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        תוצאת חיפוש

        פברואר 2001

        אשר ברק, אורי אפרתי ומרדכי ר' קרמר
        עמ'

        אשר ברק(1), אורי אפרתי(1), מרדכי ר' קרמר(2)

         

        היחידה למחלות ריאות ילדים, בי"ח שיבא תל-השומר(1), המכון למחלות ריאה: מרכז רפואי ע"ש רבין, פתח תקווה(2)

         

        בשנים האחרונות, התפתח הסיווג של מחלות דרכי הנשימה הקטנים: הסימפונונים (bronchioles). מגוון המחלות והגורמים הרבים והמשותפים לחלקם, גורמים לא פעם לבלבול. מחלות הסימפונונים מסוג ברונכיוליטיס חסימתי (bronchiolitis obliterans – ב"ח) וברונכיוליטיס חסימתי עם דלקת בהתארגנות (bronchiolitis obliterans with organizing pneumonia – בחד"ה). מהווה סיבות חשובות למחלות ריאה מפושטות והסננתיות. ההכרה בהבדלים שבין שתי תיסמונות אלו מאפשרת קביעת פרוגנוזה וטיפול מתאים לחולה. בסקירה ספרותית זו מדווח על המיבנה האנטומי של הסימפונונים, הסיווג הפתולוגי והקליני של מחלות הסימפונונים. מושם דגש על המשותף והשונה שבמחלות ב"ח ובחד"ה: מהלך קליני, בדיקות רנטגן, טיפול ופרוגנוזה של כל אחת ממחלות אלו.

        אפריל 2000

        יוסף לבצלטר, גרשון פינק, אליעזר קליינמן, יצחק רוזנברג ומרדכי ר' קרמר
        עמ'

        Preflight Assessment by Hypoxic Inhalation Test in Cardio-Pulmonary Patients 


        J. Lebzelter, G. Fink, E. Kleinman, I. Rosenberg, M.R. Kramer

         

        Pulmonology Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva

         

        Flying may expose passengers to hypoxic conditions, which may induce hypoxemia, particularly in those with chronic heart and/or lung disease. Onset of dyspnea, wheezing, chest pain, cyanosis and right heart failure can lead to urgent need for oxygen during flight. The hypoxia inhalation test (HIT) provides a safe and simple means of identifying those who may develop hypoxemia during flight.

        We report our experience with 48 self-reporting patients who underwent HIT prior to pre-planned air travel. They inhaled for 15-minute periods a reduced oxygen concentration (F1O2 15%) under normobaric conditions, during which O2 saturation was monitored by pulse oximeter; electrocardiogram, blood pressure and symptoms were also monitored. O2 saturation of 85% (PaO2 50 mm Hg) was considered a positive test. In the 8 cases (17%) with a positive test, 5 had chronic obstructive pulmonary disease and 3 had cardiovascular and/or combined heart-lung disease.

        We calculated predicted O2 partial pressure in altitude (PaO2 ALT) and compared it to actual results in the 8 patients with a positive HIT. In 5, use of the predicted formula would have under-diagnosed the hypoxemia that developed during the HIT. Thus, the results of the HIT changed treatment strategy in these patients. We recommend that patients with positive tests use O2 (2LPM or 4LPM) during flight.

        HIT is practical and of potential benefit in the objective assessment of patients with various degrees of heart, lung or combined heart-lung disease. Clinicians should be aware of the relative risk of hypoxia during flight in such patients, and of the value of HIT in identifying them, leading to increase in its use.

        מרץ 2000

        פאני אנדלמן, מירי נויפלד, עירית א' רידר-גרוסוסר, אורי קרמר, יורם שגב ויצחק פריד
        עמ'

        Presurgical Neuropsychological assessment in Epilepsy: The Wada Test

         

        Fani Andelman, Miri Neufeld, Irith Reider-Groswasser, Uri Kremer, Yoram Segev, Itzhak Fried

         

        Functional Neurosurgery and EEG and Epilepsy Units, Section of Neuroradiology; and Pediatric Neurology Unit; Tel Aviv-Sourasky Medical Center, Tel Aviv

         

        37 candidates for epilepsy surgery underwent the intra-carotid amytal procedure (IAP; also known as the Wada test) to determine hemispheric speech dominance and memory capacity. 31 demonstrated left hemisphere speech dominance, 2 showed evidence for bilateral language and 4 demonstrated right hemispheric language dominance.

        Our study supports a correlational relationship between handedness, lesion laterality and age of onset of seizures, as reported in earlier studies. Left-handed patients with a left hemisphere lesion whose seizures began to an early age had a strong tendency for reversed language dominance.

