Medipost Spring 2008
Dear Friends,
We at the Tel Aviv Sourasky Medical Center continue our work on behalf of the inhabitants of Israel. We continue to strive to offer them the finest care for the betterment of their health.
The project to construct the Sammy Ofer Heart Institute is progressing as planned. So far we have transferred all of the different functions that were in the old emergency room building and demolished it, while simultaneously beginning to dig out the foundations of the new building.
We remind you that at the base of the new hospital tower, we will be constructing an emergency hospital. The emergency hospital will be built to provide wide protection from a missile attack (both conventional and chemical) to some 600 patients. We are making every effort to speed up construction of the tower because who knows what
tomorrow will bring?! Still, we hope that we will never have to use it, and remain optimistic that the future may bring us quieter, better days.
We are currently planning several projects of critical importance, for which we will soon be seeking out resources and funding in order to see these projects come to fruition:
-
The construction of new modern pediatric out patient clinics near the Dana Children's Hospital.
-
The construction of a new cardio-vascular research center on the top floors of the Heart Institute building: Over the years, our cardiovascular research team has won national and worldwide recognition in basic and clinical research and has made major contributions in the fields of vascular biology, cardiovascular physiology and electrophysiology, atherosclerosis, interventional cardiology as well as cardiac imaging. We have developed focused research programs in cell biology and mainly vascular biology with groups at the Weizman institute and at the Tel Aviv University. The Comprehensive Cardio Vascular Research Center should facilitate communication between the various units and staff members, thus enhancing teamwork and research productivity. Our vision is to build a Research Center that will provide an environment that will foster public and patient awareness, research activities and innovative approaches to all aspects of cardiac patient care.
I wish you, dear friends, a happy Pesach, a beautiful spring and many, many smiles.
Yours,
Ronit Blum, Director
Association of Friends
DONATIONS:
The Claims Conference continues to support generously for the benefit of Tel Aviv's elderly population, and particularly the Holocaust survivors among them. Recently another generous donation has been approved for the construction of two new internal wards in the Heart Institute Building. The old wards will be moved from their current home in the old hospital building. We hope to complete this important project by 2010.
Wolfson Family Charitable Trust
The Wolfson Family Charitable Trust recently donated funds towards the purchase of another linear accelerator for the Radiology Institute. This is the third accelerator that has been purchased with the Wolfson Family Trust's generous help.
Crown Family Foundation
Through the Chicago Jewish Federation, the Crown Family Foundation continues to help our medical center, most recently through a generous donation that helped us purchase a new digital mammography machine for the Breast Institute.
Esther Lewkowicz
Another generous donation that was earmarked for this purchase of the mammography machine was made on behalf of Esther Lewkowicz of Belgium, a long-time benefactor of the hospital who has always been so generous to our hospital through the Keren Hayesod.
The Ellran Foundation
The Ellran Foundation has committed to donating $250,000 towards the construction of an occupational therapy institute that will be able to help the elderly population we treat. The institute will both preserve and better the lives of our elderly patients by improving their functionality and their quality of life.
Many thanks to all of our generous benefactors.
DONOR EVENTS:
Tel Aviv Sourasky Medical Center
In memory of
Rabbi Israel Miller z"l
President of the Claims Conference
1983-2002
Rabbi Israel Miller, of blessed memory, was the president of the Conference on Jewish Material Claims Against Germany, an organization that supports Holocaust survivors. On a tour of one of our internal medicine wards in 2000, Rabbi Miller was shocked and distraught by the conditions under which the elderly patients, many of them survivors, were hospitalized in the old building. At that moment he decided that the time had come to change those hospitalization conditions and make things better. The elderly and infirm of Tel Aviv, he said, would no longer suffer abominable hospitalization conditions, and the rest, as they say, is history.
From that day since, the Claims Conference has contributed to the renovation of three internal medicine wards and their move to new quarters. Now, with the help of the Claims Conference, there's a new floor to the Rehabilitation Building that houses our geriatric services , and they have recently approved additional support for the construction of two new internal wards in the Sammy Ofer Heart Institute-whose construction began recently.
