Dear Friends,
Here we are again, on Spring’s doorstep after a wet winter of rain and rockets falling on our heads. The "Pillar of Smoke operation" in Gaza has ended and the national elections has given everyone hope that the economic and security situations will improve now.
We don’t lose hope that together, dear friends, we will overcome the difficulties we face ahead and continue to work towards the advancement and development of our Tel Aviv Sourasky Medical Center.
We are happy to report that we have recently closed a chapter in our history, a chapter that extended as far back as 20 years: With the help of our dear Friends of the TASMC, we have completed the transfer of all hospitalization wards from the old Ichilov building to their new home in the newer, roomier, upgraded buildings. All this is done for our patients, for the citizens of Tel Aviv and its environs, and in particular for the elderly patients we serve, among them holocaust survivors to whom we strive to offer the highest care and with the warmth that they deserve.
To help us accomplish this remarkable event, we also have the Claims Conference to thank. The Claims Conference has been remarkably helpful in enabling us to realize our goals, and they generously gave of their time and money to help us achieve this important milestone for all of our patients. For this we offer them a very special thanks for all their efforts!
Department of Internal Medicine “C”
The last of the internal medicine departments to make the move from the old Ichilov building. The Dermatology Department and its clinics will be moving to its new home in the Sammy Ofer Heart Building after the Passover holiday. From now on, the Ichilov building will house the research laboratories and ambulatory clinics.
This chapter of our history may be closing, but the challenges are still numerous, the tasks are still many. With your help, dear friends, we will achieve our goals.
We wish you and your families a happy, healthy and quiet Pesach.
Yours,
Ronit Blum – Director
Association of friends
What else is new?
We continue to move our departments in to the Sammy Ofer Heart Building. The Heskel & Menashi Ephraim Neurology Department recently moved in to the Ofer Heart Building as has the Neurosurgery Department.
Dana Dwek Children’s Hospital
We have begun renovations on the Pediatric Surgery Department of the Dana Dwek Children’s Hospital. The renovations are being done through the generous help of Maurice and Solo Dwek, who are helping us see this project through.
We still have one more pediatric ward that we intend to renovate, and we are looking for donations to help us accomplish this important mission.
General Rehabilitation Department
The General Rehabilitation Dept. has been renovated enlarged and through the generous help of the Claims Conference and the Porter Foundation that also generously helps us to renovate the eastern facade of the Rehabilitation building on Henrietta Szold St.
Adopt-A-Researcher Project
The Adopt-a-Researcher project continues on in to its third year, and with great success! We call upon donors to join us and adopt a researcher and help us support bright young physician researchers develop their career and keep these important research projects in Israel and at the TASMC.
Ceremonies to Thank our Donors
Mr. Menashi Ephraim
Mr. Menashi Ephraim hails from London. Thanks to his generous donations, we have been able to establish the Ephraim Day Care Cancer Centre, as well as the Heskel and Menashi Ephraim Prostate Cancer Centre, the Heskel and Menashi Ephraim Neurology ward, which is now located in the Sammy Ofer Heart Building, and the Heskel and Menashi Ephraim Children’s Ambulatory Pavilion.
Mr. Menashi Ephraim recently visited Israel and Israeli President Shimon Peres thanked him personally at a moving ceremony. We held the ceremony to thank Mr. Menashi Ephraim in the new ward, and it was attended by Tel Aviv Mayor Ron Huldai and Professor Gabi Barbash, the staff of the pediatric clinics and the Neurology Department.
Inauguration of the Embryonic Stem Cell Laboratory In Memory of Mayer Wolfe, Wolfe Family, Perelson Family, Vision Ltd.
The PGD- Stem Cell Laboratory in Memory of Mayer Wolfe, of blessed memory, has been opened. The laboratory is part of the IVF unit, run by Dr. Dalit Ben-Yosef.
