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Kaufman E, Garfunkel A, Galili D, Zusman SP, Malamed SF, Findler M, Elad S. [Allergy-related emergencies]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2002; 19:60-6, 102. [PMID: 11852451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Allergic reactions can develop to any of the drugs or materials commonly used in dentistry. They exhibit a broad range of clinical signs and symptoms ranging from mild, delayed reactions to immediate and life-threatening reactions developing within seconds. Allergies usually manifest themselves in reactions that are related to histamine release in one of three ways: skin reactions, respiratory problems and anaphylaxis. Anaphylaxis is the most critical allergic reaction in the dental environment. Measures such as airway management, oxygen supplementation, antihistamine, adrenaline and corticosteroid medication, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.
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Garfunkel A, Galili D, Findler M, Zusman SP, Malamed SF, Elad S, Kaufman E. [Chest pains in the dental environment]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2002; 19:51-9, 101. [PMID: 11852449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Chest pain does not necessarily indicate cardiac disease. The most common causes of acute chest pain encountered in dental situations include hyperventilation, pulmonary embolism, angina pectoris and myocardial infarction. Stress and fear often cause rapid breathing or hyperventilation. This usually occurs in young adults and although the hyperventilating patient often complains of chest pain, this is rarely a manifestation of cardiac disease. Pulmonary embolism usually indicates the occlusion of a pulmonary artery causing severe chest pain. The primary clinical manifestation of angina pectoris is chest pain. Although most instances of anginal pain are easily terminated, the dentist must always consider the possibility that the supposed anginal attack is actually a sign of acute myocardial infarction (AMI). AMI is a clinical syndrome caused by a deficient coronary arterial blood supply to a region of myocardium that results in cellular death. There is a high incidence of mortality among AMI with death often occurring within 2 hours of the onset of signs and symptoms. The initial clinical manifestations of all types of chest pain can be similar. Therefore the dentist must develop proficiency in constituting a differential diagnosis and an efficient management protocol. As in most medical situations prevention is the most powerful tool. However, if chest pains do occur, measures such as airway management, oxygen supplementation, coronary artery dilation, analgesis and in extreme cases, cardiopulmonary resuscitation and evacuation to the emergency room, may be necessary.
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Zusman SP, Garfunkel A, Galili D, Findler M, Malamed SF, Elad S, Kaufman E. [Legal and ethical considerations of emergencies in the dental office]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2002; 19:88-91, 103. [PMID: 11852454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The dentist has the ethical and legal responsibility to anticipate emergency situations in correlation with the patient's medical status. He has the obligation to do all in his power to prevent emergencies from happening and to be prepared to manage any emergency that might occur. This article also discusses the importance of monitoring and documentation.
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Kaufman E, Garfunkel A, Findler M, Elad S, Zusman SP, Malamed SF, Galili D. [Emergencies evolving from local anesthesia]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2002; 19:13-8, 98. [PMID: 11852446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Local anesthesia is without doubt the most frequently used drug in dentistry and in medicine. In spite of records of safety set by using these drugs, there is evidence to adverse reactions ranging from 2.5%-11%. Most of the reactions originate from the autonomic system. A recent, well-planned study indicates that adverse reactions are highly correlated to the medical status of the patient: the higher the medical risk, the greater the chance to experience an adverse reaction. This study also found that adverse reactions highly correlated to the concentration of adrenalin. Another recent study found a direct relationship between adverse reactions and the level of anxiety experienced by the patient and to the dental procedure. Most of the reactions in this study occurred either immediately at injection time and within 2 hours following the injection. Since the beginning of last century, vasoconstrictors have been added to local anesthesia solutions in order to reduce toxicity and prologue activity of the LA. However, today it is commonly agreed that this addition to local anesthesia should not be administered to cardiac patients especially those suffering from refractory dysrhythmias, angina pectoris, post myocardial infarction (6 months) and uncontrolled hypertension. Other contraindications to vasoconstrictors are endocrine disorders such as hyperthyroidism, hyperfunction of the medullary adrenal (pheochromocytoma) and uncontrolled diabetes mellitus. Cross reactivity of local anesthetic solutions can occur with MAO inhibitors, non specific beta adrenergic blockers, tricyclic antidepressants, phenothiazides and cocaine abusers. Noradrenaline added to local anesthetics as a vasoconstrictor has been described as a trigger to a great increase in blood pressure and therefore has been forbidden for use in many countries. This paper describes 4 cases of severe complications following the injections of local anesthesia of which three ended in fatality.
