83 results on '"Milton Saute"'
Search Results
2. Trimodally treatment for stage IIIa NSCLC patients increases survival while not effecting surgical mortality or complexity
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Dan Aravot, Yaron D. Barac, Efrat Krutzwald-Josefson, Aaron M. Allen, Dov Flex, Nir Peled, Mordechai R. Kramer, Yuri Peysakhovich, and Milton Saute
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Pneumonectomy ,Neo adjuvant therapy ,Chemo-radiation ,Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Introduction Advanced non-small cell lung cancer (NSCLC) is still a therapeutic challenge as the 5-year survival is under 30%. The optimal treatment regimen is still under debate. Hypothesis Neo adjuvant (NA) treatment given pre-pneumonectomy does not increase surgical complexity or peri-OP mortality while it has a potential to increase long term survival. Methods We have conducted a retrospective study of 169 patients who underwent a pneumonectomy for NSCLC between January 2005 to December 2015 and focused on stage IIIa patients; a cohort of 51 patients, 30 which received neo adjuvant chemo-radiation (NA group) prior to pneumonectomy and 21 patients who had undergone pneumonectomy followed by adjuvant treatment (Adjuvant group). Surgical complexity and short- and long-term survival were evaluated. Surgical complexity was assessed by surrogates as surgery duration, hospitalization length and interdepartmental transfer. Results While no statistically significant differences were found in surgery duration, hospitalization length, morbidity in the 1st year post-OP and the peri-OP mortality; The long term beneficiary effect among the neo adjuvant patients was clear; while 30% of the NA patients were alive 8 years post-OP, there were no survivors in the adjuvant group 5.5 years post-OP. Conclusion We conclude that while NA treatment has no effect on operation complexity, peri-OP mortality or post-OP morbidity; its impact on long term survival is protuberant, therefore, we believe that NA treatment should be considered as the treatment of choice in advanced NSCLC in need for pneumonectomy. more...
- Published
- 2019
- Full Text
- View/download PDF
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3. Stereotactic body radiotherapy for central lung tumors, yes we can!
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Yasmin Korzets ceder, Eyal Fenig, Aron Popvtzer, Nir Peled, Mordechai R. Kramer, Milton Saute, Dima Bragilovsky, Tzippy Schochat, and Aaron M. Allen
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Medical physics. Medical radiology. Nuclear medicine ,R895-920 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background SBRT is standard therapy for early stage lung cancer. Toxicity in central tumors has been a concern. RTOG 0813 showed that central SBRT is safe and effective. We report our experience with central SBRT. Methods We reviewed the records of patients treated with SBRT for central lung tumors ( more...
- Published
- 2018
- Full Text
- View/download PDF
4. Correction to: Trimodally treatment for stage IIIa NSCLC patients increases survival while not effecting surgical mortality or complexity
- Author
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Dan Aravot, Yaron D. Barac, Efrat Krutzwald-Josefson, Aaron M. Allen, Dov Flex, Nir Peled, Mordechai R. Kramer, Yuri Peysakhovich, and Milton Saute
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Surgery ,RD1-811 ,Anesthesiology ,RD78.3-87.3 - Abstract
The original article [1] contained an error whereby all authors’ names were mistakenly inverted. This error has now been corrected.
- Published
- 2019
- Full Text
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5. Trimodally treatment for stage IIIa NSCLC patients increases survival while not effecting surgical mortality or complexity
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Yuri Peysakhovich, Efrat Krutzwald-Josefson, Milton Saute, Mordechai R. Kramer, Nir Peled, Aaron M. Allen, Dan Aravot, Dov Flex, and Yaron D. Barac
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Surgery ,030204 cardiovascular system & hematology ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,Pneumonectomy ,0302 clinical medicine ,Stage IIIA NSCLC ,medicine ,business.industry ,Retrospective cohort study ,General Medicine ,lcsh:RD1-811 ,Cardiac surgery ,Surgery ,Regimen ,030228 respiratory system ,Cardiothoracic surgery ,lcsh:Anesthesiology ,Cohort ,Neo adjuvant therapy ,Cardiology and Cardiovascular Medicine ,business ,Adjuvant ,Research Article ,Chemo-radiation - Abstract
Introduction Advanced non-small cell lung cancer (NSCLC) is still a therapeutic challenge as the 5-year survival is under 30%. The optimal treatment regimen is still under debate. Hypothesis Neo adjuvant (NA) treatment given pre-pneumonectomy does not increase surgical complexity or peri-OP mortality while it has a potential to increase long term survival. Methods We have conducted a retrospective study of 169 patients who underwent a pneumonectomy for NSCLC between January 2005 to December 2015 and focused on stage IIIa patients; a cohort of 51 patients, 30 which received neo adjuvant chemo-radiation (NA group) prior to pneumonectomy and 21 patients who had undergone pneumonectomy followed by adjuvant treatment (Adjuvant group). Surgical complexity and short- and long-term survival were evaluated. Surgical complexity was assessed by surrogates as surgery duration, hospitalization length and interdepartmental transfer. Results While no statistically significant differences were found in surgery duration, hospitalization length, morbidity in the 1st year post-OP and the peri-OP mortality; The long term beneficiary effect among the neo adjuvant patients was clear; while 30% of the NA patients were alive 8 years post-OP, there were no survivors in the adjuvant group 5.5 years post-OP. Conclusion We conclude that while NA treatment has no effect on operation complexity, peri-OP mortality or post-OP morbidity; its impact on long term survival is protuberant, therefore, we believe that NA treatment should be considered as the treatment of choice in advanced NSCLC in need for pneumonectomy. more...
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- 2019
- Full Text
- View/download PDF
6. Intensity-modulated radiotherapy is a safe and effective treatment for localized malignant pleural mesothelioma
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Aaron M. Allen, Michael Simon, Elizabeth Dudnik, Milton Saute, Orit Eldan, Mordechai R. Kramer, Alona Zer, Nir Peled, and Tzippy Shochat
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Pulmonary and Respiratory Medicine ,Extrapleural Pneumonectomy ,Chemotherapy ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medical record ,Incidence (epidemiology) ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Localized disease ,medicine ,Mesothelioma ,Radiology ,business ,Rare disease - Abstract
Background Malignant pleural mesothelioma (MPM) is a rare disease and management of localized disease is controversial. Radiotherapy has been shown to be useful after extrapleural pneumonectomy (EPP), as well as with less aggressive surgery. As no reports of the treatment of this disease have ever been published from Israel, we report our experience with MPM and intensity-modulated radiotherapy (IMRT). Methods The complete medical records of patients treated for MPM at the Rabin Medical Center from 1 August 2007 to 31 March 2016 were reviewed. Twenty-seven patients were treated with IMRT, either post-EPP or without EPP. Patients received 54 Gy in 2 Gy fractions using the restricted field IMRT technique. Chemotherapy was administered sequentially in 26% of patients. Patients were followed up from the date of diagnosis to death or treatment failure. Results Seventy-eight percent of patients had the epithelioid subtype. Nearly all patients were male (85%) and 90% of non-surgical patients were administered chemotherapy compared to 56% of post-EPP patients. All patients completed therapy and only 16% had grade 1-2 radiation pneumonitis, with no incidence of grade 3 or higher. The median follow-up was 22 months and the mean overall survival was 34.9 months. The mean time to progression following radiation therapy was 26.7 months. The mean time to local and distant failure was 19 and 16 months, respectively. Conclusions IMRT for localized pleural mesothelioma is a tolerable and effective therapy both post-EPP or without surgery. These results suggest that future investigation in this area is required. more...
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- 2018
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7. Stereotactic body radiotherapy for central lung tumors, yes we can!
- Author
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Nir Peled, Dima Bragilovsky, Milton Saute, Aaron M. Allen, Tzippy Schochat, Mordechai R. Kramer, Eyal Fenig, Aron Popvtzer, and Yasmin Korzets ceder
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Adult ,Male ,lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,lcsh:R895-920 ,Adenocarcinoma ,Radiosurgery ,lcsh:RC254-282 ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Median follow-up ,Carcinoma, Non-Small-Cell Lung ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Stage (cooking) ,Lung cancer ,Radiation treatment planning ,Aged ,Retrospective Studies ,Aged, 80 and over ,Lung ,business.industry ,Research ,Retrospective cohort study ,Radiotherapy Dosage ,Middle Aged ,medicine.disease ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Small Cell Lung Carcinoma ,Radiation therapy ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Carcinoma, Squamous Cell ,Carcinoma, Large Cell ,Female ,Radiology ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Background SBRT is standard therapy for early stage lung cancer. Toxicity in central tumors has been a concern. RTOG 0813 showed that central SBRT is safe and effective. We report our experience with central SBRT. Methods We reviewed the records of patients treated with SBRT for central lung tumors ( more...
