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Yahav-Shafir D, Ilgiyaev E, Galante O, Gorfil D, Statlender L, Soroksky A, Carmi U, Sinai YB, Iprach N, Haviv-Yadid Y, Makhoul M, Fatnic E, Ginosar Y, Einav S, Helviz Y, Fink D, Sternik L, Kogan A. Extracorporeal membrane oxygenation in obstetric patients: An Israeli nationwide study. Artif Organs 2024; 48:392-401. [PMID: 38112077 DOI: 10.1111/aor.14691] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/19/2023] [Accepted: 11/26/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The leading causes of maternal mortality include respiratory failure, cardiovascular events, infections, and hemorrhages. The use of extracorporeal membrane oxygenation (ECMO) as rescue therapy in the peripartum period for cardiopulmonary failure is expanding in critical care medicine. METHODS This retrospective observational study was conducted on a nationwide cohort in Israel. During the 3-year period, between September 1, 2019, and August 31, 2022, all women in the peripartum period who had been supported by ECMO for respiratory or circulatory failure at 10 large Israeli hospitals were identified. Indications for ECMO, maternal and neonatal outcomes, details of ECMO support, and complications were collected. RESULTS During the 3-year study period, in Israel, there were 540 234 live births, and 28 obstetric patients were supported by ECMO, with an incidence of 5.2 cases per 100 000 or 1 case per 19 000 births (when excluding patients with COVID-19, the incidence will be 2.5 cases per 100 000 births). Of these, 25 were during the postpartum period, of which 16 (64%) were connected in the PPD1, and 3 were during pregnancy. Eighteen patients (64.3%) were supported by V-V ECMO, 9 (32.1%) by V-A ECMO, and one (3.6%) by a VV-A configuration. Hypoxic respiratory failure (ARDS) was the most common indication for ECMO, observed in 21 patients (75%). COVID-19 was the cause of ARDS in 15 (53.7%) patients. The indications for the V-A configuration were cardiomyopathy (3 patients), amniotic fluid embolism (2 patients), sepsis, and pulmonary hypertension. The maternal and fetal survival rates were 89.3% (n = 25) and 100% (n = 28). The average ECMO duration was 17.6 ± 18.6 days and the ICU stay was 29.8 ± 23.8 days. Major bleeding complications requiring surgical intervention were observed in one patient. CONCLUSIONS The incidence of using ECMO in the peripartum period is low. The maternal and neonatal survival rates in patients treated with ECMO are high. These results show that ECMO remains an important treatment option for obstetric patients with respiratory and/or cardiopulmonary failure.
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Affiliation(s)
- Dana Yahav-Shafir
- Department of Anaesthesiology, Sheba Medical Centre, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eduard Ilgiyaev
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of General Intensive Care, Shamir Medical Center, Zerifin, Israel
| | - Ori Galante
- Intensive Care Unit, Soroka University Medical Centre, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dan Gorfil
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiothoracic Surgery, Cardiothoracic Intensive Care Unit, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Liran Statlender
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- General Intensive Care Unit, Rabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
| | - Arie Soroksky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Intensive Care Unit, Wolfson Medical Centre, Holon, Israel
| | - Uri Carmi
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yitzhak Brzezinski Sinai
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nisim Iprach
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Anesthesia and Intensive Care, Meir Medical Center, Kfar-Saba, Israel
| | - Yael Haviv-Yadid
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Intensive Care Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Maged Makhoul
- Department of Cardiac Surgery, Rambam Medical Center, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elena Fatnic
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University, Ein Karem Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehuda Ginosar
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Anesthesiology, Mother & Child Anesthesia Unit, Hadassah Hebrew University, Ein Karem Medical Center, Jerusalem, Israel
| | - Sharon Einav
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yigal Helviz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Daniel Fink
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Leonid Sternik
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiac Surgery, Sheba Medical Centre, Tel Hashomer, Israel
| | - Alexander Kogan
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardiac Surgery, Sheba Medical Centre, Tel Hashomer, Israel
- Cardiac Surgery Intensive Care Unit, Sheba Medical Centre, Tel Hashomer, Israel
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Gat T, Galante O, Sadeh R, Kobal SL, Fuchs L. Self-learning of cardiac ultrasound by medical students: can augmented online training improve and maintain manual POCUS skills over time? J Ultrasound 2024; 27:73-80. [PMID: 37493967 PMCID: PMC10909045 DOI: 10.1007/s40477-023-00804-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/25/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The use of cardiac point of care ultra-sound is rapidly growing and so is the demand for quality POCUS teaching. POCUS teaching is usually conducted in small groups requiring much space and equipment. This study attempts to test whether providing access to an E-learning module as an adjunct to a cardiac POCUS course can increase students' image acquisition skills. This will show POCUS teaching can improve significantly without having to invest a significant amount of resources. METHODS Medical students (N = 125) were divided into two groups and had undergone a hands-on Cardiac POCUS course before their internal clerkship. During the clerkship, members of both groups got to practice their POCUS skills in the internal wards. One group was provided with accounts to a cardiac POCUS teaching E-learning platform (eMedical Academy©). After limited time for self- practice, both groups underwent a pre-validated ultrasound examination. The two groups' test results were then compared for each POCUS view and for the total exam score. RESULTS The E-learning group performed significantly better than the course-only group in the 6-min exam total score, and at acquiring the following views: parasternal long axis view, apical four-chamber view, and the inferior vena cava view. CONCLUSION E-learning platforms can be an efficient tool for improving cardiac POCUS teaching and maintaining POCUS skills. Using it as a supplement to a hands-on course provides better POCUS skills without the need of extra hands-on teaching.
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Affiliation(s)
- Tomer Gat
- Soroka Medical Center, Beer-Sheva, Israel.
| | | | - Re'em Sadeh
- Emergency Department, Shamir Medical Center, Beer Yaakov, Israel
| | - Sergio L Kobal
- Division of Cardiology, Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Intensive Care Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Koter N, Gat T, Furth M, Sadeh R, Galante O, Tomer O, Klein S, Muszkat M, Fuchs L, Nachshon A. Severity of a Vipera palaestinae envenomation objective findings associated with a complicated hospitalization course following a Vipera palaestinae bite. Toxicon 2023; 234:107304. [PMID: 37778739 DOI: 10.1016/j.toxicon.2023.107304] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/03/2023]
Abstract
The most common snake in Israel, responsible for most snakebites is Vipera palaestinae (VP). Envenomation signs and symptoms vary from local manifestations to systemic reactions that may end with death. Antivenom treatment, given to high-risk patients, reduces complications and mortality but carries risks. As of now, there is no standardized protocol for adults bitten by VP based on objective clinical and laboratory findings. We conducted A retrospective analysis of 159 patients admitted to two large tertiary care institutions in the center (Hadassah University Medical Center) and south (Soroka University Medical Center) of Israel with Vipera palaestinae bites during 1990-2017. Epidemiological and clinical data were extracted, and the patients were divided into two groups based on hospitalization time (over or under 48 h). 159 patients were included in this study. The average hospitalization time was 66.1 h, with 49.7% of patients admitted over 48 h. The main factors that statistically correlated with a longer hospitalization time were: Male gender, lower extremity bite, platelets lower than 150 K at presentation, leukocyte count of over 10 K at presentation and elevated D-Dimer levels. This study provides factors which are associated with a severe VP envenomation. These clinical or laboratory findings (along with accompanying clinical symptoms) are associated with a higher risk of a prolonged hospitalization with more complications and may require a more intensive treatment and monitoring.
