Perigastric Abscess Resection During Roux-en-Y Bypass Surgery After Gastric Banding.

Laparoscopic adjustable gastric banding (LAGB) has a low rate of perioperative morbidity and mortality, while long-term complications are not rare. band erosion may be insidious and the patient may be asymptomatic. We present an unusual case of a 51-year-old patient who developed an intra-abdominal abscess after LAGB and required a resectional Roux-en-Y gastric bypass procedure. The patient's perioperative course was uneventful.  Removal of the abscess with partial gastrectomy and completion of a RYGB was safe and feasible.

Lower rates of neural tube defects in Israel following folic acid supplementation policy.

Neural tube defects (NTDs) are common and disabling congenital malformations that remain a public health challenge despite prevention efforts. In 2000, The Israeli Ministry of Health published recommendations on daily folic acid (FA) supplementation for women of reproductive age and established a national NTD registry. This study aims to evaluate the long-term impact of the FA supplementation policy on NTD rates in Israel and the need for further intervention. In this descriptive report, we present the rate of NTD-affected pregnancies recorded in the registry between 2000 and 2012, their subtype (anencephaly, spina bifida or other), outcome (live birth, stillbirth or pregnancy termination), ethnic group (Jewish, Bedouin and non-Bedouin Muslim) and years of maternal education. The final analysis included 2374 NTD cases reported between 2000 and 2012, compared with 1,668,073 live births. During this period NTD rates decreased from 20.3 to 11.2 cases per 10,000 live births, a 45% reduction. Reductions were seen in rates of spina bifida, anencephaly and encephalocele. NTD rates decreased in all pregnancy outcomes and in all ethnic groups, though rates among Bedouins remain high. Women with higher levels of education tended to have lower NTD rates, and were more prone to choose termination of an affected pregnancy. Following the institution of FA supplementation in Israel, a substantial reduction was seen in NTD rates. Nonetheless, Israeli NTD rates remain higher than in other developed countries. FA interventions should continue to be vigorously implemented, especially in vulnerable populations. The global success of mandatory fortification of grain strongly advocates its consideration in Israel.

"What shall I do unto this people?" - BIOETHICAL DILEMMAS IN JEWISH THOUGHT ON MEDICAL RESOURCE ALLOCATION: THE COEXISTENCE OF OPPOSING VIEWS.

Life and death decisions have always been part of the medical profession. Modem discussions on resource allocation in health care deal with such critical situations, and seek ethical solutions that will benefit individuals and society as well as conserve scarce resources. Deontological ethics and utilitarianism are opposing ethical views, each with its own theory on solving moral dilemmas. Utilitarian logic aims at maximizing the benefit for the greatest number of people, while deontological theories strive to uphold pervasive moral principles. Jewish thought has always confronted the toughest of human predicaments head-on. As we review part of the Jewish discourse on distributive justice throughout the ages, we will show its relevance to modem discussions on medical resource allocation. As in modem secular ethics, Jewish thought juxtaposes the two aforementioned philosophical viewpoints, and constantly attempts to reconcile them. Extracting from each theory its strengths, the ethical conclusions reached in Jewish religious texts are relevant to issues of resource allocation throughout the ages.