- Published
- 2018
- Full Text
- View/download PDF
8. Safety and Allograft Function Post Native Lung Pneumonectomy, A Single Lung Transplant Center Experience
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Victoria, Rusanov, primary, Osnat, Shtraichman, additional, Milton, Saute, additional, Yuri, Peysakhovich, additional, Dror, Rosengarten, additional, and Mordechai R, Kramer, additional
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- 2020
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9. Malignant Melanoma in Association With a Thymic Nevus in a Patient With a Giant Congenital Nevus
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Daniel Benharroch, Alexander Yakobson, Meora Feinmesser, Milton Saute, and Yulia Shvartser-Beryozkin
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Adult ,medicine.medical_specialty ,Skin Neoplasms ,Dermatology ,Pathology and Forensic Medicine ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Nevus ,skin and connective tissue diseases ,Melanoma ,neoplasms ,Neurofibromatosis type I ,Nevus, Pigmented ,integumentary system ,business.industry ,Meninges ,Thymus Neoplasms ,General Medicine ,medicine.disease ,Thymic Tissue ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Giant Congenital Nevus ,Cutaneous melanoma ,Female ,Lymph ,business - Abstract
Nevi and melanocytic proliferations are known to appear in multiple extracutaneous sites, including lymph nodes and meninges. We report a case of an anterior mediastinal mass in a patient with a giant congenital nevus and neurofibromatosis type I. Histologically, the tumor was found to be a malignant melanoma in the thymus arising in association with a nevus that involved most of the thymic tissue. There was no sign of cutaneous melanoma on skin examination. We suggest that the tumor originated from the benign nevus in the thymus, a rare extracutaneous location for nevi and malignant melanoma. more...
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- 2017
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10. Survival following lung transplantation for artificial stone silicosis relative to idiopathic pulmonary fibrosis
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Paul D. Blanc, Dror Rosengarten, Milton Saute, Oren Fruchter, Osnat Shtraichman, Benjamin D. Fox, Elizabeth Fireman, Victoria Rusanov, Mordechai R. Kramer, and Yael Raviv
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medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology ,03 medical and health sciences ,Idiopathic pulmonary fibrosis ,0302 clinical medicine ,Silicosis ,Internal medicine ,medicine ,Lung transplantation ,030212 general & internal medicine ,Occupational lung disease ,Survival rate ,Lung ,business.industry ,Proportional hazards model ,Hazard ratio ,Public Health, Environmental and Occupational Health ,respiratory system ,medicine.disease ,respiratory tract diseases ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,030228 respiratory system ,business - Abstract
Background Silicosis is a progressive lung disease resulting from the inhalation of respirable crystalline silica. Lung transplantation is the only treatment for end-stage silicosis. The aim of this study was to analyze the survival experience following lung transplantation among patients with silicosis. Methods We reviewed data for all patients who underwent lung transplantation for silicosis and a matched group undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF) at a single medical center between March 2006 and the end of December 2013. Survival was followed through 2015. Results A total of 17 lung transplantations were performed for silicosis among 342 lung transplantations (4.9%) during the study period. We observed non-statistically significant survival advantage (hazard ratio 0.6; 95%CI 0.24–1.55) for those undergoing lung transplantation for silicosis relative to IPF patients undergoing lung transplantation during the same period. Conclusions Within the limits of a small sample, survival in silicosis patients following lung transplantation was not reduced compared to IPF. Am. J. Ind. Med. 9999:1–7, 2016. © 2016 Wiley Periodicals, Inc. more...
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- 2017
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11. Use of sirolimus and low-dose calcineurin inhibitor in lung transplant recipients with renal impairment: Results of a controlled pilot study
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Shitrit, David, Rahamimov, Ruth, Gidon, Sahar, Bakal, Ilana, Bargil-Shitrit, Ariella, Milton, Saute, and Kramer, Mordechai R.
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- 2005
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12. The Israeli Experience: Using Older Donors in Lung Transplant; Are Old Lungs Better Than No Lungs?
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Yuri Peysakhovich, Yaron D. Barac, R. Toledano, I. Baroch, Milton Saute, M.R. Kramer, R. Sharoni, A. Neymark, and Dan Aravot
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Pulmonary and Respiratory Medicine ,Transplantation ,Lung transplants ,Pediatrics ,medicine.medical_specialty ,Lung ,business.industry ,medicine.medical_treatment ,Post transplant ,Donor lungs ,medicine.anatomical_structure ,medicine ,Lung transplantation ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Donor pool ,Survival rate - Abstract
Purpose The state of Israel represents a unique transplant environment; deprived from neighboring countries organ sharing, and operating under a distinctive religious limitation. Furthermore, as the single Israeli Lung transplant center our center is required to provide transplant solutions to a verity of recipients which may be considered in many transplant centers as sub-optimal candidates. Hence, the usage of the extremely limited donor pool is in constant debate. In recent years we have been using in increasing frequency lungs from older donors (> 60), and thus we have been deliberating whether these organs should be transplanted in older Vs younger recipients. Hence, our goal was to review Israel's Lung transplant data base to evaluate the longevity of old Vs. young donor lungs transplanted in young Vs. old recipients. Methods Israel's Lung transplant data base was reviewed from January 2012to December 2017. Both clinical and demographic characteristics were extracted. Short and long-term survival were evaluated. Results 247 donor lungs were used to preform 262 lung transplants; 167 donors were younger than 60 years (67.1%) and 80 donors were older than 60 years (22.39%). We choose to focus on the 1-year survival of the Bi-lateral orthotopic lung transplantation patients. We found a statistically significant survival difference one-year post transplant between the 4 groups (0.02): While the survival rate was ∼81% when both the donors and the recipients were younger than 60 years, it dropped to ∼ 57%-63% once the donors were older than 60 years (Figure 1). Conclusion In this unique environment of both recipients and donors’; young donors transplanted into young recipients had the best survival at 1-year post-transplant. Once, using older donors the survival at 1-year post-transplant was reduced regardless if transplanted into young or old recipients. Future analysis, should address the concept claiming that using old lungs is better than no lungs in a large scale multi center studies. more...
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- 2020
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13. Comprehensive assessment of frailty score as a tool to assess potential recovery in cardiac surgery
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Victor Rubchevsky, Dan Aravot, Danny Gorphil, Yaron D. Barac, Milton Saute, and Efrat Kurtzwald Josefson
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Frailty ,business.industry ,Frail Elderly ,MEDLINE ,Cardiac surgery ,Text mining ,medicine ,Humans ,Surgery ,Frail elderly ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Algorithms ,Aged - Published
- 2019
14. Correction to: Trimodally treatment for stage IIIa NSCLC patients increases survival while not effecting surgical mortality or complexity
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Efrat Krutzwald-Josefson, Aaron M. Allen, Milton Saute, Nir Peled, Yuri Peysakhovich, Mordechai R. Kramer, Yaron D. Barac, Dan Aravot, and Dov Flex
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Lung Neoplasms ,lcsh:Surgery ,030204 cardiovascular system & hematology ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Fluorodeoxyglucose F18 ,Carcinoma, Non-Small-Cell Lung ,Positron Emission Tomography Computed Tomography ,Stage IIIA NSCLC ,medicine ,Humans ,Pneumonectomy ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Surgical mortality ,Correction ,lcsh:RD1-811 ,Chemoradiotherapy, Adjuvant ,General Medicine ,Middle Aged ,Combined Modality Therapy ,Survival Analysis ,Neoadjuvant Therapy ,Surgery ,Cardiac surgery ,030228 respiratory system ,lcsh:Anesthesiology ,Chemotherapy, Adjuvant ,Cardiothoracic surgery ,Female ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,business - Abstract
Advanced non-small cell lung cancer (NSCLC) is still a therapeutic challenge as the 5-year survival is under 30%. The optimal treatment regimen is still under debate.Neo adjuvant (NA) treatment given pre-pneumonectomy does not increase surgical complexity or peri-OP mortality while it has a potential to increase long term survival.We have conducted a retrospective study of 169 patients who underwent a pneumonectomy for NSCLC between January 2005 to December 2015 and focused on stage IIIa patients; a cohort of 51 patients, 30 which received neo adjuvant chemo-radiation (NA group) prior to pneumonectomy and 21 patients who had undergone pneumonectomy followed by adjuvant treatment (Adjuvant group). Surgical complexity and short- and long-term survival were evaluated. Surgical complexity was assessed by surrogates as surgery duration, hospitalization length and interdepartmental transfer.While no statistically significant differences were found in surgery duration, hospitalization length, morbidity in the 1st year post-OP and the peri-OP mortality; The long term beneficiary effect among the neo adjuvant patients was clear; while 30% of the NA patients were alive 8 years post-OP, there were no survivors in the adjuvant group 5.5 years post-OP.We conclude that while NA treatment has no effect on operation complexity, peri-OP mortality or post-OP morbidity; its impact on long term survival is protuberant, therefore, we believe that NA treatment should be considered as the treatment of choice in advanced NSCLC in need for pneumonectomy. more...