The lab offers genetic analysis on single cells biopsied from embryos at a very early stage of development, shortly following fertilization. This procedure is called Preimplantation Genetic Diagnosis (PGD) and is performed for couples at high risk of transmitting a genetic defect and who wish to ensure the birth of a healthy baby. It requires In Vitro Fertilization (IVF) which makes the pre-implantation embryos available for biopsy and single-cell molecular techniques for the genetic analysis. Following PGD, embryos diagnosed as being disease-free are transferred into the uterus for implantation. The laboratories include also a human embryonic stem cell research lab, which focuses on studying issues related to early developmental processes, genetic disorders and different aspects of cell therapy using the human embryonic stem cells we derive directly from diseased embryos which are usually obtained as a by-product of PGD.
Thanks to a generous donation by the Wolfe/Perelson family and Vision Ltd., we were able to open these state of the art labs and preserve our leadership in this field.
New Services
A Revolutionary Limb Lengthening Treatment – Firstly In Israel.
The pediatric orthopedic department of the Dana-Dwek Children’s Hospital at the TASMC has introduced a revolutionary limb lengthening treatment. This new method of lower limb lengthening is designed to treat shortening caused by congenital or acquired conditions i.e. neurologic and genetic diseases, dwarfism, fractures, infection, tumor of the muscles or skeleton and more. This treatment is performed by Dr. Eitan Segev, Director Limb Lengthening & Deformity Correction Service at the Orthopedic Department at the Dana-Dwek Children’s Hospital.
Five patients have so far undergone lengthening of six limbs using this technique; first surgeries were performed with the assistance of Prof. John Herzenberg director of the International Center for Advanced Orthopedics- Sinai Hospital of Baltimore USA.
The new technique entails the introduction of a magnetic telescopic metal nail ('Precise nail') into the canal of a long thigh or leg bone. After performing a controlled break in the bone and stabilizing the nail with screws, the limb is lengthened at a rate of 1 mm per day up to 6.5 centimeters.
The lengthening is controlled by an external compact electric mobile device, which is applied to the skin for a few minutes per day and induces a magnetic field around the limb. The lengthening process is done by the patient in the comfort of his home.
The magnetic field penetrates and activates rare earth magnets inside the telescopic nail, the rotation movement induced is translated by a series of gears into linear motion and the limb is lengthened gradually over a few weeks.
Lengthening is performed at 1 mm per day to allow gradual and safe regeneration of bone, muscles, tendons, blood vessels and nerves, according to biological principles.
The new technique has many advantages over the old way of limb lengthening, which consisted of using external fixators around the limb that were held with metal pins to the bone. The metal pins penetrated the skin and caused pain, recurrent infections, unsightly scarring and limitation of the range of joint motion during lengthening.
The experience gained in leading world centers that began using this nail for the last year and in Dana Hospital are favorable, with a very low rate of complications and good results.
Announcing the opening of the GIT Malignancies Center, under the direction of Dr. Ravit Geva
Gastrointestinal malignancies (GIT) include colon and rectal cancer, gastric cancer, pancreatic cancer, neuroendocrine carcinoma and several other, less frequent diagnoses.
Since treatment for gastrointestinal malignancies often requires a multidisciplinary approach, patients might find themselves "lost in the system", bouncing back and forth between various specialists. To address this problem, the Tel Aviv Sourasky Medical Center launched The GIT Malignancies Center - offering patients a multidisciplinary "one stop shop" approach. The services offered in the new center include an oncology specialist clinic, a specialist nutritionist clinic, a specialist gastroenterology clinic for complex cases, a joint oncology-endocrinology clinic for neuroendocrine cancers and a joint oncology-colorectal surgery clinic for rectal and anal cancers. All patients are accompanied by a physicians assistant, who follow them throughout the treatments. In addition, the center works closely with a specialist dermatologist for the treatment of skin reactions and offers genetic counseling.
Since its launch late 2012, the GIT Malignancies Center has quickly become one of the busiest clinics in the hospital's Oncology division.
Our center's treatment approach is inspired by those already implemented in leading North American and European cancer centers, which follows patients throughout their treatment process, all the way to full recovery.
