Cobbler's Chest: This Is How It Is Repaired There are some children with a bridge in their teeth and there are others with a “bridge” in their chest! Straightening teeth hardly phases children today, but straightening the breastbone - repairing a congenital defect that affects about 1 in 1,000 children - this is quite another matter altogether. What is interesting is that today "Cobbler's Chest" is treated utilizing an innovative method based on the same principle as straightening teeth: the insertion of a metal support or brace, which lifts the breastbone up and outwards and in so doing, straightens it. The surgical procedure uses a minimally invasive technique, thus obviating the need for a major operation involving the opening of the chest cavity. Dr. Enrique Freud, Director of Child and Adolescent Surgery at Schneider Children's, explains: "Cobbler's Chest is a disorder whereby the breastbone, the central bone in the chest to which the ribs are attached, is sunken creating a depression in the anterior wall of the chest cavity. Sometimes the breastbone sinks in so far that there is pressure on the heart and breathing is affected, but even when the depression is relatively shallow and there are no accompanying health problems, there is frequent need to cosmetically correct the disorder from the aesthetic and social standpoints". Utilizing an innovative approach, a thorascoscope-endoscope generally used in thoracic (chest) operations is applied. Through two tiny incisions, a brace made of iron and titanium is inserted into the chest cavity. The procedure is conducted with the aid of a camera-optic located at the tip of the thorascoscope. The metal brace, between 25-35 cm in length (depending on the age of the patient), is placed beneath the breastbone and over time, pushes it outwards permanently supporting it. The operation takes about an hour and a half, does not require the removal of bones and cartilage, the loss of blood is minimal and the child is left with only a tiny scar. This represents a breakthrough, especially when comparing this method to accepted surgical treatment, which includes making a wide incision in the chest cavity. "The brace is inserted while it is bent according to the desired shape to be created in the chest," continues Dr. Freud. "Inside, it is turned over and the convex shape straightens the bone by pushing it outwards. The brace remains inside the chest for two to three years, after which it is removed through a simple operation". Children who undergo this ingenious technique are discharged after 10 days in hospital, and a short while later, they return to full function, including gymnastics lessons, swimming and riding bicycles. Diagnosis of Familial Mediterranean Fever (FMF) The Clinic and Laboratory for FMF at Schneider Children's is a national and international referral center. Please visit our website at: http://www.tau.ac.il?~racheli/genedis/fmf/fmf.html Diagnostic services provided by Schneider Children's include a clinical evaluation and a broad molecular examination, during which all 13 known mutations causing FMF are scanned. Up till now, over 2000 patients have been diagnosed at Schneider Children's following clinical examinations and laboratory tests through a speedy and reliable service, precluding return visits to clinics and the emergency room. The Importance of Molelcular Testing Different mutations can have various ramifications regarding the severity of the disease and particularly the risk of complications, which can lead to extensive kidney damage (Amyloidosis of the Kidneys). In view of the fact that existing therapy can cure attacks and prevent kidney damage, there is great importance to the early identification of the problem and its proper treatment. Testing assists in the decision regarding the type of treatment most suitable for the child. Following consultation with a family doctor or a community pediatrician, you may make an appointment through our Outpatient Appointment Service at Tel: 972-3-9253210. For further details, please contact the Immunogenetic Clinic at Tel: 972-3-9377659, or Fax: 972-3-9377660. Cost of the Testing Molecular testing is not included in the basic basket of health services and is provided to all members of HMOs against payment. http://www.harcourthealth.com Itzik the Clown Itzik is a clown and a magician who has been volunteering his activities at Schneider Children's for over 8 years. He visits the Department of Pediatric Surgery every week and delights children with magical tricks, distributes gifts, organizes birthday parties, and more. Itzik has a close relationship with the medical staff and assists them in treating children. The staff use his services in order to complement rehabilitation, such as enhancing physical therapy respiratory exercises by inflating balloons, helping the child afraid to get out of bed after an operation, distracting the child during painful burn treatment, and so on. Itzik feels as if he is one of the team at Schneider Children's and says that working with the children in the medical center gives him