- Published
- 2019
- Full Text
- View/download PDF
15. Robotic-Assisted Thymectomy: How Less Invasive Can We Be?
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Milton, Saute
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Robotic Surgical Procedures ,Humans ,Minimally Invasive Surgical Procedures ,Thymus Gland ,Thymectomy - Published
- 2018
16. Limitations in Exercise and Functional Capacity in Long-term Postpneumonectomy Patients
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Sonia Schneer, Liora Yehoshua, Leonardo Fuks, Mordechai R. Kramer, Benjamin D. Fox, Alexander Sagie, Milton Saute, and Baruch Vainshelboim
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Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Vital capacity ,medicine.medical_treatment ,Exercise intolerance ,Ventricular Function, Left ,Pulmonary function testing ,Pneumonectomy ,Carcinoma, Non-Small-Cell Lung ,Internal medicine ,Activities of Daily Living ,medicine ,Humans ,Respiratory system ,Aged ,Aged, 80 and over ,Exercise Tolerance ,Ejection fraction ,Lung ,business.industry ,Rehabilitation ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Ventricle ,Exercise Test ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Pneumonectomy results in impairments of pulmonary function and exercise intolerance associated with respiratory limitations. However, exercise capacity and functional capacity are less known at long-term followup. The aims of this study were to assess exercise tolerance and functional capacity among long-term postpneumonectomy patients and to identify the limiting factors in exercise related to comorbidities and which lung was involved. Methods Seventeen postpneumonectomy patients aged 59 ± 13 years and 5.5 ± 4.2 years postoperation were prospectively studied. Pulmonary function tests (PFTs), cardiopulmonary exercise test (CPET), Doppler-echocardiography, 6-minute walk test (6MWT) distance, and "senior fitness tests" (SFTs) were conducted with all patients. Results Exercise capacity and PFT were diminished ((Equation is included in full-text article.)O2 peak; 11.5 ± 3.3 mL·kg·min, 48 ± 17% predicted, forced vital capacity % predicted; 55 ± 13, FEV1% predicted; 46 ± 14, respectively). Most patients presented with low exercise cardiovascular parameters and normal breathing reserve (17 ± 12 L) during CPET. No significant differences were shown between right and left pneumonectomy and comorbidities related to exercise limitations (χ= 1.96, P = .376). Functional capacity in walking and SFTs were near normal (6MWT distance; 490 ± 15 m, 89 ± 25% predicted). Echocardiography showed normal left ventricle systolic function (ejection fraction, 60 ± 4%) with mildly elevated systolic pulmonary arterial pressure (38 ± 12 mm Hg). Conclusions Long-term postpneumonectomy patients demonstrated decreased exercise capacity, limited primarily by the cardiovascular system regardless of lung resection side or comorbidities, although tests of functional capacity were near normal. Most patients can maintain near normal life in activities of daily living, but the long-term cardiopulmonary exercise function should be considered for meticulous evaluation and clinical care to preserve physiological reserves. more...
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- 2015
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17. High-Dose Radiotherapy as Neoadjuvant Treatment in Non-Small-Cell Lung Cancer
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Aaron M. Allen, Milton Saute, Tzippy Shochat, Alona Zer, Nir Peled, Dov Flex, Elizabeta Dudnik, Mordechai R. Kramer, and Eyal Fenig
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Male ,Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Disease-Free Survival ,03 medical and health sciences ,Pneumonectomy ,0302 clinical medicine ,Carcinoma, Non-Small-Cell Lung ,medicine ,Humans ,Lung cancer ,Etoposide ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Mortality rate ,Not Otherwise Specified ,Radiotherapy Dosage ,General Medicine ,Chemoradiotherapy ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Neoadjuvant Therapy ,Radiation therapy ,Oncology ,030220 oncology & carcinogenesis ,Adenocarcinoma ,Female ,Radiology ,Cisplatin ,business ,medicine.drug - Abstract
Background: Trimodality therapy (chemoradiation followed by surgery) provides a benefit in progression-free survival but not overall survival. We sought to determine if a high dose of radiation could be delivered safely and provide a clinical benefit. Methods: Consecutive patients with stage IIIA or IIIB non-small-cell lung cancer (NSCLC) treated with concurrent chemoradiotherapy followed by surgery were reviewed with IRB approval. Results: A total of 48 patients were treated from November 2007 to May 2014. Of these, 64% had stage IIIA disease while 36% had stage IIIB; 46% had adenocarcinoma, 34% squamous, and 23% NSCLC not otherwise specified. The median dose of chemoradiotherapy was 72 Gy (60–72). Overall, 86% of patients received cisplatin (50 mg/m2) and etoposide (50 mg/m2) concurrently with radiotherapy; 72% of patients underwent lobectomy following chemoradiotherapy and 28% underwent pneumonectomy. The 30- and 90-day mortality rates were 0%. The nodal downstaging rate was 82% and there was a 64% rate of pathologic complete response. The overall survival was 29.9 months (95% CI, 19–86 months). The median time to locoregional progression was 35.1 months and the median time to distant progression was 39.3 months. Locoregional failure was 8% and distant failure was 44%. Conclusion: High-dose preoperative chemoradiotherapy was safe and effective. This combination should be further considered. more...
- Published
- 2017
18. Lung transplantation in cystic fibrosis patients in Israel: The importance of ethnicity and nutritional status
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Moshe Hoshen, Dario Prais, Victorya Rusanov, Mordechai R. Kramer, Milton Saute, Yael Raviv, Dror Rosengarten, Hannah Blau, Huda Mussaffi, and Hagit Levine
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,Adolescent ,Cystic Fibrosis ,medicine.medical_treatment ,Population ,Bronchiolitis obliterans ,Nutritional Status ,Cystic fibrosis ,03 medical and health sciences ,Liver disease ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Internal medicine ,medicine ,Ethnicity ,Lung transplantation ,Humans ,030212 general & internal medicine ,Israel ,education ,Child ,Bronchiolitis Obliterans ,Retrospective Studies ,Transplantation ,education.field_of_study ,Lung ,business.industry ,Incidence (epidemiology) ,Graft Survival ,Middle Aged ,medicine.disease ,Prognosis ,humanities ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,Female ,business ,Follow-Up Studies ,Lung Transplantation - Abstract
Objectives To assess the characteristics that correlate with better outcomes after lung transplantation for patients with cystic fibrosis (CF). Methods We retrospectively reviewed the charts of all patients with CF who underwent lung transplantation between 1996-2014 at Rabin Medical Center, Israel. Results Fifty patients with CF underwent 55 lung transplantations. Eighteen patients (36%) died during the study period. Actuarial survival was 83%, 68%, 62% and 39% at 1, 3, 5 and 10 years, respectively. Better survival correlated with: BMI at 6-months and 1-year after transplantation (p=0.002 and p=0.003, respectively), ischemic time of less than 300 minutes (p=0.023), absence of liver disease (p=0.012) and Jewish compared to Arab ethnicity (p=0.007). Freedom from bronchiolitis obliterans syndrome (BOS) was 87%, 75% and 72% at 1, 3 and 5 years, respectively. BOS was more common and appeared earlier in the Arab than in the Jewish population (p=0.012, p=0.007). Additionally, prolonged time free of BOS correlated with male gender (p=0.039), older age (p more...