Mind/Body: The New Clinic of Physical Empowerment For the treatment of Medically Unexplained Symptoms
In a unique group of patients, no disease is found and the cause for ongoing symptoms of pain remains unexplained,. This despite a thorough medical, laboratory and imaging studies. In addition, treating the symptoms brings only partial or temporary relief, which leaves the patients in suffering and despair.
A variety of systems could be affected by this condition which is practically seen in all areas of medicine. It includes chronic, unremitting pain, or headaches, non-epileptic seizures, gait instability, recurrent falling, limb paralysis, sensation of pins and needles, difficulty in swallowing, chest pain, eczema, constant itching, urinary complains, abdominal pain, fatigue and more. All are chronic, may last for years, and respond poorly to multiple treatments. The continuing long-term suffering results in a sensation of helplessness that may develop into depression and significantly impairs the social and family life of the patients as well as their working ability. This condition is currently recognized as 'medically unexplained symptoms'. It is not rare. Studies show that up to 10% of the patients seen in primary medical clinics and up to 25% of those seen in specialized hospital clinics may suffer from medically unexplained symptoms [!].
The current understanding of this phenomenon points to a dysfunction of the mind-body interaction. For example: the brain in unable to relate to, or subconsciously blocks, emotions normatively related to a severe mental distress. Instead, the brain subconsciously converts these emotions into a physical sensation such as pain, paralysis, blindness etc. Symptoms may arise long after a possible distress has occurred and subjects could be affected from childhood through to old age. One of the main problems treating these patients is that this process is subconscious. The patients are aware only to a severe physical condition and are unaware of any current or past distress. That is why patients suffering from this phenomenon continue searching for help among physicians specializing in the treatment of the apparent symptoms and are reluctant to seek mental aid and avoid it when they are consulted to do so.
In the neurological arena, they encounter many patients eventually diagnosed with 'unexplained medical symptoms'. They have seen patients with paralysis, subjects unable to walk or bound to a wheel-chair, with severe diffuse pain or headaches, with unremitting tremors, and which are all unresponsive to multiple treatments.
The Clinic of Physical Empowerment was created to help these patients. Since most of the patients refuse referrals to psychological facilities, and do not respond to conventional treatment, the clinic was designed as a unique model in Israel headed by Dr. Amnon Mosek a senior neurologist, who serves as Deputy Chief, the Department of Neurology and Director of Headache and Facial Pain Clinic.
Patients diagnosed with unexplained medical symptoms are referred from the various departments of the hospital and from all over Israel. As our reputation develops, more physicians are familiar with the clinic and the number of patients (currently a few hundred) grows steadily. The clinic's hope is that the new window of opportunities open for those patients will enhance the treatment for the difficult group to ease their suffering.
The TASMC announces the purchase of advanced Embryo sonic machines for IVF treatment at the Lis Maternity hospital
The Racine In Vitro Fertilization I.V.F. Unit at Tel Aviv Sourasky Medical Center has recently implemented the The EmbryoScope® Time-lapse system. Through some generous donations the Racine IVF Unit was able to be the first to clinically use this advanced system in its IVF lab. This state of the art technology is a unique platform facilitating improved IVF treatment, flexible work routines and effective communication, through comprehensive documentation of embryo development and evolving improvements in embryo selection.
The EmbryoScope® Time-lapse system allows the uninterrupted culture of embryos while maximizing the amount of embryo development information collected. Evolving selection criteria are helping the clinicians and embryologists to improve IVF outcomes.
A first in Israel: Free vascularized lymph nodes transfer for the treatment of lympdedema performed by Dr. Arik Zaretski, plastic surgeon.
The lymphatic system is part of the circulatory system; it maintains the flow of fluids around the body while removing and transporting waste products from tissues. Under normal conditions, venous capillaries reabsorb 90% of the fluid in the tissues, and lymphatic channels absorb the remaining 10% of lymph fluid, proteins and other molecules. Lymphatic fluid passes to the regional lymph nodes and empties into the venous system, most commonly by way of the thoracic duct.