the biggest satisfaction. He describes himself as being nuts about it. Itzik entertains all children, irrespective of religion or nationality. Dr. Enrique Freud, Director of the Surgery Department, says that "Itzik succeeds in getting things from the children that no doctor or nurse can do". According to Dr. Freud, humor and laughter are positive influences on the recovery process of the child, and help encourage the child and his family. "The level of anxiety and tension in the child and his family are diminished when Itzik comes into the room. Children hospitalized for prolonged periods just wait for the day that Itzik the Clown will arrive." Itzik the Clown is always "on alert" every day of the year. In the event of terrorist attacks or other critical contingencies, the department's Head Nurse calls him to come cheer up the children. Itzik, of course arrives as soon as possible, every day at any hour. The Navigator: Always Operating One Step Ahead Meet the Navigator: A surgical navigation network for the planning and monitoring of delicate brain and spinal column surgery and some orthopedic procedures (and in the near future, also ear, nose and throat operations). The Navigator is a computerized system that allows the physician to pre-program surgery, and during surgery, to conduct the desired steps. The Navigator arrived at Schneider Children's in 2002 as a replacement for a similar outmoded device. Since then, the number of procedures conducted with the navigator has risen dramatically. Dr. Shalom Michowiz, Director of the Pediatric Neurosurgical Unit at Schneider Children's explains: "The digital device is fed with all kinds of images and other relevant information, which assist the surgeon in preparing a number of options for conducting the operation. During surgery, it helps the physician navigate a path deep into the organ undergoing treatment, with the most direct and precise approach and with minimal collateral damage to the surrounding tissues. With the assistance of the Navigator, we perform procedures today that were extremely difficult or even impossible to do in the past." The Navigator offers the surgeon several options for proceeding during surgery. Infrared rays emitted by the device direct the surgeon's instrument, making simultaneous comparison between the original surgical plan appearing on the computer screen and the actual performance. In this way, the device represents a sophisticated and real-time monitoring system that achieves excellent results. "The major advantage of the Navigator is in its ability to allow us to reach deep, complicated and critical areas with a level of precision of up to half a millimeter," says Dr. Michowiz. "For example, we had to operate on a premature baby who suffered from a deep brain abscess. With the device, we succeeded in draining the abscess with one 'bulls-eye' prick in the right place, and in fact, completed the surgery despite the depth and problematic nature of the area." Using the Navigator for the first time in Israel to repair a knee joint, the successful surgery was conducted at Schneider Children's by Dr. Elhanan Bar-On, Head of the Pediatric Orthopedic Unit. Group Preparation for Children Prior to Surgery The Perioperative Clinic, which provides group preparation for surgery, was established recently at Schneider Children's in order to improve service and to reduce anxiety and stress that children experience during the surgical process. Heretofore, children were given preparation for their surgery in a haphazard manner. Together with the appointment date for the scheduled surgery, the child and his parents receive an invitation to the Perioperative Clinic. Instruction is given alongside anesthesia testing and focuses on an introduction to the unfamiliar surroundings of the operating room and the sedation process - from the initial fasting and the administration of the anesthetic, to the operation itself, recovery, and the final healing stages. During instruction, parents and children work with creative materials and play games with medical devices such as an oxygen mask, surgeon's mask and syringes. In this way, an unknown world is transformed into a known entity for them. Similarly, questions are answered. Thereafter, the group tours the operating theater, where children and parents are given the opportunity to hear an explanation on site and to meet the surgical team. Preparation sessions take place in the afternoon hours so that children do not miss any classes at school, and are conducted by medical, nursing and educational personnel. Liver and Kidney Transplantation Kidney Transplants During the past decade, the kidney transplantation program at Schneider Children's headed by Dr. Natan Bar-Natan, has performed over 200 kidney transplants in children from 1 - 18 years. A large percentage of these transplants concerned living-related donors. The Dialysis Unit and the Nephrology Clinic headed by Dr. Miriam Davidovits, provide support and assistance both before and after surgery. The rate of success of kidney transplants in children is similar