We wish to express its heartfelt gratitude for Rabbi Miller, of blessed memory. Recently, we held a wonderful ceremony, attended by the Miller family members, the management and board of directors of the Claims Conference in the diaspora and in Israel, as well as the management of the TASMC. The inspiring ceremony dedicated the Lobby in the name of Rabbi Miller (which is located at the second floor near the Internal Wards). May his memory be a blessing to us all.
NEW MEDICAL SERVICES:
A New Center for Experimental and Clinical Application of Cell Therapy and Immunotherapy of Cancer and Non-Malignant Indications
Recently a new center for experimental and clinical application of cell therapy and immunotherapy of cancer and non-malignant indications was established at the Tel Aviv Sourasky Medical Center. Prof. Shimon Slavin, the former director of Israel's National Center for Stem Cell Transplantation (Cancer Immunotherapy) at the Hadassah Medical Center in Jerusalem will serve as the Scientific and Medical Director of the International Center for Cell Therapy & Center (ICTC). The new center was established with the generous donation of Mr. Ilan Ben Dov and his non-profit organization and supported by Prof. Slavin's association, both joining efforts to promote new approaches for treatments of otherwise incurable malignant and non-malignant diseases. The ICTC includes an outpatient service for treating patients in need on the top floor of the Arison Medical Tower, and state of the art research laboratory and cell processing center on the 6th floor of the old hospital building . The 1,200 m2 (13,000ft2) research laboratories will be used for basic and applied research focusing on development of new therapeutic procedures, based on innovative basic science. The cell processing center includes GMP rooms, three positively pressurized to ensure maximal sterility of cell cultures used for treatment of cancer and for rehabilitation of damaged tissues, and two negatively pressurized clean rooms to allow safe handling of therapeutic cancer-seeking viruses for the treatment of otherwise resistant malignancies.
The ICTC aims to collaborate with both in-house and external investigators and medical centers interested in pre-clinical and clinical research, focusing on development of new therapeutic procedures based on immunotherapy and cell-therapy for the treatment of malignant and non-malignant indications. The new center will also focus on the use of stem cells isolated from patients own bone marrow for repair of bone and cartilage, certain cardiovascular diseases, neurological disorders including multiple sclerosis and spinal injuries.
The ICTC will consist of state of the art technologies to procure, select and manipulate blood, bone marrow and cord blood derived stem cells and lymphocytes for adoptive cell-mediated immunotherapy of cancer, induction of transplantation tolerance to bone marrow and organ allografts and regulation of autoimmune diseases. For cancer patients the center will provide personalized anti-cancer modalities, not excluding allogeneic stem cell transplantation focusing on the use of haploidentically mismatched stem cells, following reduced intensity conditioning, using tumor cell vaccines and oncolytic viruses for selective targeting of residual cancer cells in patients with metastatic disease. Our goal is to try and cure cancer by eradication of invisible minimal residual disease in high risk patients at an early stage of the disease. For patients with recurrent metastatic disease an attempt will be made to achieve a transient stage of minimal residual disease by conventional or high dose chemotherapy supported by autologous stem cell transplantation and then attempt to delay, control or possibly eradicate residual disease with targeted immunotherapy. A multi-disciplinary approach for regenerative medicine is currently in progress. The facility started operation in January 2008.
We welcome fruitful discussions and potential collaborations in basic and applied research with investigators in academic centers and pharmaceutical industries towards productive joint efforts for faster progress in clinical application of innovative procedures based on clinical application of the best of basic science at the patient's bedside.
New Neuro-Radiology Interventional Service
The past decade has witnessed an exponential growth in the scope of diseases amenable to neuro-endovascular intervention and treatment. A new Neuro-radiology Interventional Service initiated in the Tel Aviv Sourasky Medical Center last year is headed by Dr. Shimon Maimon, one of Israel's top imaging physicians and a world leader in this field. Imaging, diagnosis and treatment of patients with a pathology of cranial (head and neck) blood vessels is performed by this service, which offers treatment to patients who suffer from Brain Arteriovenous Malformation (AVM) and Fistula (malformed pathways between blood vessels); the narrowing of blood vessels in the skull, neck and in the brain; brain aneurysms (where blood vessels in the brain area become locally dilated); intra-cranial tumors and various spinal cord diseases. The service offers a comprehensive approach applying advanced techniques such as the insertion of coated stents into the brain's most delicate arteries, with the ultimate goal of preventing the need for surgical intervention.