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Affiliation(s)
- Netta Koter
- Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tomer Gat
- Department of Internal Medicine, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Maayan Furth
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Re'em Sadeh
- Emergency Department, Shamir Medical Center, Beer-Yaakov, Israel
| | - Ori Galante
- Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Orr Tomer
- Department of Internal Medicine, Hadassah Medical Centre, Jerusalem, Israel
| | - Sarit Klein
- Department of Internal Medicine, Hadassah Medical Centre, Jerusalem, Israel
| | - Mordechi Muszkat
- Department of Internal Medicine, Hadassah Medical Centre, Jerusalem, Israel
| | - Lior Fuchs
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Akiva Nachshon
- General Intensive Care Unit, Dept. of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Centre, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Galante O, Hasidim A, Almog Y, Cohen A, Makhoul M, Soroksky A, Zikri-Ditch M, Fink D, Ilgiyaev E. Extracorporal Membrane Oxygenation in Nonintubated Patients (Awake ECMO) With COVID-19 Adult Respiratory Distress Syndrome: The Israeli Experience. ASAIO J 2023; 69:e363-e367. [PMID: 37505201 PMCID: PMC10627399 DOI: 10.1097/mat.0000000000001996] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
In this retrospective multicenter observational study, we describe the Israeli experience with veno-venous extracorporeal membrane oxygenation (VV ECMO) for the treatment of COVID-19-induced severe adult respiratory distress syndrome (ARDS), in which ECMO cannulation was done while the patients were awake and spontaneously breathing without endotracheal tube, namely "awake ECMO." We enrolled all adult patients with severe ARDS due to COVID-19, treated with VV ECMO between March 1, 2020, and November 30, 2021, in which cannulation was done while the patient was awake and spontaneously breathing. During the study period, 365 COVID-19 ARDS patients were treated with VV ECMO. Of these, 25 (6.8%) were treated as awake ECMO. The patient's mean age was 52 years, and 80% were male. Nine of the 25 patients (36%) remained awake throughout their intensive care unit stay and were not sedated and mechanically ventilated at all. Sixteen (64%) were eventually intubated while being on ECMO. Six months survival was 76%. Median mechanical ventilation-free days on ECMO was 8 (interquartile range 5-12) days. This hypothesis-generating study suggests that treating COVID-19 ARDS patients with VV ECMO without sedation and mechanical ventilation is feasible, yet, additional research will be required in order to determine if this modality offers a survival benefit and to identify who are the patients most likely to benefit from it.
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Affiliation(s)
- Ori Galante
- From the Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Ariel Hasidim
- From the Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaniv Almog
- From the Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Cohen
- General Intensive Care Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Maged Makhoul
- Cardiothoracic Surgery, Rambam Medical Center, Haifa, Israel
| | - Arie Soroksky
- Intensive Care Unit, Wolfson Medical Center, Holon
- Sackler School of Medicine University of Tel Aviv, Israel
| | - Meital Zikri-Ditch
- Intensive Care Unit, Kaplan Medical Center, Rehovot, Israel
- Hebrew University, Jerusalem, Israel
| | - Daniel Fink
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Eduard Ilgiyaev
- Intensive Care Unit, Shamir Medical Center, Sackler School of Medicine University of Tel Aviv, Israel
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Galante O, Braiman D, Haim M, Kobal SL. A case report of rapid diagnosis of atrial-oesophageal fistula by transthoracic echocardiogram with agitated saline injection. Eur Heart J Case Rep 2023; 7:ytad254. [PMID: 37323534 PMCID: PMC10266174 DOI: 10.1093/ehjcr/ytad254] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/30/2022] [Accepted: 05/19/2023] [Indexed: 06/17/2023]
Abstract
Background Catheter ablation is a common treatment for atrial fibrillation (AF). Atrial-oesophageal fistula (AOF) is a rare yet fatal complication of catheter ablation. Chest computed tomography (CT) is the diagnostic modality of choice but may be undiagnostic in up to 24% of cases. Case summary We present the case of a 61-year-old male who presented with pleuritic chest pain, hypotension, fever, and coffee-ground emesis 20 days after cryoablation for AF. His chest CT was undiagnostic. Atrial-oesophageal fistula was diagnosed by injecting agitated saline into the nasogastric tube during a transthoracic echocardiogram (TTE) that showed bubbles in the left atrium and ventricle. Discussion In the case presented, as often happens, the diagnosis of AOF was delayed for several days, during which the patient presented with septic shock and concomitant multiorgan failure. The high mortality rate associated with AOF is partially attributable to delayed diagnosis. As prompt surgical intervention offers the best chance of survival, a high level of suspicion is of the utmost importance. We suggest contrast-enhanced TTE as a potential diagnostic tool when a rapid and definitive diagnosis is crucial and CT is inconclusive. Since this procedure is not without risk, proper risk consideration and management are necessary.
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Affiliation(s)
- Ori Galante
- Internal Medicine Division, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Medical Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Braiman
- Internal Medicine Division, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Haim
- Department of Cardiology, Electrophysiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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6
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Fatnic E, Blanco NL, Cobiletchi R, Goldberger E, Tevet A, Galante O, Sviri S, Bdolah-Abram T, Batzofin BM, Pizov R, Einav S, Sprung CL, van Heerden PV, Ginosar Y. Outcome predictors and patient progress following delivery in pregnant and postpartum patients with severe COVID-19 pneumonitis in intensive care units in Israel (OB-COVICU): a nationwide cohort study. Lancet Respir Med 2023:S2213-2600(22)00491-X. [PMID: 36746165 PMCID: PMC9949483 DOI: 10.1016/s2213-2600(22)00491-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND A key unresolved controversy in severe COVID-19 pneumonitis in pregnancy is the optimum timing of delivery and whether delivery improves or worsens maternal outcomes. We aimed to assess clinical data on every intensive care unit (ICU) day for pregnant and postpartum women admitted to the ICU with COVID-19, with a particular focus on the days preceding and following delivery. METHODS In this multicentre, nationwide, prospective and retrospective cohort study, we evaluated all pregnant women who were admitted to an ICU in Israel with severe COVID-19 pneumonitis from the 13th week of gestation to the 1st week postpartum. We excluded pregnant patients in which the ICU admission was unrelated to severe COVID-19 pneumonitis. We assessed maternal and neonatal outcomes and longitudinal clinical and laboratory ICU data. The primary overall outcome was maternal outcome (worst of the following: no invasive positive pressure ventilation [IPPV], use of IPPV, use of extracorporeal membrane oxygenation [ECMO], or death). The primary longitudinal outcome was Sequential Organ Failure Assessment (SOFA) score, and the secondary longitudinal outcome was the novel PORCH (positive end-expiratory pressure [PEEP], oxygenation, respiratory support, chest x-ray, haemodynamic support) score. Patients were classified into four groups: no-delivery (pregnant at admission and no delivery during the ICU stay), postpartum (ICU admission ≥1 day after delivery), delivery-critical (pregnant at admission and receiving or at high risk of requiring IPPV at the time of delivery), or delivery-non-critical (pregnant at admission and not critically ill at the time of delivery). FINDINGS From Feb 1, 2020, to Jan 31, 2022, 84 patients were analysed: 34 patients in the no-delivery group, four in postpartum, 32 in delivery-critical, and 14 in delivery-non-critical. The delivery-critical and postpartum groups had worse outcomes than the other groups: 26 (81%) of 32 patients in the delivery-critical group and four (100%) of four patients in the postpartum group required IPPV; 12 (38%) and three (75%) patients required ECMO, and one (3%) and two (50%) patients died, respectively. The delivery-non-critical and no-delivery groups had far better outcomes than other groups: six (18%) of 34 patients and two (14%) of 14 patients required IPPV, respectively; no patients required ECMO or died. Oxygen saturation (SpO2), SpO2 to fraction of inspired oxygen (FiO2) ratio (S/F ratio), partial pressure of arterial oxygen to FiO2 ratio (P/F ratio), ROX index (S/F ratio divided by respiratory rate), and SOFA and PORCH scores were all highly predictive for adverse maternal outcome (p<0·0001). The delivery-critical group deteriorated on the day of delivery, continued to deteriorate throughout the ICU stay, and took longer to recover (ICU duration, Mantel-Cox p<0·0001), whereas the delivery-non-critical group improved rapidly following delivery. The day of delivery was a significant covariate for PORCH (p<0·0001) but not SOFA (p=0·09) scores. INTERPRETATION In patients who underwent delivery during their ICU stay, maternal outcome deteriorated following delivery among those defined as critical compared with non-critical patients, who improved following delivery. Interventional delivery should be considered for maternal indications before patients deteriorate and require mechanical ventilation. FUNDING None.