to that reported by the major centers in Europe and the United States and stands at 93%. Liver Transplants Over the past 5 years, extensive experience has been gained at Schneider Children's in the realm of liver operations and transplants in children from the age of 8 months up to 14 years. The breakthrough in conducting liver transplants and complex surgical procedures is due to the expertise of Prof. Eitan Mor, Director of the Liver Transplantation Unit, who underwent advanced training in the field during a 5-year course of study in the United States. These complex operations are performed in cooperation with Dr. Bar-Natan and the Pediatric Anesthesia Unit headed by Dr. Yakov Katz. During this period: 30 liver transplants were conducted with a success rate of 86% - on a par with major centers in the world; of these, 11 were living-related donors (between parent and child). 9 liver operations were performed to remove huge tumors, and 8 required porto-systemic bypass in children suffering from high blood pressure in the portal vein. The Pediatric Gastroenterology Institute, headed by Prof. Gabriel Dinari, conducts examinations of patients before and after the transplant. The transplantations are coordinated by Dr. Riki Shapira who underwent advanced training abroad. The services include: Donor matching Assistance of a Social Worker Intensive Care Unit which is ready to receive and treat all urgent cases Close contact with Transplantation Centers in the United States and Europe in the event that there is a need for a repeat transplant Biofeedback Therapy Prolonged pain and stressful periods appear in children all the time and under all circumstances. The Clinic treats children and adolescents suffering from the following symptoms: Prolonged pain such as headaches and abdominal pain Stress situations: due to school examinations, fear of elevators, public places, and more Dizziness Healing Technique in Children It is simpler to develop healing techniques for children in comparison to adults, as they are open to being helped by games, friendly computer programs, instructional imagination exercises and more. Up till now, the Clinic has assisted about 200 children in improving their daily function through the reduction in the level of pain and sometimes, leading to the suspension of medications. News and Initiatives A computer friendly program, which has been especially developed for stressful situations in children, offers game methods to reduce tension and allows technical healing and self-control exercises. For further details, you are invited to contact us Sundays to Thursdays between 08.00-14.00, Tel: 972-3-9253616. Fees Treatment is accorded to members of all HMOs against payment. Treatment of Eating Disorders and Feeding in Small Children Possible Signs for Identification of the Problem Multiple regurgitation Difficulty in chewing and swallowing fluid, partially solid and solid foods Keeping food in the mouth (rumination) Eating during sleeping at night Selective eating Turning the matter of food and feeding into a central issue every day Someone cares for you… The new Clinic, which is attached to the Day Care Hospitalization Unit, provides treatment to the child and his family, and is staffed by an experienced team including pediatricians, nurses, a psychiatrist, psychologist, occupational therapist and dietician. The unique diagnostic program developed by the clinic assists in matching treatment to the child and providing support and direction for family members. Remember Early identification of the problem can help contain expected damage to the patient and his family, and also prevent a possible permanent situation. Making an Appointment To schedule an evaluation, prior consultation should be made with the community pediatrician, whose recommendations should be forwarded as a referral to the Clinic for Eating and Feeding Disorders in the Day Care Hospitalization Unit. The Clinic staff will contact the parents of the child in order to make an appointment. For further information, you are requested to contact the Clinic nurses, Esti and Shlomit, Sundays - Thursdays, between the hours of 08.00-16.00, Tel: 972-3-9253713 or 972-3-9253663. First in Israel – Chronic Pain Management Clinic A clinic has been opened at Schneider Children's Medical Center of Israel, the only one of its kind in the country, for the treatment of chronic pain in children and adolescents. The Chronic Pain Clinic joins the few other specialized clinics in the world designated to services of this kind. The multidisciplinary clinic is led by a team of doctors who have specialized in pediatric anesthesiology and have undergone additional advanced training in pain management. In keeping with the declaration that Schneider Children's is a "hospital without pain", the new Chronic Pain Management Clinic has been established as part of the overriding concept of the medical center, which claims that every patient deserves treatment for pain and not only for disease. The clinic is geared to children and adolescents who suffer protracted pain over a