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Michaelson-Cohen R.,Hebrew University of Jerusalem | Gershoni-Baruch R.,Rambam Healthcare Campus | Sharoni R.,Genetic Institute | Shochat M.,Raphael Recanati Genetic Institute | And 2 more authors.
Fetal Diagnosis and Therapy | Year: 2014

Non-invasive prenatal testing (NIPT) of cell-free fetal DNA in maternal plasma is a novel approach, designed for detecting common aneuploidies in the fetus. The Israeli Society of Medical Geneticists (ISMG) supports its use according to the guidelines stated herein. The clinical data collected thus far indicate that NIPT is highly sensitive in detecting trisomies 21 and 18, and fairly sensitive in detecting trisomy 13 and sex chromosome aneuploidies. Because false-positive results may occur, an abnormal result must be validated by invasive prenatal testing. At this juncture, NIPT does not replace existing prenatal screening tests for Down syndrome, as these are relatively inexpensive and cost-effective. Nonetheless, NIPT may be offered to women considered to be at high risk for fetal chromosomal abnormalities as early as 10 weeks of gestation. The ISMG states that NIPT should be an informed patient choice, and that pretest counseling regarding the limitations of NIPT is warranted. Women at high risk for genetic disorders not detected by NIPT should be referred for genetic counseling. A normal test result may be conveyed by a relevant healthcare provider, while an abnormal result should be discussed during a formal genetic consultation session. © 2014 S. Karger AG, Basel.


Aaron S.,Technion - Israel Institute of Technology | Aaron S.,Maria Fareri Childrens Hospital | Mainzer G.,Rambam Healthcare Campus | Lorber A.,Technion - Israel Institute of Technology | Lorber A.,Rambam Healthcare Campus
Catheterization and Cardiovascular Interventions | Year: 2012

Percutaneous closure of secundum atrial septal defect and patent foramen ovale has gained widespread use in recent years. We present a small series of four cases in which a "cobra-like" formation occurred in an Occlutech Figulla device during the deployment of the left disk, and propose a technique that may resolve this problem. © 2011 Wiley Periodicals, Inc.


Ofran Y.,Rambam Healthcare Campus | Ofran Y.,Technion - Israel Institute of Technology | Rowe J.M.,Rambam Healthcare Campus | Rowe J.M.,Shaare Zedek Medical Center | Rowe J.M.,Technion - Israel Institute of Technology
Current Opinion in Hematology | Year: 2015

PURPOSE OF REVIEW: Acute myeloid leukemia (AML) is a heterogeneous disease. Detection of minimal residual disease (MRD) has the potential to improve risk stratification, and its routine monitoring may allow timely therapeutic actions such as allogeneic hematopoietic stem cell transplantation. The current review will discuss challenges and available evidence for clinical application of MRD detection in AML management. RECENT FINDINGS: The heterogeneous nature of AML, variations in genetic aberrations and immunophenotypes among patients and between malignant subclones coexisting within a single patient, is a challenge for the development of a reliable MRD test in AML. MRD value was demonstrated in subtypes of AML in which reliable leukemia-specific genetic marker is present (e.g., core-binding leukemia, AML positive for NPM1 mutation). Multicolor flow cytometry and quantitative PCR monitoring for Wilms tumor 1 gene transcript have also been shown to correlate with disease progression. MRD results should always be interpreted within patient-specific clinical context considering other risk factors and timing of MRD eradication. SUMMARY: Introduction of MRD testing into routine clinical practice is a challenge in AML. An improvement in laboratory techniques along with identification of additional leukemia-specific markers is required. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Bar-Sela G.,Rambam Healthcare Campus | Hershkovitz D.,Technion - Israel Institute of Technology | Haim N.,Rambam Healthcare Campus | Kaidar-Person O.,Rambam Healthcare Campus | And 2 more authors.
Oncology Letters | Year: 2013

