natan weksler - Academia.edu (original) (raw)
Papers by natan weksler
European Journal of Anaesthesiology, May 1, 2005
Objective: To assess the ability of medical students to learn and retain skills of airway manipul... more Objective: To assess the ability of medical students to learn and retain skills of airway manipulation for insertion of the endotracheal tube, the laryngeal mask airway (Laryngeal Mask Company, Henley-on-Thames, UK) and the oesophageal-tracheal Combitube ® (Kendall-Sheridan Catheter Corp., Argyle, NY, USA). Methods: A 6-month prospective study was conducted among fifth-year medical students attending a 3-week clerkship in the Division of Anesthesiology and Critical Care Medicine in the Soroka Medical Center. All the students viewed a demonstration of insertion technique for the endotracheal tube, the laryngeal mask airway and the Combitube ® , followed by formal teaching in a mannikin. At the end of the program, the insertion skills were demonstrated in the mannikin, the success rate on the first attempt was registered and the students were requested to assess (by questionnaire) their ability to execute airway manipulation (phase 1). Six months later, the students were requested to repeat the insertion technique, and a similar re-evaluation applied (phase 2). Results: The success rate, during the first phase, at first attempts was 100% for the laryngeal mask airway and the Combitube ® , compared to 57.4% for the endotracheal tube (P Ͻ 0.02), and 92.6%, 96.2% and 62.9% (P Ͻ 0.02) respectively for the second phase of the study. Conclusion: Learning and retention skills of medical students, in a mannikin, are more accentuated with the laryngeal mask airway and the Combitube ® than seen with an endotracheal tube.
A 75-year-old male was brought from a retirement home to the emergency department of a county hos... more A 75-year-old male was brought from a retirement home to the emergency department of a county hospital. He had been a heavy smoker (45 pack years) but had quit smoking 5 years earlier, after his cigarettes had caused some fire incidents. These episodes, together with decreased concentration and memory and inability to take care of himself had obliged the family (two sons and a daughter) to admit him to the retirement home. In the past year he had become increasingly demented and required continual supervision. Over the previous six months he also required assistance in performing usual activities such as feeding, washing and changing clothes. He no longer recognized family members and he sat in a chair throughout the day without any communication with those around him. Three days before his admission to the hospital he refused food and fluids. On the day prior to admission he vomited, developed a fever and subsequently became oliguric and stuporotic. At the request of the family he was taken to the hospital by ambulance. A referral letter from the family physician reported co-morbidity with hypertension, chronic ischemic heart disease and mild chronic renal failure. His daily medications included enalapril, mononitrate and a mild diuretic. Physical examination in the emergency room revealed a dehydrated and obtunded patient. The blood pressure was 75/50, the heart rate was 98/min, the temperature was 35.5°C, and the respiratory rate was 36/min. The examining physician noted guarding of the abdomen, especially in the epigastric area, rebound tenderness and the absence of bowel sounds. The results of blood tests revealed: a hemoglobin level of 16.9 g/dl, WBC 18 800/ml, BUN 88 mg/dl, creatinine 4.8 mg/dl, sodium 122 mEq/1, potassium 3.0 mEq/1, chloride 98 mEq/1 and bicarbonate 17.5 mEq/1. An infusion of saline was started and oxygen was administered through a nasal cannula. The bladder was catheterized and 50 ml of concentrated urine was drained. A plain radiograph of the abdomen showed free air under the right diaphragm. A surgical consultant suspected a perforated viscus, probably a duodenal ulcer, and discussed the feasibility of an urgent laparotomy. The anesthesiol
Springer eBooks, 2001
