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Introduction: The field of otolaryngology, head and neck surgery faces a wide range of medical conditions, starting with upper airway morbidity, head and neck tumors, hearing loss and deafness, ear diseases, nose, sinuses, and anterior skull base conditions, pediatric otolaryngology, laryngology and facial and reconstructive plastic surgery. The current issue of this journal presents a variety of manuscripts that are in the forefront of our specialty in Israel and around the world. The management of laryngeal tumors is undergoing thorough modification aiming to preserve the organ while early tumors are treated endoscopically using laser technology. The human papilloma virus is one of the major changes that recently emerged as an important etiologic factor for oropharyngeal carcinoma in young nonsmokers. Hearing loss and deafness are negative contributors to the quality of life. Congenital hearing loss has a major effect on brain development, and speech and language development, therefore, early cochlear implantation is beneficial for well child development. Different aspects associated with cochlear implantation are discussed in this issue. Many fields that are associated with our specialty are gradually utilized by otolaryngologists, for example the utilization of ultrasound by surgeons. The field of otolaryngology head and neck surgery is dynamic and abundant with innovative technologies that are presented in this article, starting with cochlear implants, robotic surgery, and the utilization of 3D printers for complicated facial reconstructions. We are in the midst of a journey and we may assume that the future holds great promise both for our patients and for us as health care providers.

Background: Hyperemesis gravidarum (HG) affects around 1% of pregnant women. The experience is traumatic, and many women hesitate to start a subsequent pregnancy in view of the tendency of HG to re-occur., Objectives: A 25 year old woman who experienced HG in her previous pregnancy was very afraid to start a second pregnancy, as she considered the termination of the first, traumatic pregnancy. She was advised to use pre- emptive antiemetic therapy with an anti emetic drug before any symptom appeared. The pregnancy passed with only mild nausea and vomiting., Discussion: Several controlled randomized studies have shown the effectiveness of pre emptive therapy in preventing a repeat of HG symptoms.

Introduction: Fetal alcohol spectrum disorder is presently estimated to affect more than 1-2 % of babies in North America. In Israel it is quite rarely diagnosed. Many of the children adopted from the former Soviet Union were born to alcoholic women., Background: A 4.5 year old boy adopted from Ukraine, presented with inattention, hyperactivity and aggressiveness. He was born with severe intra uterine growth restriction (IUGR) and continued to grow on the 3rd percentile. His biological mother was alcohol dependent., Discussion: This case highlights the need to consider the differential diagnosis of children with ADHD plus aggressive behavior, as well as maintaining a high index of suspicion of FASD in children adopted from the Soviet Union.

Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition during gestation. Approximately 85% of pregnant women suffer from some degree of this condition, while hyperemesis gravidarum (HG), the most severe form, affects up to 2% of women. Although being the leading cause for hospitalization during pregnancy, NVP has received little attention from the medical community. NVP negatively affects women's quality of life, household activity and work productivity. In Canada, the financial cost of NVP, ranges from $132 to $653 per woman/week. In extreme cases, severe NVP results in therapeutic abortions. On the other hand, NVP has been shown to have a protective effect against spontaneous abortions and congenital malformations. Lately, there has been an interest in the hypothesis that NVP is a mechanism protecting the fetus from phytochemicals. Early treatment can prevent future complications and deterioration of the symptoms. Various studies have demonstrated the effectiveness and safety of antiemetic therapy in pregnancy. However, fear of teratogenicity and lack of clinical guidelines lead to trial and error NVP management. We present an updated algorithm for the management of NVP.

Serous otitis media (also known as otitis media with effusion) is one of the most prevalent pediatric diagnoses. However, the recommended clinical approach and significance of this entity are controversial. Pathogenesis is usually based upon a combination of factors as overviewed in the body of the article. The cognitive and behavioral effects amongst children suffering serous otitis media were extensively studied and data points to little if any effects during long term follow-ups in otherwise healthy children. The therapeutic approach can be divided into watchful waiting, systemic drugs, topical drugs, mechanical therapies and surgical therapy (i.e. ventilation tube insertion). The reviewed literature mainly supports the effectiveness of the surgical approach in carefully selected cohorts of patients.