long period (at least a month), or recurring attacks of pain over an extended period (at least three months). Pain in children that is not treated with the same efficiency as pain in adults. The reasons for this are many: there is less known of the mechanisms of pain in children than in adults, children are less demanding of treatment for pain, it is more difficult to understand children and frequently the medical staff are wary of treating pain in very small children. Over recent years, the health system has changed its attitude to the matter of pain in general and in children in particular, and raised awareness of the need to treat and prevent pain, irrespective of its cause. "In the past it was thought that pain was the body's way of fighting disease and that the suppression of pain might interfere with treatment. Today it is acknowledged that this was simply untrue. This is especially so in the case of children, when pain must be fought and not disregarded," says Dr. Rachel Efrat, Director of the Pain Management Unit at Schneider Children's. A pain management service has been operating at Schneider Children's for some years. As part of the renewal, the Chronic Pain Clinic provides services also to children who are not hospitalized at the medical center. The clinic, which is headed by Dr. Mila Katchko, is multidisciplinary and its staff includes professionals in psychology, physical therapy and occupational therapy, as well as pediatric specialists and nurses who have undergone advanced training in pain management. The staff of the clinic maintains close and ongoing contact with the child's attending physician and other relevant specialists concerning diagnosis and the course of treatment. The Computer Revolution - A New Horizon Opens The future is already here: Computer systems are advancing rapidly and the first, "Ofek" (meaning "horizon") network, has revolutionized what was up until yesterday a science fiction fantasy, improving the quality of treatment and service at Schneider Children's Medical Center. What was a short time ago thought to be science fiction fantasy has become a daily reality, causing us to wonder: how did we ever manage before?… On the other hand, a physician conducting a bedside consultation while holding a tablet PC - a small mobile wireless computer, which displays at the click of a key, the up-to-date medical folder of the patient - is already a sight that does not arouse any amazement. The pilot project that was conducted together with Microsoft, highlights the quality of the Ofek network - an internet information highway representing the jewel in the crown in the computer revolution that has been taking place at Schneider Children's. The Ofek network is an extraordinary project in which Schneider is taking part. The system provides the attending physician with updated information about the patient, including his medical history, past treatments, examinations and relevant laboratory tests, sensitivity to medications and so on. It is in fact a viewing medium for wide-ranging information about the patient, from admission to discharge, while the system simultaneously documents all tests that were conducted during hospitalization. At the same time, the network shortens time-consuming tasks such as archive retrieval of needed data from other medical institutions. In order to install the system fully at Schneider, it was necessary to purchase new equipment, such as computers, printers and so on. Equipping took place gradually, according to budgetary allocations and with the assistance of contributions from organizations such as Nortel and Bank Hapoalim. We have advanced a step further in information sharing both internally and within the community, and in most of the units, the era of handwriting and even working with Word programs are already history. It is important to note that the Ofek network has joined other designated information programs that are operating successfully at Schneider Children's. Two of them are "Clicks" and "Adnan" systems, which are comprehensive digitized, multi-field medical folders, allowing the extraction of cross-sections or segments according to need. Another is called "Impact" which collects data from all other operating systems, collates them and produces graphic cross-sectional reports. All the information systems are connected to the help-desk source in the Computer Systems Unit at Schneider Children's, which provides technical support to users. And that is not all: Viewing stations connected to the Imaging Department today accord doctors the opportunity of viewing high-resolution relevant imaging studies online. The viewing network has been in operation for some time in the intensive care unit and will be introduced shortly to Orthopedics as well as the surgical suite. The vision is that everything will eventually be digitized and interconnected. Only the horizon is the limit… Outpatient Appointment Service You are invited to enjoy this novel service for making appointments in one of our Outpatient Clinics. Our staff will be pleased to give you personal