Delegates at the 94th Hadassah national convention in LA were given a preview of tomorrow's medicine.
By JUDY SIEGEL-ITZKOVICHdoctor 224.88(photo credit: AP)
Before-and-after videoclips are the best way to impress people about what cutting-edge medicine can do. And this is what happened with the 2,000 delegates to the 94th national convention of Hadassah Women's Zionist Organization of America, held recently in Los Angeles. The Hadassah Medical Organization - the main beneficiary of HWZOA's generous fundraising - sent half-a-dozen senior physicians to update the delegates about two Israeli medical centers' recent achievements.
A young woman nearly killed in the terror attack at the Hebrew University's Mount Scopus a few years ago is now flourishing; another who had been suffering from severe palsy due to dystonia is now doing her national service with young children; two healthy twins have been born to a carrier of the defective gene for breast cancer after unaffected embryos were selected for implantation; surgery through natural orifices like the navel, which will shorten recovery time and minimize pain, have been approved.
THE HADASSAH doctors' filmed presentations and live addresses were followed by a question-and-answer session for over 150 people; if the physicians had set up consultation clinics in the hotel, they would have been kept busy for days.
The doctors were introduced by Hadassah Medical Organization director-general Prof. Shlomo Mor-Yosef and his deputy, Dr. Yair Birnbaum.
Hadassah neurosurgeon Dr. Zvi Israel, who came on aliya from the UK in 1990, presented the amazing benefits for many patients of deep-brain stimulation (DBS). In this procedure, an electrode is permanently lodged in a specific part of the brain while the patient is awake. The first successful use was to reduce Parkinson tremors, but it also seems to offer hope for psychiatric problems such as depression, obsessive-compulsive disorder and schizophrenia, chronic pain and other conditions.
"Except for Soroka University Medical Center in Beersheba, our neurosurgery department is the only one between Tel Aviv and Eilat," said Israel. "We receive patients from all over the country and also from abroad and treat cancer, aneurysms, stroke and trauma."
In response to a question asking how many in the audience knew somebody with Parkinson's disease, almost every hand was raised. Suitable patients who have not been helped by medications have responded well to deep-brain stimulation.
But, said Israel, DBS can also treat a variety of other conditions. "We are working with Prof. Hagai Bergman of the Hebrew University-Hadassah Medical School on the basal ganglia in the brain. We want to understand better how the basal ganglia deep in the brain work, and stimulate these areas. The answer to depression and schizophrenia will probably come from electric stimulation."
HADASSAH ALSO uses DBS to treat Tourette's syndrome, in which sufferers have tics and suddenly uncontrollable behavior, including abusive language. "Tourette's usually burns out by itself when the patient reaches adulthood and after psychological therapy. But when it continues, we use DBS. One woman is doing pretty well, and has even gotten married and is expecting a baby. But it doesn't work for all patients," Israel reported. "There is one center in the world that is already using surgery to treat Alzheimer's. We hope to cooperate. Medicine doesn't fully understand the mechanisms behind autism, but when we do, we believe we will have a neurosurgical therapy for it too.
A 19-year-old Israeli named Talia was shown suffering from dystonia, a rare genetic movement disorder more common in Ashkenazi Jews. Over the years, her condition made it increasingly difficult to walk, putting her in a wheelchair. When Israel and his colleagues suggested a DBS electrode, she and her parents felt she had nothing to lose. Two weeks later, she was walking.
"It's a new world for me," said Talia. "My life looks entirely different." Israel explained that Talia had been invited to appear at the Hadassah convention, but decided against it at the last minute because, now working with children in national service, she didn't want to leave them. Israel described a male patient named Uri who was debilitated from a movement order and after DBS was able to dance at his daughter's wedding.
"OUR FIELD is one of the most exciting in medicine. We can sometimes turn back the clock. Our center is a national center of excellence, and our goal is to develop a comprehensive surgery unit for epilepsy, psychosurgery and surgery for chronic pain syndromes. We hope to incorporate stem cell and gene therapy as they become available."
Prof. Avi Rivkind, Hadassah's well-known chief of the surgery and trauma unit, was accompanied by Inna Zusman, a young woman who had been nearly killed by the terror attack on the Mount Scopus campus of the Hebrew University during the second intifada. Although she has to use a wheelchair, her survival is a virtual miracle. "She was destroyed, as if an atom bomb had fallen on her. Today she drives a car. When I look at her, I feel as if I have a new baby," said Rivkind, hugging her.