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Affiliation(s)
- Elena Fatnic
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nikole Lee Blanco
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roman Cobiletchi
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esty Goldberger
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aharon Tevet
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Soroka Medical Center, Faculty of Health Science, Ben Gurion University, Beer Sheva, Israel
| | - Sigal Sviri
- Medical Intensive Care Unit, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Bdolah-Abram
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Baruch M Batzofin
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reuven Pizov
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sharon Einav
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; General Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Charles L Sprung
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - P Vernon van Heerden
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yehuda Ginosar
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Hebrew University Ein Karem Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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7
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Lorusso R, De Piero ME, Mariani S, Di Mauro M, Folliguet T, Taccone FS, Camporota L, Swol J, Wiedemann D, Belliato M, Broman LM, Vuylsteke A, Kassif Y, Scandroglio AM, Fanelli V, Gaudard P, Ledot S, Barker J, Boeken U, Maier S, Kersten A, Meyns B, Pozzi M, Pedersen FM, Schellongowski P, Kirali K, Barrett N, Riera J, Mueller T, Belohlavek J, Lorusso R, De Piero ME, Mariani S, Di Mauro M, Folliguet T, Taccone FS, Camporota L, Swol J, Wiedemann D, Belliato M, Broman LM, Vuylsteke A, Kassif Y, Scandroglio AM, Fanelli V, Gaudard P, Ledot S, Barker J, Boeken U, Maier S, Kersten A, Meyns B, Pozzi M, Pedersen FM, Schellongowski P, Kirali K, Barrett N, Riera J, Mueller T, Belohlavek J, Lo Coco V, Van der Horst ICC, Van Bussel BCT, Schnabel RM, Delnoij T, Bolotin G, Lorini L, Schmiady MO, Schibilsky D, Kowalewski M, Pinto LF, Silva PE, Kornilov I, Blandino Ortiz A, Vercaemst L, Finney S, Roeleveld PP, Di Nardo M, Hennig F, Antonini MV, Davidson M, Jones TJ, Staudinger T, Mair P, Kilo J, Krapf C, Erbert K, Peer A, Bonaros N, Kotheletner F, Krenner Mag N, Shestakova L, Hermans G, Dauwe D, Meersseman P, Stockman B, Nobile L, Lhereux O, Nrasseurs A, Creuter J, De Backer D, Giglioli S, Michiels G, Foulon P, Raes M, Rodrigus I, Allegaert M, Jorens P, Debeucklare G, Piagnarelli M, Biston P, Peperstraete H, Vandewiele K, Germay O, Vandeweghe D, Havrin S, Bourgeois M, Lagny MG, Alois G, Lavios N, Misset B, Courcelle R, Timmermans PJ, Yilmaz A, Vantomout M, Lehaen J, Jassen A, Guterman H, Strauven M, Lormans P, Verhamme B, Vandewaeter C, Bonte F, Vionne D, Balik M, Blàha J, Lips M, Othal M, Bursa F, Spacek R, Christensen S, Jorgensen V, Sorensen M, Madsen SA, Puss S, Beljantsev A, Saiydoun G, Fiore A, Colson P, Bazalgette F, Capdevila X, Kollen S, Muller L, Obadia JF, Dubien PY, Ajrhourh L, Guinot PG, Zarka J, Besserve P, Malfertheiner MV, Dreier E, Heinze B, Akhyari P, Lichtenberg A, Aubin H, Assman A, Saeed D, Thiele H, Baumgaertel M, Schmitto JD, Ruslan N, Haverich A, Thielmann M, Brenner T, Ruhpawar A, Benk C, Czerny M, Staudacher DL, Beyersdorf F, Kalbhenn J, Henn P, Popov AF, Iuliu T, Muellenbach R, Reyher C, Rolfes C, Lotz G, Sonntagbauer M, Winkels H, Fichte J, Stohr R, Kalverkamp S, Karagiannidis C, Schafer S, Svetlitchny A, Fichte J, Hopf HB, Jarczak D, Groesdonk H, Rommer M, Hirsch J, Kaehny C, Soufleris D, Gavriilidis G, Pontikis K, Kyriakopoulou M, Kyriakoudi A, O'Brien S, Conrick-Martin I, Carton E, Makhoul M, Ben-Ari J, Hadash A, Kogan A, Kassif Lerner R, Abu-Shakra A, Matan M, Balawona A, Kachel E, Altshuler R, Galante O, Fuchs L, Almog Y, Ishay YS, Lichter Y, Gal-oz A, Carmi U, Nini A, Soroksky A, Dekel H, Rozman Z, Tayem E, Ilgiyaev E, Hochman Y, Miltau D, Rapoport A, Eden A, Kompanietz D, Yousif M, Golos M, Grazioli L, Ghitti D, Loforte A, Di Luca D, Baiocchi M, Pacini D, Cappai A, Meani P, Mondino M, Russo CF, Ranucci M, Fina D, Cotza M, Ballotta A, Landoni G, Nardelli P, Fominski EV, Brazzi L, Montrucchio G, Sales G, Simonetti U, Livigni S, Silengo D, Arena G, Sovatzis SS, Degani A, Riccardi M, Milanesi E, Raffa G, Martucci G, Arcadipane A, Panarello G, Chiarini G, Cattaneo S, Puglia C, Benussi S, Foti G, Giani M, Bombino M, Costa MC, Rona R, Avalli L, Donati A, Carozza R, Gasparri F, Carsetti A, Picichè M, Marinello A, Danzi V, Zanin A, Condello I, Fiore F, Moscarelli M, Nasso G, Speziale G, Sandrelli L, Montalto A, Musumeci F, Circelli A, Russo E, Agnoletti V, Rociola R, Milano AD, Pilato E, Comentale G, Montisci A, Alessandri F, Tosi A, Pugliese F, Giordano G, Carelli S, Grieco DL, Dell'Anna AM, Antonelli M, Ramoni E, Zulueta J, Del Giglio M, Petracca S, Bertini P, Guarracino F, De Simone L, Angeletti PM, Forfori F, Taraschi F, Quintiliani VN, Samalavicius R, Jankuviene A, Scupakova N, Urbonas K, Kapturauskas J, Soerensen G, Suwalski P, Linhares Santos L, Marques A, Miranda M, Teixeira S, Salgueiro A, Pereira F, Ketskalo M, Tsarenko S, Shilova A, Afukov I, Popugaev K, Minin S, Shelukhin D, Malceva O, Gleb M, Skopets A, Kornelyuk R, Kulikov A, Okhrimchuk V, Turchaninov A, Shelukhin D, Petrushin M, Sheck A, Mekulov A, Ciryateva S, Urusov D, Gorjup V, Golicnik A, Goslar T, Ferrer R, Martinez-Martinez M, Argudo E, Palmer N, De Pablo Sanchez R, Juan Higuera L, Arnau Blasco L, Marquez JA, Sbraga F, Fuset MP, De Gopegui PR, Claraco LM, De Ayala JA, Peiro M, Ricart P, Martinez S, Chavez F, Fabra M, Sandoval E, Toapanta D, Carraminana A, Tellez A, Ososio J, Milan P, Rodriguez J, Andoni G, Gutierrez C, Perez de la Sota E, Eixeres-Esteve A, Garcia-Maellas MT, Gutierrez-Gutierrez J, Arboleda-Salazar R, Santa Teresa P, Jaspe A, Garrido A, Castaneda G, Alcantara S, Martinez N, Perez M, Villanueva H, Vidal Gonzalez A, Paez J, Santon A, Perez C, Lopez M, Rubio Lopez MI, Gordillo A, Naranjo-Izurieta J, Munoz J, Alcalde I, Onieva F, Gimeno Costa R, Perez F, Madrid I, Gordon M, Albacete Moreno CL, Perez D, Lopez N, Martinenz D, Blanco-Schweizer P, Diez C, Perez D, Prieto A, Renedo G, Bustamante E, Cicuendez R, Citores R, Boado V, Garcia K, Voces R, Domezain M, Nunez Martinez JM, Vicente R, Martin D, Andreu A, Gomez Casal V, Chico I, Menor EM, Vara S, Gamacho J, Perez-Chomon H, Javier Gonzales F, Barrero I, Martin-Villen L, Fernandez E, Mendoza M, Navarro J, Colomina Climent J, Gonzales-Perez A, Muniz-Albaceita G, Amado L, Rodriguez R, Ruiz E, Eiras M, Grins E, Magnus R, Kanetoft M, Eidevald M, Watson P, Vogt PR, Steiger P, Aigner T, Weber A, Grunefelder J, Kunz M, Grapow M, Aymard T, Reser D, Agus G, Consiglio J, Haenggi M, Hansjoerg J, Iten M, Doeble T, Zenklusen U, Bechtold X, Faedda G, Iafrate M, Rohjer A, Bergamaschi L, Maessen J, Reis Miranda D, Endeman H, Gommers D, Meuwese C, Maas J, Van Gijlswijk MJ, Van Berg RN, Candura D, Van der Linden M, Kant M, Van der Heijden JJ, Scholten E, Van Belle-van Haren N, Lagrand WK, Vlaar AP, De Jong S, Cander B, Sargin M, Ugur M, Kaygin MA, Daly K, Agnew N, Head L, Kelly L, Anoma G, Russell C, Aquino V, Scott I, Flemming L, Gillon S, Moore O, Gelandt E, Auzinger G, Patel S, Loveridge R. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study. Lancet Respir Med 2023; 11:151-162. [PMID: 36402148 PMCID: PMC9671669 DOI: 10.1016/s2213-2600(22)00403-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. METHODS EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. FINDINGS Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. INTERPRETATION Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. FUNDING None.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