A 75-year-old male was brought from a retirement home to the emergency department of a county hos... more A 75-year-old male was brought from a retirement home to the emergency department of a county hospital. He had been a heavy smoker (45 pack years) but had quit smoking 5 years earlier, after his cigarettes had caused some fire incidents. These episodes, together with decreased concentration and memory and inability to take care of himself had obliged the family (two sons and a daughter) to admit him to the retirement home. In the past year he had become increasingly demented and required continual supervision. Over the previous six months he also required assistance in performing usual activities such as feeding, washing and changing clothes. He no longer recognized family members and he sat in a chair throughout the day without any communication with those around him. Three days before his admission to the hospital he refused food and fluids. On the day prior to admission he vomited, developed a fever and subsequently became oliguric and stuporotic. At the request of the family he was taken to the hospital by ambulance. A referral letter from the family physician reported co-morbidity with hypertension, chronic ischemic heart disease and mild chronic renal failure. His daily medications included enalapril, mononitrate and a mild diuretic. Physical examination in the emergency room revealed a dehydrated and obtunded patient. The blood pressure was 75/50, the heart rate was 98/min, the temperature was 35.5°C, and the respiratory rate was 36/min. The examining physician noted guarding of the abdomen, especially in the epigastric area, rebound tenderness and the absence of bowel sounds. The results of blood tests revealed: a hemoglobin level of 16.9 g/dl, WBC 18 800/ml, BUN 88 mg/dl, creatinine 4.8 mg/dl, sodium 122 mEq/1, potassium 3.0 mEq/1, chloride 98 mEq/1 and bicarbonate 17.5 mEq/1. An infusion of saline was started and oxygen was administered through a nasal cannula. The bladder was catheterized and 50 ml of concentrated urine was drained. A plain radiograph of the abdomen showed free air under the right diaphragm. A surgical consultant suspected a perforated viscus, probably a duodenal ulcer, and discussed the feasibility of an urgent laparotomy. The anesthesiol
PubMed, Feb 16, 2005
Aim: An association has been proposed between perioperative administration of 80% oxygen and a lo... more Aim: An association has been proposed between perioperative administration of 80% oxygen and a lower incidence of wound infection after colorectal surgery. The present study was conducted to assess this hypothesis. Methods: Thirty-eight patients (ASA classification 1 and 2) undergoing elective colorectal cancer surgery were allocated at random to 2 groups. Group 1 consisted of 19 patients who received an admixture of 80% oxygen and 20% nitrogen during anesthesia through an orotracheal tube and during the 2 first hours in the recovery room through a tight facemask with reservoir. Group 2 consisted of 19 patients who received an admixture of 70% nitrous oxide and 30% oxygen during anesthesia, followed by administration of 30% oxygen delivered by a blender through a tight facemask with reservoir in the same manner than group 1, during the first 2 hours in the recovery room. Wound infection was evaluated daily during hospital stay and after 7 days, 2 weeks, and 1 month. Results: The incidence of wound infection was 12.5% in group 1 and 17.6% in group 2 (p=0.53). Conclusions: The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80% oxygen during the perioperative period.
PubMed, Aug 1, 2007
Introduction: Monitoring methods for the early diagnosis of one-lung intubation (OLI) are nonspec... more Introduction: Monitoring methods for the early diagnosis of one-lung intubation (OLI) are nonspecific and controversial. In this study, we evaluated a new acoustic monitoring system for the detection of OLI. Methods: Lung sounds were collected from 24 adult surgical patients scheduled for routine surgical procedures. Four piezoelectric microphones attached to the patients' backs were used to sample lung sounds during induction of anesthesia and endotracheal tube positioning. To achieve OLI, the endotracheal tube was inserted and advanced down the airway so that diminished or no breath sounds were heard on the left side of the chest. The tube was then withdrawn stepwise until equal breath sounds were heard. Fiberoptic bronchoscopy confirmed the tube's final position. Acoustic analyses were preformed by a new algorithm which assumes a Multiple Input Multiple Output system, in which a multidimensional Auto-Regressive model relates the input (lungs) and the output (recorded sounds) and a classifier, based on a Generalized Likelihood Ratio Test, indicates the number of ventilated lungs without reconstructing the original lung sounds from the recorded samples. Results: This algorithm achieved an OLI detection probability of 95.2% with a false alarm probability of 4.8%. Conclusion: Higher detection values can be achieved at the price of a higher incidence of false alarms.
