Galilee Medical Center (Hebrew: המרכז הרפואי לגליל, HaMerkaz HaRefu'i LaGalil), abbreviated GMC, is a hospital located in the coastal city of Nahariya and is the second largest hospital in northern Israel (after Rambam Hospital in Haifa). It was established in 1956.The hospital located on the outskirts of Nahariya, three kilometers from the city center, serving half a million residents of the western Galilee, from Karmiel to the coast.
INTRODUCTION:Endoscopic ultrasound guided fine needle aspiration/biopsy (EUS-FNA/FNB) is the main diagnostic tool for solid pancreatic lesions. However, it is associated with a limited diagnostic yield. AIM:We aimed to assess the optimal needle passes number of FNA\FNB needles to achieve maximum diagnostic yield. METHODS:We performed a retrospective study including all patients who were diagnosed with pancreatic adenocarcinoma by EUS-FNA/FNB. The diagnostic yield was reported for all needles according to the number of needle passes. RESULTS:Overall, 227 patients underwent EUS-FNA/FNB. FNBs in 85 patients (37.4%), and FNA in 142 patients (62.5%). The needle number passes in the FNB was 1.46 ± 0.70 versus 2.11 ± 1.12 in the FNA group (p < 0.0001). One, two, and three needle passes yielded a diagnosis rate of malignancy in 76.8%, 68.4% and 70% of cases respectively for histology, while for cytology, the yield was 78.6%, 89.4% and 100%, respectively. For FNB needle types, the acquire needle outperformed the other needle, as the histological yield for one pass was 78.6%, 80% for two passes, and 57.1% for three passes, while for cytology, the yield was 79.3%, 90%, and 100% for one, two and three passes, respectively. For the FNA needle, the cytological yield was 88.7% for one pass, and higher for two and three passes. CONCLUSION:The number of needle passes for FNB (maximum three passes) was lower than FNA needles (3-4 passes) to obtain an optimal diagnostic yield.
OBJECTIVE:This study investigated the prevalence and risk factors for acute cholecystitis following the placement of fully covered self-expandable metal stents (FC-SEMS) during endoscopic retrograde cholangiopancreatography into the common bile duct (CBD), across patients with various indications. We aimed to evaluate whether FC-SEMS placement increases the risk of acute cholecystitis and to identify associated risk factors. METHODS:In this retrospective, multicenter study, 365 medical records from multiple hospitals were reviewed. All patients underwent FC-SEMS placement for biliary strictures. Demographic and clinical data, including complications, were collected. Logistic regression analysis was performed to assess associations between acute cholecystitis and variables such as gallbladder stones, CBD stones, CBD diameter, and stent length. RESULTS:Acute cholecystitis occurred in 8.8% of patients. On univariate analysis, the presence of gallbladder stones and smaller CBD diameter were significantly associated with increased risk of acute cholecystitis ( P = 0.01 and P = 0.02, respectively). Shorter stents (40-60 mm) were associated with a markedly higher incidence of acute cholecystitis (10.4%) compared to longer stents (70-100 mm) (1.5%; P = 0.02). Multivariate logistic regression revealed that gallbladder stones (odds ratio: 4.2; 95% confidence interval: 1.76-9.85; P = 0.001) and reduced CBD diameter (odds ratio: 0.88; 95% confidence interval: 0.79-0.98; P = 0.02) independently predicted acute cholecystitis among the subgroup of patients with 40-60 mm long stents. Patients who developed acute cholecystitis had significantly longer follow up durations (279.5 vs. 176.8 days; P < 0.05). CONCLUSION:FC-SEMS placement, particularly with shorter stents, is associated with an increased risk of acute cholecystitis, especially in patients with gallbladder stones and narrower CBD diameters. These findings underscore the need for careful patient selection, individualized stent sizing, and extended follow up in high-risk populations.