Human epidermal growth factor 2 (HER2) positivity rates for gastric or gastroesophageal junction (GEJ) adenocarcinoma have been reported at 15-25%. Cyclin D1 (BCL1) is a non-specific proliferative marker. The prognostic significance of HER2 and cyclin D1 is inconclusive, with contradictory data. The aim of this study was to evaluate the incidence of HER2 overexpression in gastric or GEJ patients. The presence of a possible correlation between HER2 status and cyclin D1 staining was assessed; both were evaluated as prognostic markers for survival. The clinical data and histological specimens of 150 consecutive patients diagnosed with gastric or GEJ adenocarcinoma, and treated at our hospital from June 2005 to March 2009, were analyzed. Pathological specimens were immunohistochemically stained for HER2. Immunoreactivity was determined according to the scoring system for gastric carcinoma. Cyclin D1 immunoreactivity was also tested. The results demonstrated that HER2 was positive in 14/150 (9.3%) patients. HER2-positive (HER2+) and HER2-negative (HER2-) patients did not differ significantly with regard to other clinicopathological parameters. In a multivariate analysis, HER2 positivity was revealed to be a poor prognosis variable (P=0.046; 95% CI, 1.03-3.58). In patients with non-metastatic disease, median survival was 59 months for HER2- and 42 months for HER2+ patients, but this difference was not significant. In patients with metastatic disease, median survival was 9.5 months and 2.5 months for HER2- and HER2+ patients, respectively (P=0.041). Cyclin D1 was not idemonstrated to be a prognostic factor and was not associated with HER2 overexpression. The rate of positive HER2 status in the current group of unselected patients with gastric and GEJ adenocarcinoma was relatively low compared with that observed in the literature. Nevertheless, HER2 positivity was associated with a poor prognosis.


Lehavi A.,Rambam Healthcare Campus | Lehavi A.,University of Queensland | Sandler O.,Rambam Healthcare Campus | Mahajna A.,Rambam Healthcare Campus | And 3 more authors.
Obesity Surgery | Year: 2015

Background: Rhabdomyolysis is a relatively uncommon, severe complication of anesthesia and surgery in the morbidly obese. As the use of propofol-based anesthesia has been associated with an increased risk of rhabdomyolysis and metabolic acidosis, this pilot study was designed to assess the effect of propofol anesthesia on the incidence of rhabdomyolysis in morbidly obese patients undergoing bariatric surgery. Methods: Thirty, morbidly obese patients (body mass index 43 ± 3 kg/m2) scheduled for bariatric laparoscopic sleeve gastrectomy were randomized to receive either propofol (P) or inhalational anesthetic (I)-based balanced general anesthesia. A sample of venous blood gas analysis including pH, bicarbonate concentrations, and calculated base excess was taken at the end of the operation. Creatine phosphokinase (CPK), troponin I, blood urea nitrogen, and creatinine plasma concentrations were measured at the end of the surgery and again 24 h later. Results: All patients enrolled to the study completed it without significant complications. CPK, troponin I, blood urea nitrogen, and creatinine plasma concentrations at the end of the operation and at 24 h, as well as the bicarbonate concentration and the base excess at the end of the operation were not significantly different between the two study groups. A statistically significant mild respiratory acidosis was noted in the inhalational anesthetic group (pH 7.30 ± 0.04 vs. 7.36 ± 0.02 in the propofol group) Conclusions: This small-size pilot study may suggest that propofol-based anesthesia is not related to increased incidence of rhabdomyolysis in morbidly obese patients undergoing short, uncomplicated bariatric surgery. © 2015, Springer Science+Business Media New York.


Amit A.,Gynecologic Oncology Unit | Person O.,Oncology Institution | Keidar Z.,Rambam Healthcare Campus
Current Opinion in Obstetrics and Gynecology | Year: 2013

Purpose of Review: To evaluate the role of fluorodeoxyglucose (FDG) PET/CT as cancer response testing in gynecological malignancies. Recent Findings: The application of FDG PET/CT in patients with endometrial and ovarian cancer to evaluate treatment response was found to have no clinical benefits.Patients with cervical cancer seem to benefit from the use of PET/CT in estimation of treatment response. The influence of different treatments on FDG uptake, timing, frequency of examination, and survival advantage are evaluated and discussed. Summary: Growing evidence supports an important role for functional imaging FDG PET/CT as a monitoring tool in patients with uterine-cervix carcinoma. Further studies are needed to establish the clinical benefits of this modality in this population. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Klein A.,ek Medical Center | Klein A.,Rambam Healthcare Campus | Gralnek I.M.,ek Medical Center
Current Opinion in Critical Care | Year: 2015

Purpose of review Acute, nonvariceal upper gastrointestinal bleeding (UGIB) is a common medical emergency encountered worldwide. Despite medical and technological advances, it remains associated with significant morbidity and mortality. Recent findings Rapid patient assessment and management are paramount. When indicated, upper endoscopy in patients presenting with acute UGIB is effective for both diagnosis of the bleeding site and provision of endoscopic hemostasis. Endoscopic hemostasis significantly reduces rebleeding rates, blood transfusion requirements, length of hospital stay, surgery, and mortality. Furthermore, early upper endoscopy, defined as being performed within 24h of patient presentation, improves patient outcomes. Summary A structured approach to the patient with acute UGIB that includes early hemodynamic resuscitation and stabilization, preendoscopic risk stratification using validated instruments, pharmacologic and endoscopic intervention, and postendoscopy therapy is important to optimize patient outcome and assure efficient use of medical resources. © Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Nikomarov D.,Rambam Healthcare Campus | Zaidman M.,Pediatric Orthopedic Surgery Unit | Katzman A.,Pediatric Orthopedic Surgery Unit | Keren Y.,Rambam Healthcare Campus | Eidelman M.,Pediatric Orthopedic Surgery Unit
Journal of Pediatric Orthopaedics Part B | Year: 2013

