondiabetic rat heart by postC was completely abrogated in diabetic rats. This inhibition is not relieved by insulin-induced normoglycemia. The PI3K pathway and mitochondrial adenosine triphosphate-dependent potassium channel activation are involved in the mechanism of postC. In diabetic rats, STAT3 activation was strongly reduced, as was postC cardioprotection, suggesting that the inability of insulin to restore postC may be attributed to diabetes-induced STAT3-mediated inhibition of PI3K signaling. Copyright © 2011, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Source

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