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Moral appeals to altruism as a means to influence people's prosocial behavior are common, especially in organ donation, but communicators might not consider that conceptions of altruism differ among people, cultures, and scholars. In organ donation employing altruism as the main appeal is contested and some propose using solidarity or reciprocity as alternative prosocial appeals. This qualitative study explored views of people from diverse Israeli groups (29 focus groups) and medical professionals (140) regarding the appropriateness of employing these 3 moral appeals in organ donation. The analysis presents frameworks of contrasting conceptions of altruism that point to potential unintended effects when applying a restrictive conception. It also identifies communication challenges associated with introducing solidarity or reciprocity as prosocial and value-laden persuasive appeals.

Scientific advances enable parents to choose the sex of their offspring. This innovative technology has confronted society with the need to decide whether what is possible is also permissible, and under what terms. The debate over sex selection invokes various important issues, including gender stereotypes, discrimination of women, personal and parental reproductive autonomy, abortion, and more. As a result, different societies have made different determinations, reflecting their particular circumstances, social norms, culture, history, and religion. While some abstain from any formal regulation, which in effect allows unrestricted practices in respect to sex selection, others enforce a strict prohibition. Israel has chosen an intermediate position, conforming to the prevailing prohibitive stance (in Europe and Canada for instance), but allowing for certain exceptions. The Israeli regulations represent an authentic resolution of the issue that demonstrates Israel’s unique, autonomous bioethics status among Western liberal democratic nations.

Force feeding of fasting hunger-striking prisoners is the subject of considerable controversy in Israel and elsewhere, posing a direct conflict between two basic ethical values: that of human life and respect for autonomy. The Israel Medical Association, as well as the World Medical Association, has taken the position that force feeding of such prisoners is an act of torture and is therefore unethical. However this paper presents an opposing view, which recently became the law in Israel, that, whereas the rights of prisoners to decree a hunger strike as a form of protest should be respected, if the prolongation of the strike reaches a stage of clear and present danger to the life and health of a prisoner, the saving of the prisoner's life must take precedence over considerations of autonomy. The paper present the steps that should be taken, including extensive and empathic efforts to persuade the prisoner to end his/her fast; gaining the approval of a hospital's ethics committee; and gaining the approval of a district court judge; the feeding is to be carried out in the most humane and sensitive manner as befitting a lifesaving procedure for any patient. This position is consistent with Israel's Basic Law: Human Dignity and Liberty, Israel's Patient Rights Law, Israel's "Do not stand idly by your fellow man's blood" Law, with several Israeli court decisions and in keeping with the dominant Israeli culture. Finally, instructions for physicians who object to such measures are discussed, ascertaining the freedom of conscience as well as preserving the life of the hunger-strikers.

Because the number of organs available for transplantation does not meet the needs of potential recipients, some have proposed that a potentially effective way to increase registration is to offer a self-benefit incentive that grants a 'preferred status' or some degree of prioritization to those who register as potential donors, in case they might need organs. This proposal has elicited an ethical debate on the appropriateness of such a benefit in the context of a life-saving medical procedure. In this paper we review arguments and ethical concerns raised by scholars, and studies of views of members of the public regarding the prioritization incentive system. We also report on our study of the views of those involved in organ transplant and of other medical professionals in Israel, as over half a decade ago Israel implemented a prioritization incentive system. Bioethicists propose that key stakeholders' views can provide additional arguments and perspectives on controversial issues. Proponents justify the prioritization incentive drawing mainly on arguments related to its potential effectiveness, reciprocity and fairness. Opponents point to the fact that registering is not binding and not an actual donation, and raise concerns regarding equity, autonomy and gaming the system. Ethical concerns raised by the practitioners in the study were examined in light of scholars' arguments and actual registration and donation data. Practitioners involved in transplantation raised ethical concerns corresponding to those raised by scholars as well as additional concerns. They also challenged proponents' assumptions regarding the utility of the incentive system from their own experience and argued that proponents obscure the meaning of reciprocity.

Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

In addressing various options for registering prospective organ donors and creating a “disrespectfulness ranking,” MacKay and Robinson (2016) have embarked on the proposition that available options...

Nanomedicine offers remarkable options for new therapeutic avenues. As methods in nanomedicine advance, ethical questions conjunctly arise. Nanomedicine is an exceptional niche in several aspects as it reflects risks and uncertainties not encountered in other areas of medical research or practice. Nanomedicine partially overlaps, partially interlocks and partially exceeds other medical disciplines. Some interpreters agree that advances in nanotechnology may pose varied ethical challenges, whilst others argue that these challenges are not new and that nanotechnology basically echoes recurrent bioethical dilemmas. The purpose of this article is to discuss some of the ethical issues related to nanomedicine and to reflect on the question whether nanomedicine generates ethical challenges of new and unique nature. Such a determination should have implications on regulatory processes and professional conducts and protocols in the future.

Information technology has revolutionized health care. However, the development of dedicated mobile health software has been lagging, leading to the use of general mobile applications to fill in the void. The use of such applications has several legal, ethical, and regulatory implications. We examined the experience and practices governing the usage of a global mobile messenger application (WhatsApp) for mobile health purposes in a national cohort of practicing otolaryngologists in Israel, a known early adaptor information technology society.Cross-sectional data were collected from practicing otolaryngologists and otolaryngology residents via self-administered questionnaire. The questionnaire was composed of a demographic section, a section surveying the practices of mobile application use, mobile health application use, and knowledge regarding institutional policies governing the transmission of medical data.The sample included 22 otolaryngology residents and 47 practicing otolaryngologists. Of the physicians, 83% worked in academic centers, and 88% and 40% of the physicians who worked in a hospital setting or a community clinic used WhatsApp for medical use, respectively. Working with residents increased the medical usage of WhatsApp from 50% to 91% (P = .006). Finally, 72% were unfamiliar with any institutional policy regarding the transfer of medical information by personal smartphones.Mobile health is becoming an integral part of modern medical systems, improving accessibility, efficiency, and possibly quality of medical care.The need to incorporate personal mobile devices in the overall information technology standards, guidelines, and regulation is becoming more acute. Nonetheless, practices must be properly instituted to prevent unwanted consequences.

In an explicit attempt to reduce physician paternalism and encourage patient participation in making health care decisions, the informed consent doctrine has become a foundational precept in medical ethics and health law. The underlying ethical principle on which informed consent rests — autonomy — embodies the idea that as rational moral agents, patients should be in command of decisions that relate to their bodies and lives. The corollary obligation of physicians to respect and facilitate patient autonomy is reflected in the rules that have been created to implement consent procedures, especially those requiring disclosure of relevant information.However, there are many practical impediments to patient self-determination in health care decisionmaking. Well-meaning physicians often lack the time to live up to the ideal of facilitating genuine, informed deliberation with and by their patients, and many lack the motivation or skill to do so successfully.

In addressing the creation and regulation of biobanks in different countries, a short descriptive introduction to the social and cultural backgrounds of each country is mandatory. The State of Israel is relatively young (established in 1948), and can be characterized as a multi-religious (Jewish, Muslim, Christian, Druz, and others), multi-ethnic (more than 14), multi-cultural (Western “Ashkenazi” Jewry, Oriental “Sfaradi” Jewry, Soviet Jewry, Israeli Arabs, Palestinian Arabs) society, somewhat similar to the American melting pot. The current population is 8.3 million, a sharp rise resulting from a 1.2 million influx of immigrants from the former Soviet Union in the 1990s. Seventyfive percent are Jewish, 20% Arabs (the majority of whom are Muslims), and several other minorities. The birth rate is 3.8 per family, the highest in the Organization for Economic Cooperation and Development (OECD).