| | - Maria Elena De Piero
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Silvia Mariani
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Thierry Folliguet
- Department of Cardiac Surgery, Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Justyna Swol
- Department of Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University Hospital of Vienna, Vienna, Austria
| | - Mirko Belliato
- Anestesia e Rianimazione II Cardiopolmonare, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Alain Vuylsteke
- ECMO Retrieval Service & Critical Care, Royal Papworth Hospital, NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Yigal Kassif
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Fanelli
- Department of Surgical Sciences, Anesthesia and Intensive Care Medicine, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, France,Le laboratoire de Physiologie et Médecine Expérimentale du Coeur et des Muscles (PhyMedExp), Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Stephane Ledot
- Intensive Care Unit, Royal Brompton & Harefield hospitals, London, UK
| | - Julian Barker
- Cardiothoracic Critical Care Unit, Whythenshawe Hospital, Manchester, UK
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Bad Krozingen, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Kersten
- Medizinische Klinik, Uniklinik Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, Universitair Ziekenhuis Leuven Gasthuisberg University Hospital, Leuven, Belgium
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Hospital, Lyon, France
| | - Finn M Pedersen
- Cardiothoracic Intensive Care Unit, University Hospital, Copenhagen, Denmark
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit, Comprehensive Cancer Center, Center of Excellence in Medical Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Kaan Kirali
- Cardiovascular Surgery Department, Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Nicholas Barrett
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Jordi Riera
- Critical Care Department, Val d'Hebron Research Institute, Barcelona, Spain
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital, Prague, Czech Republic,1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Makhoul M, Keizman E, Carmi U, Galante O, Ilgiyaev E, Matan M, Słomka A, Sviri S, Eden A, Soroksky A, Fink D, Sternik L, Bolotin G, Lorusso R, Kassif Y. Outcomes of Extracorporeal Membrane Oxygenation (ECMO) for COVID-19 Patients: A Multi-Institutional Analysis. Vaccines (Basel) 2023; 11:vaccines11010108. [PMID: 36679953 PMCID: PMC9865577 DOI: 10.3390/vaccines11010108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 11/22/2022] [Revised: 12/18/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In March 2020, COVID-19 was announced as a global pandemic. The first COVID-19 patient was connected to an ECMO device in Israel during that time. Since then, over 200 patients have required ECMO support due to COVID-19 infection. The present study is a multi-institutional analysis of all COVID-19 patients requiring veno-venous (VV) ECMO in Israel. The aim was to characterize and compare the survivors and deceased patients as well as establish risk factors for mortality. METHODS This retrospective multi-institutional study was conducted from March 2020 to March 2021 in eleven of twelve ECMO centers operating in Israel. All COVID-19 patients on VV ECMO support were included in the cohort. The patients were analyzed based on their comorbidities, procedural data, adverse event on ECMO, and outcomes. Univariate and multivariate analyses were used to compare the deceased and the surviving patients. RESULTS The study included 197 patients, of which 150 (76%) were males, and the mean age was 50.7 ± 12 years. Overall mortality was 106 (54%). Compared with the deceased subjects, survivors were significantly younger (48 ± 11 vs. 53 ± 12 years), suffered less from ischemic heart disease (IHD) (3% vs. 12%), and were ventilated for a significantly shorter period (≤4 days) prior to cannulation (77% vs. 63%). Patients in the deceased group experienced more kidney failure and sepsis. Rates of other complications were comparable between groups. CONCLUSIONS Based on this study, we conclude that early cannulation (≤4 days) of younger patients (≤55 years) may improve overall survival and that a history of IHD might indicate a reduced prognosis.
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Affiliation(s)
- Maged Makhoul
- Department of Cardiac Surgery, Rambam Medical Center, Haifa 3525408, Israel
- Correspondence:
| | - Eitan Keizman
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
| | - Uri Carmi
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Faculty of Health Ben Gurion University, Soroka Medical Center, Beer-Sheva 8400711, Israel
| | - Eduard Ilgiyaev
- Intensive Care Unit, Shamir Medical Center, Zerifin 703301, Israel
| | - Moshe Matan
- Intensive Care Unit, The Baruch Padeh Medical Center, Poriya 1528001, Israel
| | - Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier CollegiumMedicum, 85-094 Bydgoszcz, Poland
| | - Sigal Sviri
- Medical Intensive Care, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Arieh Eden
- Department of Anesthesiology Critical Care and Pain Medicine, Carmel Lady Davis Medical Center, Haifa 3436212, Israel
| | - Arie Soroksky
- Intensive Care Unit, E. Wolfson Medical Center, Tel Aviv 6423906, Israel
| | - Danny Fink
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem 91120, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
| | - Gil Bolotin
- Department of Cardiac Surgery, Rambam Medical Center, Haifa 3525408, Israel
| | - Roberto Lorusso
- Cardiovascular Research Institute, Maastricht (CARIM), 6200 Maastricht, The Netherlands
| | - Yigal Kassif
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
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9
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Kosto A, Gozlan‐Talmor A, Levy E, Nalbandyan K, Fuchs L, Galante O. Unusual presentation of aggressive high‐grade B‐cell lymphoma of colonic origin: A case report and review of the literature. Clin Case Rep 2022; 10:e05929. [PMID: 35734188 PMCID: PMC9192348 DOI: 10.1002/ccr3.5929] [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: 12/10/2021] [Revised: 04/10/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Colonic lymphoma is a rare disease. The presented case is unique, being manifested with abrupt onset, including circulatory shock and lactic acidosis as the initial presentation. Although rare, colorectal lymphoma should be included in the DD of patients with abdominal symptoms. Shock and lactic acidosis can be an initial presentation of colonic lymphoma. Diagnosis is mostly based on pathology and the evaluation of ascites.
