Eran Pras, MD, Elon Pras, MD, Tengiz Bakhan, PhD, Etgar Levy-Nisenbaum, BSc, Hadas Lahat, MSc, Ehud I. Assia, MD, Hana J. Garzozi, Daniel L. Kastner, MD, PhD, Boleslaw Goldman, MD and Moshe Frydman, MD
Ilan Leibovitch, MD, Ronan Lev, MD, Yoram Mor, MD, Jacob Golomb, MD, Zohar A. Dotan and Jacob Ramon, MD
Background: Extensive necrosis is rare in primary renal cell carcinoma. This finding may reflect the biological characteristics of the carcinoma and therefore could be of prognostic and clinical value.
Objectives: To assess the incidence of necrosis in renal cell carcinoma and its potential prognostic value.
Methods: We conducted a consecutive retrospective study of 173 patients after radical nephrectomy for renal cell carcinoma. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database.
Results: Extensive necrosis was found in 31 tumor specimens (17.9%). Univariate analysis showed that the specimens with extensive necrosis were significantly larger and manifested more perirenal and venous extension than the tumors without necrosis. The size of the renal tumor was the only parameter that remained significant in multivariate analysis (P=0.0001). Overall disease-free survival did not differ significantly between patients with necrotic tumors and those without (68% and 66% respectively).
Conclusions: The finding of extensive necrosis in renal cell carcinoma specimens does not seem to be related to tumor biology but rather may reflect the relation between size and vascularity of the tumor.
Yaron Yagev, MD, Rafael S. Carel, MD and Ronit Yagav, MD
Background: The association of carpal tunnel syndrome with occupational risk factors is well established. However, in clinical practice these factors are only rarely considered and evaluated. Managing these risk factors could prevent the occurrence of future cases and alleviate treatment of the afflicted individuals.
Objectives: To estimate the role of occupational risk factors in a large group of patients diagnosed by electrophysiological studies as suffering from CTS.
Methods: A group of 396 subjects (204 women, 165 men) who were tested in one laboratory by electrophysiological studies were further evaluated (by questionnaire) to determine the possible role of occupational and other risk factors in the etiology of their syndrome.
Results: Persons employed in high force — low repetitive or low force — high repetitive jobs, harbor an extra risk for developing CTS as compared with controls, OR=3.21 (95% C1 = 1.5-6.9) and OR=4.72 (95%C1 = 1.8-12.5), respectively. These jobs include typists/secretaries, nursing personnel, production workers and housewives.
Conclusion: Evaluation of a general group of examinees referred for electrophysiological studies on sympatology compatible with CTS may show that occupational risk factors play a substantial role in the development of symptoms. By increasing the awareness of clinicians and the public to these risk factors, appropriate preventive measures can be introduced and the burden of the disease reduced.
by Eytan Cohen, MD, Arie Goldschmid, PhD and Moshe Garty, MD
Background: Fixed dose combination therapy varies among countries.
Objective: To compare the list of fixed-dose combination therapies used in the USA, UK and Israel.
Methods: The total list of drugs and FDC drugs were counted manually from a list of generic names. We also counted the number of drugs in four characteristic subgroups:
cardiovascular, anti-infective, gastrointestinal, and dermatological. Data for drugs in the USA, UK and Israel were taken from the Physician’s Desk Reference (PDR 1997), the British National Formulary (BNF March 1997) and the Monthly Ethical Drug Indexed Compilation (MEDIC July 1997) respectively.
Results: The global percentage of FDC drugs in the USA and UK was higher than in Israel (20%, 25% and 15% respectively). A similar trend was found in all subclasses of FDC drugs except for the anti-infective category in which the percentage of FDC drugs was low and similar in all countries.
Conclusion: The list of FDC drugs varies greatly between the USA, UK and Israel. reflecting the differences in the outcome of debate between the pharmaceutical companies and the regulatory authorities.
Paull Radu, MD and Jacob Atsmon, MD
Philip Sax, PhD
Background: It is not clear to what extent the drug economy in Israel's health maintenance organizations is responsive to major healthcare reforms.
Objective: To provide information on how drug expenditures, revenues, net costs and drug utilization have changed in the wake of the 1995 National Health Insurance Law in Israel.
Methods: This study compares trends in aggregate sick fund expenditures, revenues (patient co-payment) and net costs (expenditures less revenues) in Israel's four health maintenance organizations for the 3 year period 1992-1994 prior to the introduction in 1995 of the NHI Law, with that of the 4 year period 1995-1998 following its introduction. This analysis is similarly carried out for Israel’s largest HMO, Clalit Health Services, and for the three smaller HMOs combined.
Results: The pace of growth in the pre-NHI era in drug expenditures and particularly in drug revenues was drastically reduced in the NHI era - whether measured as totals or as per insured person (age-adjusted) or in real terms at constant medicine prices. These trends were mirrored to a large extent in
Conclusions: The impact of the NHI Law on the HMO drug economy has been substantial. The evidence suggests a decline in both the qualitative (basket of drugs consumed) and quantitative (volume of drugs consumed) elements of growth. These changes in expenditure and revenue trends are discussed in the light of the evolving involvement of the Israel Ministry of Health in drug policy within the framework of the NHI, with emphasis on the basket of drugs reimbursed and copayments for prescriptions.
Rachel Wilf-Miron, MD, MPH , Kareen Nathan, MSc, Fabienne Sikron, MA and Vita Barell, BA
Background: Investigation of causes of death can help inform intervention policy aimed at reducing preventable mortality.
Objectives: To assess mortality causes and trends over time and identify target groups with excessive mortality rates among Israeli youth aged 10-24, in order to formulate an intervention policy for prevention of adolescent mortality.
Methods: Mortality data for Israeli residents aged 10-24 were extracted from the Central Bureau of Statistics computerized death certificate file for the period 1984-95. Trends were evaluated by cause of death and demographic characteristics.
Results: The crude mortality rate among Israeli youth aged 10-24, during 1993-1995, was 39.6 per 100000. Rates were 2.7 times higher among males, increased with age, and reached a peak among 18-21 year olds. Rates were 1.4 times higher among Arabs than among Jews. The sharp increase in mortality among Jewish males of military service age (18-21 years) was due mainly to motor vehicle crashes and suicide. Although overall mortality decreased by 9.4% from 1984-86 to 1993-95, the gap between the subgroups increased. MVCrelated mortality increased over time by 100% among Arab males. The rate of completed suicide among Jewish males increased by 110%. Although injury-related mortality is lower in Israel compared with the U.S., similar demographic differentials and trends were found in both countries.
Conclusions: Suicide among Jewish males of military service age, as well as MVC fatalities among Arab males, present a growing public health issue. Intervention strategies should therefore be targeted towards these subgroups in order to minimize the rates of preventable death.
Aya Biderman, MD and David Galinsky, MD
Marwan Shinawi, MD, Riva Brik, MD and Drora Berkowitz, MD
Hisham Darwish, MD, Walid Sweidan, MD, Michael Silberman, MD, Abdil Rahim Abu-Saleh, MD and Nadir Arber, MD