Pulmonary Institute

Petah Tikva, Israel

Pulmonary Institute

Petah Tikva, Israel
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Nitzan M.,Jerusalem College of Technology | Romem A.,Pulmonary Institute
Medical Devices: Evidence and Research | Year: 2014

Oxygen saturation in the arterial blood (SaO2) provides information on the adequacy of respiratory function. SaO2 can be assessed noninvasively by pulse oximetry, which is based on photoplethysmographic pulses in two wavelengths, generally in the red and infrared regions. The calibration of the measured photoplethysmographic signals is performed empirically for each type of commercial pulse-oximeter sensor, utilizing in vitro measurement of SaO2 in extracted arterial blood by means of co-oximetry. Due to the discrepancy between the measurement of SaO2 by pulse oximetry and the invasive technique, the former is denoted as SpO2. Manufacturers of pulse oximeters generally claim an accuracy of 2%, evaluated by the standard deviation (SD) of the differences between SpO2 and SaO2, measured simultaneously in healthy subjects. However, an SD of 2% reflects an expected error of 4% (two SDs) or more in 5% of the examinations, which is in accordance with an error of 3%-4%, reported in clinical studies. This level of accuracy is sufficient for the detection of a significant decline in respiratory function in patients, and pulse oximetry has been accepted as a reliable technique for that purpose. The accuracy of SpO2 measurement is insufficient in several situations, such as critically ill patients receiving supplemental oxygen, and can be hazardous if it leads to elevated values of oxygen partial pressure in blood. In particular, preterm newborns are vulnerable to retinopathy of prematurity induced by high oxygen concentration in the blood. The low accuracy of SpO2 measurement in critically ill patients and newborns can be attributed to the empirical calibration process, which is performed on healthy volunteers. Other limitations of pulse oximetry include the presence of dyshemoglobins, which has been addressed by multiwavelength pulse oximetry, as well as low perfusion and motion artifacts that are partially rectified by sophisticated algorithms and also by reflection pulse oximetry. © 2014 Nitzan et al.

Cohen H.A.,Pediatric Ambulatory Community Clinic | Cohen H.A.,Tel Aviv University | Blau H.,Tel Aviv University | Blau H.,Pulmonary Institute | And 3 more authors.
Pediatrics | Year: 2014

OBJECTIVES: Seasonal variations in asthma are widely recognized, with the highest incidence during September. This retrospective population study aimed to investigate whether this holds true in a large group of asthmatic children in primary care and to assess the impact of age, gender, urban/rural living, and population sector. METHODS: The key study outcomes were the diagnosis of asthma exacerbations and asthma medication prescriptions, recorded by family physicians during 2005 to 2009. These were analyzed by "week of diagnosis" in Clalit Health Services' electronic medical record database. Regression models were built to assess relative strength of secular trends, seasonality, and age-group in explaining the incidence of asthma exacerbations. RESULTS: A total of 919 873 children aged 2 to 15 years were identified. Of these, 82 234 (8.9%) were asthmatic, 61.6% boys and 38.4% girls; 49.1% aged 2 to 5 years, 24.1% 6 to 9 years, and 26.8% 10 to 15 years. We observed a 2.01-fold increase in pediatric asthma exacerbations and 2.28-fold increase in prescriptions of asthma bronchodilator medications during September (weeks 37-39 vs weeks 34-36) compared with August. The association between the opening of school and the incidence of asthma-related visits to the primary care physician was greatest in children aged 2 to 5 years (odds ratio, 2.15) and 6 to 11 years (1.90-fold). Adolescents (age 12-15 years) had a lesser peak (1.81-fold). In late fall there was a second rise, lasting with fluctuations throughout winter, with a trough in summer. CONCLUSIONS: Returning to school after summer is strongly associated with an increased risk for asthma exacerbations and unscheduled visits to the primary care physician. © 2014 by the American Academy of Pediatrics.