attention and provide you with the appropriate service that you need. The Appointment Service is operated by personnel solely for the purpose of making appointments by telephone. The service allows you to make appointments and change prior appointments according to your convenience. Making appointments is accomplished by one telephone call to the service, without any need to take other steps, and significantly reduces waiting time by an average of two weeks. As an additional service to patients with appointments at the hospital, you will receive a personal reminder from our automated "telephone reminder" service, concerning the appointment date and the time, as well as pertinent details about forms and special preparations that may need to be done prior to treatment. What do you need to do? When you call our Outpatient Appointment Service, please give the Identity Number of the patient (child) and indicate the name of the Outpatient Department required. You will need to bring with you to the hospital the referral letter from the child's pediatrician and Form #17 (payment coverage) from your HMO. The service operates daily, Sunday-Thursday, between the hours of 08.00-16.00. The (multi-line) telephone number of the service is: 972-3-9253210-3 In all cases of uncertainty with regards to the appropriate clinic, please consult with the service personnel. A Musical Link to the World of Hearing Children with cochlear implants participate in this project at Schneider Children's, the only one of its kind in the world, where music therapy is used as a means to leave the world of silence. Listen to this: Deaf children can hear music. This is one of the "miracles" happening at Schneider Children's Medical Center. Children born with profound bilateral hearing loss or hearing loss acquired during their lives and for whom standard hearing aids were unhelpful can today find the ultimate solution - "cochlear implants". The transplant replaces the function of the hairs within the normal inner ear, and translates sounds into electrical pulses that traverse the auditory canals to the brain. In most deaf children, there are an insufficient number of these hairs even though the other auditory nerve channels are perfectly normal. The cochlear implant is a minute electrode that is inserted into the inner ear during surgery. It is connected to an exterior part with a microphone, which absorbs the sounds and processes them into electrical pulses. The pulses are conveyed to the electrode in the ear, which stimulates the auditory nerve according to the sound signals it received. With the aid of intensive training, the child learns to interpret these sound signals into meaning. This is a long process, whose success depends on intensive auditory training augmented by speech and language therapy by a communications technician. Advanced Micro-Technology The Cochlear Implant Center at Schneider Children's opened in 2001 during which time both children and adults have undergone operations. It is a multidisciplinary center, which works in cooperation with the Department of Otolaryngology (Dr. Eyal Raveh) and the Department of Audiology (Prof. Joseph Attias), and is complemented by an array of personnel, mainly audiologists and language therapists. Patients in the Cochlear Implant Center enjoy the latest advances in micro-technology: in addition to speech processors, which are connected to the body inside a pocket, there are also microprocessors available today that are hidden behind the ear. The treatment brings results: the majority of the children developed speech and language, and study in normal educational frameworks - some of them are regular chatterboxes… In order to further enhance the range of auditory therapies, the Implant Center recently introduced an innovative project, the first of its kind in Israel and the world: the integration of music therapy in the rehabilitation of children with cochlear implants. During treatment, the child gets to know the different musical instruments such as a xylophone, darbuka and bells, and to play them. He learns to express himself musically, thus creating a world of musical communication between himself and the therapist - a language through which contact is made without words. The enjoyable and comfortable musical framework allows the child to express himself emotionally and thus strengthens the effect of the auditory therapy, which demands the child's intense concentration and cooperation. Among the therapeutic objectives, there is an emphasis on reducing anxieties resulting from the change in hearing, strengthening self-assurance, allowing a musical outlet for aggressive behavior and the creation of a more natural transfer to the world of hearing. In view of the young age of some of the children, the staff believes that they will absorb an enormous and significant amount of sound information in order to develop speech and language. The project began recently and includes musical exercises given by the therapist, Rina Yehoshua, an expert in music therapy. First finds concerning this innovative method