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Findler M, Galili D. [Cardiac arrest in dental offices. Report of six cases]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2002; 19:79-87, 103. [PMID: 11852453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The extreme medical emergency situation in the dental setting is cardiac arrest. The need to provide dental treatment to the medically compromised patients, suffering from very high risk heart diseases at special oral medicine hospital dentistry units, expose the dental and medical teams to the possibility of patients' death. Cardiac and cardiorespiratory arrest in these units faces the dentists with the need to perform basic and/or advanced cardiopulmonary resuscitation (CPR). Various etiologies are responsible for cardiac arrests. This article describes our experience and the outcome of six patients who have suffered cardiac arrests pre, during or post dental treatment in two special oral medicine centers. Two patients, suffering from severe congestive heart failure experienced fatal ventricular arrhythmia, both of them underwent CPR with early cardiac defibrillation, following which one patient completely recovered, and the other one expired. Two young and healthy patients experienced severe neurocardiogenic syncope with heart standstill for more than 40 seconds followed by spontaneous uneventful recovery. The fifth patient, who suffered from ventricular fibrillation as a result of an acute coronary ischemia, was resuscitated successfully. The last patient, a young woman, suffered from a severe status epilepticus causing bradycardia, which led to cardiac arrest, but recovered following CPR. All patients who did not recover spontaneously underwent methodical advanced CPR with early defibrillation. Only one patient out of the six died.
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Findler M, Elad S, Garfunkel A, Zusman SP, Malamed SF, Galili D, Kaufman E. [Syncope in the dental environment]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2002; 19:27-33, 99. [PMID: 11852447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Syncope or Fainting is, by far, the most common emergency situation in the dental practice. Syncope is defined as an abrupt, transient, short term loss of consciousness and postural tone, followed by spontaneous and complete recovery. The pathophysiology of syncope consists of a sudden cessation or decrease in cerebral perfusion. Differential diagnosis of these medical conditions is of paramount importance in uncovering unrecognized systemic diseases. The dental team plays an important role in the process of establishing the correct diagnosis by its ability to recognize and document all the clinical symptoms and signs evident at the time of fainting. The dental surgeon is expected to be familiar with the various etiologies of syncope and should be able to differentiate between them. This article provides the essentials of the diagnostic procedure and an approach to the evaluation of the unconscious patient.
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Galili D, Garfunkel A, Elad S, Zusman SP, Malamed SF, Findler M, Kaufman E. [Respiratory distress]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2002; 19:34-46, 100. [PMID: 11852448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Dental treatment is usually conducted in the oral cavity and in very close proximity to the upper respiratory airway. The possibility of unintentionally compromising this airway is high in the dental environment. The accumulation of fluid (water or blood) near to the upper respiratory airway or the loosening of teeth fragmentations and fallen dental instruments can occur. Also, some of the drugs prescribed in the dental practice are central nervous system depressants and some are direct respiratory drive depressors. For this reason, awareness of the respiratory status of the dental patient is of paramount importance. This article focuses on several of the more common causes of respiratory distress, including airway obstruction, hyperventilation, asthma, bronchospasm, pulmonary edema, pulmonary embolism and cardiac insufficiency. The common denominator to all these conditions described here is that in most instances the patient is conscious. Therefore, on the one hand, valuable information can be retrieved from the patient making diagnosis easier than when the patient is unconscious. On the other hand, the conscious patient is under extreme apprehension and stress under such situations. Respiratory depression which occurs during conscious sedation or following narcotic analgesic medication will not be dealt with in this article. Advanced pain and anxiety control techniques such as conscious sedation and general anesthesia should be confined only to operators who undergo special extended training.
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Kaufman E, Garfunkel A, Findler M, Malamed SF, Zusman SP, Elad S, Galili D. [The potential dangers of endocrinal disorders]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2002; 19:67-78, 102. [PMID: 11852452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The symptoms of most endocrine system diseases are usually clearly recognizable and most of the times are accompanied by a rich medical history. Many general practitioners are reluctant to treat such cases and prefer to refer these patients to specialists who are trained in management of the medically compromised thus increasing the chances of dental treatment without complications. However, sometimes endocrinal diseases develop slowly and their clinical manifestations are hidden or subclinical in nature. In these cases, neither the patient nor the dentist are aware of the condition and there is the potential of life threatening, emergency situations in what at first seem as simple, straightforward dental procedures. Therefore, the dentist must be able to recognize the clinical problem, differentiate between the different symptoms and initiate the proper management protocol. The most unstable endocrinal disorders that should be treated with great care are diabetes mellitus, mainly hypoglycemia, hyperthyroidism and adrenal insufficiency. The general practitioner dentist can treat patients suffering from these disorders providing the disease is well controlled and balanced and that the dental treatment is not very traumatic.