Dor Yeshorim, a genetic testing programme focusing on the ‘genetic compatibility’ of prospective couples in Orthodox Jewish communities in Europe, the US and Israel, is at the centre of our paper. We discuss the specific understandings of risks that enable the effective implementation of the Dor Yeshorim model in Orthodox populations. Furthermore, we compare Dor Yeshorim to the premarital genetic testing programme for thalassaemia in Cyprus and analyse the particular social practices which generate different notions of genetic identity in these two projects. In the Cypriot programme, where individual carrier status is disclosed, unfavourable genetic carrier status is conceptualized on the individual level and often solved by resorting to prenatal genetic diagnosis upon pregnancy. In the case of Dor Yeshorim, where no information on carrier status but only on the ‘genetic compatibility’ of both partners is revealed, a notion of ‘genetic couplehood’ arises which conceptualizes ‘genetic risk’ not individually but as a matter of genetic jointness. If a prospective couple is found out to be ‘genetically incompatible’, marriage plans usually are cancelled. Furthermore, by not disclosing individual carrier information, Dor Yeshorim successfully avoids a pressing issue which ‘secular’ genetic testing programmes struggle with: the peril of ‘knowing too much’.

Organ transplantation remains one of modern medicine's remarkable achievements. It saves lives, improves quality of life, diminishes healthcare expenditures in end-stage renal patients, and enjoys high success rates. Yet the promise of transplantation is substantially compromised by the scarcity of organs. The gap between the number of patients on waiting lists and the number of available organs continues to grow. As of January 2006, the combined waiting list for all organs in the United States was 90,284 (64,933, 17,269, and 3,006 for kidney, liver, and heart respectively). Unfortunately, thousands of potential organs are lost each year, primarily due to lack of consent to donation from the deceased before death, or from the family thereafter. Only fifty percent of potential donors – the “conversion” rate – become actual donors. The costs attributed to organ shortage are substantial – Medicare paid over $15.5 billion in 2002 for treating patients with end-stage renal-disease, who predominate on organ waiting lists.

Conflicting opinions exist in the literature regarding the exact anatomical course of the great auricular nerve. The aim of this work was to study the pathway of its anterior branch and endings in relation to the parotid gland. Material and Methods: Thirty-seven specimens were dissected from 19 fresh adult cadavers and studied including the parotid gland at the region of the termination of the anterior branch of the nerve. The causes of death were not due to pathology in the parotid region. All the specimens were fixed in formaldehyde, serially cut, stained by haematoxylin and eosin, and examined by light microscope. Results: In most of the glands (21/37=57%), there was no evidence of well-organized nerve fibres of the great auricular nerve inside the parotid gland. In a few (5/37=13%), nerve fibers were seen to penetrate the interlobular septa and in 30% of the cases (11/37) nerve bundles were found deep in the gland along side small ducts and close to thin-walled blood vessels. Conclusion: These findings prove that there are anatomical variations of the endings of the anterior branch of the great auricular nerve. The significance of nerve bundles deep in the gland along ducts and near vessels remains to be explored. Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd. All rights reserved.

Information Technology (IT) and computing capabilities are revolutionizing the practice of medicine in an unprecedented way. Some current legal and ethical concerns evolving from this revolution are addressed, pointing to the emerging concepts in Israeli jurisprudence, which regards medical IT as an important contribution to patient empowerment, to medical risk management and in managing the resources of a national health system.

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement.

Shared decision making (SDM) - involving patients in decisions relevant to their health - has been increasingly influential in medical thought and practice around the world. This paper reviews the current status of SDM in Israel, including efforts to promote SDM in the legislation and healthcare system, its influence in medical training and the national health plans, and funding for SDM-related research. Published studies of SDM in Israel are also reviewed. Although informed consent and patients' right to information are regulated by Israeli law, little provision is made for SDM. Further, there are few organized programs to promote SDM among medical professionals or the public, and governmental support of SDM-related research is minimal. Nonetheless, patients have begun to influence litigation in both formal and informal capacities, medical schools have begun to incorporate courses for improving physician-patient communication into their curricula, and the largest national health plan has initiated a plan to increase public awareness. A review of the limited research literature suggests that although patients and physicians express a desire for greater patient involvement, they often have reservations about its implementation. Research also suggests that despite the positive effects of SDM, such an approach may only infrequently be applied in actual clinical practice. In conclusion, though not actively promoting SDM at present, Israel's universal coverage and small number of health plans make rapid, widespread advances in SDM feasible. Israeli policymakers should thus be encouraged to nurture burgeoning initiatives and set plausible milestones. Comparing the status of SDM in Israel with that in other countries may stimulate further advancement.

