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Furie N, Mandelboim M, Zuckerman N, Belkin A, Seluk L, Shafran I, Mass R, Levy L, Chatterji S, Baltaxe E, Peled M, Shulimzon T, Avigdor A, Amit S, Onn A, Marom EM, Rahav G, Segel MJ. Persistent Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia in Patients Treated With Anti-CD20 Monoclonal Antibodies. Open Forum Infect Dis 2023; 10:ofad464. [PMID: 37808896 PMCID: PMC10551847 DOI: 10.1093/ofid/ofad464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
We report 8 cases of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in patients previously treated with anti-CD20 monoclonal antibodies. Polymerase chain reaction of nasopharyngeal swabs for SARS-CoV-2 was negative in most cases; viral cell cultures confirmed that viable SARS-Co-2 virus was present. Four patients were treated with anti-SARS-CoV-2 hyperimmune globulins with rapid resolution of disease.
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Affiliation(s)
- Nadav Furie
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Mandelboim
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Neta Zuckerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Ana Belkin
- Internal Medicine D, Sheba Medical Center, Tel Hashomer, Israel
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Lior Seluk
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Inbal Shafran
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ronen Mass
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
| | - Liran Levy
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sumit Chatterji
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
| | - Erik Baltaxe
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michael Peled
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tiberiu Shulimzon
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
| | - Abraham Avigdor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Division of Hematology and Bone-Marrow Transplantation, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Amit
- Microbiology Laboratory, Sheba Medical Center, Tel Hashomer, Israel
| | - Amir Onn
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Edith M Marom
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Diagnostic Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Michael J Segel
- Institute of Pulmonology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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2
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Bachar K, Shulimzon T, Segel MJ. Nontuberculous mycobacteria infections of the pleura: A systematic review. Respir Med 2022; 205:107036. [PMID: 36335889 DOI: 10.1016/j.rmed.2022.107036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/11/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Nontuberculous mycobacterial (NTM) pleuritis is an uncommon manifestation of NTM infection. Case reports and small case series have shown a variable clinical course and high mortality rates. OBJECTIVE To describe patients' characteristics, clinical presentation and outcomes of NTM pleural infections. METHODS A systematic review of cases of NTM pleural infections published in PubMed-indexed journals from 1980 to 2021. RESULTS A total of 206 cases of NTM pleural infections were found and analyzed. Fifty-eight percent of cases were males. The mean age was 57.5 yrs (range 9-87 yrs). Forty-three percent of patients were immunosuppressed, and 43% had a chronic lung disease; thirty-two percent had neither risk factor. In addition to the pleural infection, 67% of cases had a concurrent pulmonary NTM infection, and in 18 cases there was another extrapulmonary site of NTM infection. In 29% of cases the pleural infection was the sole manifestation of NTM disease. The most common isolated mycobacterium was Mycobacterium avium complex (65%). Fifty-three percent and 26% of patients required pleural effusion drainage and a surgical intervention, respectively, to treat the infection, in addition to anti-NTM chemotherapy. Forty percent of patients developed pneumothorax, 16% suffered from empyema, and 16.5% had broncho-pleural fistula. The reported mortality rate was 24%. CONCLUSION NTM pleural infections may arise in immunocompetent and immunosuppressed patients, with or without chronic lung disease or concurrent NTM pulmonary infection. These infections carry a poor prognosis and a high risk of complications requiring surgical interventions in addition to anti-NTM chemotherapy.
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Affiliation(s)
- Keren Bachar
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel; Medical Corps, Israel Defense Forces, Israel.
| | - Tiberiu Shulimzon
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | - Michael J Segel
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Bachar K, Shulimzon T, Ofek E, Segel MJ. Pleuritis due to Mycobacterium xenopi without pulmonary infection. Access Microbiol 2022; 4:000328. [PMID: 35693475 PMCID: PMC9175977 DOI: 10.1099/acmi.0.000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022] Open
Abstract
Nontuberculous mycobacteria (NTM) may cause pulmonary and extra-pulmonary disease in both immunocompetent and immunocompromised patients. Pleuritis is an uncommon manifestation on NTM disease, and pleuritis caused by Mycobacterium xenopi has only been described once before. Because it is considered to be an environmental contaminant, isolation of M. xenopi from bronchopulmonary secretions or other sites is often dismissed. The disease caused by M. xenopi is usually a pulmonary infection and typically occurs in severely immunocompromised individuals or in immunocompetent patients with an underlying chronic lung disease. We describe an unusual case of pleuritis caused by M. xenopi in a patient without an underlying chronic lung disease and with no evidence of a concurrent M. xenopi pulmonary infection.