These procedures are performed under general anesthesia, since the margin of error for the instrumentation is calculated in millimeters as the circumference of the catheters used measures between 0.3-4 mm.
After acquiring significant experience in intra-cranial vascular procedures, we wish to expand this service and offer it to acute stroke patients. Each year more than 1000 stroke patients are admitted to the TASMC. This large number - which exceeds that of any other hospital in Israel - is the result of the highest prevalence of elderly citizens living in Tel Aviv. With the current conservative treatment, 10% to 15% of stroke patients will die in hospital, and 20% -25% within a year. Moreover, 60% of the survivors be left with neurological deficiencies and functional disability. The implementation of this new and advanced therapeutic approach will substantially reduce these devastating outcomes. We hope to be the first to introduce the comprehensive therapeutic concept in Israel and allow our stroke patients to benefit from it.
This interventional neurovascular approach can also be incorporated in the treatment of acute stroke. We operate a multidisciplinary stroke team, headed by Prof. Nathan Bornstein --a world leader in this field. -The team includes vascular neurologists, critical care physicians, a neuro-radiologist and the interventional neuro and endovascular operator.
Similar to the approach in heart attacks, after an expedited diagnostic process -- efforts are made to dissolve the clots that block blood supply to the brain tissue (i.e. Thrombolysis), or even intervene by an endovascular technique allowing the clot to be "pulled out" and blood flow to be restored to the brain.
Opening a Pediatric Endocrinology and Diabetes Service
Recently, the Dana Children's Hospital opened a pediatric endocrinology and diabetes unit, under the direction of Dr. Naomi Weintraub who was recently recruited from the Schneider Children Hospital.
Diabetes can turn up even in babies that have no genetic background or tendencies. Therefore it is of such importance to diagnose it in time and treat it with insulin so that the acidity of the blood won't fall and cause complications that could affect all of the organs in the body.
The institute also treats growth problems for children. Early puberty can cause early bone growth and thus can affect the final height of the child.
For The First Time In Israel, Two Patient Suffering From Treatment-Resistant Depression Received A Vagal Nerve Stimulator Implant (VNS)
The surgical procedure was conducted by Prof. Itzchak Freed head of the Functional Neurosuregery unit and Prof. Dan Fliss head of ENT Department, at the Tel Aviv Sourasky Medical Center. The VNS is the only FDA-approved implantable device approved for the treatment of depression. The device is situated in the neck and when in place it can be programmed externally, to transmit repeated electric stimuli to the Vagus nerve. Apparently, such stimulation, when given over a period of several months or longer, can often alleviate symptoms even in prolonged and treatment-resistant cases. Dr. Shaul Schreiber, Director of the Psychiatric Division and Dr. Gabi Barkai, a leader in the ambulatory Neuropsychiatry field note that approximately 4.5% of the population suffers from depression at any given time. About 20% of them suffer from depression that does not respond to medical treatment. Even though its mechanism of action in the brain remains unclear, research has shown that VNS can be a safe and efficient treatment for such hard-to-treat depression. Since 2005, about 3000 VNS implantations where made throughout the world. Of those patients who responded favorably, 70% enjoyed sustained remission for up to two years following implantation. This procedure provides hope for many patients who previously had just a minute chance of remission from depression.
Ovarian Transplants In Cancer Patients:
Improved cancer treatment regimens have increased the survival rate of children and young women with ovarian cancer, and cure rates could exceed 90%. However in addition to the short-term side effects, chemotherapy, mainly alkylating agents and radiotherapy, could destroy the germinal cells. The consequences of germ cell depletion are premature ovarian failure and sterility.
Because of time limitations, oocyte or embryo preservation is impractical for most patients. Furthermore, these options are typically not offered to children, or patients without a partner.
Ovarian tissue cryopreservation (OTCP) is an emerging technology that aims to sustain the reproductive function of women and children who are faced with sterilizing chemotherapy, radiotherapy, or radical reproductive surgery.