The growth of information technology and telecommunications has created promising opportunities for better, faster, more accessible, barrier-free health care; telemedicine (TM). The feasibility of many TM projects depends on resolving legal issues. Mastering technical issues or providing training remain important benchmarks for implementation of TM, but legal issues constrain progress. This article identifies the key legal issues, maps current legislation, and offers a forecast of necessary steps to expedite the dissemination of TM.

The purpose of this Consensus Statement is to focus on implantable cardioverter-defibrillator (ICD) deactivation in patients with irreversible or terminal illness. This statement summarizes the opinions of the Task Force members, convened by the European Heart Rhythm Association (EHRA) and the Heart Rhythm Society (HRS), based on ethical and legal principles, as well as their own clinical, scientific, and technical experience. It is directed to all healthcare professionals who treat patients with implanted ICDs, nearing end of life, in order to improve the patient dying process. This statement is not intended to recommend or promote device deactivation. Rather, the ultimate judgement regarding this procedure must be made by the patient (or in special conditions by his/her legal representative) after careful communication about the deactivation's consequences, respecting his/her autonomy and clarifying that he/she has a legal and ethical right to refuse it. Obviously, the physician asked to deactivate the ICD and the industry representative asked to assist can conscientiously object to and refuse to perform device deactivation.

Solutions to many of the problems confronted by public health policymakers depend on getting people to behave in a way that promotes the common interest even though the desired conduct may not serve the self-interest of each individual. If individuals make choices that undermine a public good (PG), society faces the choice of either giving up the desired good, or finding a way to influence individual decisionmaking to guarantee a sufficient level of cooperation. Economists characterize these challenges as “collective action problems” (CAPs). We argue in this paper that framing common challenges in public health as collective action problems would help policy planners draw on a large body of literature and insights in behavioral and social sciences that has not yet been incorporated into the mainstream of the field. The traditional economic account of collective action problems stems from the premise that sub-optimal participation in collective efforts to create and preserve public goods, such as a clean environment, is a direct result of rational decisions made by individuals to advance their own interests over those of the group, while often consuming the benefits of investments made by others (i.e., “free riding”). Yet, emerging scholarship in the behavioral and social sciences sheds new light on the choices that people make, and especially on what is ostensibly “free riding” behavior, leading to the general conclusion that failures to create and sustain are often attributable to cognitive and behavioral tendencies that can be modified. These insights should be harnessed within the field of public health policy to help us understand how to reduce the number of people who shirk responsibilities to larger groups. Importantly, these studies lead to the conclusion that CAPs are often imperfectly conceptualized as simple “free rider” problems. This developing body of knowledge also highlights the more complex composition of CAPs. This paper analyzes several public health issues using an enriched CAPs framework in order to illustrate its advantages in prescribing public policies. In planning for solving CAPs in public health, we advocate a more prominent incorporation of behavioral components. Interestingly, the literatures in medicine and public health have thus far given little attention to CAPs in many situations that would fit well with the body of knowledge gained in the fields of behavioral law and economics. We also believe that lessons learned in resolving CAPs in bio-medicine could foster a more general discussion of the obligations of citizenship and individual as well as communal responsibilities, but space limitations preclude a more detailed exposition of this thesis here.In this paper, we use two case studies. One regards vaccination, an archetypal example of collective action in public health. The other regards organ donation. In the immunization case, collective action is necessary in order to achieve herd immunity; once such immunity is achieved, the benefits of decreased mortality and morbidity are available to all. However, given the reality of herd immunity, those who refrain from vaccination are nevertheless protected by the actions of their vaccinated peers. Nonvaccinated people hence enjoy a free ride — they are provided protection (herd immunity) at no cost (the injection and possible adverse sequelae). Exemptors from vaccination do expose themselves to possible outbreaks of the pertinent disease, but such eventualities are considered rare. Yet if a sufficiently large number of people avoid vaccination, then there will be insufficient herd immunity. Indeed, in recent decades decreased vaccination rates have led to outbreaks. Policy remedies have concentrated on the use of mandatory vaccination laws (mostly pre-school vaccination requirements), coupled with legislation (the Vaccine Injury Compensation Program in the US and similar laws in other countries) that provides no-fault, administrative compensation for adverse effects that have been scientifically linked to covered vaccines. Still, a tendency to relax mandatory vaccination laws by introducing exemption clauses has decreased the number of vaccinated children. This is a constant source of worry for those interested in maintaining herd immunity.In the case of organ donation, we have the technology to save lives, but the waiting list for organs is growing (numbering more than 100,000 people), waiting periods on the lists are frustratingly long, and more than 7,000 people die while awaiting an organ.Noticeably, the number of people who die in circumstances that make them potential organ donors is sufficient to eliminate death while awaiting an organ and significantly reducing the length of the waiting lists. Yet in many countries, including the US, the actual retrieval rate based on donor cards or families' consent is only 50% of the potential, though the public's expressed support for organ donation reaches 90 percent or more. Policy solutions developed in the US include, among others, improved identification systems, organ procurement organization best practice guidelines, and massive public education campaigns. The results are encouraging but these measures alone will nevertheless remain insufficient. In the following, we briefly summarize salient concepts as they relate to decisionmaking of individuals and groups bearing on the resolution of CAPs. Our goal is to identify and incorporate additional tools that may aid public health policymakers to deal with less-than ideal collective action outcomes. We start with a succinct description of PGs, CAs, and resulting CAPs as they relate to choice-making. We then turn our attention to behavioral economics and end by highlighting a few key conclusions.