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Affiliation(s)
- Keren Bachar
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | - Tiberiu Shulimzon
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | - Efrat Ofek
- Department of Pathology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | - Michael J. Segel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Pulmonology, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
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Shulimzon T, Chatterji S. Infections and Damaged Flexible Bronchoscopes: Time for a Change. Chest 2020; 155:1299. [PMID: 31174639 DOI: 10.1016/j.chest.2018.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Tiberiu Shulimzon
- Interventional Pulmonology Unit, Sheba Medical Center, Ramat Gan, Israel.
| | - Sumit Chatterji
- Interventional Pulmonology Unit, Sheba Medical Center, Ramat Gan, Israel
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Bar J, Urban D, Ofek E, Ackerstein A, Redinsky I, Golan N, Kamer I, Simansky D, Onn A, Raskin S, Shulimzon T, Peled M, Zeitlin N, Halparin S, Jurkowicz M, Abukhalil R, Perelman M, Ben-Nun A. Neoadjuvant pembrolizumab (Pembro) for early stage non-small cell lung cancer (NSCLC): Updated report of a phase I study, MK3475-223. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8534] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8534 Background: Resected NSCLC clinical stage I or II harbor a 5 year survival of only 30-50%. Immunotherapy might be more effective in low-burden disease. We hypothesized that neo-adjuvant immunotherapy is a feasible, safe and effective treatment (Tx) for early stage NSCLC. Methods: MK3475-223 is an ongoing phase I study of neoadjuvant pembrolizumab in stage I-II NSCLC. All Pembro Txs are 200mg q 3 weeks (wks). Objectives: determine safety; recommended phase 2 dose/schedule; pathological & radiological response. Doses-schedule limiting toxicities (DLT) were defined as significant surgical complications (bleeding, delayed wound healing, ARDS, prolonged air-leak) or a significant delay of surgery. The doses-schedule escalation cohorts were (i) single pembro dose 3 wk prior to surgery; (ii) 2 pembro doses, 2 wks later surgery; (iii) 2 pembro doses, 1 wk later surgery. Expansion cohort received the doses-schedule of cohort (iii). Percentages of remaining viable tumor in the post-Tx were assessed, 10% or less was considered amajor pathological response (MPR). IHC for pre-Tx PDL1 was done. Efficacy was evaluated for the patients who had received 2 doses of pembrolizumab. Results: No DLT occurred in the dose-schedule escalation cohorts. 10 patients received 2 cycles of neo-adjuvant pembrolizumab. 4 patients achieved a MPR (4/10 who received 2 cycles of pembro; 40%; 95% C.I. 16.7-68.8%). No correlation is seen between the levels of PDL1 pre-Tx and the pathologic response. Size of the tumor and N status was also not in any apparent correlation with MPR (data not shown). Interestingly, all of the MPR cases had a relatively long interval from 1st Tx till surgery. Clinical trial information: NCT02938624. Conclusions: Neo-adjuvant pembro is safe and feasible. A promising sign of efficacy is seen. Achieving MPR might require a longer 1st-Tx-surgery interval. Predictive biomarkers for response might be different from those in advanced disease. Recruitment and correlative studies are ongoing.[Table: see text]
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Affiliation(s)
- Jair Bar
- Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Damien Urban
- Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Efrat Ofek
- Department of Pathology, Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Nir Golan
- Thoracic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Iris Kamer
- Institute of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - David Simansky
- Thoracic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Amir Onn
- Institute of Pulmonology, Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Michael Peled
- Pulmonology Instutite, Sheba Medical Center, Ramat Gan, Israel
| | - Nona Zeitlin
- Thoracic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | | | | | | | - Marina Perelman
- Department of Pathology, Sheba Medical Center, Ramat Gan, Israel
| | - Alon Ben-Nun
- Department of Thoracic Surgery, Chaim Sheba Medical Center, Ramat-Gan, Israel
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6
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Chatterji S, Ofek E, Shulimzon T. Flexible bronchoscopy and cryoextraction for critical airway obstruction caused by an endobronchial angioleiomyoma. Respirol Case Rep 2019; 7:e00415. [PMID: 30911396 PMCID: PMC6415697 DOI: 10.1002/rcr2.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 11/18/2022] Open
Abstract
Angioleiomyomas are rare airway tumours with potential to cause central airway obstruction or haemoptysis. Methods described to manage them include surgical resection, or rigid bronchoscopy and thermal ablation techniques. We describe a case presenting with central airway obstruction, safely and effectively treated with cryoextraction of the tumour using flexible bronchoscopy.