        Asymmetry of at least 20% in performing the memory test was taken as the cutoff score for demonstrating laterality of lesions. The asymmetry score correctly predicted laterality of lesions in all 28 patients; 6 did not have asymmetry scores and 3 were examined for language only. None of the patients who successfully passed the Wada memory test had any significant postsurgical memory deficits; 1 had transient reduction in verbal memory and 4 who did not pass the test were not operated on for this reason.

        Our results demonstrate the importance of the Wada test in determining cerebral speech dominance, in predicting post-surgical amnesia, and support its usefulness in predicting laterality of seizure focus in candidates for temporal lobectomy.

        אלכס ירמולובסקי, אלן כץ, אייל פניג, גרשון פינק, דניאל בן דיין, אהרון סולקס ומרדכי ר' קרמר
        עמ'

        High Dose Endobronchial Brachy - Therapy for Malignant Airway Obstruction

         

        Alex Yarmolovsky, Alan Katz, Eyal Fenig, G. Fink, Daniel Bendayan, Aaron Sulkes, Mordechai R. Kramer

         

        Institutes of Pulmonology and Oncology, Rabin Medical Center, Beilinson Campus, Petah Tikva, and Sackler Faculty of Medicine, Tel Aviv University

         

        Brachytherapy is especially suitable for palliative treatment of endobronchial tumors adjacent to internal organs that might be damaged by intensive external beam radiation, but are easily accessed with a flexible bronchoscope. This treatment is mostly palliative.

        30 patients underwent such palliative high-dose endobronchial brachytherapy to alleviate malignant airway obstruction. With the aid of a flexible fiberoptic bronchoscope an endobronchial catheter was inserted adjacent to the tumor and treatment delivered using a 192Ir remote afterloader for 5-10 min, in 2 or 3 sessions.

        There was symptomatic improvement in 26 (86%) and objective improvement in 27 (90%). 1 patient died of hemoptysis.

        פברואר 2000

        א' טליאנסקי, א' קרמר ומ' נויפלד
        עמ'

        Phenobarbital Coma for Psychogenic Status Epilepticus

         

        A. Taliansky, U. Kramer, M.Y. Neufeld

         

        EEG and Epilepsy Unit, Dept. of Neurology and Neuropediatric Unit, Tel Aviv-Sourasky Medical Center

         

        Among patients seen for epileptic seizures, there is a subgroup of those who do not have epilepsy but suffer from psychogenic paroxysmal events which mimic epileptic seizures. The differential diagnosis between them is of the utmost importance, as incorrect diagnosis of seizures subjects the patient to incorrect management. In the case psychogenic status epilepticus, the treatment may endanger the patient.

        We report 3 women, aged 20, 20 and 28 and a man aged 24 with psychogenic status epilepticus admitted to an intensive care unit and treated by induction of phenobarbital coma when other antiepileptic medication failed.

        נובמבר 1998

        י' קלוגר, י' פז, נ' גברט, ב' שגיא וא' קרמר
        עמ'

        Open Reduction and Internal Sternal Fracture Fixation

         

        Y. Kluger, Y. Paz, N. Gebart, B. Sagie, A. Kremer

         

        Rabin Trauma Center and Dept. of Cardiothoracic Surgery, Tel Aviv-Souraski Medical Center and Sackler Faculty of Medicine, Tel Aviv University

         

        We describe a 63-year-old woman who sustained a sternal fracture after a motor vehicle crash. Due to persistent pain, open reduction and internal fixation of the sternal fracture were performed; recovery was uneventful.

        מרץ 1998

        יעקב גורביץ, יוסי פז, מנחם מצא, אמיר קרמר, דימיטרי פבני, אורן לב-רן, חיים לוקר ורפאל מור
        עמ'

        Skeletonized Internal Mammary Arteries for Coronary Bypass Grafting

         

        Jacob Gurevitch, Yosef Paz, Menachem Matsa, Amir Kramer, Dimitri Pevni, Oren Lev-Ran, H. Locker, Raphael Mohr

         

        Dept. of Thoracic and Cardiovascular Surgery, Sourasky-Tel Aviv Medical Center

         