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Affiliation(s)
- Amit Kosto
- Department of Internal Medicine Soroka University Medical Center; Faculty of Health Sciences Ben Gurion University of the Negev Beer‐Sheva Israel
| | - Aya Gozlan‐Talmor
- Department of Hematology Soroka University Medical Center; Faculty of Health Sciences Ben Gurion University of the Negev Beer‐Sheva Israel
| | - Etai Levy
- Department of Hematology Soroka University Medical Center; Faculty of Health Sciences Ben Gurion University of the Negev Beer‐Sheva Israel
| | - Karen Nalbandyan
- Department of Pathology Soroka University Medical Center; Faculty of Health Sciences Ben Gurion University of the Negev Beer‐Sheva Israel
| | - Lior Fuchs
- Medical Intensive Care Unit Soroka University Medical Center; Faculty of Health Sciences Ben Gurion University of the Negev Beer‐Sheva Israel
| | - Ori Galante
- Medical Intensive Care Unit Soroka University Medical Center; Faculty of Health Sciences Ben Gurion University of the Negev Beer‐Sheva Israel
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10
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Galante O, Borer A, Almog Y, Fuchs L, Saidel-Odes L. Double-gloving in an Intensive Care Unit during the COVID-19 pandemic. Eur J Intern Med 2022; 100:127-129. [PMID: 35177304 PMCID: PMC8841223 DOI: 10.1016/j.ejim.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ori Galante
- Medical Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.Box 151, Beer-Sheva, Israel, 84101
| | - Abraham Borer
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.Box 151 Beer-Sheva, Israel, 84101; Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.Box 151 Beer-Sheva, Israel, 84101
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.Box 151, Beer-Sheva, Israel, 84101
| | - Lior Fuchs
- Medical Intensive Care Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.Box 151, Beer-Sheva, Israel, 84101
| | - Lisa Saidel-Odes
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.Box 151 Beer-Sheva, Israel, 84101; Infectious Diseases Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.Box 151 Beer-Sheva, Israel, 84101.
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11
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Fuchs L, Galante O, Almog Y, Dayan RR, Smoliakov A, Ullman Y, Shamia D, Ohayon RBD, Golbets E, El Haj K, Taylor J, Weissberg I, Novack V, Barski L, Rosenberg E, Gohar E, Abed MA, Sagy I. Point of Care Lung Ultrasound Injury Score—A simple and reliable assessment tool in COVID-19 patients (PLIS I): A retrospective study. PLoS One 2022; 17:e0267506. [PMID: 35544450 PMCID: PMC9094523 DOI: 10.1371/journal.pone.0267506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/10/2022] [Indexed: 12/26/2022] Open
Abstract
Background In COVID-19 patients, lung ultrasound is superior to chest radiograph and has good agreement with computerized tomography to diagnose lung pathologies. Most lung ultrasound protocols published to date are complex and time-consuming. We describe a new illustrative Point-of-care ultrasound Lung Injury Score (PLIS) to help guide the care of patients with COVID-19 and assess if the PLIS would be able to predict COVID-19 patients’ clinical course. Methods This retrospective study describing the novel PLIS was conducted in a large tertiary-level hospital. COVID-19 patients were included if they required any form of respiratory support and had at least one PLIS study during hospitalization. Data collected included PLIS on admission, demographics, Sequential Organ Failure Assessment (SOFA) scores, and patient outcomes. The primary outcome was the need for intensive care unit (ICU) admission. Results A total of 109 patients and 293 PLIS studies were included in our analysis. The mean age was 60.9, and overall mortality was 18.3%. Median PLIS score was 5.0 (3.0–6.0) vs. 2.0 (1.0–3.0) in ICU and non-ICU patients respectively (p<0.001). Total PLIS scores were directly associated with SOFA scores (inter-class correlation 0.63, p<0.001), and multivariate analysis showed that every increase in one PLIS point was associated with a higher risk for ICU admission (O.R 2.09, 95% C.I 1.59–2.75) and in-hospital mortality (O.R 1.54, 95% C.I 1.10–2.16). Conclusions The PLIS for COVID-19 patients is simple and associated with SOFA score, ICU admission, and in-hospital mortality. Further studies are needed to demonstrate whether the PLIS can improve outcomes and become an integral part of the management of COVID-19 patients.
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Affiliation(s)
- Lior Fuchs
- Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- * E-mail:
| | - Ori Galante
- Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaniv Almog
- Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Roy R. Dayan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alexander Smoliakov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yuval Ullman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Shamia
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ran Ben David Ohayon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Evgeny Golbets
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Khaled El Haj
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jonathan Taylor
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Itai Weissberg
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Barski
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Eli Rosenberg
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Gohar
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Muhammad Abo Abed
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Galante O, Sadeh R, Smoliakov A, Muraveva A, Almog Y, Schneider E, Frenkel A, Fuchs L. Real time wire localization by ultrasound during central line insertion improves accurate positioning in all upper torso sites. J Crit Care 2021; 67:79-84. [PMID: 34717163 DOI: 10.1016/j.jcrc.2021.10.009] [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] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate whether point of care ultrasound can improve central venous catheter tip positioning. MATERIAL AND METHODS A single center retrospective case control study. We compared the precision of central venous catheter tip positioning between two intensive care units while in only one of the units, we used point of care ultrasound for guidewire identification. RESULTS 207 cases in which central venous catheter was inserted using point of care ultrasound guided method, compared to 192 controls. The primary outcome of correct placement of the central venous catheter tip was significantly higher in the point of care ultrasound guided group (97.6% vs 88.0% p = 0.001). Central venous catheter tip was located too low among 12% of patients in the control group while in only 2.4% of patients in the point of care ultrasound group (p = 0.001). Logistics regression analysis revealed that the correct placement of central venous catheter tip in the point of care ultrasound group versus the control group had an odds ratio of 4.9 (CI 1.6-14.5 P = 0.004). CONCLUSION Point of care ultrasound for guidewire identification and localization, while inserting central venous catheter from all upper torso sites, improves precision positioning.
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Affiliation(s)
- Ori Galante
- Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
| | - Re'em Sadeh
- Faculty of Health Sience, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Smoliakov
- Institute of Diagnostic Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Alona Muraveva
- Institute of Diagnostic Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Schneider
- Faculty of Health Sience, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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13
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Tsaban G, Galante O, Almog Y, Ullman Y, Fuchs L. Feasibility of machine integrated point of care lung ultrasound automatic B-lines tool in the Corona-virus 2019 critical care unit. Crit Care 2021; 25:345. [PMID: 34560883 PMCID: PMC8464101 DOI: 10.1186/s13054-021-03770-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/13/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Gal Tsaban
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel.,Department of Cardiology, Soroka University Medical Center, Beersheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Yuval Ullman
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, Soroka University Medical Center, P.O.B 151, Beersheva, Israel. .,Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel.
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14
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Reichmann-Ariel D, Sadeh R, Galante O, Almog Y, Fuchs L. Central venous catheter insertion- guidewire migration ratio: Right heart to inferior vena cava. PLoS One 2021; 16:e0252726. [PMID: 34133420 PMCID: PMC8208537 DOI: 10.1371/journal.pone.0252726] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Central Venous Catheters (CVC) are being used in both intensive care units and general wards for multiple purposes. A previous study Galante et al. (2017) observed that during CVC insertion through Subclavian Vein (SCV) or the Internal Jugular Vein (IJV) the guidewire is sometimes advanced to the Inferior Vena Cava (IVC), and at other times to the right atrium. The rate of IVC wire cannulation and the association with side and point of insertion is unknown. OBJECTIVE In this study, we describe guidewire migration location during real time CVC cannulation (right atrium versus IVC) and report the association between the insertion site and side of the CVC and the location of guidewire migration, Right Atrium (RA)/Right Ventricle (RV) versus IVC guidewire migration. METHODS This is a retrospective study in the medical intensive care unit among patients that have received CVC during the study years 2014-2020. The rate of IVC versus right atrium/right ventricle wire migration during the procedure were analyzed. The association between the side and point of CVC insertion and the wire migration site was analyzed as well. RESULTS One hundred and sixty-six patients were enrolled. 33.7% of wires migrated to the IVC and 66.3% to the versus right atrium/right ventricle. The rate of wire migration to the IVC was similar in the IJV site and the SCV site. There was no association between the side of CVC insertion and wire migration to the IVC. CONCLUSION About a third of all wire migrations, during CVC Seldinger technique insertion, were identified in the IVC, with no potential for wire associated arrhythmia. There was no association between CVC insertion point (SCV versus IJV) nor the side of insertion and the site of guidewire migration.