At the TASMC. this procedure was performed by Dr. Foad Azem- Director of the fertility preservation service, Prof. Joseph Lessing- Director of the Obstetrics and Gynecology Department and .Dr. Yoav Barnea, Director of the plastic and reconstructive breast surgery service.
The procedure was performed on a 47-year old patient who had recovered from breast cancer. The patient underwent cryopreservation seven years ago at the age of 40, prior to the chemotherapy treatment. On the morning of the procedure, the ovarian tissue was thawed and transplantation was performed through laparotomy. The pieces were sutured using the remaining ovary as a host for transplantation. The course following the procedure was uneventful and we are monitoring the recovery of the hormonal function of the ovary bimonthly. Normally it takes about 6 months until the ovary shows signs of recovery. Once the patient has recovered, she will undergo in-vitro fertilization and embryo transfer into the uterine cavity with a goal to achieve pregnancy.
Note that the technology is still in its early stages as pregnancies have been reported only in two patients around the world.
For The First Time In Israel- A Catheterization Procedure For The Treatment of Sinusitis
Chronic sinusitis is a common disease among adults and children. When medical treatment does not help, endoscopic sinus surgery is recommended. In this operation, mechanical obstruction of the sinuses outflow is removed by inserting rigid fiberoptic and surgical instruments through the nostril. This technique is advanced when compared to traditional operations that were performed through external incisions.
Sinuplasty is a new, minimally invasive technique that applies the principle of heart catheterization to the sinuses. Under dynamic x-ray guidance, a catheter is inserted to the involved sinus through the sinus' partially obstructed ostium (opening). A small balloon is inserted along the catheter and is inflated at the sinus ostium. After ostium dilatation, the balloon is removed.
Dr. Roee Landsberg, nose and sinus specialist at the TASMC, is the first to perform sinuplasty in Israel: "The procedure is associated with precision, minimal tissue trauma, minimal bleeding and almost no complications. However, in my opinion, the procedure is called for only when ostium narrowing is the cause for sinusitis, and is therefore suitable only for a specific group of patients."
The Cochlear Implant
The treatment offers help to those who suffer from deep or severe sensory neural hearing loss and even deafness. The implant offers the possibility of hearing to those who were born deaf, and to some of the people who suffer from neural deafness-those who cannot be helped by hearing devices.
The cochlear implant is one of the most intelligent bio-technological developments found to repair and rehabilitate the auditory system. It bypasses the damaged sensory cells of the inner ear, creating a contiguous path and allows direct electro/acoustic stimulation between the outer world and the inner cochlear or auditory nerve. The implant is a sophisticated electronic device which mimics the physiological hearing process.
The implantation surgery is performed through the close cooperation between physicians from the E.N.T. department, a radiologist and a speech therapist. Surgery is performed under general anesthesia, and generally has a 3-hour duration. The procedure is performed through an incision behind the auricle of the ear.
About a month after the implant, the internal system is ready to "broadcast" and starts the rehabilitation of the hearing process with the help of speech therapists who have specialized in the diagnosis and rehabilitation of the hearing-handicapped.
The TASMC team leading this new treatment:
Dr. Daniel Zik, deputy head of the Ear Nose and Throat department.
Dr. Ari DeRowe, head of the Pediatric ENT department
Dr. Mordechai Himmelfarb, head of the Auditory Institute
Nitza Chorev, speech therapist at the Auditory Institute
Salivary Glands Stones
About 1.3% of the population suffers from salivary stones ( Sialolithiasis) either in the salivary glands or their ductal system. Those stones may cause recurrent episodes of painful infection of the salivary glands. The stones are formed mainly in the Submandibular gland (76%) or the Parotid gland (22%), with comparable incidence in males and females of any age. Though the exact cause of sialolith formation is not clear, there are contributing factors such as inflammation of the salivary gland, reduced salivary secretion and stagnation. A genetic factor may also play a role as well in some cases.