- Published
- 2017
19. Metallic stents for airway complications after lung transplantation: long-term follow-up
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Mordechai R. Kramer, Milton Saute, Oren Fruchter, Yael Raviv, and Nader Abdel-Rahman
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Palliative care ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Pulmonary function testing ,Self-expandable metallic stent ,Humans ,Medicine ,Lung transplantation ,Survival rate ,business.industry ,Stent ,General Medicine ,Surgery ,Airway Obstruction ,Transplantation ,Metals ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Follow-Up Studies ,Lung Transplantation - Abstract
Objectives Bronchial stenosis is still a significant source of morbidity and mortality following lung transplantation (LTX) and often mandating placement of a bronchial stent. It has been suggested that although self-expanding metal stents offer excellent early palliation, their long-term complication rates are unacceptably high, and hence, their usage in many transplantation centres has been nearly abandoned. The aim of the study was to assess short- and long-term complication rates and survival in LTX patients with bronchial stenosis treated with insertion of self-expanding metal stents. Methods From January 1997 to March 2013, 435 patients underwent LTX (325 single-LTX and 110 bilateral LTX). Of 503 actual anastomoses at risk (derived by subtracting the number of anastomoses in 30 patients who died within 30 days of LTX), 60 airway complications (11.9%) in 47 patients required self-expanding metal stent insertion. We assessed the early results and long-term outcomes and survival compared with LTX patients in whom stents were not required. Results The median follow-up period ranged from 1 to 132 (median 54) months. Immediate relief of symptoms was achieved in the vast majority of patients (95%). One-, three- and five-year survival in patients who required self-expanding metal stent placement were 77.7, 66.6 and 55.5%, respectively. The corresponding survival rates in LTX patients without stents were 69, 64.9 and 61.1% (P > 0.05). Conclusions Self-expanding metal stents are safe and effective tools in the management of airway complications post-LTX and provide immediate improvement in symptoms and pulmonary function tests in the vast majority of cases. The long-term complication rate is low, and mortality is similar to that in LTX patients who did not require stent insertion. more...
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- 2013
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20. Survival following lung transplantation for artificial stone silicosis relative to idiopathic pulmonary fibrosis
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Dror, Rosengarten, Benjamin D, Fox, Elizabeth, Fireman, Paul D, Blanc, Victoria, Rusanov, Oren, Fruchter, Yael, Raviv, Osnat, Shtraichman, Milton, Saute, and Mordechai R, Kramer
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Male ,Survival Rate ,Treatment Outcome ,Silicosis ,Humans ,Female ,Middle Aged ,Idiopathic Pulmonary Fibrosis ,Lung Transplantation ,Proportional Hazards Models ,Retrospective Studies - Abstract
Silicosis is a progressive lung disease resulting from the inhalation of respirable crystalline silica. Lung transplantation is the only treatment for end-stage silicosis. The aim of this study was to analyze the survival experience following lung transplantation among patients with silicosis.We reviewed data for all patients who underwent lung transplantation for silicosis and a matched group undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF) at a single medical center between March 2006 and the end of December 2013. Survival was followed through 2015.A total of 17 lung transplantations were performed for silicosis among 342 lung transplantations (4.9%) during the study period. We observed non-statistically significant survival advantage (hazard ratio 0.6; 95%CI 0.24-1.55) for those undergoing lung transplantation for silicosis relative to IPF patients undergoing lung transplantation during the same period.Within the limits of a small sample, survival in silicosis patients following lung transplantation was not reduced compared to IPF. Am. J. Ind. Med. 60:248-254, 2017. © 2017 Wiley Periodicals, Inc. more...
- Published
- 2016
21. RET Fusion Lung Carcinoma: Response to Therapy and Clinical Features in a Case Series of 14 Patients
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Milton Saute, Keren Paz, Maya Ilouze, Mor Moskovitz, Rivka Katznelson, Doron Lipson, Lior Soussan Gutman, Nir Peled, Elizabeth Dudnik, Mira Wolner, Hadas Gantz Sorotsky, Hovav Nechushtan, Vincent A. Miller, Assaf Moore, Amanda Katz, V. Neiman, Addie Dvir, Julia A. Elvin, Maya Gottfried, Noa Gordon, Michal Sarfaty, and Siraj M. Ali more...
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0301 basic medicine ,Pulmonary and Respiratory Medicine ,Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,endocrine system diseases ,Cabozantinib ,Oncogene Proteins, Fusion ,Pyridines ,medicine.medical_treatment ,Platinum Compounds ,Pembrolizumab ,Adenocarcinoma ,Antibodies, Monoclonal, Humanized ,Targeted therapy ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Carcinoma ,medicine ,Humans ,Anilides ,Neoplasm Metastasis ,Lung cancer ,Aged ,Neoplasm Staging ,Chemotherapy ,Lung ,business.industry ,Proto-Oncogene Proteins c-ret ,Middle Aged ,medicine.disease ,Survival Analysis ,Surgery ,030104 developmental biology ,medicine.anatomical_structure ,Treatment Outcome ,chemistry ,030220 oncology & carcinogenesis ,Female ,business ,Transcription Factors - Abstract
Background RET (rearranged during transfection) fusions have been reported in 1% to 2% of lung adenocarcinoma (LADC) cases. In contrast, KIF5B-RET and CCDC6-RET fusion genes have been identified in 70% to 90% and 10% to 25% of tumors, respectively. The natural history and management of RET-rearranged LADC are still being delineated. Materials and Methods We present a series of 14 patients with RET-rearranged LADC. The response to therapy was assessed by the clinical response and an avatar model in 2 cases. Patients underwent chemotherapy, targeted therapy, and immunotherapy. Results A total of 14 patients (8 women; 10 never smokers; 4 light smokers; mean age, 57 years) were included. KIF5B-RET and CCDC6-RET variants were diagnosed in 10 and 4 cases, respectively. Eight patients had an early disseminated manifestation, seven with KIF5B-RET rearranged tumor. The features of this subset included bilateral miliary lung metastases, bone metastases, and unusual early visceral abdominal involvement. One such patient demonstrated an early and durable complete response to cabozantinib for 7 months. Another 2 patients treated with cabozantinib experienced a partial response, with rapid significant clinical improvement. Four patients with tumors harboring CCDC6-RET and KIF5B-RET fusions showed pronounced and durable responses to platinum-based chemotherapy that lasted for 8 to 15 months. Two patients' tumors showed programmed cell death ligand 1-positive staining but did not respond to pembrolizumab. The median overall survival was 22.8 months. Conclusion RET-rearranged LADC in our series tended to occur as bilateral disease with early visceral involvement, especially with KIF5B fusion. Treatment with cabozantinib achieved responses, including 1 complete response. However, further studies are required in this group of patients. more...
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- 2016
22. P3.03-040 Long Term Outcomes Following IMRT for Mesothelioma Post EPP and Unresectable
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Nir Peled, Milton Saute, Alona Zer, Michael S. Simon, Elizabeth Dudnik, and Aaron M. Allen
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Pulmonary and Respiratory Medicine ,Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Long term outcomes ,Mesothelioma ,medicine.disease ,business - Published
- 2017
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23. Endobronchial Closure of Bronchopleural Fistulae Using Amplatzer Devices
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Tamir Dagan, Milton Saute, Nader Abdel-Rahman, Mordechai R. Kramer, Oren Fruchter, Yael Raviv, and Elchanan Bruckheimer
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Bronchography ,business.industry ,Fistula ,Sedation ,medicine.medical_treatment ,Closure (topology) ,Septal Occluder Device ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Contrast medium ,Pneumonectomy ,medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Severe complication - Abstract
Bronchopulmonary fistulae (BPFs) are a severe complication of lobectomy and pneumonectomy and are associated with high rates of morbidity and mortality. We have developed a novel, minimally invasive method of central BPF closure using Amplatzer devices (ADs) that were originally designed for the transcatheter closure of cardiac defects. Ten patients with 11 BPFs (eight men and two women, aged 66.3 ± 10.1 years [mean ± SD]) were treated under conscious sedation with bronchoscopic closure of the BPFs using ADs. A nitinol double-disk occluder device was delivered under direct bronchoscopic guidance over a guidewire into the fistula. By extruding a disk on either side of the BPF, the fistula was occluded. Bronchography was performed by injecting contrast medium through the delivery sheath following the procedure to ensure correct device positioning. In nine patients, the procedure was successful and symptoms related to the BPF disappeared following closure by the AD. The results were maintained over a median follow-up period of 9 months. Therefore, we state that endobronchial closure using an AD is a safe and effective method for treatment of a postoperative BPF. more...