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Affiliation(s)
| | - Re’em Sadeh
- Clinical Research Center, Soroka University Medical Center, Be’er Sheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Soroka University Medical Center, Be’er Sheva, Israel
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka University Medical Center, Be’er Sheva, Israel
| | - Lior Fuchs
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Medical Intensive Care Unit, Soroka University Medical Center, Be’er Sheva, Israel
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15
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Galante O, Almog Y, Rainey E, Fuchs L. Accurate positioning of extracorporeal membrane oxygenation cannulas using real-time trans-thoracic echocardiography. Perfusion 2020; 35:554-557. [PMID: 32460616 DOI: 10.1177/0267659120919658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this retrospective observational case series, we aimed to evaluate the use of real-time trans-thoracic echocardiography in accurate positioning of extracorporeal membrane oxygenation cannulas. Patients admitted to the intensive care unit with severe adult respiratory distress syndrome in need for extracorporeal membrane oxygenation were screened. Twenty-one extracorporeal membrane oxygenation cannulas were inserted in 10 patients, and 95% of the cannulas were located exactly at the vena cava-right atria junction as planned. Real-time point-of-care trans-thoracic echocardiography for the exact positioning of extracorporeal membrane oxygenation cannula is feasible, simple, time saving, and accurate.
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Affiliation(s)
- Ori Galante
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli Rainey
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Thoracic and Cardiac Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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16
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Rahmani TRI, Nasasra T, Fuchs L, Almog Y, Lurie Y, Galante O. Acute thrombotic microangiopathic kidney injury due to Echis coloratus envenomation. Clin Toxicol (Phila) 2019; 58:284-286. [DOI: 10.1080/15563650.2019.1629450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tzvi-Ran Ilan Rahmani
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Taysir Nasasra
- Department of Medicine, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yaniv Almog
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yael Lurie
- The Rappaport Faculty of Medicine, Israel Poison Information Center, Rambam Health Care Campus, Technion-Israel Institute of Technology Haifa, Haifa, Israel
| | - Ori Galante
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel
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17
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Galante O, Amit G, Granot Y, Davrath LR, Abboud S, Zahger D. High-frequency QRS analysis in the evaluation of chest pain in the emergency department. J Electrocardiol 2017; 50:457-465. [DOI: 10.1016/j.jelectrocard.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Indexed: 11/24/2022]
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Kobal SL, Lior Y, Ben-Sasson A, Liel-Cohen N, Galante O, Fuchs L. The feasibility and efficacy of implementing a focused cardiac ultrasound course into a medical school curriculum. BMC Med Educ 2017; 17:94. [PMID: 28558692 PMCID: PMC5450418 DOI: 10.1186/s12909-017-0928-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 05/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Teaching cardiac ultrasound to medical students in a brief course is a challenge. We aimed to evaluate the feasibility of teaching large groups of medical students the acquisition and interpretation of cardiac ultrasound images using a pocket ultrasound device (PUD) in a short, specially designed course. METHODS Thirty-one medical students in their first clinical year participated in the study. All were novices in the use of cardiac ultrasound. The training consisted of 4 hours of frontal lectures and 4 hours of hands-on training. Students were encouraged to use PUD for individual practice. Finally, the students' proficiency in the acquisition of ultrasound images and their ability to recognize normal and pathological states were evaluated. RESULTS Sixteen of 27 (59%) students were able to demonstrate all main ultrasound views (parasternal, apical, and subcostal views) in a six-minute test. The most obtainable view was the parasternal long-axis view (89%) and the least obtainable was the subcostal view (58%). Ninety-seven percent of students correctly differentiated normal from severely reduced left ventricular function, 100% correctly differentiated a normal right ventricle from a severely hypokinetic one, 100% correctly differentiated a normal mitral valve from a rheumatic one, and 88% correctly differentiated a normal aortic valve from a calcified one, while 95% of them correctly identified the presence of pericardial effusion. CONCLUSIONS Training of medical students in cardiac ultrasound during the first clinical year using a short, focused course is feasible and enables students with modest ability to acquire the main transthoracic ultrasound views and gain proficiency in the diagnosis of a limited number of cardiac pathologies.
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Affiliation(s)
- Sergio L Kobal
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Yotam Lior
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alon Ben-Sasson
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noah Liel-Cohen
- Cardiology Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, all at Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, all at Soroka University Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Yardeni D, Galante O, Fuchs L, Munteanu D, Mermershtain W, Shaco-Levy R, Almog Y. Ipilimumab Treatment-Induced Distal Esophageal Dissection in a Patient with Advanced Prostate Cancer. Isr Med Assoc J 2016; 18:435-436. [PMID: 28471570] [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: 06/07/2023]
Affiliation(s)
- David Yardeni
- Institute of Gastroenterology and Hepatology, Soroka Medical Center and Faculty of HealthSciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Daniela Munteanu
- Institute of Gastroenterology and Hepatology, Soroka Medical Center and Faculty of HealthSciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Wilmosh Mermershtain
- Department of Oncology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ruthy Shaco-Levy
- Department of Pathology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Galante O, Avni YS, Fuchs L, Ferster OA, Almog Y. Coronavirus NL63-induced Adult Respiratory Distress Syndrome. Am J Respir Crit Care Med 2016; 193:100-1. [DOI: 10.1164/rccm.201506-1239le] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kalchiem-Dekel O, Maimon N, Shack AR, Smoliakov A, Shaco-Levy R, Fruchter O, Fox BD, Kramer MR, Galante O. An unusual presentation of malignant melanoma metastatic to the lungs and bronchi. Bilateral ground-glass opacities with a "crazy paving" component. Am J Respir Crit Care Med 2015; 191:954-5. [PMID: 25876203 DOI: 10.1164/rccm.201411-1954im] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Avriel A, Paryente Wiessman M, Almog Y, Perl Y, Novack V, Galante O, Klein M, Pencina MJ, Douvdevani A. Admission cell free DNA levels predict 28-day mortality in patients with severe sepsis in intensive care. PLoS One 2014; 9:e100514. [PMID: 24955978 PMCID: PMC4067333 DOI: 10.1371/journal.pone.0100514] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 05/26/2014] [Indexed: 01/04/2023] Open
Abstract
Aim The aim of the current study is to assess the mortality prediction accuracy of circulating cell-free DNA (CFD) level at admission measured by a new simplified method. Materials and Methods CFD levels were measured by a direct fluorescence assay in severe sepsis patients on intensive care unit (ICU) admission. In-hospital and/or twenty eight day all-cause mortality was the primary outcome. Results Out of 108 patients with median APACHE II of 20, 32.4% have died in hospital/or at 28-day. CFD levels were higher in decedents: median 3469.0 vs. 1659 ng/ml, p<0.001. In multivariable model APACHE II score and CFD (quartiles) were significantly associated with the mortality: odds ratio of 1.05, p = 0.049 and 2.57, p<0.001 per quartile respectively. C-statistics for the models was 0.79 for CFD and 0.68 for APACHE II. Integrated discrimination improvement (IDI) analyses showed that CFD and CFD+APACHE II score models had better discriminatory ability than APACHE II score alone. Conclusions CFD level assessed by a new, simple fluorometric-assay is an accurate predictor of acute mortality among ICU patients with severe sepsis. Comparison of CFD to APACHE II score and Procalcitonin (PCT), suggests that CFD has the potential to improve clinical decision making.