PubMed, Jan 13, 2006
The Robinow syndrome is an extremely rare congenital syndrome that causes facial malformations, a... more The Robinow syndrome is an extremely rare congenital syndrome that causes facial malformations, as well as genital, cardiac and skeletal abnormalities. Patients with this syndrome undergo several operations during their life. Because of the facial abnormalities they carry a potential risk for difficult intubation. We describe the case of a boy who underwent several operations with documented difficult intubation. The laryngeal mask airway provided a good solution for airway control and afforded adequate ventilation under both controlled mechanical ventilation and spontaneous breathing.
PubMed, Dec 1, 2002
Awareness during anesthesia (AGA) is known as an intraoperative incident which could lead to a se... more Awareness during anesthesia (AGA) is known as an intraoperative incident which could lead to a series of untoward effects, among them symptoms compatible with the posttraumatic stress syndrome (PTSS). Incidence of AGA ranges between 0.1% and 0.7%, most of the reports indicating a 0.2% rate of all general anesthesias. Nevertheless, some patients are considered to be in a higher than usual risk for developing this incident. The list of AGA high-risk situations include caesarian section, open heart surgical procedures, marked obesity, major trauma with hemodynamic instability and chronic use of drugs, alcohol or tobacco smoking. The usual preanesthetic informed consent does not mention AGA among the possible undesired effects of general anesthesia, neither in Israel nor in other parts of the world. This paper rises the question of the indication to discuss the AGA matter, as part of the informed consent, with any patient who is prone develop it in a significant higher percentage than the general population. The topic can be discussed by the primary care physician or by the surgeon, but this represents the obvious task of the anesthesiologist during his/her first contact with the patient before anesthesia and surgery. It is the authors belief that a preoperative discussion on AGA might substantially reduce the magnitude of repercussions of AGA among high-risk patients to develop this anesthetic complication.
Critical Care Medicine, Dec 1, 1999
Springer eBooks, 1997
Continuous hemofiltration is a worldwide used technique for renal replacement therapy in septic h... more Continuous hemofiltration is a worldwide used technique for renal replacement therapy in septic hypercatabolic patients, mostly when renal failure is present [1, 2]. However, in the late 80s Barzilay and coworkers found an improved survival in nonoliguric septic patients, when continuous hemofiltration was added to conventional therapeutic measures as fluids, and vasopressors together with aprotinin as protease inhibitor and allopurinol plus vitamin C as free-radicals scavengers [3] .
Critical Care Medicine, Dec 1, 1999
... Gurman, Gabriel M; Roy-Shapira, Aviel; Weksler, Nathan; Fisher, Alan; Almog, Yaniv. ... The s... more ... Gurman, Gabriel M; Roy-Shapira, Aviel; Weksler, Nathan; Fisher, Alan; Almog, Yaniv. ... The structured questionnaire included demographic data, Katz's physical activities of daily living(pADL) scores, a global assessment of congnitive function, and regular indoor and outdoor ...
Journal of Clinical Monitoring and Computing, May 29, 2014
Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anes... more Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO 2 to detect EBI (the working hypothesis was that the origin of CO 2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO 2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15 mmHg, absence of CO 2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO 2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27 mmHg, did not affect the above-the-cuff measured CO 2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO 2 above the cuff in a maximum of 3 min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO 2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup.
Pediatric Anesthesia, Apr 1, 2004
Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuro... more Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, related to a mutation in the TrkA gene, characterized by inability to sweat, insensitivity to pain and recurrent episodes of hyperpyrexia. There are two Bedouin tribes in Israel with different mutations of the TrkA gene: one in the southern region and the other in the northern region. The Soroka University Medical Center is the referral centre for the entire southern region of Israel. One in 4500 anaesthesia cases involves a patient with CIPA. We reviewed 40 anaesthesia records of 20 patients with CIPA for anaesthetic technique and incidence of side-effects. Sixteen patients developed complications in the immediate perioperative period: mild hypothermia in one patient and cardiovascular events in 15 others with one case of cardiac arrest. These complications were unrelated to the anaesthetic drug administered. There were no events of hyperthermia or postoperative nausea. Cardiovascular complications following anaesthesia are common in patients with the southern Israel variant of CIPA. Hyperthermia, previously recognized as a major concern in patients with congenital insensitivity to pain with anhydrous, was not seen in our patients. We conclude that cardiovascular involvement is frequently encountered in CIPA patients following anaesthesia and is the major concern in their anaesthetic management.