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- 2011
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24. The role of routine bronchoscopy for early detection of bronchial stump recurrence of lung cancer—1 year post-surgery
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Nir Peled, Milton Saute, Yael Refaeli, Yael Raviv, Dov Flex, Anat Amital, Benjamin D. Fox, David Shitrit, and Mordechai R. Kramer
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Male ,Pulmonary and Respiratory Medicine ,Cancer Research ,medicine.medical_specialty ,Lung Neoplasms ,Neoplasm, Residual ,medicine.medical_treatment ,Pneumonectomy ,Polyps ,Bronchoscopy ,Risk Factors ,Carcinoma, Non-Small-Cell Lung ,medicine ,Humans ,Prospective Studies ,Stage (cooking) ,Completion Pneumonectomy ,Lung cancer ,Aged ,Neoplasm Staging ,medicine.diagnostic_test ,business.industry ,Respiratory disease ,Middle Aged ,medicine.disease ,Squamous metaplasia ,Surgery ,Early Diagnosis ,Oncology ,Dysplasia ,Female ,Radiology ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Local recurrence after complete resection (R(0)) occur in approximately 20% of patients with stage I disease and in up to 50% with stage III. This study focuses on early detection of stump recurrence by a routine bronchoscopy.Prospective analysis 1 year after surgery between April 2006 and April 2008.104 NSCLC patients (age 69.1+/-9.6 years) participated in the study; 97 underwent lobectomy and 7 pneumonectomy. 61% were stage I, 25% stage II, 10% IIIA, 5% IIIB and 1% stage IV. 66% had N0, 21% had N1 disease, 9% N2 disease and 4% had N3. Bronchoscopy was performed 12.9+/-3.8 months after surgery. Nine percents had stump polyp, 5 (5%) had a suspicious mucosa. Four of the nine polyps were malignant. Nine other patients had squamous metaplasia and two had squamous dysplasia. Malignant stump recurrence was observed in four cases, all had a stump polyp. All had R(0), but two had short (1.0 cm) tumor-free bronchial margin, two had N1 disease and two N2 disease. Fisher exact analysis showed short bronchus (p=0.003), N2 vs. N0-1 (p=0.012), and N1 vs. N0 (p=0.011) as significant risk factor for stump recurrence. For stump recurrence, one patient underwent completion pneumonectomy and has no evidence for disease (32.2 months), two patients were treated by chemotherapy and one patient died from pneumonia before therapy.Routine bronchoscopy 1 year after thoracic resection for NSCLC is justified in patients who are at high risk for local recurrence, i.e. short free bronchial margins and N2/N1 disease. more...
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- 2009
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25. Lung transplantation in patients with scleroderma: case series, review of the literature, and criteria for transplantation
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David Shitrit, Benjamin Medalion, Nir Peled, Yael Raviv, Mordechai R. Kramer, Anat Amital, and Milton Saute
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Male ,medicine.medical_specialty ,Hypertension, Pulmonary ,Pulmonary Fibrosis ,medicine.medical_treatment ,Scleroderma ,Pulmonary function testing ,Pulmonary fibrosis ,Humans ,Medicine ,Lung transplantation ,Glucocorticoids ,Transplantation ,Scleroderma, Systemic ,business.industry ,Respiratory disease ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Respiratory Function Tests ,Surgery ,Treatment Outcome ,Respiratory failure ,Practice Guidelines as Topic ,Female ,business ,Immunosuppressive Agents ,Lung Transplantation - Abstract
Lung transplantation in patients with scleroderma: case series, review of the literature, and criteria for transplantation. Clin Transplant 2009: 23: 178-183. a 2009 John Wiley & Sons A/S. Abstract: Backgrounds: The use of lung transplantation (LTX) to treat respiratory failure because of scleroderma is controversial. We present our experience, review the current literature, and suggest specific criteria for LTX in scleroderma. Of the 174 patients who underwent LTX at our center, seven (4%) had scleroderma-associated respiratory failure. Patients and methods: A MEDLINE search of the English literature was performed for studies of LTX in patients with scleroderma between 1986 and 2006. A Kaplan-Meier survival curve was calculated over the time of the studies. Results: The MEDLINE search yielded one large review and four small case series. The small case series were included in the review. The review and our series yield a total of 54 patients. Mean patient age was 47.1 yr; 59.3% were female. Pre-operative lung data were available for 24 patients: 22 (92%) had pulmonary fibrosis and 17 (71%) had pulmonary hypertension. Most patients (69%) underwent single-lung transplantation. Mean forced expiratory volume at one s after LTX was 67% (range 56-87%). There was no difference in infection and rejection rates between the patients with scleroderma and other LTX recipients. The two- and five-yr survival rates were 72% and 55%, respectively. Conclusions: LTX is a valid option in well-selected patients with sclero- derma and pulmonary fibrosis, yielding good pulmonary function and acceptable morbidity and mortality. more...
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- 2009
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26. The Use of Surfactant in Lung Transplantation
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Milton Saute, Anat Amital, David Shitrit, Benjamin Medalion, Yael Raviv, Mordechai R. Kramer, and llana Bakal
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Adult ,Lung Diseases ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Primary Graft Dysfunction ,law.invention ,law ,Animals ,Humans ,Medicine ,Intubation ,Lung transplantation ,Prospective Studies ,Prospective cohort study ,Aged ,Transplantation ,Lung ,medicine.diagnostic_test ,business.industry ,Graft Survival ,Pulmonary Surfactants ,Middle Aged ,respiratory system ,Intensive care unit ,Surgery ,Oxygen ,Treatment Outcome ,medicine.anatomical_structure ,Anesthesia ,Cattle ,Female ,business ,Chest radiograph ,Lung Transplantation - Abstract
Background. Lung transplantation impairs surfactant activity, which may contribute to primary graft dysfunction (PGD). Prompted by studies in animals and a few reports in humans, this study sought to determine if the administration of surfactant during transplantation serves as an effective preventive measure. Methods. An open, randomized, controlled prospective design was used. Forty-two patients scheduled for single (n= 38) or double (n=4) lung transplantation at a major tertiary medical center were randomly assigned to receive, or not, intraoperative surfactant treatment. In the treated group, bovine surfactant was administered at a dose of 20 mg phospholipids/kg through bronchoscope after the establishment of bronchial anastomosis. The groups were compared for oxygenation (PaO 2 /FiO 2 ), chest X-ray findings, PGD grade, and outcome. Results. Compared with the untreated group, the patients who received surfactant were characterized by better postoperative oxygenation mean PaO 2 /FiO 2 (418.8 ± 123.8 vs. 277.9 ± 165 mm Hg, P=0.004), better chest radiograph score, a lower PGD grade (0.66 vs. 1.86, P=0.005), fewer cases of severe PGD (1 patient vs. 12, P more...
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- 2008
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27. LATE-BREAKING ABSTRACT: Lung transplantation in cystic fibrosis patients in Israel: The importance of ethnicity and nutritional status
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Dario Prais, Hagit Levine, Milton Saute, Mordechai R. Kramer, Huda Mussaffi, Dror Rosengarten, Yael Raviv, Moshe Hoshen, Victorya Rusanov, and Hannah Blau
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medicine.medical_specialty ,education.field_of_study ,Lung ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Population ,Ethnic group ,Nutritional status ,medicine.disease ,Cystic fibrosis ,Transplantation ,medicine.anatomical_structure ,Internal medicine ,medicine ,Lung transplantation ,Intensive care medicine ,education ,business - Abstract
Background: Lung transplantation is the last resort therapeutic option for end-stage lung disease in cystic fibrosis (CF). Aims: To evaluate the national Israeli experience with lung transplantation for patients with CF at Rabin Medical Center (RMC). To assess the characteristics that correlates with better outcomes. Methods: We retrospectively reviewed the medical charts of all CF patients who underwent lung transplantation between 1996-2014 at RMC. Results: Fifty CF patients underwent 54 lung transplantations between 1996-2014. Twenty-four were male (48%). Age at transplantation was 28.3±9.1 years (11-50 years). Eighteen patients (36%) died during the study period. For the whole group actuarial survival was 83%, 68%, 62% and 39% at 1, 3, 5 and 10 years respectively. Better survival correlated with: FEV1%>60% at 6 months post transplantation (p Freedom from BO was 87%, 75% and 72% at 1, 3 and 5 years respectively. BO was more common in Arab than the Jewish population (p=0.012). Longer time without BO correlated with: Male gender (p=0.039), Jewish compared to Arab ethnicity (p=0.007), older age (p Conclusions: Our survival and freedom from BO rates are similar the registry of the ISHLT 2014. BMI 1 year post transplantation is an important determinant of survival and longer time without BO. Arab ethnicity was correlated with higher incidence and earlier appearance of BO. more...