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Findler M, Cantor J, Haddad L, Gordon W, Ashman T. The reliability and validity of the SF-36 health survey questionnaire for use with individuals with traumatic brain injury. Brain Inj 2001; 15:715-23. [PMID: 11485611 DOI: 10.1080/02699050010013941] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In order to examine the reliability and validity of the SF-36 for use with individuals with TBI, the SF-36 and three measures of health-related problems in persons with TBI (BDI-II, TIRR Symptom Checklist, Health Problems List) were administered to 271 individuals without a disability, 98 individuals with mild TBI, and 228 individuals with moderate-severe TBI. Internal consistency (reliability) was demonstrated for all SF-36 scales. Significant correlations were found between the SF-36 scales and the other measures, with stronger correlations emerging in the TBI groups. The TBI groups obtained significantly lower SF-36 scores than the comparison group, and the mild TBI group scored lower than the moderate-severe group. For the most part, the differences between the TBI groups disappeared when BDI-II scores were controlled for. These findings suggest that the SF-36 is a reliable and valid measure for use with persons with TBI.
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Findler M, Galili D. [The association between periodontal diseases and coronary artery diseases--a literature review]. REFU'AT HA-PEH VEHA-SHINAYIM (1993) 2001; 18:56-62, 77. [PMID: 11460763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The relation between periodontal disease and atherosclerotic cardiovascular disease was reported the first time at the end of the Eighties. Screening of the English written reported research papers revealed an increased risk of coronary artery disease and Cerebrovascular disease, in patients suffering from chronic periodontal infection. The same relation was found in patient who underwent multiple tooth extraction as a result of chronic advanced periodontal disease. These observations stress the importance of maintaining good oral hygiene and the prevention of chronic periodontal disease. The precise mode of influence, pathophysiology is still obscured, possible mechanisms were suggested. An indirect risk, by raising infection markers, such as fibrinogen and c-reactive protein. Other possibilities are by direct influence on Atherosclerotic plaque formation or another common cardiovascular risk factor such as smoking which influence both cardiovascular and periodontal diseases.
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Garfunkel AA, Galili D, Findler M, Lubliner J, Eldor A. Bleeding tendency: a practical approach in dentistry. COMPENDIUM OF CONTINUING EDUCATION IN DENTISTRY (JAMESBURG, N.J. : 1995) 1999; 20:836-8, 840-2, 844 passim. [PMID: 10649954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The dental profession faces the problems of exaggerated bleeding on a daily basis. The hemostatic, as well as the fibrinolytic processes are better understood today, and the dentist should be familiar with them. The activation of coagulation factors and their clinical expression in the circulation are both described. The most frequently used blood coagulation tests are explained. Antithrombotic medications are frequently used and their implications in dentistry are accentuated. Protocols of prevention and treatment of exaggerated bleeding following dental procedures are included. Among them, the transfusion of clotting factors and the administration of antifibrinolytic medications (tranexamic acid) are recommended for both congenital or acquired bleeding tendencies.
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Elad S, Cohen G, Zylber-Katz E, Findler M, Galili D, Garfunkel AA, Or R. Systemic absorption of lidocaine after topical application for the treatment of oral mucositis in bone marrow transplantation patients. J Oral Pathol Med 1999; 28:170-2. [PMID: 10235370 DOI: 10.1111/j.1600-0714.1999.tb02018.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper evaluates lidocaine absorption via oral mucosa following its topical application for symptomatic treatment of bone marrow transplantation (BMT)-induced oral mucositis. Five patients with high-grade oral mucositis after allogeneic BMT were entered consecutively into the study. Five healthy individuals served as controls. All 10 participants rinsed their mouth with 5 ml of a 2% lidocaine solution for 1 min, after which they expectorated the liquid. Blood samples were drawn at 1, 5, 10, 20, 30 and 60 min after rinsing and centrifuged. Plasma lidocaine levels were measured by fluorescence polarization immunoassay. In the BMT patients, plasma lidocaine levels were lower than the therapeutic range of this drug (0.2 microg/ml vs 1.5-5.5 microg/ml), while in the controls no detectable lidocaine levels were noted. The data from this preliminary study indicate that lidocaine prescribed as an anesthetic mouthwash in BMT patients with oral mucositis results in minor systemic absorption of the drug.
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Findler M, Galili D, Kaufman E, Garfunkel AA. [Adrenaline in local anesthetics]. HAREFUAH 1997; 133:224-8. [PMID: 9461697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Shenkman Z, Findler M, Lossos A, Barak S, Katz J. Permanent neurologic deficit after inferior alveolar nerve block: a case report. Int J Oral Maxillofac Surg 1996; 25:381-2. [PMID: 8961023 DOI: 10.1016/s0901-5027(06)80037-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Permanent neurologic damage after an inferior dental nerve block is reported. Clinical manifestations included hemisensory syndrome, facial nerve palsy, hearing impairment, and ataxia. Possible mechanisms and preventive measures are discussed.