Chronic rhinitis (CR) affects large populations worldwide, diagnosed in 40% of the population and is often associated with co-morbidities, such as asthma, sinusitis, rhinoconjunctivitis cognitive dysfunction, and leads to loss of work and school days. Recently, global clinical guidelines were proposed for allergic rhinitis (AR). Similarly, an Israeli expert panel, consisting of ENT and Allergy/Immunology specialists, was delegated to discuss the current approaches to CR (including allergic and non-allergic rhinitis) and to submit a consensus paper. The guidelines, briefly presented herein, describe the epidemiology, mechanisms, diagnostic procedures, treatment modalities and clinical-management algorithms. It is adapted to the Israeli health system and will be distributed to all physicians by the Israel Medical Association. The new clinical guidelines are expected to update current knowledge, improve communication between medical disciplines, provide medico-legal support and improve the management of CR.

In the last decade, the Israeli healthcare system dealt with many casualties that resulted from terrorist actions and at the same time maintained preparedness for other potential hazards such as natural disasters, toxicological, chemical, radiological and biological events. There are various models for emergency preparedness that are utilized in different countries. The aim of the article is to present the structure and the methodology of the Israeli healthcare system for emergencies. Assuring emergency preparedness for the different scenarios is based on 5 major components that include: comprehensive contingency planning; control and command of operations; central control of readiness; capacity building; coordination and collaboration among the numerous emergency agencies. CLose working relationships between the military and civilian systems characterize the operations of the emergency system. There is a mutual sharing of information, coordinated operations to achieve risk assessment and determine priorities, and consensual allocation of resources. The ability of the medical system to operate in optimal coordination with interface bodies, including the Israel Defense Forces, is derived from three main elements: the shortage of resources necessitate that all agencies work together to develop an effective response to emergencies; the Israeli society is characterized by transition of personnel from the military to the civilian system which promotes joint operations, whereas in most other countries these systems are completely separated; and also developing mechanisms for continuous and coordinated operation in routine and emergency times, such as the Supreme Health Authority. The Israeli healthcare system was put to the test several times in the Last decade, during the terror wave that occurred between 2001-2006, the 2nd Lebanon War and in operation "Cast Lead". An extensive process of learning lessons, conducted during and following each of these periods, and the existence of a mechanism which facilitated the definition of a systematic policy and the examination of its implementation, enabled the healthcare system to provide medical services to the population and to improve its preparedness by an ongoing process.

Neurofibromatosis type 1 (NF1) is an autosomal dominant condition that primarily involves the skin and the nervous system. It affects about 1 in 4000 individuals. NF1 is caused by a mutation in the nfl gene located on chromosome 17q11.2. Neurofibromin, the protein products of the normal nf1 gene, acts as a tumor suppressor and limits cell growth. Mutation in this gene leads to cell overgrowth and an increased risk of developing benign and malignant tumor. The diagnosis of NF1 is made in an individual with any two of the following clinical features: café-au-lait spots, intertriginous freckling, Lisch nodules, neurofibromas, optic glioma, distinctive bone lesions and first degree family relative with NF1. Learning and developmental disorders are the most common neurologic complication of neurofibromatosis type 1 and can be responsible for significant lifetime morbidity. This report provides a review on cognitive and developmental manifestation of children with NF1 and the importance of early diagnosis and treatment.