Lymphoedema manifests as swelling of one or more limbs; the head and neck, breast or genitalia may also be involved. Lymphoedema is caused by abnormal lymph transport that causes an accumulation of protein-rich interstitial fluid, leading to swelling. At the chronic stage, lymphoedema causes proliferation of fatty tissue and progressive fibrosis. Significant functional and psychological morbidity, such as disfigurement, pain and complications results from end-stage sequelae of lymphoedema.
Causes of lymphoedema are divided to either primary (hereditary) causes, related to the congenital malformation of the lymphatic channels, or secondary, resulting from disruption to the lymphatic system, usually after ablative surgery and / or radiation therapy.
Lymphoedema is considered to be an incurable condition, but successful management of the condition is possible in cases of early diagnosis and intervention. The standard therapy for lymphoedema is manual lymphatic drainage (MLD) alone or as a component of decongestive lymphatic therapy (DLT).
Recently, the surgical treatment of lymphoedema has been gaining increased popularity at leading microsurgical centers worldwide and is now considered an important adjunctive treatment option for patients with lymphoedema. The most advanced surgical technique with the best promising results is free vascularized lymph nodes transfer. Healthy lymph nodes are harvested from the chest or abdominal wall and transplanted to the affected limb using a microsurgical technique and high magnification operating microscope. The new transplanted nodes secrete endothelial growth factors that promote formation on new lymphatic vessels into the nodes, enabling them to function as a pump that evacuates lymphatic fluid from the surrounding tissue into the vascular system.
A multidisciplinary team for treating lymphoedema patients have been formed headed by Dr. Arik Zaretski, the Head of Microsurgery Service. The team is composed of microsurgeons, lymphatic physiotherapists and radiologists. At a spatially designated outpatient clinic for lymphoedema patients, they evaluate candidates for surgery. After a thorough evaluation, they offer the most advanced micro lymphatic surgery – the free micro vascularized lymphnode transfer.
Renal Denervation (RDN) Catheter-based Therapy for Hypertension
Prof. Shmuel Banai: Director, The Interventional Cardiology Unit
How many people are affected by hypertension?
Hypertension is a significant and growing global health issue affecting approximately 1.2 billion people worldwide. The prevalence of high blood pressure increases with age, obesity and sedentary lifestyles. Since all three factors are on the rise worldwide, hypertension treatment represents a huge and growing clinical challenge as well as a major public health cost burden. The estimated annual global healthcare expenditure directly attributable to hypertension is estimated at $500 billion.
How is hypertension treated?
Patients with mild hypertension are advised to make behavioral and dietary changes such as losing weight, exercising, reducing sodium intake and increasing potassium intake. If these approaches are unsuccessful, drug treatment is usually prescribed.
While pharmacological therapy plays a role in hypertension management, these are not always effective. Approximately 50 percent of patients with hypertension remain uncontrolled, and approximately 15–20 percent of those are defined as resistant.
What is renal denervation (RDN) and why might it be effective at lowering blood pressure in
cases where pharmaceutical therapies have failed?
The nerves leading in and out of the kidneys play a central role in sympathetic nervous system hyperactivation, which is an established contributor to hypertension. Surgical disruption of sympathetic nerves has been a proven method for lowering blood pressure in the past. Sympathetic renal denervation is done today in the catheterization laboratory for the treatment for resistant hypertension.
RDN addresses uncontrolled hypertension by reducing the drive of the sympathetic nervous system, which is central to blood pressure regulation. It is a minimally invasive procedure that modulates the output of the sympathetic nerves located outside the renal artery walls.
What is the procedure?
A flexible catheter is introduced through the femoral artery in the upper thigh and is threaded through the renal artery near each kidney. Once in place, the tip of the catheter delivers low-power radio frequency (RF) energy according to a special algorithm, or pattern, to modulate the surrounding sympathetic nerves. Renal denervation does not involve a permanent implant.
What impact does the procedure have on the patient?
Clinical research shows that RDN therapy can provide significant and sustained reduction in blood pressure levels for patients with uncontrolled blood pressure despite multiple anti-hypertensive medications.