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Affiliation(s)
- Avital Avriel
- Pulmonology Institute, Department of Internal Medicine, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Maya Paryente Wiessman
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yaniv Almog
- Medical Intensive Care Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Perl
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Ori Galante
- General Intensive Care Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael J. Pencina
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Amos Douvdevani
- Clinical Biochemistry and Pharmacology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- * E-mail:
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Galante O, Abramovich E, Nevo-Shor A, Almog Y. Hantavirus pulmonary syndrome in an Israeli man returning from South America. Isr Med Assoc J 2014; 16:259-261. [PMID: 24834767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Nevo-Shor A, Abramovich E, Almog Y, Galante O. Laryngeal edema, rhabdomyolysis and acute renal failure following ingestion of "black rock". Isr Med Assoc J 2013; 15:451-452. [PMID: 24079070] [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: 06/02/2023]
Affiliation(s)
- Anat Nevo-Shor
- Department of Medicine, Soroka University Medical Center, Beer Sheva, Israel
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Galante O, Lador N, Schwarzfuchs D. Bilateral pulmonary emboli. BMJ Case Rep 2012; 2012:bcr-2012-007827. [PMID: 23257065 DOI: 10.1136/bcr-2012-007827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ori Galante
- Medical Intensive Care Unit, Soroka University Medical Center, Beer-Sheva, Israel.
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Amit G, Galante O, Davrath LR, Luria O, Abboud S, Zahger D. High-frequency QRS analysis in patients with acute myocardial infarction: a preliminary study. Ann Noninvasive Electrocardiol 2012; 18:149-56. [PMID: 23530485 DOI: 10.1111/anec.12023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The 12-lead electrocardiogram (ECG) is a primary tool in the evaluation and risk stratification of patients with suspected acute myocardial infarction (AMI), even though the initial ECG of these patients is often normal or nondiagnostic. Myocardial ischemia induces depolarization changes that can be quantified by analysis of high-frequency QRS (HFQRS) components. We aimed to demonstrate the potential usefulness of HFQRS analysis in diagnosing myocardial ischemia by characterizing the morphological patterns of the HFQRS signals in patients with AMI before and following reperfusion. METHODS Five-minute high-resolution ECG was acquired from 30 patients with AMI (age 55 ± 11 years, 26 men) upon their admission to the intensive coronary care unit (ICCU). Serial ECGs were acquired following coronary revascularization and after additional 24 hours (24h). High-frequency morphology index (HFMI), quantifying the extent of ischemic patterns was computed by a custom software, and its values were compared between the serial ECG measurements. RESULTS HFMI values were significantly higher on the admission ECG as compared to the post intervention ECG (4.6 ± 2.9% vs 3.4 ± 2.3%, P < 0.05) and to the 24h ECG (4.6 ± 2.9% vs 2.8 ± 2.1%, P < 0.01). In 79% of the patients who were successfully revascularized HFMI value decreased from admission ECG to 24h ECG. CONCLUSIONS Analysis of HFQRS morphology in patients with AMI provides information about the existence and severity of myocardial ischemia. HFQRS analysis may aid in risk stratification of patients with suspected myocardial ischemia, complementarily to conventional ECG.
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Affiliation(s)
- Guy Amit
- Biological Signal Processing Ltd., Tel-Aviv, Israel
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Galante O, Zahger D, Wagshal A, Katz A, Amit G. [Brain natriuretic peptide (BNP) level predicts long term ventricular arrhythmias in patients with moderate to severe left ventricular dysfunction]. Harefuah 2012; 151:20-62. [PMID: 22670496] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Brain natriuretic peptide (BNP) is a powerful predictor of mortality in patients with left ventricular dysfunction. Since malignant ventricular arrhythmias such as sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) are a major cause of death among those patients, we postulated that BNP levels can predict their long-term occurrence. OBJECTIVES To study the association between malignant ventricular arrhythmias and BNP level over a long term follow-up. METHODS We prospectively followed 94 patients with ischemic heart disease and left ventricular dysfunction, all implanted with an implantable cardioverter defibrillator (ICD). BNP level was measured at baseline and ICD interrogation and clinical status were recorded at 6 months intervals for a median of 3.5 years. RESULTS Patients with BNP levels in the highest quartile experienced significantly more arrhythmic events than those at the lower three quartiles (OR 2.2, 95% C.I 1.2-4.2). In a multivariate analysis only BNP level predicted arrhythmic events. Among patients implanted for primary prevention of sudden cardiac death, BNP at the lowest quartile significantly predicted low event rate. CONCLUSION While high BNP level is predictive of malignant ventricular arrhythmias, low levels among patients implanted for primary prevention can identify a low risk subgroup for which the ICD might be of borderline therapeutic benefit.
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Affiliation(s)
- Ori Galante
- Department of Cardiology, Soroka University Medical Center, Ashkelon, Israel.
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Romem A, Galante O, Shelef I, Almog Y. Posterior reversible encephalopathy syndrome complicating septic shock. Isr Med Assoc J 2011; 13:776-778. [PMID: 22332452] [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: 05/31/2023]
Affiliation(s)
- Ayal Romem
- Department of Medicine, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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29
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Amit G, Galante O, Luria O, Davrath LR, Abboud S, Toledo E, Zahger D. Feasibility of high-frequency QRS analysis in patients with acute myocardial infarction. J Electrocardiol 2011. [DOI: 10.1016/j.jelectrocard.2011.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Avital A, Galante O, Baron J, Smoliakov A, Heimer D, Avnun LS. Spontaneous pneumothorax in the third trimester of pregnancy. BMJ Case Rep 2009; 2009:bcr07.2009.2068. [PMID: 22096473 DOI: 10.1136/bcr.07.2009.2068] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The present report concerns a young woman previously diagnosed as having childhood asthma who presented with a secondary spontaneous pneumothorax during the third trimester of pregnancy; at term a caesarean section was recommended for safety reasons. Post partum a severe fixed ventilatory defect unresponsive to inhaled bronchodilator and a short oral course of steroids ruled out asthma. Diffuse bronchiectasis was found on her chest CT scan, although this was not evident clinically. Known aetiologies for diffuse bronchiectasis (cystic fibrosis, anti-α1 antitrypsin deficiency, rheumatic diseases, mycobacterial infections, childhood infections and immune deficiencies) were ruled out. Therefore it is believed her bronchiectasis was idiopathic or congenital. No recommendations from recent guidelines on how to manage labour in a woman after a spontaneous pneumothorax could be found. However, a literature search revealed that pregnant women usually experience primary pneumothorax and may continue in natural labour; however, it is unknown how best to manage a woman with secondary spontaneous pneumothorax.
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Affiliation(s)
- Abriel Avital
- Soroka University Medical Center, PO Box 151, Beer-Sheva, 84101, Israel
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31
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Galante O, Amit G, Zahger D, Wagshal A, Ilia R, Katz A. B-type natruiretic peptide levels stratify the risk for arrhythmia among implantable cardioverter defibrillator patients. Clin Cardiol 2009; 31:586-9. [PMID: 19072881 DOI: 10.1002/clc.20336] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We sought to study the association between brain natriuretic peptide (BNP) levels and the occurrence of ventricular arrhythmias in patients with left ventricular dysfunction (LVD) and an implantable cardioverter defibrillator (ICD). METHODS This was a prospective study of consecutive, stable, ambulatory patients with moderate and severe ischemic LVD and an ICD. A plasma BNP level was obtained at recruitment. Patients were evaluated every 3-6 mo for a minimum of 1 y. The primary end point was the occurrence of malignant ventricular arrhythmia or sudden cardiac death (SCD). RESULTS The cohort consisted of 94 subjects (6 women) with a mean +/- standard deviation (SD) age of 69 +/- 10 y. The ICD implantation indication was primary and secondary prevention of SCD in 49% and 51% of subjects, respectively. A primary end point occurred in 27 patients (29%), and was more frequent in symptomatic heart failure patients and those implanted for secondary prevention of SCD. The median BNP level was significantly higher among patients who experienced an end point (191 pg/ml versus 142 pg/ml, p = 0.03). After controlling for New York Heart Association heart failure class and ICD implantation indication, the odds ratio (OR) for experiencing an adverse outcome among the upper BNP quartile versus all others was 3.5 (95% confidence interval [CI]: 1.2-10.2). Among patients implanted for primary prevention of SCD, none of the patients in the lower BNP quartile (BNP < 91 pg/ml) experienced an adverse outcome. CONCLUSIONS These results suggest that abnormally high BNP levels not only predict cardiac death, but also arrhythmic death in this patient population, and a low BNP level can serve to identify low risk patients. (c)
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Affiliation(s)
- Ori Galante
- Cardiology Department, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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32
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Galante O, Abriel A, Avnun LS, Rugachov B, Almog Y. Severe unrecognised hypoglycaemia presenting as pseudonormoglycaemia and unexplained coma in two patients with renal failure. BMJ Case Rep 2009; 2009:bcr07.2008.0416. [PMID: 21686821 DOI: 10.1136/bcr.07.2008.0416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe the occurrence of pseudonormoglycaemia and the consequences of severe prolonged hypoglycaemia observed in two patients with renal failure requiring renal replacement therapy. There was a persistent discrepancy, in both cases, between glucose levels measured by the hospital laboratory and those measured by the bedside glucometer, resulting in a significantly false high glucose measurement (pseudonormoglycaemia). This inaccurate glucose determination led to a delayed diagnosis of their truly severe and prolonged hypoglycaemia ultimately leading to prolonged coma and death. Icodextrin, a polysaccharide commonly used in continuous ambulatory peritoneal dialysis solutes, and maltose-containing solutions such as immunoglobulins for intravenous administration, can cause a dangerous overestimation of glucose levels determined by capillary blood glucose analysers utilising glucose dehydrogenase. A high level of awareness is required in order to avoid incidents related to misinterpretation of glucose levels.