BACKGROUND:To evaluate pregnant women's intentions to deliver with labor epidural analgesia (LEA) and identify factors influencing decision-making in a diverse population in northern Israel. METHODS:A cross-sectional survey was conducted at Galilee Medical Center from February to July 2024. Women completed pre- and post-labor questionnaires assessing demographics, religiosity, prior experience, prenatal education, attitude towards LEA, reasons for not intending to deliver with and actual LEA use. Statistical analysis included multivariate logistic regression. RESULTS:The LEA rate among participants was 83.5% (380/455) (83.5%); 257 (56.5%) had indented to deliver with. Among those not intending to deliver with LEA, 66.7% (132/198) eventually delivered with. There were 297 (65.3%) Arab and 158 (34.7%) Jewish women; 180 (39.6%) identified as Muslim, 158 (34.7%) Jewish, 92 (20.2%) Druze, and 25 (5.5%) Christian. Factors associated with intention to deliver with LEA were nulliparity (P=0.024), childbirth preparation course (P=0.002), internet as source of information (P=0.016), and previous delivery with LEA (P <0.001). Factors associated with not intending to deliver with but ultimately delivering with LEA were nulliparity (P=0.033), partner presence (P <0.001), labor induction (P=0.044), and previous delivery with LEA (P <0.001). CONCLUSION:Attitudes toward LEA are shaped by culture, knowledge, prior experiences, and social support. In our cohort, the most important factors for delivering with LEA when not intending to were previous delivery with LEA and partner presence. Factors associated with not delivering with LEA were preference for natural childbirth and fear of LEA-associated side effects. Promoting evidence-based information through language-adapted platforms can further improve informed decision-making about LEA.
Background:Prolonged rupture of membranes (ROM) is associated with peripartum infections; the optimal timing to initiate prophylactic antibiotic treatment is inconclusive. We compared maternal and neonatal infectious morbidity and bacterial distribution in chorioamniotic-membrane cultures according to a ROM-to-delivery interval of 12-18 versus >= 18 hours. Methods:This retrospective cohort study was conducted in a single tertiary university-affiliated hospital from January 2020 to January 2023. Labor was induced in term singleton pregnant women with ROM >= 12 hours who did not deliver spontaneously within 12-24 hours. Prophylactic ampicillin was administered based on risk factors. Outcomes were compared between ROM 12-18 hours (n = 683) and >18 hours (n = 1039); the latter uniformly received intrapartum antibiotics. The primary maternal outcome was clinical chorioamnionitis. The secondary outcomes included intrapartum fever, cesarean delivery, puerperal endometritis and hospitalization length. Neonatal outcomes included early-onset sepsis, 5-minute Apgar score <7, length of stay, respiratory distress and ventilation support. Results:The clinical chorioamnionitis rate was comparable between the ROM 12- to 18- and the >= 18-hour groups. However, intrapartum fever occurred more frequently in the former (15.5% vs. 11.6%, P = 0.024), and postoperative infections were significantly higher (11.7% vs. 4.5%, P = 0.020). Cesarean deliveries were more common in ROM >= 18 versus 12-18 hours (21.3% vs. 16.3%, P = 0.028). Neonatal outcomes were similar between the groups. The bacterial distributions among chorioamniotic-membrane cultures were similar, the most common isolated pathogens were Enterobacteriaceae. Conclusions:Although the risk of chorioamnionitis was similar, the incidence of intrapartum fever and postoperative infections were higher in ROM 12-18 versus >= 18 hours. Initiating antibiotic prophylactic treatment at 12 hours post-prelabor ROM may be beneficial.
IntroductionThe purpose of this study was to examine the accuracy of three-dimensional (3D) Doppler ultrasound imaging to predict successful medical treatment for missed miscarriages.MethodsThe 129 women included underwent transvaginal ultrasound 24 h after misoprostol administration for missed miscarriage. Endometrial thickness and uterine cavity volume were measured using three-dimensional (3D) ultrasound and virtual organ computer-aided analysis software. The following 3D Doppler indices were calculated: vascularity index, flow index, and vascularity flow index. Treatment failure was defined as the need for surgical evacuation of the uterus. Treatment was considered successful when no surgical intervention was necessary.ResultsTwenty-nine women underwent curettage (treatment failure); all had histologic evidence of conception. One hundred women required no surgical intervention (treatment success). All 3D Doppler indices were significantly higher in the treatment failure than success group: median vascularity index 3.2% vs. 1.02% (p = 0.027), mean flow index 32.2 vs. 27.04 (p = 0.008), and median vascularity flow index 2.04 vs. 0.27 (p = 0.007). Uterine volume and endometrial thickness were significantly greater among women who underwent curettage vs. those who did not.Conclusions3D Doppler indices can predict the success or failure of medical treatment for missed miscarriage, as can endometrial thickness and uterine cavity volume.
