Shlomo Mor-Yosef

Role of centralization of surgery in stage IB carcinoma of the cervix: A review of 498 cases

A review was undertaken of 498 patients with stage IB carcinoma of the cervix managed over a 15-year period in the Regional Gynaecological Oncology Centre, Gateshead. All but 4 were treated by radical hysterectomy, with adjuvant radiotherapy and/or chemotherapy for those with involved pelvic nodes. The overall 5-year survival in those with negative nodes was 91.4% compared with 50.5% in those with positive nodes (P less than 0.05). Of those dying from the disease, 7 patients only (1.4%) developed central recurrence, the remainder experiencing pelvic side-wall or distant recurrence. There was no difference in survival related to patient age. There were three deaths related to surgery and a fistula rate of only 1.2%. Bladder hypotonia and lymphocyst affected a minority of patients in the long term. The data support the case for radical surgery in stage IB carcinoma of the cervix, managed on a centralized referral basis.

Malignant melanoma of the uterine cervix: Case report and review of the literature

Malignant melanoma of the uterine cervix is an extremely rare manifestation, and neither retrospective nor prospective studies on this disease entity have been published. A patient with this disease entity is described. In addition, the data contained in 25 published case reports were collated in an attempt to clarify the origin, presenting symptoms, macroscopic appearance, and staging of the tumor. Although there is no consensus as to comprehensive treatment, radical hysterectomy is generally advocated. The prognosis in these patients is poor.

Is it time for a reconsideration of the criteria for cone biopsy

Between August 1985 and November 1988, 475 laser cone biopsies were performed at the Regional Gynaecological Oncology Unit in Gateshead. Of these, 332 were performed for abnormal cervical cytology and unsatisfactory colposcopy. The negative cone rate in this group was 34%. In those with cytological abnormalities up to and including mild dyskaryosis the figure was 64% and there were no cases of invasive disease. In this group the authors have reconsidered the criteria for cone biopsy and suggested biopsy of the visible ectocervical lesion combined with endocervical curettage or brushing. Those with negative histology or cytological abnormalities less than moderate dyskaryosis should be managed conservatively.

Familial gonadal germinative failure: endocrine and human leukocyte antigen studies

Two primary amenorrheic sisters were diagnosed as 46,XX pure gonadal dysgenesis. Their brother, a normal phenotypic and genotypic male, was azoospermic due to primary germinative failure. Parental consanguinity was observed, suggesting an autosomal recessive inheritance. This is the first reported family in which both an otherwise healthy male and two females were affected by gonadal germinative failure. Endocrine studies showed impaired gonadal function in the three affected siblings. The two females with gonadal dysgenesis and the azoospermic male shared one human leukocyte antigen haplotype; the second haplotype, however, was different. The common haplotype was also found in the oligomenorrheic sister whose gonadotropin-releasing hormone test was compatible with normal ovarian function, in the mother, and in one of her offspring who had a normal spermiogram. Hence, linkage between human leukocyte antigens and gonadal failure in this family had been excluded. The possible etiology of familial, chromosomally competent, gonadal failure is discussed.

Applying Lessons from Medical Management of Conventional Terror to Responding to Weapons of Mass Destruction Terror: The Experience of a Tertiary University Hospital

This article aims to summarize the accumulating experience of Hadassah University Hospitals in Jerusalem, Israel with ongoing terror attacks. The authors review their ongoing documented data from the first two years of the last wave of Palestinian terror attacks. Injury patterns and epidemiology of 1,916 terror victims are analyzed. The main finding is that terror is associated with significantly more severe and resource-demanding injuries than other forms of trauma. Main lessons and conclusions from managing this terror wave are presented. The authors believe that preparedness and application of lessons learned from conventional terror will enhance the durability of society against terror associated with weapons of mass destruction.

Terror Politics and Medicine: The Role of Leadership

The ongoing intensive wave of terror assaults against Israel is already approaching its fourth year. The endurance of the Israeli population to this hardship can be attributed, to a certain extent, to proficient leadership. Directing a tertiary university hospital, such as Hadassah, throughout this dire period has required distinctive leadership capabilities. Problems such as staff management during crisis, security, provision of information to the public and media, coping with the clinical routine, teaching and research activities and handling the economic burden, were all aspects of hospital administration that had to be taken care of. We believe that the core issue of medical management in time of terror attacks is establishing the right balance between the specific and peacetime routine. The measures taken to deal with these difficulties can serve as a model of contingency management in the field of medicine as well as other areas.‐

Ranking Risk Factors for Perinatal Mortality: Analysis of a nation-wide study

This paper analyses data from the Israeli nationwide perinatal census, with the aim of revealing the possible causes of perinatal death, and to assess the effects of risk factors, using a logistic regression analysis. The analysis provided an estimate of the net effect of each characteristic independently, thus identifying high‐risk pregnancies that should be monitored with greater intensity. Five variables were found to have a significant effect on perinatal death. Among these, in order of decreasing risk: fetal presentation, maternal diseases complicating pregnancy, number of fetuses, ethnic origin, and maternal age. Other variables such as parity, standard of hospital, the mothers country of birth and domiciliary circumstances, did not significantly affect perinatal mortality.

Neonatal Fetal Death Following Cesarean Section Secondary to Hyperextended Head in Breech Presentation

Abstract. There is a general agreement that infants with hy‐perextension in breech presentation should be delivered by Cesarean section in order to prevent spinal cord injuries and neonatal deaths. The following case report illustrates complete spinal cord transection in a fetus with hyperextended head in breech presentation delivered by Cesarean section who died 8 days after delivery.

A Co-payment for Consultant Services: Primary Care Physicians' Referral Actualization

Prospective evaluation of the effect of a new co-payment for specialists consultations on actualization of referrals (2,432 patient), was examined. Actualization of the appointment, reasons for not actualizing, and sociodemographic characteristics were recorded. Actualization was 85.1% in community consultation clinics and 91.7% in hospital outpatient clinics. The main reasons for non actualization were: inability to reach the clinic (53.4%), the problem had resolved (15%), and co-payment (2%). In addition, 19.1% stated that they did not actualize a past consultant visit due to co-payment. Referring physicians noted that co-payment had some effect on their decision, especially with the elderly or lower income patients. A relatively small compulsory co-payment was not found to have a long term effect on utilization of specialists’ services.

Caring for a major government official: challenges and lessons learned.

Objective:Analysis of the medical, organizational, and administrative issues surrounding the care of a dignitary in an intensive care unit. The Story:On January 4, 2006, Ariel Sharon, the Israeli Prime Minister was emergently admitted to the Hadassah–Hebrew University Medical Center in Jerusalem owing to a severe intracranial hemorrhage. Immediately following his admission, he underwent an extensive neurosurgical procedure to control the bleeding. Thereafter, he required intensive care for 5 months and underwent additional procedures. This admission presented organizational and administrative challenges. Organization of Medical Care:The major challenge was to provide the Prime Minister with the best medical care while avoiding the “very important person syndrome” and simultaneously continuing routine hospital activities. To coordinate his complicated medical management, a consultation forum was established composed of all the physicians directly involved in Mr. Sharons care. Additionally, a senior intensivist was chosen to coordinate the medical care and, along with a physician from the hospital administration, assist with administrative issues. Administrative Aspects:Among the issues that the coordinating team addressed, with the help of many other hospital services, included patient confidentiality vs. public information, security of the patients medical chart (including laboratory data and imaging), and coordination with security personnel. Conclusion:The acute care of a major governmental official requires the medical staff to address many administrative issues, while providing the “very important person” patient with appropriate intensive medical care. This article presents a strategy for addressing these issues.