Sclerosing osteomyelitis of Garré continues to be a puzzling entity, with a nonspecific clinical description and course, an obscure pathogenesis, and no consensus on a predictable and helpful method of treatment. The proposed treatment options according to the literature are observation, analgesics and NSAIDs, and bone curettage. Here we present a 15-year-old girl treated by resection of a 12 cm-long lesion after failed conservative treatment, followed by bone transport using a circular external fixator. This treatment method has not been described previously for this condition. The duration of bone transport was 3 months, and the total duration of the frame treatment was 12 months. After hardware removal, and at 2.5-year follow-up, the patient was asymptomatic and achieved good functional results. To the best of our knowledge, this is the first description of bone resection and transport for the treatment of this condition, even though it is well described for the treatment of chronic osteomyelitis and other conditions necessitating bone resection. On the basis of this case we suggest that resection and bone transport using a circular external fixator for the treatment of sclerosing osteomyelitis of Garré might be an effective and safe method. Of course, being a rare entity, large cohorts are difficult to obtain, and more data and longer follow-up are required to form a convincing recommendation. Level IV evidence. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Blumenfeld Z.,Rambam Healthcare Campus
Expert Review of Obstetrics and Gynecology | Year: 2011

Premature ovarian failure (POF) is defined as ovarian failure and early menopause before the age of 40 years. This POF occurs in 1% of women younger than 40 and up to 0.1% women younger than 30, and may have different etiologic causes, such as genetic, autoimmune, iatrogenic, toxic, enzymatic, infectious and metabolic. The etiologic cause can be diagnosed in less than half of the cases. Signs of intermittent ovarian function in karyotypically normal women have been described, but predicting the probability of spontaneous remission in a specific woman is impossible. The possible beneficial effect of treatments such as immunosuppressive therapies, gonadotropin-releasing hormone (GnRH) agonists, exogenous high-dose gonadotropins and estrogen replacement, published in numerous anecdotal case reports, is unclear, and the cause-effect relationship has not been proven by prospective randomized studies. Therefore, in order to find effective treatments, basic pathophysiologic mechanisms must be better understood. For those women who want to conceive, it seems reasonable to attempt a corrective therapy based on defined etiology, before falling back on a donor oocyte program. Iatrogenic POF after chemotherapy has gained worldwide interest owing to significantly improved survival in the last three decades, and owing to the ability to preserve future fertility and ovarian function in many young female survivors of young-age malignancy. The attempts of IVF-assisted reproductive technologies and embryos or unfertilized oocytes cryopreservation, combined with ovarian tissue cryopreservation and coadministration of GnRH agonists in parallel to chemotherapy, may maximize future fertility and minimize long-term POF in these women. © 2011 Expert Reviews Ltd.


PubMed | Rambam Healthcare Campus
Type: Journal Article | Journal: World journal of gastrointestinal endoscopy | Year: 2016

To evaluate the impact of endoscopic ultrasonography (EUS) quality assessment on EUS procedures by comparing the most recent 2013-2014 local EUS procedural reports against relevant corresponding data from a 2009 survey of EUS using standardized quality indicators (QIs).Per EUS exam, 27 QIs were assessed individually and by grouping pre-, intra-, and post-procedural parameters. The recorded QI frequencies from 200 reports (2013-2014) were compared to corresponding data of 100 reports from the quality control study of EUS in 2009. Data for QIs added after 2009 to professional guidelines (added after 2010) were also tabulated.Significant differences (P-value < 0.05) were found for 13 of 20 of the relevant QIs examined. 4 of 5 pre-procedural QIs, 6 of 10 intra-procedural QIs, and 3 of 5 post-procedural QIs all demonstrated significant upgrading with a P-value < 0.05.Significant improvements were demonstrated in QI adherence and thus EUS reporting and delivery quality when the 2013-2014 reports were compared to 2009 results. QI implementation facilitates effective high-quality EUS exams by ensuring comprehensive documentation while limiting error.

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