OBJECTIVES To investigate the contribution of diagnosis-specific information sheets at discharge from the emergency department on parental understanding of the discharge instructions. METHODS The study group consisted of a convenience sample of parents of children discharged home from the emergency department of an urban tertiary care pediatric facility (n=95). At discharge by the physician, all were given a disease-specific information sheet to accompany the physician's discharge instructions. Thereafter, the parents were asked to complete the same 13-item questionnaire used in our previous study, covering demographics, level of anxiety, and quality of physician's explanation, in addition to a description, in their own words, of their child's diagnosis and treatment instruction and an indication of their preferred auxiliary method of delivery of information. The findings were compared with the study group in the first phase study (n=287) who did not receive the disease-specific information sheet. The BMDP statistical package was used for the analysis. RESULTS No statistically significant differences between the two groups in age, sex, and education, level of anxiety before or after the emergency department visit, or time of day were observed. Full understanding of the diagnosis was noted in 73% of the parents who received the information sheet and 72% of the parents in our previous study who did not. Corresponding rates of understanding of the treatment instructions were 92% and 82%. On statistical analysis, the distribution of the diagnosis-specific information sheet significantly improved parental understanding of the treatment instructions (P=0.025), but not of the diagnosis (P=0.54). CONCLUSIONS Although overall parental understanding of emergency department discharge instructions is good, understanding of the treatment instructions can be further improved with the use of diagnosis-specific information sheets.

Periodic examination of UNOS’s policies is a useful feature of an ongoing effort to assure just and equitable allocation of lifesaving organs and to avoid potential exploitation by individuals. Yet, those whom the authors seek to protect - the majority of patients on the waiting lists and fortunate recipients - are in a morally awkward position because they have not indicated their willingness to donate organs prior to their ailments. Our comment explores this issue.