Survey of Anesthesiology, Apr 1, 1990
Scandinavian Journal of Infectious Diseases, 1998
Necrotizing fasciitis is a severe life-threatening infection. The portal of entry is usually a si... more Necrotizing fasciitis is a severe life-threatening infection. The portal of entry is usually a site of disruption of the skin barrier. We report a case of fatal necrotizing fasciitis caused by an accidental toothpick injury--a unique injury mechanism not reported this far to cause necrotizing fasciitis. Although toothpick injuries are usually regarded as trivial, it should be kept in mind that they have the potential to cause such a lethal infection.
PubMed, May 1, 2001
The age distribution of a given national population is of utmost importance when dealing with pub... more The age distribution of a given national population is of utmost importance when dealing with public health and analyzing the use of various national health facilities. This is based on the totally different use of health sources by different age groups. Despite continuous prolongation of life expectancy and the related aging of the western hospitalized population the sub-group of patients over 100 year old of age is unusual demographically and accounts for only a very small portion of the total number of patients hospitalized in surgical wards. During the 5 year experience between 1995 and 2000 seventeen such patients were admitted to our surgical departments. Eight of those underwent 11 operations with zero peri-operative mortality and no significant complications. These 11 operations in this elderly population are the basis of our report.
World Journal of Urology, Dec 1, 1991
Osseous metastases may cause severe unremitting pain that may be difficult to control. We report ... more Osseous metastases may cause severe unremitting pain that may be difficult to control. We report a case of severe pain due to metastases of prostate cancer into the vertebral column, which was well controlled for 93 days with b.i.d, bolus epidural morphine injections. The starting dose was 80 mg/day, which was increased during the 93-day period to 540 rag/day without producing any side effects.
European Journal of Anaesthesiology, May 1, 2005
Objective: To assess the ability of medical students to learn and retain skills of airway manipul... more Objective: To assess the ability of medical students to learn and retain skills of airway manipulation for insertion of the endotracheal tube, the laryngeal mask airway (Laryngeal Mask Company, Henley-on-Thames, UK) and the oesophageal-tracheal Combitube ® (Kendall-Sheridan Catheter Corp., Argyle, NY, USA). Methods: A 6-month prospective study was conducted among fifth-year medical students attending a 3-week clerkship in the Division of Anesthesiology and Critical Care Medicine in the Soroka Medical Center. All the students viewed a demonstration of insertion technique for the endotracheal tube, the laryngeal mask airway and the Combitube ® , followed by formal teaching in a mannikin. At the end of the program, the insertion skills were demonstrated in the mannikin, the success rate on the first attempt was registered and the students were requested to assess (by questionnaire) their ability to execute airway manipulation (phase 1). Six months later, the students were requested to repeat the insertion technique, and a similar re-evaluation applied (phase 2). Results: The success rate, during the first phase, at first attempts was 100% for the laryngeal mask airway and the Combitube ® , compared to 57.4% for the endotracheal tube (P Ͻ 0.02), and 92.6%, 96.2% and 62.9% (P Ͻ 0.02) respectively for the second phase of the study. Conclusion: Learning and retention skills of medical students, in a mannikin, are more accentuated with the laryngeal mask airway and the Combitube ® than seen with an endotracheal tube.