of treatment look very promising. And let us not forget: the project has become a reality due to the contribution of a family foundation in Canada. Light Weight - for Children and Adolescents Who Suffer From Obesity Gaining weight and obesity is rapidly becoming the most common nutritional disorder in children and adolescents around the world. Reduced physical exercise and improper eating habits typify modern lifestyles. Over and above the mental suffering involved, obesity is identified with a high-risk morbidity in adolescents together with a range of social and occupational problems. There is great importance in the early treatment of obesity, due to the increased probability of changing nutritional and physical exercise habits at that age. The objective of the treatment is long-term education, and the creation and inculcation of correct eating habits. This is a gradual process based upon treatment provided by a multidisciplinary team, which deals comprehensively with physical, psychological, family and social problems of the obese child or adolescent. The program includes: Medical follow-up Physicians from the Institute of Endocrinology oversee medical follow-up. Medical examination includes a general physical check-up, tests for fat levels in the body, establishment of an optimal weight target according to growth, and metabolic status tests. Workshops for slimming and building good eating habits Sessions are conducted by a pediatric dietician, with the objective of instilling good eating habits and learning techniques for weight maintenance that are achieved at the end of the workshop. Each workshop comprises 15 weekly sessions, conducted in homogeneous groups according to age and in an intimate atmosphere. Physical activity Physical exercise is conducted under the guidance of an expert dietician qualified in nutritional sport and is herself a professional sportswoman. Professional support Behavior modification for children and adolescents is provided. Where necessary, referrals are made to the psychosocial team in the hospital. Personal dietary advice Individual advice is provided to those children for whom existing frameworks are unsuitable. For further details and registration, please contact the "Light Weight" team at 972-3-9253900. Objectives Workshop activities are aimed at broadening and strengthening the skills needed by children entering first grade. During the first half of the year, the workshops conduct activities primarily to improve the child's basic abilities. During the second half of the year, children are given more complex tasks, which demand use of all the skills and proficiency that they garnered during the first half of the year. About the activities… Workshop sessions take place once a week in small groups of up to ten children, and comprise games and creative activity in a warm and supportive atmosphere. Skills acquired in the workshops: Motor Movement: Gross motor skills - balance when seated and in movement Fine motor skills - pencil holding and dexterity exercises in graphics, cutting, pasting and more Cognitive and Language Skills: Memory, continuity of tasks, listening and concentration Improvement in verbal expression and understanding instructions Acquiring proper habits for work, planning and execution of tasks, development of thought processes and self-control Social Skills: Attention to rules and parameters Exercises in planning and implementing group tasks - dealing with cooperation and a sense of competitiveness, ability to take others into account during work, sharing tools and materials Emotional Skills: Dealing with stimulation and frustration For further details and registration, you are invited to contact 972-3-9253696. A nominal fee is charged for the workshops. Cochlear Implants What is a cochlear implant? Cochlear implants convert sound information into electrical information and represent an alternative to the cells of sensation that are lacking in the inner ear. The electrical information that is received from the implant is transferred directly to the auditory nerve via a network of electrodes that are inserted into the inner ear. Following the operation, computerized orientation of the cochlear implant is performed in order to achieve optimal programming of hearing. The operation takes about 4 hours, and following implantation, the child returns for weekly therapy sessions over the next 6 months. Evaluation of Candidacy Evaluation of candidates for cochlear implantation, surgery and post-operative rehabilitation therapy is conducted by the Institute of Audiology and the Ear, Nose and Throat Clinic at Schneider Children's Medical Center by a team of physicians and a qualified and experienced speech and language clinician. Senior doctors and clinicians in the department have all undergone advanced training in cochlear implantation, objective hearing assessment and hearing rehabilitation in leading institutions abroad. Hearing assessment includes objective testing for auditory nerve function, inner ear function and location of the disorder in the auditory system that