The first 'awake' cerebral angiography is performed in Israel by Dr. Shadi Jahshan
In 1927, Egas Moniz, a Portuguese physician, performed the first cerebral angiography. This is a technique that allows blood vessels in and around the brain to be visualized, and it was the main diagnostic tool for more than four decades, allowing physicians to "look" into the brain and to plan future surgeries .In 1974, the CT (computed tomography) became the major non-invasive diagnostic tool, replacing the cerebral angiography, which is an invasive tool.
In the past 20 years the cerebral angiography field has again become an important tool, but this time as an interventional tool, for the treatment of different brain vascular pathology. Recent scientific publications have demonstrated the superiority of this tool when compared with the traditional way for treatment including "opening" the skull in to fix these pathologies.
In Israel today there are only five centers that can offer this service which includes the treatment of cerebral aneurysms, arterio-venous malformations and more recently, mechanical thrombectomy for patients that presented with acute stroke and occlusion of intracranial artery. This allows immediate restoration of blood flow to the potentially infracted brain tissue, and may prevent major illness and disability.
Recently, Dr. Shadi Jahshan, a neurosurgeon in Neurosurgery Department at the Tel Aviv Sourasky Medical Center, performed the first "awake" cerebral angiography in Israel, for the treatment of vascular anomaly. During the procedure, the performer received real time feedback from the patient. This new approach allows the physician to diagnose in the real time every small complication and react immediately and potentially to prevent a major injury to the patient.
Inauguration of the ‘Marot’ Centre for the diagnosis, treatment and research of autism in children and youth
Recently, the Institute for Child Development in the Pediatric Neurology has opened a new unit in the Dana Dwek Children’s Hospital: The ‘Marot’ Center. The ‘Marot’ Center is a unique place that is devoted to the diagnosis, treatment and research of the gradient of autism in children and youth. Dr. Hagit Shimoni Nagar is the head of this center.
The diagnosis is based upon an assessment by a psychologist who specializes in autistic spectrum disorders, a psychiatrist as well as a developmental neurologist. These experts work with educators and pedagogical authorities to draw a full picture. The diagnosis also enables medical staff to rule out autism and uncover other developmental issues. The treatments offered focus on communication and behavioral skills and are treated individually and in groups. The services are geared to youths between the ages of 6-18 who suffer from social problems with difficulty communicating as well as all grades of autism.
Clinical Trials
Dr. Ido Wolf, head of Medical Oncology Unit at the TASMC, discusses a study on the novel endocrine aspects of cancer
Breast cancer is the most common malignant tumor among females, affecting up to one in eight women. Despite advances in breast cancer treatment, the median survival of patients who suffer from metastatic disease is about two years. Thus, the development of more active and less toxic therapies is of major importance. The TASMC currently is conducting laboratory as well as clinical studies in breast cancer managed by Dr. Ido Wolf, the manager of medical Oncology Unit at TASMC. Those studies are aimed at identifying novel mechanisms involved in the malignant transformation of the breast. The discovery of such mechanisms may enhance the development of novel therapies for the disease. These are some of their recent projects:
Identification of klotho as a tumor suppressor in breast cancer: The klotho protein plays an important role in various physiologic activities and its deletion in mice results in pre-mature aging. We analyzed the expression of klotho in hundreds of samples of breast cancer and found high expression in normal breast but reduced expression in breast cancer. Moreover, we found that restoring its expression can inhibit growth of breast cancer cells. Further analysis revealed klotho as a modulator of major signaling pathways in breast cancer, including the insulin pathway. Thus, klotho can serve as both prognostic factor and a potential therapeutic target in breast cancer.
Diabetes mellitus and breast cancer: Following Their clinical observations, they have conducted a retrospective analysis of diabetic and non-diabetic breast cancer patients and found that diabetic patients presented with higher tumor stage and size, and their tumors were more often HR negative. Those results suggest that at diagnosis, diabetes mellitus is associated with negative prognostic factors. The laboratory also conducted a meta-analysis of published studies and identified significant correlation between diabetes mellitus and breast cancer risk. Following these discoveries they are currently exploring a role for exendin-4, a novel therapy for diabetes, as a potential therapy for breast cancer.