Background: For medical students studying in a traditional medical curriculum, advancement from the pre-clinical years to clinical clerkships requires a conceptual move from disease-oriented thinking to problem-oriented medicine., Objective: To implement an educational tool in the introductory course of clinical medicine that will assist students in the development of comprehensive medical reasoning, including the generation of a dynamic problem list, its assessment and the construction of investigative and treatment plans., Methods: Since 2001 a novel brief Problem-Based Learning (PBL) experience has been offered as a component of the Introduction to Medicine course given to 4th year medical students prior to the start of their clinical years at the Hebrew University Medical School. The brief experience consists of daily meetings given to small groups of students at the final stages of the pre-clinical courses. Each PBL day covers a single clinical case revealed sequentially over 3-5 structured sessions, interspersed with periods of self-directed learning. Cases are highly structured and contain all of the required information pertaining to the clinical problems presented., Results: Evaluations of this course over 4 years by both students and teachers have been outstanding, with students consistently stating in their written comments that the PBL experience was one of the most meaningful learning experiences they have encountered during the pre-clinical phase of their training., Conclusions: This brief PBL experience appears to help in building up the students' clinical competence during their first clerkship experiences. It may be especially useful for medical schools using the traditional medical curriculum.

Background: Head louse infestations are prevalent worldwide. Over the past 20-25 years, 15-20% of all children in Israel between 4 and 13 years of age have been infested with head lice. This is mainly due to the existence of ineffective pediculicides on the market., Objective: To examine the pediculicidal efficacy and safety of Prioderm Cream Shampoo in an open clinical study., Methods: The active ingredient of Prioderm Cream Shampoo is malathion (1%) and it was applied to the hair of infested children three times for 10 minutes at 5-day intervals., Results: Of 419 children examined, aged 6-14 years, from four schools in Jerusalem, 109 (26.0%) were infested with lice and eggs, while 110 (26.3%) were infested only with nits. All 109 louse-infested children were included in the study while 86 (78.8%) complied with the instructions for use. Treatment was successful in 79 children (91.8%), while failure was observed in 3 children after the first treatment and in 4 children after the third treatment. Although 21.5% of the children disliked the odor of the product, there were no significant side effects related to this formulation., Conclusions: The product was very effective in controlling louse infestations under clinical conditions and caused no serious side effects.

Objective: This study describes the development and evaluation of a curricular program aimed at improving the clinical and communication skills required for managing the clinical encounter with adolescents, among pediatric and family practice residents using the technique of standardized patients., Methods: A daylong curricular unit which included: clinical interviews with simulated patients presenting typical clinical problems occurring among adolescents; a teaching unit explaining the principles of communication with adolescents and a clinical discussion and feedback session using video clips. Forty-eight residents in pediatrics and family practice undertook the curricular unit. A total of 120 doctor-simulated patient interviews were documented using six patients' case scenarios representing somatization disorder, eating disorder, chronic illness and non-compliance, pregnancy, drug abuse and menstrual disorder., Results: The doctors' self-estimation of clinical skills associated with adolescent medicine that was documented at the beginning of the curricular unit was generally reported as low. In most of the cases the participants did not identify the main problem and diagnoses that were presented. The problems least correctly diagnosed were eating disorder and non-compliant chronic illness. Only in the cases of somatization and pregnancy more than half of the residents identified the problems that were presented. At the end of the curricular unit the doctors expressed a very high level of satisfaction with the program., Conclusion: The present study developed and evaluated a short and structured curricular unit dealing with the principles of communication with adolescent patients using the technique of simulated/standardized patients. It was found that the lack in these skills, which was identified in pediatric and family practice residents, could be bridged using this educational technique.

Factors influencing the decision-making process of the Abortions High Committees (after the 23rd week of pregnancy), and whether there are differences between decisions of different Committees were examined. A questionnaire was sent to the 45 members of these committees of whom 24 responded (53%). Some hospitals refused to cooperate because they did not want to evoke discussion about the practices of the Committees. The significant factors that play a part in the decision as to whether or not to allow an abortion are the medical condition of the fetus, the medical and psychological state of the mother, and the week of pregnancy. The data also show that women committee members are more inclined to authorize abortion than men, and that the more religious members are less inclined to authorize abortions. No differences were found between hospitals, and the age of committee members had no influence. Members did not accord any importance to fear of litigation in their considerations.