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- 2015
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28. Minimally invasive thoracoscopic sympathectomy for palmar hyperhidrosis via a transaxillary single-port approach*1
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Bernardo A. Vidne, Milton Saute, Marius Berman, Viacheslav Bobovnikov, and Georgios P. Georghiou
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,Hyperhidrosis ,business.industry ,medicine.medical_treatment ,Compensatory hyperhidrosis ,Horner syndrome ,Atelectasis ,Retrospective cohort study ,medicine.disease ,Surgery ,Pneumothorax ,Sympathectomy ,Anesthesia ,Thoracoscopy ,medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 months, range 6-18 months) and value of transaxillary single-port thoracic sympathectomy using a thoracoscope with an operating channel for the treatment of hyperhidrosis. Between December 1992 and October 2002, 176 consecutive patients (94 men, 82 women, mean age 21 years) with hyperhidrosis underwent thoracoscopic sympathectomy via a 12-mm single-port approach. Data on postoperative morbidity and outcome were analyzed to validate the technique. Mean operative time per side was 9 min; there was no conversion to an open procedure. Ninety-five percent of the patients were discharged the next day. Thirty-day mortality was zero. Complications included unilateral transient Horner's syndrome (n=1), residual pneumothorax requiring chest drainage from the port entry (n=4), and segmental atelectasis of the lung (n=4) which was treated conservatively. Complete relief of symptoms was observed in all patients at the 6-month follow-up; 45% experienced compensatory hyperhidrosis. Single-port thoracoscopic sympathectomy produces excellent medical and cosmetic results in patients with hyperhidrosis, and is associated with a short hospital stay and a low risk of complications. Overall satisfaction is high. A few patients may experience compensatory symptoms. more...
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- 2004
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29. Pulmonary Carcinoid
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Tali Krelbaum, Milton Saute, Alon Yellin, Mordechai R. Kramer, Gershon Fink, Mendel Glazer, and Daniel Bendayan
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Pulmonary and Respiratory Medicine ,education.field_of_study ,medicine.medical_specialty ,business.industry ,Carcinoid tumors ,medicine.medical_treatment ,Population ,Respiratory disease ,Atelectasis ,Retrospective cohort study ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Pneumonectomy ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,education ,Survival rate ,Carcinoid syndrome - Abstract
Objective To determine the characteristic features and outcome of pulmonary carcinoid tumors in Israel. Methods Retrospective analysis of the clinicopathologic data and outcome of patients from four major hospitals in Israel in the last 20 years. Results There were 142 cases of pulmonary carcinoid tumors: typical (n = 128) and atypical (n = 14). We calculated an annual incidence of about 2.3 to 2.8 cases per 1 million population. The ratio of female to male patients was 1.6:1. The prevalence of smoking was similar to the general population in patients with typical carcinoids and twice as high in the atypical group. Bronchial obstruction was the cause of most of the presenting symptoms and signs and included obstructive pneumonitis, pleuritic pain, atelectasis, and dyspnea (41%). Carcinoid syndrome was extremely rare and occurred in only one patient with metastatic disease. Most of the tumors (68%) arose in the major bronchi. Diagnosis was made using fiberoptic bronchoscopy in 52% of patients without evidence of endobronchial hemorrhage. Nodal involvement and distant metastases occurred in 57% and 21%, respectively, in the atypical group, and 10% and 3%, respectively, in the typical group. The treatment of choice was surgical: lobectomy (56%) or pneumonectomy (16%). The respective 5-year survival rates for patients with typical and atypical tumors were 89% and 75% (not significant), and the 10-year survival rates were 82% and 56% (p Conclusion Pulmonary carcinoid is an uncommon tumor in the Israeli population. With early diagnosis and aggressive surgical therapy, long-term prognosis is excellent. more...
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- 2001
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30. Primary Pulmonary Amyloidosis Due to Low-Grade B Cell Lymphoma
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Georgios P. Georghiou, Milton Saute, Olga Boikov, and Bernardo A. Vidne
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Lung Diseases ,Male ,Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,Lung Neoplasms ,Lymphoma, B-Cell ,Amyloid ,Pulmonary amyloidosis ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Low grade B-cell lymphoma ,B-cell lymphoma ,Aged ,business.industry ,Amyloidosis ,General Medicine ,medicine.disease ,Systemic amyloidosis ,Lymphoma ,030228 respiratory system ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Pulmonary involvement is not an infrequent complication of systemic amyloidosis, although affected patients rarely have significant pulmonary symptoms. In contrast, localized (primary) pulmonary amyloidosis is rare. We report a case of pulmonary low-grade B cell lymphoma with amyloid production, causing localized pulmonary amyloidosis. more...
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- 2007
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31. Impact of Native Lung Pneumonectomy in Single-Lung Transplant Recipients
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Milton Saute, Benjamin Medalion, Viktoria Rusanov, B.D. Fox, M.R. Kramer, and Dror Rosengarten
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Pulmonary and Respiratory Medicine ,Transplantation ,medicine.medical_specialty ,Lung ,business.industry ,medicine.medical_treatment ,Surgery ,Pneumonectomy ,Single lung transplant ,medicine.anatomical_structure ,medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2015
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32. Recurrence of Pulmonary Veno-occlusive Disease After Heart-Lung Transplantation
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Mordechai R. Kramer, Gabriel Izbicki, Tuvia Ben-Gal, Milton Saute, Gideon Sahar, D Bendayan, David Shitrit, Itzhak Schechtman, and Gershon Fink
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Hypertension, Pulmonary ,medicine.medical_treatment ,Recurrence ,medicine ,Humans ,Lung transplantation ,Pulmonary wedge pressure ,Transplantation ,Lung ,business.industry ,Respiratory disease ,medicine.disease ,Pulmonary hypertension ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Heart Transplantation ,Pulmonary Veno-Occlusive Disease ,Cardiology and Cardiovascular Medicine ,business ,Lung Transplantation ,Rare disease - Abstract
Pulmonary veno-occlusive disease, a rare cause of pulmonary hypertension, is characterized by extensive and diffuse occlusion of pulmonary veins by fibrous tissue. Although the diagnosis can be suspected by the presence of the classic clinical triad of severe pulmonary arterial hypertension, radiographic evidence of pulmonary hypertension and edema, and normal pulmonary artery occlusion pressure, the definitive diagnosis is histopathologic. The prognosis of pulmonary veno-occlusive disease is poor with most described patients dying within 2 years of diagnosis. Although anti-coagulation, oxygen, and vasodilator therapies are effective temporarily, the definitive treatment is lung transplantation. We describe the recurrence of pulmonary veno-occlusive disease at 3 months after heart-lung transplantation in a 26-year-old man. Recurrence after transplantation for this disease has not been reported previously, and lung transplantation was thought to be definitive treatment. With this 1st report of early recurrence of pulmonary veno-occlusive disease after heart-lung transplantation, we believe that extrapulmonary factors may play a role in the pathogenesis of this rare disease. more...
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- 2005
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33. Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: long-term follow-up
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Nader Abdel-Rahman, Bayya Abed El Raouf, Elchanan Bruckheimer, Milton Saute, Mordechai R. Kramer, and Oren Fruchter
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Lung Neoplasms ,Long term follow up ,Septal Occluder Device ,medicine.medical_treatment ,Bronchopleural fistula ,Pneumonectomy ,Young Adult ,Postoperative Complications ,Bronchoscopy ,medicine ,Humans ,Lung Abscess ,Young adult ,Lung cancer ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Pleural Diseases ,medicine.disease ,Surgery ,Treatment Outcome ,Cardiothoracic surgery ,Etiology ,Female ,Radiology ,Bronchial Fistula ,business ,Follow-Up Studies - Abstract
Background: The development of a bronchopleural fistula (BPF) is associated with high rates of morbidity and mortality. We have developed a minimally invasive method of bronchoscopic BPF closure using Amplatzer devices (AD) and Amplatzer vascular plugs (AVP), with excellent short-term results. Objectives: The aim of the present report was to explore the long-term outcome of patients treated by Amplatzer occluders and the durability of this novel modality of BPF treatment. Methods: A total of 31 central BPF in 31 patients (mean age 66.8 years, range 19-91) were sealed under moderate sedation bronchoscopically by either AD (n = 19) or AVP (n = 12). The average follow-up period was 17.6 months (range 1-68 months). Results: The main etiology for BPF was surgery (n = 24), pneumonectomy (n = 14) or lobectomy/segmentectomy (n = 10). The underlying disease was either primary (n = 19) or metastatic (n = 2) lung cancer. The immediate success rate was 96% as symptoms related to BPF disappeared in 30 of the 31 patients. Short-term (Conclusion: Endobronchial closure of BPF using both types of Amplatzer occluders (AD and AVP) is a minimally invasive effective modality of treatment with high safety profile and satisfactory long-term outcome considering the poor prognosis in this particular group of patients. more...