do not require the cooperation of the child. Similarly, the candidate undergoes additional tests to assess the child's ability to cope with the implantation. The Therapeutic Environment About 7,000 children with various hearing disorders are treated every year in the center. Therapy takes place in a warm, friendly and colorful atmosphere in order to make things as comfortable as possible for the child and his parents. Cost of the Operation: The basket of health services covers the total cost of the operation for children and partially for adults. For further details, please contact 972-3-9253010. Correction of Facial Distortions The Cranio-Facial Plastic Surgery Service at Schneider Children's generates wonders in children born with gross facial distortions. Ronit's story exemplifies the enormous transformation that such an operation can bring to a child who had previously hung her head in shame. "The ugly duckling hung his head and moved away from the group of geese. His heart was broken. Why don't they want to be my friends? Is it just because I look different?" Hans Christian Anderson's famous tale is allegoric to the lives of children who suffer from facial distortions - and as a result, from social estrangement. Research studies reveal that these children have difficulty in utilizing their hidden potential. The Pediatric Cranio-Facial Plastic Surgery Service at Schneider Children's has succeeded in combating the cruelties of nature - and changing it. "Ronit is an adolescent youngster who personifies the anguish that children with facial problems have to endure," says Dr. Meir Cohen, a sub-specialty graduate of facial plastic surgery from the University of Toronto. "Ronit was born with a facial cleft extending from the lip up to the orbit of the eye combined with Goldenhar Syndrome, which is characterized by a disruption in partial facial development." "I remember the first day in Grade 1 and the excitement beforehand," says Ronit. "But the happiness did not last long," she adds cynically. "The children from the upper classes mocked me relentlessly, and called me a witch and a monster. After two weeks, I told my mother that I would never go back to school." Ronit indeed did not return to school. During the ensuing eight years, she spent most of her time at home in front of the television set. "When we examined Ronit about a year ago, we found a clever but sad young girl, neglected and lacking in confidence," says Dr. Cohen. "It was clear that there was a need for immediate social and surgical intervention in order to save this wretched young girl from a cycle of neglect and despair." Ronit underwent evaluation by Shoshana Oshri from Social Services at Schneider Children's and was simultaneously invited to a monthly meeting of the team dealing with children with facial disorders. The team also comprises: Dr. Shalom Michowiz - a pioneer in cranio-facial surgery at Schneider Children's Dr. Benny Shalev - an ophthalmologist and expert in plastic surgery of the eye orbits Galit Shai - in charge of the plastic surgery clinic Hannah Kfir - senior clinical psychologist Varda Spielman - social worker Batya Himmelfarb - an expert in occupational therapy and eating disorders Yifat Ables-Nitzan - communications technician Dr. Dov Inbar and Dr. Yehuda Sanetzky - specialists in child development Dr. Yoram Stern - an expert in pediatric ENT disorders Dr. Mila Katchko and Dr. Trabkin - senior anesthesiologists In addition, physicians from the Genetics, Pulmonology, Mouth and Jaw, Orthodontics and Intensive Care Units also participate according to need. During the meeting with Ronit and her parents, the team discussed possibilities and risks connected with the complex operation to repair the face. A month later, Ronit underwent surgery. The operation took 12 hours which included exposure of the skull, repair of the indentations with bone paste, filling the cheekbone with fatty implants taken from the buttocks, reconstruction of the nose with bone grafts fixed with titanium plates to the forehead, and constructing the cheek bone with bone grafts taken from the skull. Ronit was kept under observation for 12 hours in the Intensive Care Unit and then moved to the surgical ward for three days. There were no complications following the surgery, and Ronit and her parents were thrilled with the "transformation". A month later, the dramatic alteration in her facial appearance was discernible, as well as the change in her behavior and a significant improvement in her self-confidence. "Ronit's story is an excellent example of the enormous influence that facial appearance has on the lives of children and adolescents in western society, where good looks are the key to success," says Dr. Cohen. "Since the fifties, four major industries - clothing, cosmetics, movies and television - glorified the cult surrounding external appearance. Luckily, this was accompanied by tremendous development in the possibilities of facial improvement." These possibilities include the use of bioactive implants (such as bone paste), which have the capability of