        The skeletonized internal mammary artery (IMA) is longer, and its immediate spontaneous blood flow is greater than that of the pedicled IMA, thus providing increased versatility for complete, arterial myocardial revascularization without the use of saphenous vein grafts. From April 1996 to May 1997, 583 patients underwent coronary artery bypass grafting here and in 415 (71%) complete arterial revascularization was achieved using bilateral skeletonized IMA. The right gastroepiploic artery was used in 57 (13%); there were 329 males (79%) and 86 women (21%); average age was 64 (30-87) and 175 (36%) were older than 70; 131 (32%) were diabetics. Average number of grafts was 3.2 (range 2-6 grafts). At 30 days, 5 (1.2%) had died and there had been 6 perioperative infarcts (1.4%), 5 CVA's (1.2%), and 6 had sternal wound infections (1.4%). Up to 1-12 months of follow-up was achieved in 409 (99%). Late mortality was 1.4% (of which 3 were noncardiac). 394 (97%) were angina-free at latest follow-up. We conclude that arterial revascularization using bilateral skeletonized IMA is safe, as postoperative morbidity and mortality are low, even in old and diabetic patients.

        נובמבר 1997

        אילן בר, משה שמחה, אבירם ניסן, ירון שרגל, מרדכי קרמר וגדעון מרין
        עמ'

        Limited Axillary Thoracotomy for Recurrent Spontaneous Pneumothorax

         

        I. Bar, M. Simha, A. Nissan, Y. Shargal, M. Kramer, G. Merin

         

        Depts. of Cardiothoracic Surgery and of Surgery, and Pulmonary Institute, Hadassah--University Hospital, Ein Karem; and Dept. of Surgery, Hadassah--University Hospital, Mt. Scopus, Jerusalem

         

        Recurrent spontaneous pneumothorax often requires surgical intervention. Recently, less invasive thoracic surgical techniques, such as video-assisted thoracoscopy (VAT) and limited axillary thoracotomy (LAT), have been developed and used for different thoracic procedures. We describe our results with limited axillary thoracotomy, as compared with those of video-assisted thoracoscopy as reported in the literature. From October 1994 to May 1996, 14 patients with recurrent spontaneous pneumothorax, aged 16-33 years, underwent limited axillary thoracotomy, resection of blebs and apical pleurectomy, using multifire GIA 80 staplers (Auto Suture Inc.). There were no complications or recurrences during 5-17 months of follow-up. Mean operative time was 52.2 minutes and mean hospital stay 2.3 days postoperatively. Full activity was regained within 12.1 days. In comparison with over 75 cases of VAT from the literature, LAT is safe and offers the potential benefits of decreased operative time, hospital stay and cost.

        ינואר 1997

        מרדכי ר' קרמר, אילן בר, ליאוניד אידלמן, מילי בובליל, איריס ניצן, צ'רלס ספרונג, שמעון גודפרי, גדעון מרין
        עמ'

        Volume Reduction Surgery in Emphysema

         

        M.R. Kramer, I. Bar, I. Eidelman, M. Bublil, I. Nitzan, C. Sprung, S. Godfrey, G. Merin

         

        Depts. of Cardiothoracic Surgery and Anesthesiology, and Institute of Pulmonology, Hadassah-University Hospital and Hebrew University-Hadassah Medical School, Jerusalem

         

        Volume reduction surgery (VRS) is a new procedure based on the concept that relieving hyperinflation in emphysema improves diaphragmatic and chest wall mechanics and ventilation perfusion mismatch. We present our early experience with 16 patients who underwent VRS from August 1995 to June 1996. Patient selection was based on: PFT, CT scan, V/Q scan, ABG's and 6-min walk. After pulmonary rehabilitation, operation was by median sternotomy and bilateral lung shaving. Pulmonary function improved significantly. FEV1 increased from 0.68 ± 0.2 to 1.0 ± 0.2 L (p<0.01) and FVC increased from 1.7 ± 0.5 to 2.7 ± 0.5 L (p<0.017). Total lung capacity decreased from 129% ± 24% to 108% ± 20% (p<0.03). 6-min walk increased from 221 ± 90 to 404 ± 123 meters (p<0.001). Complications included 1 death, prolonged air leak in 7 cases and infection in 2. Quality of life improved substantially in 12 of the 16 cases; in 3 cases there was only slight improvement and in 1 the condition became worse. Volume reduction surgery is a promising surgical solution in selected patients with advanced emphysema.

        הבהרה משפטית: כל נושא המופיע באתר זה נועד להשכלה בלבד ואין לראות בו ייעוץ רפואי או משפטי. אין הר"י אחראית לתוכן המתפרסם באתר זה ולכל נזק שעלול להיגרם. כל הזכויות על המידע באתר שייכות להסתדרות הרפואית בישראל. מדיניות פרטיות
        כתובתנו: ז'בוטינסקי 35 רמת גן, בניין התאומים 2 קומות 10-11, ת.ד. 3566, מיקוד 5213604. טלפון: 03-6100444, פקס: 03-5753303