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- 2013
34. Pulmonary arteriovenous malformation treated by lobectomy
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Marius Berman, Milton Saute, Georgios P. Georghiou, and Bernardo A. Vidne
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Pulmonary Artery ,Arteriovenous Malformations ,Lesion ,medicine ,Humans ,Pulmonary arteriovenous malformation ,Telangiectasia ,Lung ,Aged ,Left lung ,medicine.diagnostic_test ,business.industry ,Vascular disease ,Interventional radiology ,General Medicine ,medicine.disease ,Surgery ,Pulmonary Arteriovenous Fistula ,Radiographic Image Enhancement ,Pulmonary Veins ,Contrast echocardiography ,Female ,Radiology ,Blood Gas Analysis ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Pulmonary arteriovenous malformation (PAVM) may occur primarily or in association with hereditary hemorrhagic telangiectasia. We present a case of PAVM in the central lower lobe of the left lung of a 75-year-old woman, which was successfully treated by lobectomy. Contrast echocardiography is an excellent tool for evaluation of this uncommon lesion. Advances in interventional radiology have led to the introduction of obliterative techniques for the treatment of PAVM. However, in the presence of a large solitary malformation centrally located, as in our case, and in high-risk patients, surgery is still a safe and effective first option. more...
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- 2003
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35. Endobronchial closure of bronchopleural fistulae using amplatzer devices: our experience and literature review
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Oren, Fruchter, Mordechai R, Kramer, Tamir, Dagan, Yael, Raviv, Nader, Abdel-Rahman, Milton, Saute, and Elchanan, Bruckheimer
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Male ,Treatment Outcome ,Septal Occluder Device ,Humans ,Minimally Invasive Surgical Procedures ,Endoscopy ,Female ,Bronchial Fistula ,Middle Aged ,Pulmonary Surgical Procedures ,Pneumonectomy ,Aged ,Follow-Up Studies - Abstract
Bronchopulmonary fistulae (BPFs) are a severe complication of lobectomy and pneumonectomy and are associated with high rates of morbidity and mortality. We have developed a novel, minimally invasive method of central BPF closure using Amplatzer devices (ADs) that were originally designed for the transcatheter closure of cardiac defects. Ten patients with 11 BPFs (eight men and two women, aged 66.3±10.1 years [mean±SD]) were treated under conscious sedation with bronchoscopic closure of the BPFs using ADs. A nitinol double-disk occluder device was delivered under direct bronchoscopic guidance over a guidewire into the fistula. By extruding a disk on either side of the BPF, the fistula was occluded. Bronchography was performed by injecting contrast medium through the delivery sheath following the procedure to ensure correct device positioning. In nine patients, the procedure was successful and symptoms related to the BPF disappeared following closure by the AD. The results were maintained over a median follow-up period of 9 months. Therefore, we state that endobronchial closure using an AD is a safe and effective method for treatment of a postoperative BPF. more...
- Published
- 2011
36. Endobronchial closure of bronchopleural fistulas with Amplatzer vascular plug
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Oren Fruchter, Milton Saute, Yael Raviv, Mordechai R. Kramer, Dror Rosengarten, and Elchanan Bruckheimer
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Septal Occluder Device ,Fistula ,medicine.medical_treatment ,Sedation ,Thoracic ,Pneumonectomy ,Bronchoscopy ,Medicine ,Humans ,Minimally Invasive Surgical Procedures ,Aged ,Aged, 80 and over ,Bronchography ,medicine.diagnostic_test ,business.industry ,Respiratory Tract Fistula ,General Medicine ,Middle Aged ,Pleural Diseases ,medicine.disease ,Bronchial Fistula ,Surgery ,Treatment Outcome ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
OBJECTIVE: Bronchopulmonary fistula (BPF) is a severe complication following lobectomy or pneumonectomy and is associated with a high rate of morbidity and mortality. We have developed a novel minimally invasive method of central BPF closure using Amplatzer vascular plug (AVP) device that was originally designed for the transcatheter closure of vascular structures in patients with small BPF. METHODS: Patients with BPFs were treated under conscious sedation by bronchoscopic closure of BPFs using AVP. After locating the fistula using bronchography, the self-expanding nitinol made AVP occluder to be delivered under direct bronchoscopic guidance over a loader wire into the fistula followed by bronchography to assure correct device positioning and sealing of the BPF. RESULTS: Six AVPs were placed in five patients, four males and one female, with a mean age of 62.3 years (range: 51–82 years). The underlying disorders and etiologies for BPF development were lobectomy (two patients), pneumonectomy for lung cancer (one patient), lobectomy due to necrotizing pneumonia (one patient), and post-tracheostomy tracheo-pleural fistula (one patient). In all the patients, the bronchoscopic procedure was successful and symptoms related to BPF disappeared following closure by the AVP. The results were maintained over a median follow-up of 9 months (range: 5–34 months). CONCLUSIONS: Endobronchial closure using the AVP is a safe and effective method for treatment of small postoperative BPF. The ease of their implantation by bronchoscopy under conscious sedation adds this novel technique to the armatorium of minimally invasive modalities for the treatment of small BPF. more...
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- 2011
37. Video-assisted pericardial fenestration for effusions after cardiac surgery
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Avi Fuks, Milton Saute, Bernardo A. Vidne, Eyal E Porat, and Georgios P. Georghiou
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Pericardial effusion ,Pericardial Effusion ,Valve replacement ,Cardiac tamponade ,medicine ,Thoracoscopy ,Humans ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,medicine.diagnostic_test ,business.industry ,Thoracic Surgery, Video-Assisted ,Pericardiocentesis ,General Medicine ,medicine.disease ,Surgery ,Pericardial window ,Cardiac surgery ,Cardiac Tamponade ,Treatment Outcome ,Cardiothoracic surgery ,Echocardiography ,Heart Transplantation ,Tamponade ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Delayed-onset pericardial effusion following cardiac surgery can give rise to significant morbidity due to its presentation as well as management by traditional surgical techniques. An institutional experience of a video-assisted thoracoscopic technique to create a pericardial window, with the advantages of a minimally invasive approach combined with excellent visualization in such patients, was reviewed. A retrospective analysis was conducted on all patients undergoing video-assisted thoracoscopic for delayed pericardial effusion after cardiac surgery from January 2001 to January 2006 at our center. Seven patients with echocardiographically diagnosed delayed tamponade underwent video-assisted thoracoscopy; 5 were receiving anticoagulants after valve replacement, and 2 had undergone heart transplantation. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operative time was 45 min. There were no complications of the thoracoscopic technique. Video-assisted thoracoscopic creation of a pericardial window is safe and effective treatment for loculated pericardial effusions secondary to cardiac surgery. more...
- Published
- 2009
38. Aeromedical transport of a patient with massive chylothorax following pneumonectomy for mesothelioma
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Eytan Ish Tov, Avinoam Henig-Hadar, Ehud Deviri, Yehezkel Caine, and Milton Saute
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Extrapleural Pneumonectomy ,Male ,Mesothelioma ,medicine.medical_specialty ,Percutaneous ,Lung Neoplasms ,medicine.medical_treatment ,Chest physiotherapy ,Suction ,Chylothorax ,Mediastinal Neoplasms ,Thoracic duct ,Pneumonectomy ,medicine ,Humans ,Israel ,business.industry ,Public Health, Environmental and Occupational Health ,Air Ambulances ,Middle Aged ,medicine.disease ,United States ,Surgery ,medicine.anatomical_structure ,Blood pressure ,Aerospace Medicine ,business - Abstract
Introduction: Long-distance transportation of a patient in an unstable condition is a challenging operation. When circumstances require using a commercial flight it is even more so. Case Report: A 57-yr-old man in Israel underwent extrapleural pneumonectomy for mesothelioma, following which he developed a massive chylothorax of more than 6 L·d -1 . Due to the failure of medical treatment and the high operative risk under such conditions, it was decided to transfer him to the United States by commercial flight for a percutaneous, fluoroscopy-guided closure of the thoracic duct. The patient was accompanied by a physician and a non-medical assistant and occupied a first-class seat enclosed by curtains. He arrived at the departure airport in a hypovolemic state with low cardiac output and blood pressure of 78/60 Torr. During the flight he was treated with intravenous fluids, chest physiotherapy, and oxygen. In addition, fibrin clots blocked the drainage system on two occasions, requiring corrective action. On arrival in the United States the patient's condition had improved: his blood pressure was 123/91 Torr with a capillary oxygen saturation of 95% without supplementary oxygen. During the 18 h in transit (11 h in flight) he had lost more than 5 L of lymph. Conclusion: Under carefully controlled circumstances it is possible to use commercial flights to transport patients whose condition is unstable and complicated. Safety can be increased by focusing on the specific problems associated with the clinical condition and anticipating possible adverse events during the flight. more...