merging with facial and skull bones, titanium and mesh plates, and surgical techniques including broad separation of the facial soft tissues from the skeleton. The high standards of the anesthesiology and intensive care teams, who treat the children during surgery and thereafter, contribute immensely to these complex procedures. "With these technologies, we are able to succeed today in achieving excellent results," summarizes Dr. Cohen. "The greatest satisfaction is seeing the incredible change in self-confidence and the joie de vivre that these operations bring to children." A Doll of a Project Senior citizens sew dolls; children adopt them while traveling along the difficult road in the Cardiac Intensive Care Unit. A unique project that enhances coping strategies. A supportive and unique project for children pre-cardiac surgery that was created by teacher, Galit Yahav, from Schneider Children's Educational Center and the nursing team, and that has been in practice for 9 years in the Cardiac Intensive Care Unit (CICU), formed the basis for a special project which provides every child arriving in the department with "a personal doll". The dolls are dressed in hospital garb but are without a face or specified gender. The idea is that the child will create his own individual doll and adopt it as a partner along the difficult road ahead. The child selects the gender, decides on a name and with the help of a range of artistic materials, gives it an identity. Through creativity and play, the child shares his inner thoughts, braves the hospitalization and surgical experience, and weathers the storm with its presence. The doll is the child's constant companion remaining with the child throughout the entire hospital stay -from the moment of admission and preliminary examinations, through the surgical procedure and subsequent monitoring in the CICU, to hospitalization in the pediatrics department, recovery, and finally discharge. The dolls are designed and made by senior citizens living in the network of "Till 120" residential centers for the enjoyment of the children in the CICU. This special connection is the fruit of the partnership initiated between Miri Keller, head nurse in the CICU, and Maskit Shochat, director of the Educational Center at Schneider Children's, together with Carmella Zack, head occupational therapist of "Till 120" in Hod Hasharon. Within the framework of the project, the residents fund, sew and make the dolls and it is only through their generosity and unwavering support that the project became a reality. The dolls are undeniably effective and answer the emotional needs of both the children and their families. By contributing to a positive atmosphere and helping hospitalized children cope better with the difficult experience of open-heart surgery and all its ramifications, they exemplify their objective as a "doll of a project". The Nucleus of Imaging Pediatric Nuclear Medicine (NM) is a vital discipline in health-care in determining the function of organs and tissues, and in certain cases, supplying the only evidence of disease. NM studies are an integral part of modern pediatric practice and have a direct impact upon quick and precise diagnosis and effective treatment. In April 2002, the Pediatric Nuclear Medicine Unit was opened at Schneider Children's, the first of its kind in Israel that provides advanced NM services (non-invasive imaging studies) to children from 0-18. "Nuclear Imaging in children demands the individual adjustment of imaging methods and a highly skilled technical staff, in order to obtain top quality diagnostic pictures," explains the Director of the Unit, Dr. Zvi Bar-Sever. "Deciphering NM images in children demands broad knowledge of the range of pediatric diseases and their manifestations in scans, which evolve from normal pathological growth and development processes. Due to these reasons, separate nuclear medicine institutes for children were established over the years in children's hospitals in the United States and western Europe, and now in Israel." NM imaging is performed according to the highest professional standards and has advanced tremendously over the years with the development of new radiopharmaceuticals and highly sophisticated instrumentation. In imaging studies, tiny amounts of radioactive compounds (tracers) are administered to target, preferentially, specific organs, systems or tissues. A highly sensitive and sophisticated gamma camera externally detects these tracers, and translates it via sophisticated electronics into computerized images. In this way, it is possible for the physician to follow and measure physiological and biochemical processes, thus providing essential diagnostic information through non-invasive means. The images are collected in the digital archive, without need for films or folders. There are no reactions to the radiopharmaceuticals, which the body flushes out naturally within a few days of the examination. The Pediatric Nuclear Medicine Unit at Schneider Children's is the only such unit in Israel dedicated to NM studies in children.