At the question-and-answer session, Rivkind introduced Stacy Placks, a young South-African-born woman who lives in London and happened to be in Los Angeles during the convention. A few years ago, she came to Israel with her youth movement and during a jeep trip in the Negev was thrown out of the vehicle when the driver hit a rock. She had an emergency tracheostomy in the desert, was airlifted to Hadassah, and spent two weeks in intensive care, where she was treated by Rivkind and colleagues, and then moved to the neurology department. After returning to London, she had to take a year off from school to rehabilitate herself.
"Hadassah gave me my life back. I am here because I wanted to give something back to Hadassah," said Placks, whose only visible sign of the numerous operations she had is a delicate scar at the edge of her right eye. "The hospitals are world-class institutions, but not enough people in the world know about them."
HADASSAH-EIN KEREM chief of obstetrics and gynecology Prof. Neri Laufer explained why assisted-reproduction techniques, in which he is an expert, are increasingly in demand.
"Since the 1970s, most women compete with men in the workplace and delay having their first child. By age 40, 20-30% are infertile." In recent years, Laufer and colleagues have studied the exceptional women who spontaneously conceive after 45. These include not only Jewish women but also Beduin; 20% of Beduin women in the Negev give birth after 45. The researchers concluded that these women have a "genetic composition that gives their cells a unique ability to repair their DNA and slow their ageing process. This can be significant not only in preserving fertility but also in understanding longevity and ageing."
A few months ago, Laufer delivered the twins of a 38-year-old Jerusalemite carrier of the defective BRCA gene. Her embryos had been screened for the mutation three days after fertilization and selected for implantation when shown to be healthy. The woman had to undergo in-vitro fertilization in any case because of "mechanical infertility," in which her husband's sperm could not pass through the Fallopian tubes into her uterus. Without the screening, the significantly higher risks for breast and ovarian cancer in females and slightly higher risk of prostate and breast cancer in males could have produced a malignant tumor in her children after they reached adulthood. The case, he said, was the first reported in the medical literature.
HADASSAH SURGEON Dr. Yoav Mintz reported that the Health Ministry has just approved a protocol for performing natural orifice surgery (NOS) on patients instead of either open abdominal and chest surgery or laparoscopic ("keyhold") surgery. Unlike conventional surgery, a tiny incision less than a centimeter long is made in the navel, or surgery is performed indirectly via the mouth, vagina or rectum. This results are much less pain or bleeding, and speedier recovery, Mintz said. "This will be 'the next big thing.' Now that we have the ministry's go ahead, our medical center will become one of only a handful in the world doing such minimally invasive surgery."
Robotic surgery will also be performed in the not-too-distant future.
"Imagine a small surgical tool that floats and levitates like a miniature space ship. It could reach and visualize any part of the body, using a tiny camera and remote-controlled devices. We have done experimental surgery on pigs, and before long hope to do surgery very different from what we do today, with the surgeon sitting at a console, looking at a monitor and moving joysticks. We don't wait for the future at Hadassah; we create it," enthused Mintz.
One of the most annoying parts of minimally invasive surgery, said Mintz, is cleaning the tiny camera. It often gets dirty, making it necessary to pull the endoscope out several times during an operation. This takes up 20% of the operation time. "But we are working on a simple solution to clean the camera while it's in the body."
Birnbaum, previously director of the Ein Kerem hospital, described a new Hadassah clinical trial in which a dialysis-like machine is being used to filter out harmful antibodies responsible for the autoimmune disease lupus erythematosis, which affects mostly women. Called Lupusorb, the Hadassah-developed system was demonstrated to be safe and effective. Ten lupus patients at Hadassah took part in the experimental treatment, which is based on research of Hadassah internal medicine chief Prof. Yaakov Naparstek. It uses a filter column device incorporated into the standard process of plasmapheresis, in which blood is removed, cleansed of immune-system compounds and returned to the body. The column contains a peptide (short protein) named VRT101 that specifically binds the subgroup of auto-antibodies that cause the disease. The antibody level remained low for three weeks afterward, and there was also improvement in other components of the immune system that bolster the body's resistance to the disease.
Mor-Yosef concluded that while America has an excellent medical research system, "sometimes we at Hadassah are able to do promising things that have not yet been approved by the US Food and Drug Administration. After discussing new developments at Hadassah national conventions, we always get queries from people who want treatment."
The author was an invited guest and speaker at the Hadassah Women's Zionist Organization of America's 94th national convention, held in Los Angeles.
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