Shulimzon T.R.,Pulmonary Institute | Lieberman S.,Chest Radiology Unit
Journal of Vascular and Interventional Radiology | Year: 2016

This report describes the use of confocal laser microscopy (CLM) with CT-guided transthoracic needle biopsy (TTNB) for the diagnosis of heterogeneous large mediastinal and lung tumors. The procedure was performed in five patients diagnosed with a mediastinal mass and five patients diagnosed with a lung mass. CLM was used before CT-guided TTNB. Fluorescein administration allowed for the identification of blood vessels in both locations. Malignant cells were identified in mediastinal masses. Complications included one case of pneumothorax. In large tumors, CLM allows vascularized tissue to be differentiated from necrotic and fibrotic areas before biopsy. © 2016 SIR.

Shlomi D.,Pulmonary Institute | Shlomi D.,Clalit Health Services | Ben-Avi R.,Chaim Sheba Medical Center | Balmor G.R.,Pulmonary Institute | And 3 more authors.
European Respiratory Journal | Year: 2014

Lung cancer is the leading cause of cancer death worldwide. Age and smoking are the primary risk factors for lung cancer. Treatment based on surgical removal in the early stages of the disease results in better survival. Screening programmes for early detection that used chest radiography and sputum cytology failed to attain reduction of lung cancer mortality. Screening by low-dose computed tomography (CT) demonstrated high rates of early-stage lung cancer detection in a high-risk population. Nevertheless, no mortality advantage was manifested in small randomised control trials. A large randomised control trial in the USA, the National Lung Screening Trial (NLST), showed a significant relative reduction of 20% in lung cancer mortality and 6.7% reduction in total mortality, yet no reduction was evidenced in the late-stage prevalence. Screening for lung cancer by low-dose CT reveals a high level of false-positive lesions, which necessitates further noninvasive and invasive evaluations. Based primarily on the NLST eligible criteria, new guidelines have recently been developed by major relevant organisations. The overall recommendation coming out of this collective work calls for lung cancer screening by low-dose CT to be performed in medical centres manned by specialised multidisciplinary teams, as well as for a mandatory, pre-screening, comprehensive discussion with the patient about the risks and advantages involved in the process. Lung cancer screening is on the threshold of a new era, with ever more questions still left open to challenge future studies. © ERS 2014.

Ben-Dov I.,Pulmonary Institute | Ben-Dov I.,Tel Aviv University | Segel M.J.,Pulmonary Institute | Segel M.J.,Tel Aviv University
Autoimmunity Reviews | Year: 2014

Pulmonary alveolar proteinosis (PAP) is caused by accumulation of surfactant components in the alveoli and terminal airways. All forms of PAP are caused by insufficient surfactant clearance by alveolar macrophages. Autoimmune PAP, a rare, antibody-mediated disease, that compromises 90% of cases of PAP, is causes by IgG autoantibodies that block GM-CSF effect, a crucial step for macrophage maturation. Alveolar filling may progress to respiratory insufficiency, but the course of the disease is variable. Patients usually complain of dyspnea, mainly with exertion, and cough. Chest CT shows highly suggestive ground grass opacification crossed by heavy septal lines, leading to the typical "crazy paving" appearance. Bronchoalveolar lavage reveals "milky" fluid, containing semisolid remnants of surfactant components, packed as lamellar bodies. The surfactant appears granular and pink on PAS staining, and lung architecture is preserved. These cytological and pathological characteristics are diagnostic for PAP. In addition, a high titer of IgG anti GM-CSF autoantibodies is highly sensitive and specific for the diagnosis. The trigger for antibodies formation and their role (if any) in regulation GM-CSF activity in the normal state are unknown. Based on the specificity of these characteristics we suggest a structured framework for the diagnosis of Autoimmune PAP. Lung lavage with a large volume of saline is the standard therapy, and is effective in most patients. However, immune-modulatory therapy, by either supplying exogenous GM-CSF, or by inhibiting the CD20. + antibody forming cells, with Rituximab, is also effective in many patients. The precise role of each therapy, alone or in combination, should be systematically studied. © 2014 Elsevier B.V.