A 75-year-old male was brought from a retirement home to the emergency department of a county hos... more A 75-year-old male was brought from a retirement home to the emergency department of a county hospital. He had been a heavy smoker (45 pack years) but had quit smoking 5 years earlier, after his cigarettes had caused some fire incidents. These episodes, together with decreased concentration and memory and inability to take care of himself had obliged the family (two sons and a daughter) to admit him to the retirement home. In the past year he had become increasingly demented and required continual supervision. Over the previous six months he also required assistance in performing usual activities such as feeding, washing and changing clothes. He no longer recognized family members and he sat in a chair throughout the day without any communication with those around him. Three days before his admission to the hospital he refused food and fluids. On the day prior to admission he vomited, developed a fever and subsequently became oliguric and stuporotic. At the request of the family he was taken to the hospital by ambulance. A referral letter from the family physician reported co-morbidity with hypertension, chronic ischemic heart disease and mild chronic renal failure. His daily medications included enalapril, mononitrate and a mild diuretic. Physical examination in the emergency room revealed a dehydrated and obtunded patient. The blood pressure was 75/50, the heart rate was 98/min, the temperature was 35.5°C, and the respiratory rate was 36/min. The examining physician noted guarding of the abdomen, especially in the epigastric area, rebound tenderness and the absence of bowel sounds. The results of blood tests revealed: a hemoglobin level of 16.9 g/dl, WBC 18 800/ml, BUN 88 mg/dl, creatinine 4.8 mg/dl, sodium 122 mEq/1, potassium 3.0 mEq/1, chloride 98 mEq/1 and bicarbonate 17.5 mEq/1. An infusion of saline was started and oxygen was administered through a nasal cannula. The bladder was catheterized and 50 ml of concentrated urine was drained. A plain radiograph of the abdomen showed free air under the right diaphragm. A surgical consultant suspected a perforated viscus, probably a duodenal ulcer, and discussed the feasibility of an urgent laparotomy. The anesthesiol
Springer eBooks, 2001
A 75-year-old male was brought from a retirement home to the emergency department of a county hos... more A 75-year-old male was brought from a retirement home to the emergency department of a county hospital. He had been a heavy smoker (45 pack years) but had quit smoking 5 years earlier, after his cigarettes had caused some fire incidents. These episodes, together with decreased concentration and memory and inability to take care of himself had obliged the family (two sons and a daughter) to admit him to the retirement home. In the past year he had become increasingly demented and required continual supervision. Over the previous six months he also required assistance in performing usual activities such as feeding, washing and changing clothes. He no longer recognized family members and he sat in a chair throughout the day without any communication with those around him. Three days before his admission to the hospital he refused food and fluids. On the day prior to admission he vomited, developed a fever and subsequently became oliguric and stuporotic. At the request of the family he was taken to the hospital by ambulance. A referral letter from the family physician reported co-morbidity with hypertension, chronic ischemic heart disease and mild chronic renal failure. His daily medications included enalapril, mononitrate and a mild diuretic. Physical examination in the emergency room revealed a dehydrated and obtunded patient. The blood pressure was 75/50, the heart rate was 98/min, the temperature was 35.5°C, and the respiratory rate was 36/min. The examining physician noted guarding of the abdomen, especially in the epigastric area, rebound tenderness and the absence of bowel sounds. The results of blood tests revealed: a hemoglobin level of 16.9 g/dl, WBC 18 800/ml, BUN 88 mg/dl, creatinine 4.8 mg/dl, sodium 122 mEq/1, potassium 3.0 mEq/1, chloride 98 mEq/1 and bicarbonate 17.5 mEq/1. An infusion of saline was started and oxygen was administered through a nasal cannula. The bladder was catheterized and 50 ml of concentrated urine was drained. A plain radiograph of the abdomen showed free air under the right diaphragm. A surgical consultant suspected a perforated viscus, probably a duodenal ulcer, and discussed the feasibility of an urgent laparotomy. The anesthesiol
PubMed, Feb 16, 2005
Aim: An association has been proposed between perioperative administration of 80% oxygen and a lo... more Aim: An association has been proposed between perioperative administration of 80% oxygen and a lower incidence of wound infection after colorectal surgery. The present study was conducted to assess this hypothesis. Methods: Thirty-eight patients (ASA classification 1 and 2) undergoing elective colorectal cancer surgery were allocated at random to 2 groups. Group 1 consisted of 19 patients who received an admixture of 80% oxygen and 20% nitrogen during anesthesia through an orotracheal tube and during the 2 first hours in the recovery room through a tight facemask with reservoir. Group 2 consisted of 19 patients who received an admixture of 70% nitrous oxide and 30% oxygen during anesthesia, followed by administration of 30% oxygen delivered by a blender through a tight facemask with reservoir in the same manner than group 1, during the first 2 hours in the recovery room. Wound infection was evaluated daily during hospital stay and after 7 days, 2 weeks, and 1 month. Results: The incidence of wound infection was 12.5% in group 1 and 17.6% in group 2 (p=0.53). Conclusions: The results of this study showed no reduction in the incidence of wound infection following elective colorectal surgery in patients receiving 80% oxygen during the perioperative period.