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Affiliation(s)
- Sumit Chatterji
- Interventional Pulmonology UnitPulmonary Institute, Sheba Academic Medical CenterTel HashomerIsrael
| | - Efrat Ofek
- Department of PathologySheba Academic Medical CenterTel HashomerIsrael
| | - Tiberiu Shulimzon
- Interventional Pulmonology UnitPulmonary Institute, Sheba Academic Medical CenterTel HashomerIsrael
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7
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Nogueira AR, Chatterji S, Shulimzon T, Shoenfeld Y. Bilateral Diaphragmatic Paralysis: A Rare but not to be Neglected Cause of Dyspnea. Isr Med Assoc J 2019; 21:126-129. [PMID: 30772967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Ana R Nogueira
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
- Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | | | | | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg University, Saint Petersburg, Russian Federation
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8
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Ben Nun A, Golan N, Ofek E, Urban D, Kamer I, Simansky D, Onn A, Ackerstein A, Raskin S, Shulimzon T, Zeitlin N, Redinsky I, Halperin S, Jurkowicz M, Bar J. Neoadjuvant pembrolizumab (Pembro) for early stage non-small cell lung cancer (NSCLC): Initial report of a phase I study, MK3475-223. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy290.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Izbicki G, Grosman A, Weiler Z, Shulimzon T, Laxer U, Fink G. National asthma observational survey of severe asthmatics in Israel: the no-air study. Allergy Asthma Clin Immunol 2012; 8:8. [PMID: 22656244 PMCID: PMC3444925 DOI: 10.1186/1710-1492-8-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 06/01/2012] [Indexed: 11/21/2022] Open
Abstract
Background Asthma is considered a global public health issue requiring a significant medical expenditure as a result of its high prevalence and the low rate of disease control. Objective This is the first nationwide survey of severe asthma patients carried out in Israel. In this study we aimed to assess health resources utilization, compliance with treatment and disease-control in a subgroup of patients with severe asthma in Israel. Material and method One hundred and twenty-three patients with a diagnosis of asthma for more then one year, as well as a hospitalization during the last 12 months due to asthma exacerbation or maintenance systemic steroids therapy, were included in this non-interventional observational study. Results Asthma was uncontrolled in 43.9%, partly controlled in 50.4% and well controlled in only 5.7%. The majority of the patients (83%) were compliant with drug treatment. Conclusion The fact that 83% of the asthma patients included in this study were compliant with their asthma therapy was not manifested in asthma control. Therefore concrete tools are required for achieving and maintaining asthma control, especially in the treatment of the most severe asthmatic patients.
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Affiliation(s)
- Gabriel Izbicki
- Pulmonary Institute, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, 91031, Israel.
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10
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Ben-Dov I, Kaminski N, Reichert N, Rosenman J, Shulimzon T. Diaphragmatic paralysis: a clinical imitator of cardiorespiratory diseases. Isr Med Assoc J 2008; 10:579-583. [PMID: 18847154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Diaphragmatic paralysis has a predictable effect on lung function. However, the symptoms depend on the preexisting heart-lung diseases and may mimic various cardiorespiratory processes. We describe the presentation in six patients. In a fit man, unilateral diaphragmatic paralysis caused dyspnea only at strenuous exercise. In a patient with emphysema it caused dyspnea mainly when carrying light weights. In another patient with emphysema it caused life-threatening hypoxemia simulating parenchymal lung disease. A patient with mild chronic obstructive lung disease and nocturnal wheezing following the onset of ULDP was believed for 15 years to have asthma. A patient with bilateral diaphragmatic weakness had severe choking sensation only in the supine position, simulating upper airway obstruction or heart failure. Afemale patient suffered nocturnal sweating due to ULDP. The clinical manifestations of diaphragmatic paralysis vary and can mimic a wide range of cardiorespiratory diseases.
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Affiliation(s)
- Issahar Ben-Dov
- Institut of Respiratory Physiology and Medicine, Sheba Medical Center, Tel Hashomer, Israel.
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11
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Shulimzon T, Rozenman J, Perelman M, Bardan E, Ben-Dov I. Necrotizing granulomata in the lung preceding colonic involvement in 2 patients with Crohn's disease. Respiration 2006; 74:698-702. [PMID: 16636526 DOI: 10.1159/000092854] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 02/10/2006] [Indexed: 12/21/2022] Open
Abstract
Extraintestinal involvement, including the chest, is common in the late course of Crohn's disease. We describe 2 female patients in whom the course of the disease was unique in two aspects: (1) each had a pulmonary mass with granulomatous inflammation and necrosis, and (2) these findings had preceded the colonic involvement by 5 years. This sequence supports some of the theories on the pathogenesis of Crohn's disease and on its possible relation with sarcoidosis, another idiopathic granulomatous disease.