Amital A.,Pulmonary Institute
Presse médicale (Paris, France : 1983) | Year: 2011

Rheumatoid arthritis (RA) is a common inflammatory disease, affecting about 1% of the population. Although a major portion of the disease burden including excess mortality is due to its extra-articular manifestations, the prevalence of RA-associated lung disease is increasing. RA can affect the lung parenchyma, airways, and the pleura; and pulmonary complications are directly responsible for 10 to 20% of all mortality. Even though pulmonary infection and drug toxicity are frequent complications of RA, lung disease directly associated with the underlying RA is more common. The prevalence of a particular complication varies based on the characteristics of the population studied, the definition of lung disease used, and the sensitivity of the clinical investigations employed. An overview of lung disease associated with RA is presented here with an emphasis on parenchymal lung disease, pleural effusion, and airway involvement. Copyright © 2010. Published by Elsevier Masson SAS.

Graif Y.,Pulmonary Institute
Harefuah | Year: 2013

Exercise induced vasculitis (or purpura) is usually misdiagnosed and ignored in the literature, although it is not uncommon. We report two female patients who developed a rash on the lower legs after walking all day long. The rash was red, itchy with a burning sensation. The lesions resolved after a few days with and without steroid treatment. Allergic etiology was suspected, therefore they were sent to the allergy clinic for evaluation. Exercise-induced vasculitis tends to occur in healthy people, especially in hot weather. Extensive investigation with blood or allergy tests is not needed.

Kramer M.R.,Pulmonary Institute
Harefuah | Year: 2011

In recent years, there has been a marked improvement in the treatment of pulmonary arterial hypertension (PAH) due to the development of targeted therapies. There are now several treatment options available--oral, inhaled, and those delivered by subcutaneous or intravenous methods. These treatments have greatly improved patient survival, which in the past was 2.5 years on average. Efficient treatment choice generally proceeds from oral therapies--PDE-5 inhibitors (sildenafil) and endothelin receptor antagonists (bosentan or ambrisentan)--to inhaled prostanoids (iloprost) or subcutaneous (treprostinil). Intravenous prostacyclins are used in treating the more severe cases. The different pathways of action of each class of drugs allow a synergistic effect of combination therapy similar to malignancy or patients in congestive heart failure. The updated treatment algorithm includes combinations of therapies that target different pathways. This article will review the literature regarding combination therapy for the treatment of PAH. Combining PAH therapies that target different pathways is now a well-established treatment option, based on numerous international clinical trials, and offers new hope to patients suffering from this severe disease.

Shulimzon T.R.,Pulmonary Institute
Israel Medical Association Journal | Year: 2014

Interventional pulmonology (IP) is the newest chapter in respiratory medicine. IP includes both diagnostic and therapeutic methods. Nanotechnology, in both instrumental engineering and optical imaging, will further advance this competitive discipline towards cell diagnosis and therapy as part of the future's personalized medicine.

Shitrit D.,Pulmonary Institute
Scandinavian Journal of Infectious Diseases | Year: 2010

The management of lung abscess is usually conservative. However, in some cases drainage is necessary, commonly performed transcutaneously. Endobronchial catheter drainage is a potential alternative, though reported only sporadically. Transbronchial pigtail catheter drainage was used in 3 patients with refractory lung abscesses at our centre. The catheter was introduced endobronchially under bronchoscopic procedure. Laser was used to perforate the abscess wall through the airway into the abscess in order to provide a pathway for catheter insertion. An improvement in clinical and radiological parameters was noted immediately after catheter placement. The catheters were extracted after 4-6 days. All patients had a complete clinical recovery. Endobronchial catheters with the use of laser appear to be relatively safe and effective for the treatment of pulmonary abscess in selected patients in whom the abscess is adjacent to the central airway. When necessary, a bulge in an adjacent airway can be perforated with laser. To the best of our knowledge, there have been no previous reports of endobronchial drainage with the use of laser. © 2009 Informa UK Ltd.

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