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Galili D, Findler M, Garfunkel AA. Oral and dental complications associated with diabetes and their treatment. COMPENDIUM (NEWTOWN, PA.) 1994; 15:496-509. [PMID: 8055519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Findler M, Garfunkel AA, Galili D. Review of very high-risk cardiac patients in the dental setting. COMPENDIUM (NEWTOWN, PA.) 1994; 15:58-66. [PMID: 8187150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Findler M, Galili D, Meidan Z, Yakirevitch V, Garfunkel AA. Dental treatment in very high risk patients with active ischemic heart disease. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 76:298-300. [PMID: 8378044 DOI: 10.1016/0030-4220(93)90257-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A new method of predental treatment and management for patients with active ischemic heart disease is reported. Patients with unstable angina pectoris or who have just had a myocardial infarction underwent full treatment for pain-induced dental problems, with the use of an incremental three-level antiangina and antianxiety medication: before dental treatment; in the waiting room, and c) during dental treatment. The setting was a tertiary referral oral medical service and hospital dental clinic. Twenty-six patients were treated, 16 men, 10 women, ranging in age from 45 to 68 years. Ten patients with unstable angina pectoris and 16 patients less than 3 months after a myocardial infarction. All patients underwent comprehensive dental treatment. Good cardiovascular control was achieved, and all the procedures were uneventfully completed. This study indicates the need to reconsider the absolute versus relative contraindications for dental treatment in patients with active ischemic heart disease and recommends the use of a gradual three-level therapy.
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Findler M, Galili D, Yakirevitz V. [Problems associated with the prophylactic use of antibiotics in the prevention of infective endocarditis]. HAREFUAH 1993; 124:490-492. [PMID: 8335275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Findler M, Mazor Z, Galili D, Garfunkel AA. Dental treatment in a patient with malignant pheochromocytoma and severe uncontrolled high blood pressure. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:290-291. [PMID: 8097035 DOI: 10.1016/0030-4220(93)90138-t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A young female with severely uncontrolled hypertension suspected to result from malignant pheochromocytoma underwent combined medical and dental care for the treatment of acute dental pain. The dental treatment was performed with the patient under intravenous sedation and careful perioperative management with the use of high doses of alpha and beta receptor blocking agents. The procedure was completed without intraoperative problems and an uneventful posttreatment course.
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Bishara A, Findler M, Markitziu A, Slavin S, Brautbar C. Lichenoid reaction in bone marrow transplants suffering from chronic GVHD is associated with HLA-DQW1. Hum Immunol 1992. [DOI: 10.1016/0198-8859(92)90168-m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Levi A, Findler M, Dolfin T, Di Segni E, Vidne BA. Intrapericardial extralobar pulmonary sequestration in a neonate. Chest 1990; 98:1014-5. [PMID: 2209106 DOI: 10.1378/chest.98.4.1014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A huge pericardial effusion was diagnosed during fetal ultrasound examination performed in the 42nd week of pregnancy on a healthy 25-year-old woman. Immediately after the birth, a two-dimensional echocardiogram confirmed this finding in the infant, and an intrapericardial kidney-shaped solid mass measuring 45 x 56 x 15 mm, completely surrounded by pericardial effusion, was visualized to the left part of the heart. The heart was normal. No signs of cardiac tamponade were seen. At the age of two days, the mass was surgically resected and the pericardial fluid evacuated. Microscopic examination revealed that the mass was formed totally of normal lung tissue surrounded by normal pleura. To the best of our knowledge, this is the first case of intrapericardial extralobar sequestration consisting of an accessory lung with completely normal lung tissue.
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Snir E, Levinsky L, Salomon J, Findler M, Levy MJ, Vidne BA. Dissecting aortic aneurysm in pregnant women without Marfan disease. SURGERY, GYNECOLOGY & OBSTETRICS 1988; 167:463-5. [PMID: 3055367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Dissection of the young women without Marfan disease is related, in most instances, to pregnancy. The structural changes in the arterial wall that occur during pregnancy may predispose women to this complication of pregnancy. In this study, two young women, who had none of the characteristics of Marfan's syndrome, were operated upon for dissection of the ascending aorta. The first patient was in the 35th week of gestation and a cesarean section was performed prior to replacement of the ascending aorta. In the second patient, diagnosis of dissection and severe aortic regurgitation occurred in the postpartum period. Knowledge of this albeit relatively rare complication of pregnancy may assist the clinician in diagnosing and referring patients early for surgical treatment that, in most instances, may save the lives of both mother and fetus.
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Findler M, Vidne BA. [The artificial heart: aim or transition to heart transplantation]. HAREFUAH 1988; 114:624-6. [PMID: 3044945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Findler M, Barak J, Einav S, Snir E, Hochauser E, Vidne BA. The use of isolated auto-heart-lung perfusion apparatus on small animals. Transplant Proc 1987; 19:3792-4. [PMID: 3118525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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50
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Findler M, Vidne BA. [Revival of lung transplantation]. HAREFUAH 1987; 112:127-9. [PMID: 3301571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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