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Affiliation(s)
- Tiberiu Shulimzon
- Pulmonary Institute, Sheba Medical Center affiliated to Sackler's School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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12
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Konen E, Yellin A, Greenberg I, Paley M, Shulimzon T, Wolf M, Reichert N, Itzchak Y, Rozenman J. Complications of tracheal and thoracic surgery: the role of multisection helical CT and computerized reformations. Clin Radiol 2003; 58:341-50. [PMID: 12727161 DOI: 10.1016/s0009-9260(03)00057-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Helical computed tomography (CT) has an important role in the evaluation of a wide range of congenital and acquired thoracic abnormalities. The development of advanced computerized reformations enables the generation of bronchographic and bronchoscopic images of the tracheobronchial tree, as well as angiographic images of pulmonary arteries and veins. Additionally, it provides coronal and sagittal reconstruction imaging of parenchymal abnormalities. This information is obtained by a 20-30s procedure on a typical single channel system, which makes helical CT an optimal technique for the evaluation of patients undergoing major upper airways and thoracic interventions. The recent introduction of multisection CT scanners allows faster imaging of patients with thinner collimation, thus improving spatial resolution along the longitudinal (z) axis of the patient along with reduction of motion artefacts. This article demonstrates the use of dual and quad-section helical CT in the postoperative evaluation of patients undergoing laryngo-tracheal and thoracic interventions, including laryngoplasty, tracheal endoscopic laser ablation, lobectomy, pneumonectomy, lung transplantation, sleeve resection, pulmonary angioplasty, and pulmonary artery thromboendarterectomy. Emphasis is given to the additive value of using computerized reformations over axial images, especially for delineation of complex postoperative anatomical details in the tracheobronchial tree and pulmonary vasculature.
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Affiliation(s)
- E Konen
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Affiliated with The Sackler School of Medicine, Tel-Aviv University, Tel Hashomer, Israel.
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13
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Olchovsky D, Shimon I, Goldberg I, Shulimzon T, Lubetsky A, Yellin A, Pariente C, Karasik A, Kanety H. Elevated insulin-like growth factor-1 and insulin-like growth factor binding protein-2 in malignant pleural effusion. Acta Oncol 2002; 41:182-7. [PMID: 12102164 DOI: 10.1080/028418602753669571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Insulin-like growth factor-1 (IGF-1) and its binding proteins (IGFBPs) are produced by many tissues and are present in serum and other biological fluids. Alterations in sera of IGF-1 and 2 and IGFBPs were demonstrated in patients with malignancy, infection and other diseases causing pleural effusion. In this study the IGF-1 and IGFBP-2 content and the specific electrophoretic patterns of IGFBPs in samples of sera and pleural effusions of 25 patients with malignancy, infection and congestive heart failure were investigated. IGF-1 levels in exudative effusions of malignant solid tumors were significantly higher [(mean +/- SD), 20.9+/-7.5 nmol/L, n = 9] than in lymphoma (11.0+/-5.2 nmol/L, n = 5; p < 0.05), infection (11.4+/-6.5 nmol/L, n = 6; p < 0.05) and transudative effusion of congestive heart failure (4.3+/-3.3 nmol/L, n = 5; p < 0.02). IGFBP-2 was markedly increased in effusions of malignant solid tumors (2.14+/-0.82 mg/L, n = 9) compared with exudates of lymphoma, infection and transudates (1.10+/-0.70, 1.22+/-0.32 and 0.93+/-0.52 nmol/L, respectively, p < 0.05). Moreover, in effusion of solid tumors, IGFBP-2 levels were higher than those in corresponding sera, which suggests local production of this binding protein. The demonstration of IGFBP-2 in solid tumor cells by immunohistochemistry further supports this possibility. This work demonstrates the existence of the IGF-1/IGFBP system in pleural fluids from different etiologies and implies possible use of IGF-1 and IGFBP-2 as a potential marker of malignant effusions.