We are proud of
- The Breast health center in the Tel Aviv Sourasky Medical Center, under the direction of Prof. Schlomo Schneebaum has been recognized as a "center of excellence" for the treatment of Breast cancer, by the International Senologic Society and UICC (International Union Against Cancer).
- Professor Foad Azem of the IVF department has been given the Star Award of 2012 from the prestigious ASRM, the American Society for Reproductive Medicine.
- The Pain Clinic of the TASMC, under the direction of Dr. Silviu Brill, has been designated an accredited member of the Center for Fellowship Training (EFIC) and is now a recognized center for fellowship training by the European Union.
- The Movement Disorders Unit, under the direction of the Neurologist Dr. Tanya Gurevich, has been recognized as an international center of excellence in the field of Parkinson’s Disease. The center was awarded a special grant of $60,000 per year for five years in order to advance the treatment for patients who suffer from Parkinson’s Disease.
Nominations
- Ms. Ruth Sasportas, RN, has recently joined Tel-Aviv Sourasky Medical Center as deputy director of clinical operations and became the first nurse ever appointed as deputy director in Israel’s general hospitals. Ms. Sasportas started working in our medical center in 1989 as staff nurse, and continued as head nurse of the Pediatric Intensive care unit and later head nurse of the Open Heart Surgery department. In 2003 Ms. Sasportas was appointed to head the Operation Rooms Division at the TASMC which she did until 2008. Recently she returned from a 4 year stay in the US where she worked in Clinical affairs at ForsightLans, CA. Ms. Sasportas holds a Master degree in Nursing from Te-Aviv university and a Master degree in Health Management from Clark University.
- Professor Gustavo Malinger was recently nominated to the Director of OB-GYN Ultrasound and Oncology Department at the Lis Maternity hospital. Prof Malinger nominated after Prof. Ariel Yaffo retired to pension.
Prof Malinger was born in Montevideo, Uruguay and since 1973 resides in Israel. He is married to Dr. Patricia Saavedra and father of three children.
Following medical studies at the Hebrew University Hadassah Medical School and Tel-Aviv University Sackler School of Medicine, Dr. Malinger completed his residence in Ob-Gyn at the Edith Wolfson Medical Center in 1989. Between 1994-2012 he served as Director of the Prenatal Diagnosis Division and co-director of the Fetal Neurology Clinic at the WMC. Currently he is Director of OB-GYN Ultrasound at Lis Maternity Hospital, the OB-GYN facility of Tel Aviv Medical Center.
Prof. Malinger is Associated Clinical Professor at Sackler School of Medicine, Tel-Aviv University. He is a Board Member of the International Society of Ultrasound in Obstetrics and Gynecology and a member of the Editorial Boards of Ultrasound in Obstetrics and Gynecology and Fetal Diagnosis and Therapy. His main field of research is on the fetal brain, and he has published more than 100 articles and book chapters and has been invited to lecture on fetal brain development to countries around the world. His book, ‘Ultrasonography of the Prenatal Brain’ has been recently published by McGraw-Hill.
- Prof. Juri Kopolovic was nominated lately to the Director of the Pathology Institute in our medical center. Before Prof. Kopolovic joined us he served as a director of the Pathology Institute in Hadassah Jerusalem hospital and before he directed the Sheba Pathology Institute and the Wolfson Pathology Institute.
- Dr. Ronen Ben-Ami was nominated lately to the Director of the Infectious Diseases Unit in our medical center. Dr. Ben-Ami is also the Head of Molecular Mycology Laboratory in TASMC. He graduated with honors from the Sackler School of Medicine, and completed his training in Internal Medicine at the Tel Aviv Sourasky Medical Center and Mount Sinai Hospital in New York. He went on to do a fellowship in Infectious Diseases at our Medical Center and a research fellowship at the MD Anderson Cancer Center in Houston, Texas. Dr. Ben-Ami's research interests include opportunistic infections in cancer patients and other vulnerable patients with compromised immunity. He is the author of more than 60 original manuscripts and book chapters, and the recipient of several prestigious awards and grants, including the Israeli Science Foundation Legacy grant.