Until a decade ago, surgery was the only option for treatment of Sialolihiasis. Now, the impressive technical advances in minute endoscopy systems and lithotripsy by shock waves systems has led to the development of new, minimally invasive and nonsurgical procedures for treatment of salivary gland stones and other salivary gland problems.
The modern approach is based on diagnostic tests and then, if necessary, endoscopic examination of the involved salivary gland ductal system, and then the removal of the stone under direct vision with minute instruments. The use of the endoscopic equipment enables evaluation and treatment of a variety of salivary gland pathologies such as obstruction by plaques or stenosis (narrowing) and scarring of ducts which can be dilated and reopened by balloons. An alternative approach is the lithotripsy by shock wave systems, a similar procedure to lithotripsy of kidney stones. This approach enables fragmentation of the salivary stones in the glands or their ductal system for possible removal at a more favorable point along the duct.
In an unpublished multi-center study of 4500 patients with salivary stones who were treated with the new techniques, only 2.8% needed open surgery eventually. The new approach offers shorter operation times, cost savings and ultimately the prevention of unnecessary operations and hospitalization as well as their associated risks.
This procedure is performed by Dr. Josef Bloom at the TASMC.
CLINICAL RESEARCH:
Human embryonic stem cells for the study of human genetic diseases and breakthrough establishment of "Fragile X" chromosome cell line
Inherited genetic diseases have always been worrisome for couples who wish to conceive a child. To avoid the transmission of serious and progressive diseases that are often accompanied by much suffering on the part of the child and his/her family, affected individuals and carriers of genetic disorders can choose to have prenatal diagnosis of their fetus. As much as 50% of such pregnancies are terminated when affected embryos are detected, meaning that the women undergo the physical and psychological pain associated with clinical abortions and induced deliveries. A revolutionary new procedure at the TASMC, pre-implantation genetic diagnosis (PGD) is carried out before the woman is impregnated so that couples are spared the anguish of terminating an established pregnancy.
Our center has been offering clinical PGD since June, 2002. When we embarked on our project to derive stem cell lines from genetically abnormal pre-embryos in 2004, we required the approval of the national review board and the informed consent of the couple undergoing the procedure to let us use their affected embryos that are discarded as a matter course. Specifically, in PGD, embryos generated by in-vitro fertilization (IVF) are genetically analyzed at the 8‑cell stage and, of course, only disease-free embryos are transferred to produce a pregnancy and the birth of a healthy child. The embryos affected with severe genetic disease are discarded. Our experience is that couples who are carriers of severe genetic disease are very willing to cooperate and generously donate these embryos for our research.
This particular research that is conducted by Dr. Dalit Ben-Yosef, IVF Laboratory Director and Scientific director of Racine IVF Unit, consists of taking human embryonic cells from a day 5 pre-embryo to generate stem cell lines that carry naturally occurring mutations and to establish a research model of human inherited disorders. This is especially important for those severe diseases for which there are no adequate animal or cell models. One of the more devastating ones is called "fragile X", the most common non-chromosomal form of inherited mental retardation. In 2004, our lab succeeded in establishing, for the first time, a cell line that carries the fragile X mutation. This breakthrough discovery has enabled us to study the molecular mechanism of the disease and was recently published on the cover page of Cell Stem Cell Publication as well as on numerous well-known scientific web sites.
In summary, although previous work had shown that fragile X syndrome occurs because the mutant form of the gene, FMR1 is silenced through a cascade of epigenetic modifications, the mechanism and timing of the changes are not well understood. Our study has shown that using the newly derived human ES cell line, undifferentiated stem cells exhibited normal FMR1 expression. Only when the cells are differentiated into particular germ layers, do the genes stop functioning. Our team was also able to dissect out the sequence of regulatory changes that led to the gene silencing. Now, with a better understanding of the steps involved, we hope that therapeutic techniques can eventually be developed to prevent or reverse FMR1 inactivation in cells with fragile X.
We have also succeeded in generating stem cell lines for other genetic diseases and are currently studying them. Stem cell lines carrying genetic defects have enormous potential for disease-oriented drug screening and discovery, and should play a decisive role in investigating the potential of gene therapy in curing disease.