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Affiliation(s)
- David Olchovsky
- Department of Medicine A, Institute of Endocrinology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
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14
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Sosna J, Shulimzon T, Roznman J, Lidgi M, Lavy A, Ben-Dov IZ, Ben-Dov I. Drug-resistant pulmonary tuberculosis in Israel, a society of immigrants: 1985-1994. Int J Tuberc Lung Dis 1999; 3:689-94. [PMID: 10460101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
SETTING AND OBJECTIVES Drug-resistant tuberculosis was uncommon in Israel until 1985, when the waves of immigration began. We studied the incidence and clinical course of resistant pulmonary tuberculosis nationwide. DESIGN Isolates of Mycobacterium tuberculosis between 1985 and 1994 were surveyed. Data on 150 patients with resistance and 110 patients with drug-sensitive disease were reviewed. Ethnic origin, type of resistance, radiological findings and outcome were analysed. RESULTS In total, 16.7% of the isolates showed resistance to at least one drug; 58% had resistance to multiple drugs. In 67% of the patients the resistance was primary. Most patients were immigrants from the former USSR and from Ethiopia; none were Israeli-born Jews. Mortality with resistance was 10%, and was highest (14%) with multiple drug resistance. Mortality among drug-resistant cases was lowest (3%) among Ethiopian Jews. Cavities and extensive disease were more common with drug resistance. CONCLUSION Drug resistance has become relatively common in Israel due to immigration from the former USSR and Ethiopia. It is more extensive radiologically and carries a poorer outcome.
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Affiliation(s)
- J Sosna
- Department of Radiology, Haddasha University Medical Center, Jerusalem, Israel
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15
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Abstract
Radiation pneumonitis is a well-characterized clinicopathological syndrome. The severity of radiation-induced lung injury correlates, among other factors, with the extent of lung volume incorporated within the field of radiation. The present article describes the cases of two patients with radiation pneumonitis following pneumonectomy and mediastinal radiotherapy. Postpneumonectomy pulmonary-mediastinal shift of the remaining lung towards the operated side, with inclusion of lung parenchyma within the "mediastinal" radiation portals, resulted in a substantial (albeit clinically unsuspected) radiation pneumonitis. Chest computed tomography in the postpneumonectomy patient may be helpful to evaluate the degree of pulmonary-mediastinal shift and optimization of the radiotherapy field.
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Affiliation(s)
- T Shulimzon
- Division of Respiratory Medicine, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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16
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Abstract
Treatment of 21 steroid-dependent asthmatic patients with methotrexate (MTX) 15 mg/week was prospectively evaluated for a mean of 14.7 (SD 3.7) months. Before MTX, therapy consisted of a mean prednisone dose of 16.6 (SD 9.2) mg, in addition to inhaled beclomethasone/budesonide (mean daily dose 1157 (SD 330) micrograms) and bronchodilators. Thirteen patients were weaned from all regular systemic steroid therapy, a 50% or more reduction was achieved in four patients, and a less than 50% reduction in four patients. Abnormal liver function tests were noted in six of the 21 patients; this resolved despite continuation of MTX in five. In one patient, MTX was stopped because of symptoms as well as a fivefold rise in serum transaminases, and a speedy resolution was noted. Gastrointestinal side-effects were reported in six patients but were resolved in five with intramuscular MTX. There were no hematologic or pulmonary complications. We conclude that MTX appears to be both safe and efficacious as a steroid-sparing agent in most steroid-dependent asthmatic patients when taken over a long period.
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Affiliation(s)
- R J Shiner
- Department of Clinical Respiratory Physiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Molho M, Shulimzon T, Benzaray S, Katz I. Importance of inspiratory load in the assessment of severity of airways obstruction and its correlation with CO2 retention in chronic obstructive pulmonary disease. Am Rev Respir Dis 1993; 147:45-9. [PMID: 8420429 DOI: 10.1164/ajrccm/147.1.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Different aspects of mechanical loading were analyzed in a group of 25 patients with chronic obstructive pulmonary disease (COPD) who all had severe expiratory airflow limitation but different arterial CO2 values. It was found that the maximal expiratory flow rates (V75, V50, V25, VFRC), functional residual capacity (FRC), residual volume (RV), total lung capacity (TLC), specific airways conductance (SGaw) measured during inspiration or expiration, and lung recoil pressure (PLel) were not correlated to the PaCO2. Only five parameters were significantly linked to the PaCO2; they were the peak inspiratory flow (PIF) (r = -0.57, p < 0.002), the inspiratory vital capacity (IVC) (r = -0.46, p < 0.01), the maximal voluntary ventilation (MVV) (r = -0.49, p < 0.01), the total SGaw (r = -0.40, p < 0.03), and the forced expiratory flow volume in one second (FEV1) (r = -0.36, p < 0.05). It was concluded that the airflow limitation during the inspiratory phase has an important contribution to the CO2 retention in patients with COPD, and therefore analysis of both phases of the respiratory cycle is necessary to assess the severity of airway obstruction in this disease.
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Affiliation(s)
- M Molho
- Clinical Respiratory Physiology Laboratory, Chaim Sheba Medical Center, Tel Aviv University Sackler School of Medicine, Tel Hashomer, Israel
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