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Background: In the last decade, important advances in understanding the lung cancer cellular signal pathways have led to the designing of targeted drugs that significantly prolong survival. Recent data shows that 64% of lung adenocarcinomas harbor at least one activating driver mutation, including treatable mutations such as RET, ERBB2 (HER-2) and ROS1 gene mutations, besides the regularly screened ALK and EGFR genes. Next-Generation Sequencing (NGS) reveals more clinically meaningful genomic alterations as compared to currently used diagnostic tests. However, the clinical impact of NGS testing merits further investigation., Objectives: To evaluate the impact of NGS-based tumor profiling on therapeutic decision making in the real life setting in advanced lung cancer patients., Methods: The study population included 50 lung cancer patients who were treated at Davidoff Cancer Center, Rabin Medical Center in 2011-2015, and for whom a broad, hybrid capture-based NGS genomic profiling test was performed. The data was retrospectively collected from patient charts., Results: 39 of 46 included patients (84.8%) had one or more driver alternations, and a targeted agent was administered according to alteration discovered in 21 of 46 cases (45.7%). 15 (37.5%) treated patients were exclusively detected by NGS. The most frequent drivers were EGFR (26.1%), KRAS (19.6%), ALK (13%), STK11 (10.9%) and RET (8.7%). Interestingly, 10 patients became EGFR and ALK positive by NGS after the previous standard local molecular testing was negative., Conclusions: Molecular testing using NGS can reveal a targetable genomic alteration in the vast majority of lung tumors. Its broad use for therapeutic decision making is essential since approximately half of the patients can benefit from customized treatment upon testing results., Discussion: Although this topic needs to be further assessed in large randomized controlled trials, our positive results emphasize the importance of multiplex testing as a diagnostic test in advanced lung cancer patients. The implementation of NGS at Rabin Medical Center in the near future is highly anticipated.

Every third cancer death in Israel is due to lung cancer. Still, 80% of the lung cancer cases are related to tobacco smoking; and therefore, more must be done for primary prevention, screening for lung cancer among risk cohort and against the tobacco industry. In the last decade, significant progress in the molecular understanding of this disease brought to a marked improvement in the overall survival and in the quality of life of these patients. The treatment paradigm is shifting from "one treatment fits all" regimens to personalized treatment strategies that allow patients to be treated with a variety of novel drugs that prolong their survival and maintain their quality of life. The latest revolutionary concept of immunotherapy in lung cancer is emerging and promises further hope to this population

This article describes a rare presentation of squamous cell carcinoma of the lung, mimicking an ectopic pregnancy secreting beta-hCG protein in a 47 year old female smoker, who was treated with Methotrexate and subsequently curettage, tubectomy and right ovariectomy, because of suspected hydatidiform mole. This document presents a rare and chaotic case of lung cancer and reviews the differential diagnosis of an increased level of the beta-hCG marker and the therapeutic approach to these cases.

Bronchiolitis obliterans syndrome (BOS) is one of the main causes of mortality after lung and bone marrow transplantation. Up to 75% of lung transplantation patients develop BOS within 5 years, whereas after bone marrow transplantation 14% of the patients develop the disease with 65% mortality within 3 years. Patients demonstrate gradual decrease in pulmonary functions with no significant anatomic/imagine findings. Therapeutic trials with high dose systemic corticosteroids, immune suppression and immunomodulation did not show any significant success. However, macrolides and especially azithromycin have recently been reported as highly efficient for BOS. This review summarizes information on the disease focusing on the clinical experience with azithromycin as a treatment for BOS.

Road accidents, work accidents, or other trauma can cause impotence and are frequently followed by insurance claims. During 1990-97 we examined 230 males with such a complaint. All underwent full polysomnographic recordings in the sleep laboratory for 2 nights, during the course of which NPT (nocturnal penile tumescence) was examined with special equipment. It was assessed by an experienced technician following planned awakenings from REM sleep. In 75 of the 230 subjects (33%), satisfactory erections were observed. In 100 (43%), who experienced at least 3 periods of REM sleep, no erections occurred. These patients were categorized as suffering from organic impotence. In the remaining 55 (24%), the results were inconclusive, with only partial erections or not enough REM sleep periods. Since a man recognized as suffering from impotence may be awarded large monthly payments for life, these examinations, in our opinion, are an important tool to prevent unjustified claims, and can save the state unnecessary expenses.

Laparoscopic cholecystectomy is considered the procedure of choice for removing symptomatic, stone-containing gallbladders. It is estimated that in 30-40% of these operations stone(s) spill into the peritoneal cavity. It was assumed that these "dropped stones" are harmless and are dissolved and absorbed spontaneously. We present a 70-year-old woman in whom such a stone, dropped during laparoscopy, led to formation of an intraperitoneal abscess.

Trichobezoars are accumulations of hair casts in the stomach associated with trichophagia. The typical patient is an adolescent female who presents with alopecia and an upper abdominal mass which on moving can cause intermittent gastric outlet obstruction. Only a minority of patients have severe psychiatric disorders. When hair strands extend from the main mass in the stomach, all along the small bowel and reaching the cecum, the condition is termed the Rapunzel syndrome. In about 5% of patients there are separate hair masses in the stomach. The clinical presentation includes abdominal pain, loss of appetite, weight-loss, vomiting, loose stools, pancreatitis, jaundice, anemia and hypoalbuminemia. These signs and symptoms raise the suspicion of malignancy. Complications of bezoars include ulcers, perforation of the bowel, obstruction and intussusception. Diagnosis can be established either by barium swallow or by CT scan. Ultrasound might suggest the diagnosis, but sonographic features are definitely not pathognomonic. Treatment is surgical, as endoscopic removal is usually unsuccessful. We present 2 children in whom trichobezoars were found.

During 1989-1994, there were 322 episodes of Gram-negative enteric bacteremia in 308 children. The incidence increased from 31/100,000 in children younger than 15 years of age during 1989-1991, to 50/100,000 during 1992-1994. The most common pathogens were Klebsiella, E. Coli, Salmonella and Enterobacter. 39% of episodes were nosocomial and a significant increase was recorded for each species during the last 3 years of the study. Klebsiella represented the most common pathogen causing nosocomial bacteremia, while E. coli and Salmonella were the main pathogens causing community-acquired bacteremia. In this study in southern Israel, the incidence of Gram-negative enteric bacteremia was significantly higher in Bedouin children, with the exception of bacteremia due to Salmonella, which occurred mainly in Jewish children.

Primary iliopsoas abscess is a relatively rare disease occurring mainly in children. Since it simulates more common conditions, delay in diagnosis is almost the rule. In 2 children it simulated acute appendicitis, but in both cases a normal appendix was removed. In a third child it led to the diagnosis of right sacroiliitis, and antibiotics were given for several weeks. Ultrasound examinations in all 3 failed to reveal the diagnosis, which was reached by CT scan. The latter is the method of choice for diagnosis and is of aid in deciding on the best route for drainage.