OF NOTE:
Dr. Thelma Handler receives grant
National core facility for advanced human brain mapping:
Exploring the Active Mind
The Functional Brain Center has received a unique four-year grant from the National Institute for Psychobiology. The grant was donated by the Smith family in order to establish a national core facility for advanced brain imaging. It was awarded to only one center in Israel, based on a peer-reviewed competition.
The core facility is geared to establishing a cutting edge method for characterizing human brain function. The currently available methods for non-invasive whole-brain mapping are based on detecting local changes in neural activity in relation to behavior. These techniques provide scientists nowadays with robust means to non-invasively 'look into the active human brain' while it is mediating sensation, thought, feeling and awareness.
The grant will help to broaden the center's brain mapping capabilities to include EEG in addition to the existing MRI-- a central player in the brain-imaging revolution of the last decade. Scalp-recorded Electroencephalogram (EEG) is an old-runner in the human brain mapping field which provides information about the timing of neuronal activity. Lately the EEG has staged a triumphal comeback by being incorporated into the MRI environment for simultaneous acquisition. Importantly, these mapping techniques are closely complementary; the MRI has superior resolution in space but is sluggish in describing neuronal activity in time. On the other hand, the EEG is characterized by high temporal resolution but it is poor in indicating spatial location. Our facility today includes a state-of-the-art 3T MRI GE scanner largely dedicated for research and an EEG machine that is compatible with the MRI environment.
The core-facility intends to provide nation-wide access to these combined imaging methods in addition to educational program in imaging for users. For that the center incorporates a unique, wide-scope interdisciplinary activity in brain mapping by integrating knowledge from psychology, biology, medicine, engineering, physics and computer science into brain sciences. One of the academic goals of the center is to advance basic research in neuroscience systems toward rapid clinical translation into neuron-psychiatric disorders such as epilepsy, trauma, dementia, schizophrenia, and autism.
OUR CONTRIBUTION TO THE NATIONAL COMMUNITY
Dr Eyal Botzer Participates In A Medical Mission To Bhutan.
Dr Eyal Botzer, Director of the Pediatric Dentistry Clinic, participated in a medical mission to Bhutan. The "Bhutan Cleft Care Project" mission is devoted to treatment of patients born with cleft lip and palate. Bhutan is last Buddhist monarchy in the Himalayas, of its 670,000 citizens there are only 10 dentists and 35 dental hygienists. The mission is sponsored by the Smile Train organization, which sends numerous similar missions around the world to better care for cleft patients. Patients with a cleft lip and palate present unique dental problems that interfere with daily life and impair patient's quality of life.
In its 7th year, the Bhutan Cleft Care project trains the local medical personnel, helping them be able to treat cleft patients year-round. The medical team was multinational, with three surgeons (from the USA, Switzerland, and Bhutan), two anesthesiologists (from Canada and Germany), three nurses from Canada and the US and Dr. Eyal Botzer, a pediatric dentist. It was the first time that a dentist joined the team.
Dr Botzer's role was to screen the patients, and define the dental needs for future missions, as well as train the local dental personnel and provide dental treatment to as many patients as he possibly could. Dr Botzer examined and treated more than 250 patients. (The average dentist sees 100 patients per month.) He also trained the local dental hygienist--who serves as the dentist-- with the use of the current dental materials and modern techniques. The emphasis was on preventive treatment, due to the severe dental problems presented by the Bhutanese children.
NOMINATIONS:
-
Prof. Shlomo Berliner, who was the head of internal medicine "D" and has volunteered to head internal medicine 'E' ward. The 'E' ward is still located in the old Ichilov building, and it will eventually move over the Heart Institute that is currently under construction.
-
Prof. Shaul Dollberg, was nominated to Director, Department of Neonatology.
-
Prof. Idit Matot from Hadassah Medical Center was nominated to the Chair of the Department of Anesthesiology and Intensive Care.
-
Dr. Yehuda A. Schwarz, has been nominated as Director of Pulmonary Medicine Department.
-
Dr. Naomi Weintrob has been nominated as Director of The Pediatric Endocrinology and Diabetes Service.
-
Dr. David Zeltser has been nominated as interim head of the internal medicine "D" ward.
|