In an attempt to re-structure and formulate western bio-ethics in the '80's, the four principles of beneficence, non-maleficence, autonomy and justice were promulgated in North America and the United Kingdom. Extensive criticism was leveled against this endeavor, as being erroneous in principle or substantially inadequate. Furthermore, European opponents of this effort claimed that the Continent's 'true' set of values greatly differs from those of North America, hence negating attempts for global bio-ethics based on these principles. In this review the principles of modern American bio-ethics are presented and criticisms presently deliberated in Europe are introduced, while offering alternative principles. Israel's unique position is demonstrated by its legislation on issues such as the national health system, organ transplantation, the right to refuse medical treatment and stem cell research, all confirming that Israel begs to differ. We conclude that European values have much in common with Israel's tradition and culture, commending due modification of our ethical conceptions and training programs. The coming years should be characterized by constant dialogue between the proponents of European and American values, while Israel's individual standpoint is maintained.

Understanding discharge instructions is crucial to optimal healing but may be compromised in the hectic environment of the emergency department.To determine parents' understanding of ED discharge instructions and factors that may affect it.A convenience sample of parents of children discharged home from the ED of an urban tertiary care pediatric facility (n = 287) and a suburban level II general hospital (n = 195) completed a 13 item questionnaire covering demographics, level of anxiety, and quality of physician's explanation. Parents also described their child's diagnosis and treatment instructions and indicated preferred auxiliary methods of delivery of information. Data were analyzed using the BMPD statistical package.Full understanding was found in 72% and 78% of the parents at the respective centers for the diagnosis, and in 82% and 87% for the treatment instructions (P = NS between centers). There was no statistical correlation between level of understanding and parental age, gender, education, level of anxiety before or after the ED visit, or time of day. The most contributory factor to lack of understanding was staff use of medical terminology. Parents suggested further explanations by a special discharge nurse and written information as auxiliary methods.Overall, parental understanding of ED discharge instructions is good. However, there remains a considerable number (about 20%) who fail to fully comprehend the diagnosis or treatment directives. This subset might benefit from the use of lay terminology by the staff, institution of a special discharge nurse, or use of diagnosis-specific information sheets.

A person's right to control his or her own body, expressed through the concept of informed consent to medical treatment, has gained worldwide acceptance. Nevertheless, this right may conflict with the state's interest in preserving life in cases where patients refuse treatment in medical emergencies. This paper examines the management of treating acute anaemia in a Jehovah's Witness in Israel who refused blood transfusion on religious grounds. The medical and legal ramifications are discussed in light of the Israeli Patients' Rights Law of 1996. This law established statutory ethics committees which may, under defined conditions of emergency or threat to life, approve treatment against the patient's will. This power, previously vested in the courts, should be used only in extreme circumstances while, in general, patients' wishes and beliefs must be respected. Sensitivity to the legal and ethical aspects involved deserves greater emphasis in medical school curricula.

In a retrospective study of 38 adolescent females operated on for mammary masses, 42 fibroadenomata (FA), 2 fibrous scars around abscesses, and one papilloma were found. All were postmenarchal. Clinical and pathological features were reviewed and the patients reexamined or interviewed. FA were mostly asymptomatic and removed a few weeks after incidental discovery. They were often seen in Jewish girls of parents born in North Africa and the Middle East, and were more frequently located in the outer superior quadrant of the left breast. New FA appeared in almost half of the cases later on in the same breast, as well as in the other breast, or bilaterally. Necrosis occurred in three FA and was unrelated to the size of the tumor. There was no correlation between the size of FA, multiplicity, or necrosis, nor between increased stromal or epithelial atypia, cellularity, or mitotic activity. One explanation for the high rate of multiplicity might be related to this neoplasm occurring in an actively developing organ under hormonal control. There was no increased breast carcinoma apparent in the family history. Therefore, except in cases of fast-growing tumors, a conservative approach is recommended because of the frequency of multiple FA as well as aesthetical postoperative complications. © 1992 Wiley-Liss, Inc.