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Background: Pubic rami fractures are common in the elderly, resulting from low energy traumatic falls. The recovery of some of these patients may be disproportionately slow., Objective: To investigate the characteristics of older patients admitted with pubic rami fractures and possible associated pelvic fractures., Patients and Methods: We have prospectively examined nineteen consecutive female patients admitted from the emergency ward with a diagnosis of pubic rami fractures, during a one-year period. Patients underwent bone scans and pelvis computerized tomography., Results: Six of these patients had associated sacral fractures as demonstrated by pelvic CT scan. None of these sacral fractures was diagnosed on admission to the emergency ward., Conclusion: There is a considerable high rate of association of combined pubic and sacral fractures. Greater awareness of this clinical condition is required.

In mid-1992, improvement of quality of service was set as a major goal in the framework of a 5-year plan at this hospital. This subject was selected in preparation for a new era in health care emerging in the world in general, and in Israel in particular. 6 problematic departments with high potential for improvement were chosen for the first stage of implementing a total quality management program (TQM). The goal was to gain experience through the implementation of TQM in a few medical and nonmedical departments in preparation for implementing TQM in the entire hospital. This process is ongoing and the first conclusions and perspectives are now being studied by all involved.

Malignant skin neoplasms of the auricle and peri-auricular region constitute only 6% of all skin cancers. However, rates of recurrence and metastasis are higher than for other cutaneous malignancies. Of 81 patients with malignant skin neoplasms of the auricle, 53.1% had basal cell carcinoma, 39.5% squamous cell carcinoma and 7.4% malignant melanoma. The neoplasms were 4 times more common in men (more than in other series), and more common in those of Ashkenazi origin (75% of the patients) and in the elderly (peak incidence in the 7th decade). All patients were treated surgically, and 21 were also irradiated. In 4 with cervical metastases neck dissection was performed. The recurrence rate for all neoplasms was 12.4% and the rate of metastases to regional lymph nodes from squamous cell carcinoma, 12.5%. There was a marked correlation between positive margins after surgical excision and rates of recurrence and regional metastases. Malignant skin neoplasms of the auricle should be regarded as high risk lesions which often recur and/or metastasize. Therefore, it is recommended to excise the tumors adequately so as to get negative margins, and to follow-up with careful, frequent evaluation.