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Affiliation(s)
- Ori Galante
- Soroka University Medical Center, POB 151, Beer-Sheva, 84101, Israel
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Shalev A, Zeller L, Galante O, Shimony A, Gilutz H, Illia R. Symptomatic Brugada unmasked by fever. Isr Med Assoc J 2008; 10:548-549. [PMID: 18751640] [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: 05/26/2023]
Affiliation(s)
- Aryeh Shalev
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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34
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Boschiero LB, Saggin P, Galante O, Prati GF, Dean P, Longo M, Ancona G. Renal needle biopsy of the transplant kidney: vascular and urologic complications. Urol Int 1992; 48:130-3. [PMID: 1585505 DOI: 10.1159/000282315] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [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: 12/27/2022]
Abstract
The authors reviewed the complications of 114 needle biopsies performed in 103 transplant kidneys. The diagnostic and therapeutic approach has changed markedly as a result of the introduction of Doppler ultrasound and the possibility of selectively embolizing fistula tracts. Macroscopic haematuria was the most frequent complication (5%); in one case it appeared 1 week after biopsy and was complicated with obstructive anuria due to a pyeloureteric clot. The incidence of arteriovenous fistulae was fairly low (0.9%); a selective renal angiography was performed, confirming the vascular lesion and allowing its selective embolization. Perirenal blood collections were also rare and the amounts were small.
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Affiliation(s)
- L B Boschiero
- Division of Nephrosurgery and Renal Transplantation, Hospital B. Trento, Verona, Italy
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35
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Prati GF, Dean P, Recchia G, Luccarelli S, Muolo A, Galante O, Gulino S, Zampieri GF, Ancona G. [Urologic complications in kidney transplants: experience in 274 transplants]. Chir Ital 1983; 35:441-51. [PMID: 6395970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The urological complications after a renal transplantation still represent an event anything but rare, ranging, according to the different statistics, from 0.9% up to 23%, with a mortality between 0 and 25%. In this work done by the Verona Centre the experience on 274 transplantations is reported. The urological complications weighed with 6.2% and absence of mortality among the patients. The importance of the prevention and precocious diagnosis is confirmed.
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36
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Muolo A, Galvani E, Galante O, Gulino S, Bandini S, Zanpieri GF, Prati GF, Ancona G, Confortini P. [Surfacing of the basal vein was a vascular access for hemodialysis]. MINERVA CHIR 1982; 37:1447-54. [PMID: 7177403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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37
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Gulino S, Galante O, Prati GF, Luccarelli S, Muolo A. Su Due Casi Di Uretere Retrocavale. Urologia 1982. [DOI: 10.1177/039156038204900425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S. Gulino
- (IIIa Divisione Chirurgica degli Istituti Ospitalieri di Verona - e Cattedra di Nefrologia Chirurgica dell'Università di Padova, Sede di Verona - Primario e Prof. Inc.: P. Confortini)
| | - O. Galante
- (IIIa Divisione Chirurgica degli Istituti Ospitalieri di Verona - e Cattedra di Nefrologia Chirurgica dell'Università di Padova, Sede di Verona - Primario e Prof. Inc.: P. Confortini)
| | - G. F. Prati
- (IIIa Divisione Chirurgica degli Istituti Ospitalieri di Verona - e Cattedra di Nefrologia Chirurgica dell'Università di Padova, Sede di Verona - Primario e Prof. Inc.: P. Confortini)
| | - S. Luccarelli
- (IIIa Divisione Chirurgica degli Istituti Ospitalieri di Verona - e Cattedra di Nefrologia Chirurgica dell'Università di Padova, Sede di Verona - Primario e Prof. Inc.: P. Confortini)
| | - A. Muolo
- (IIIa Divisione Chirurgica degli Istituti Ospitalieri di Verona - e Cattedra di Nefrologia Chirurgica dell'Università di Padova, Sede di Verona - Primario e Prof. Inc.: P. Confortini)
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38
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Muolo A, Galante O, Bandini S, Prati GF, Confortini P. [Functional recovery of the transplanted kidney. Clinical and hemodynamic study]. Minerva Urol 1982; 34:79-86. [PMID: 7050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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39
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Confortini P, Muolo A, Galante O, Prati GF. La Chirurgia Renale Intersegmentaria: Stato Attuale. Urologia 1982. [DOI: 10.1177/039156038204900107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Galvani E, Rinaldi M, Muolo A, Ancona G, Tonini C, Galante O, Dean P, Gulino S, Zampieri GF, Longo M, Confortini P. [Ex-situ surgery of the kidney]. MINERVA CHIR 1980; 35:811-24. [PMID: 7005740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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41
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Rinaldi M, Muolo A, Galvani E, Galante O, Dean P, Gulino S. Auto-Trapianto Con « Work Bench Surgery » in Un Caso Di Calcolosi Coralliforme Del Rene. Urologia 1977. [DOI: 10.1177/039156037704400312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M. Rinaldi
- (Università degli Studi di Padova, sede di Verona - Facoltà di medicina e chirurgia, Cattedra di nefrologia chirurgica - Prof. inc.: P. Confortini, e Istituti Ospedalieri di Verona, 3 Divisione chirurgica - Primario: prof. P. Confortini)
| | - A. Muolo
- (Università degli Studi di Padova, sede di Verona - Facoltà di medicina e chirurgia, Cattedra di nefrologia chirurgica - Prof. inc.: P. Confortini, e Istituti Ospedalieri di Verona, 3 Divisione chirurgica - Primario: prof. P. Confortini)
| | - E. Galvani
- (Università degli Studi di Padova, sede di Verona - Facoltà di medicina e chirurgia, Cattedra di nefrologia chirurgica - Prof. inc.: P. Confortini, e Istituti Ospedalieri di Verona, 3 Divisione chirurgica - Primario: prof. P. Confortini)
| | - O. Galante
- (Università degli Studi di Padova, sede di Verona - Facoltà di medicina e chirurgia, Cattedra di nefrologia chirurgica - Prof. inc.: P. Confortini, e Istituti Ospedalieri di Verona, 3 Divisione chirurgica - Primario: prof. P. Confortini)
| | - P. Dean
- (Università degli Studi di Padova, sede di Verona - Facoltà di medicina e chirurgia, Cattedra di nefrologia chirurgica - Prof. inc.: P. Confortini, e Istituti Ospedalieri di Verona, 3 Divisione chirurgica - Primario: prof. P. Confortini)
| | - S. Gulino
- (Università degli Studi di Padova, sede di Verona - Facoltà di medicina e chirurgia, Cattedra di nefrologia chirurgica - Prof. inc.: P. Confortini, e Istituti Ospedalieri di Verona, 3 Divisione chirurgica - Primario: prof. P. Confortini)
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