PubMed, Aug 1, 2007
Introduction: Monitoring methods for the early diagnosis of one-lung intubation (OLI) are nonspec... more Introduction: Monitoring methods for the early diagnosis of one-lung intubation (OLI) are nonspecific and controversial. In this study, we evaluated a new acoustic monitoring system for the detection of OLI. Methods: Lung sounds were collected from 24 adult surgical patients scheduled for routine surgical procedures. Four piezoelectric microphones attached to the patients' backs were used to sample lung sounds during induction of anesthesia and endotracheal tube positioning. To achieve OLI, the endotracheal tube was inserted and advanced down the airway so that diminished or no breath sounds were heard on the left side of the chest. The tube was then withdrawn stepwise until equal breath sounds were heard. Fiberoptic bronchoscopy confirmed the tube's final position. Acoustic analyses were preformed by a new algorithm which assumes a Multiple Input Multiple Output system, in which a multidimensional Auto-Regressive model relates the input (lungs) and the output (recorded sounds) and a classifier, based on a Generalized Likelihood Ratio Test, indicates the number of ventilated lungs without reconstructing the original lung sounds from the recorded samples. Results: This algorithm achieved an OLI detection probability of 95.2% with a false alarm probability of 4.8%. Conclusion: Higher detection values can be achieved at the price of a higher incidence of false alarms.
PubMed, Jan 13, 2006
The Robinow syndrome is an extremely rare congenital syndrome that causes facial malformations, a... more The Robinow syndrome is an extremely rare congenital syndrome that causes facial malformations, as well as genital, cardiac and skeletal abnormalities. Patients with this syndrome undergo several operations during their life. Because of the facial abnormalities they carry a potential risk for difficult intubation. We describe the case of a boy who underwent several operations with documented difficult intubation. The laryngeal mask airway provided a good solution for airway control and afforded adequate ventilation under both controlled mechanical ventilation and spontaneous breathing.
PubMed, Dec 1, 2002
Awareness during anesthesia (AGA) is known as an intraoperative incident which could lead to a se... more Awareness during anesthesia (AGA) is known as an intraoperative incident which could lead to a series of untoward effects, among them symptoms compatible with the posttraumatic stress syndrome (PTSS). Incidence of AGA ranges between 0.1% and 0.7%, most of the reports indicating a 0.2% rate of all general anesthesias. Nevertheless, some patients are considered to be in a higher than usual risk for developing this incident. The list of AGA high-risk situations include caesarian section, open heart surgical procedures, marked obesity, major trauma with hemodynamic instability and chronic use of drugs, alcohol or tobacco smoking. The usual preanesthetic informed consent does not mention AGA among the possible undesired effects of general anesthesia, neither in Israel nor in other parts of the world. This paper rises the question of the indication to discuss the AGA matter, as part of the informed consent, with any patient who is prone develop it in a significant higher percentage than the general population. The topic can be discussed by the primary care physician or by the surgeon, but this represents the obvious task of the anesthesiologist during his/her first contact with the patient before anesthesia and surgery. It is the authors belief that a preoperative discussion on AGA might substantially reduce the magnitude of repercussions of AGA among high-risk patients to develop this anesthetic complication.
Critical Care Medicine, Dec 1, 1999
Springer eBooks, 1997
Continuous hemofiltration is a worldwide used technique for renal replacement therapy in septic h... more Continuous hemofiltration is a worldwide used technique for renal replacement therapy in septic hypercatabolic patients, mostly when renal failure is present [1, 2]. However, in the late 80s Barzilay and coworkers found an improved survival in nonoliguric septic patients, when continuous hemofiltration was added to conventional therapeutic measures as fluids, and vasopressors together with aprotinin as protease inhibitor and allopurinol plus vitamin C as free-radicals scavengers [3] .
Critical Care Medicine, Dec 1, 1999
... Gurman, Gabriel M; Roy-Shapira, Aviel; Weksler, Nathan; Fisher, Alan; Almog, Yaniv. ... The s... more ... Gurman, Gabriel M; Roy-Shapira, Aviel; Weksler, Nathan; Fisher, Alan; Almog, Yaniv. ... The structured questionnaire included demographic data, Katz's physical activities of daily living(pADL) scores, a global assessment of congnitive function, and regular indoor and outdoor ...
Journal of Clinical Monitoring and Computing, May 29, 2014
Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anes... more Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO 2 to detect EBI (the working hypothesis was that the origin of CO 2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO 2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15 mmHg, absence of CO 2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO 2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27 mmHg, did not affect the above-the-cuff measured CO 2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO 2 above the cuff in a maximum of 3 min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO 2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup.
Pediatric Anesthesia, Apr 1, 2004
Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuro... more Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, related to a mutation in the TrkA gene, characterized by inability to sweat, insensitivity to pain and recurrent episodes of hyperpyrexia. There are two Bedouin tribes in Israel with different mutations of the TrkA gene: one in the southern region and the other in the northern region. The Soroka University Medical Center is the referral centre for the entire southern region of Israel. One in 4500 anaesthesia cases involves a patient with CIPA. We reviewed 40 anaesthesia records of 20 patients with CIPA for anaesthetic technique and incidence of side-effects. Sixteen patients developed complications in the immediate perioperative period: mild hypothermia in one patient and cardiovascular events in 15 others with one case of cardiac arrest. These complications were unrelated to the anaesthetic drug administered. There were no events of hyperthermia or postoperative nausea. Cardiovascular complications following anaesthesia are common in patients with the southern Israel variant of CIPA. Hyperthermia, previously recognized as a major concern in patients with congenital insensitivity to pain with anhydrous, was not seen in our patients. We conclude that cardiovascular involvement is frequently encountered in CIPA patients following anaesthesia and is the major concern in their anaesthetic management.
Survey of Anesthesiology, Apr 1, 1990
Scandinavian Journal of Infectious Diseases, 1998
Necrotizing fasciitis is a severe life-threatening infection. The portal of entry is usually a si... more Necrotizing fasciitis is a severe life-threatening infection. The portal of entry is usually a site of disruption of the skin barrier. We report a case of fatal necrotizing fasciitis caused by an accidental toothpick injury--a unique injury mechanism not reported this far to cause necrotizing fasciitis. Although toothpick injuries are usually regarded as trivial, it should be kept in mind that they have the potential to cause such a lethal infection.
PubMed, May 1, 2001
The age distribution of a given national population is of utmost importance when dealing with pub... more The age distribution of a given national population is of utmost importance when dealing with public health and analyzing the use of various national health facilities. This is based on the totally different use of health sources by different age groups. Despite continuous prolongation of life expectancy and the related aging of the western hospitalized population the sub-group of patients over 100 year old of age is unusual demographically and accounts for only a very small portion of the total number of patients hospitalized in surgical wards. During the 5 year experience between 1995 and 2000 seventeen such patients were admitted to our surgical departments. Eight of those underwent 11 operations with zero peri-operative mortality and no significant complications. These 11 operations in this elderly population are the basis of our report.
World Journal of Urology, Dec 1, 1991
Osseous metastases may cause severe unremitting pain that may be difficult to control. We report ... more Osseous metastases may cause severe unremitting pain that may be difficult to control. We report a case of severe pain due to metastases of prostate cancer into the vertebral column, which was well controlled for 93 days with b.i.d, bolus epidural morphine injections. The starting dose was 80 mg/day, which was increased during the 93-day period to 540 rag/day without producing any side effects.