- Published
- 2009
39. The Role of Routine Bronchoscopy for Early Detection of Bronchial Stump Recurrence of Lung Cancer – 1 Year Post Surgery
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Milton Saute, N Peled, Kramer, D Flex, Yael Raviv, and David Shitrit
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medicine.medical_specialty ,Bronchoscopy ,medicine.diagnostic_test ,business.industry ,Bronchial stump ,medicine ,Early detection ,Post surgery ,Lung cancer ,medicine.disease ,business ,Surgery - Published
- 2009
- Full Text
- View/download PDF
40. Use of Amplatzer device for endobronchial closure of bronchopleural fistulas
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Mordechai R. Kramer, Elchanan Bruckheimer, David Shitrit, Anat Amital, Milton Saute, Nir Peled, Dekel Shlomi, and Eli Atar
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Fistula ,medicine.medical_treatment ,Bronchopleural fistula ,Muscle flap ,Critical Care and Intensive Care Medicine ,Amplatzer device ,Atrial septal defects ,Pneumonectomy ,Postoperative Complications ,Bronchoscopy ,Medicine ,Humans ,Covered stent ,Aged ,medicine.diagnostic_test ,business.industry ,Equipment Design ,medicine.disease ,Surgical Instruments ,Surgery ,Female ,Bronchial Fistula ,Cardiology and Cardiovascular Medicine ,business - Abstract
Bronchopulmonary fistula (BPF) is associated with high morbidity and mortality. It occurs as an uncommon but often severe complication of pneumonectomy. BPF may be treated by a range of surgical and medical techniques, including chest drain, Eloesser muscle flap, omental flap, transsternal bronchial closure, thoracoplasty, and prolonged therapy with antibiotic regimens. The use of bronchoscopy has been reported for the delivery of biological glue, coils, covered stents, and sealants. In this work, we describe a novel method of BPF closure using the Amplatzer device, which is commonly used for transcatheter closure of atrial septal defects. more...
- Published
- 2008
41. Adaptation of median partial sternotomy in head and neck surgery
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Milton Saute, Raphael Feinmesser, Eyal Raveh, Ilan Koren, Gideon Bahar, Jacob Shvero, Hanna Gilat, and Thomas Shpitzer
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Adult ,Male ,medicine.medical_specialty ,Sternum ,Lymphangioma ,Mediastinal Diseases ,Medicine ,Humans ,Parathyroid disease ,Child ,Paresis ,Parathyroid adenoma ,Aged ,Retrospective Studies ,business.industry ,Goiter ,Thyroid disease ,Mediastinum ,General Medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Medullary carcinoma ,Parathyroid carcinoma ,Thoracotomy ,Head and Neck Neoplasms ,Child, Preschool ,Female ,medicine.symptom ,business - Abstract
Upper mediastinum involvement in diseases of the head and neck may require a sternal split. This study describes our adaptation of the upper median or “minimal” sternotomy technique for the treatment of head and neck pathologies. Between April 2002 and October 2005, 17 patients aged 4 to 82 years underwent minimal sternotomy in our institution for a variety of head and neck pathologies. The 17 patients included 11 adults with metastatic thyroid disease (six metastatic papillary thyroid carcinoma, two medullary carcinoma, and one Hürthle cell carcinoma) and huge retrosternal goiter (n = 2), four adults with parathyroid disease (two primary parathyroid adenoma, one secondary hyperplasia, and one parathyroid carcinoma), and two children with lymphangioma and huge thymic cyst (one each). Average hospitalization was 8 days. Four patients needed a thoracic drain for 2 days, one had recurrent laryngeal nerve palsy, and one had phrenic nerve paresis. There were no postoperative deaths. Minimal sternotomy appears to be an excellent alternative for surgical exploration of the mediastinum and may be used in head and neck surgery for a range of indications. more...
- Published
- 2008
42. Risk factors for death while awaiting lung transplantation in Israeli patients: 1997-2006
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Milton Saute, Benjamin Medalion, Nir Peled, David Shitrit, Yvgeni Gershman, Anat Amital, and Mordechai R. Kramer
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Pulmonary and Respiratory Medicine ,Adult ,Lung Diseases ,medicine.medical_specialty ,Waiting Lists ,medicine.medical_treatment ,Population ,Walking ,Drug Administration Schedule ,Pulmonary function testing ,Internal medicine ,Epidemiology ,medicine ,Lung transplantation ,Humans ,Risk factor ,Israel ,education ,Glucocorticoids ,Aged ,education.field_of_study ,Univariate analysis ,business.industry ,Respiratory disease ,Age Factors ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,Transplantation ,Oxygen ,Treatment Outcome ,Respiratory Mechanics ,Cardiology and Cardiovascular Medicine ,business ,Epidemiologic Methods ,Lung Transplantation - Abstract
Objective: Patients with end-stage lung disease very frequently die while awaiting lung transplantation. The aim of this study was to identify factors associated with mortality in patients referred for lung transplant assessment. Methods:The files of all consecutive patients listed for lung transplantation in Israel between 1997 and 2006 were reviewed and the data were compared statistically between those who survived to transplantation. Results: A total of 229 patients were listed for lung transplantation, of whom 42 (18.3%) died while awaiting transplantation. Comparison of the patients who survived to transplantation with those who did not using univariate analysis revealed that the died-waiting group was significantly older, used steroids to a greater extent, had more IPF patients and less emphysematous, and lower mean oxygen saturation at rest (p = 0.005). There were no between-group differences in comorbid diseases or pulmonary function measurements. The 6 min walk distance was strongly and inversely correlated with risk of death before transplantation (p = 0.005). On multivariate analysis, only oxygen saturation at rest was a significant independent risk factor for death while awaiting transplantation (OR 0.886; C.I. 0.805—0.974). Conclusions: There are several risk factors for death in the Israeli population listed for LTX, including age, steroid use, emphysematous patients and lower saturation at rest. more...
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- 2007
43. Post-transplant diabetes mellitus in lung transplant recipients: incidence and risk factors
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Milton Saute, Nir Peled, Jacob E. Ollech, Anat Amital, Ayelet Ollech, Benjamin Medalion, Mordechai R. Kramer, and David Shitrit
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Pulmonary and Respiratory Medicine ,Adult ,Graft Rejection ,Male ,Risk ,medicine.medical_specialty ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Tacrolimus ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Diabetes Mellitus ,Medicine ,Lung transplantation ,Humans ,Obesity ,Risk factor ,Aged ,business.industry ,Incidence (epidemiology) ,Incidence ,Age Factors ,Immunosuppression ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Transplantation ,Regimen ,Logistic Models ,Hyperglycemia ,Female ,Cardiology and Cardiovascular Medicine ,business ,Immunosuppressive Agents ,Follow-Up Studies ,Lung Transplantation - Abstract
Objective: Post-transplant diabetes mellitus (PTDM) is a common and potentially serious complication after solid organ transplantation. There are only a few data, however, about the incidence of DM in patients undergoinglung transplantation. Patients and methods:The medical records of 119 consecutive patients who underwent lung transplantation from 1998 to September 2004 were reviewed. Patients were divided in three groups according to their diabetes status, including pre-transplant DM, the PTDM group and those without DM. Patient records and all laboratory data were reviewed and the clinical course of diabetes was monitored. All recipients were treated with tacrolimus based regimen. Results: Mean follow-up for all patients was 25 10. Twenty-three patients had DM in the pre-lung transplantation (LTX) DM group. PTDM developed in 34 of the remaining 96 patients (35.4%) with an incidence of 20%, 23% after 6 months and 12 months post-transplant. No significant difference was noted between 12 and 24 months post-LTX. The patients who developed DM were older (57 15 vs 53 13 years, p = 0.009), had increased BMI (26 5 vs 24 4, p = 0.0001), shorter time from diagnosis to LTX (21 13 vs 28 18 months, p = 0.007) more cytomegalovirus infection and more acute rejection and hyperglycemia in the first month after LTX. Four patients died in the PTDM group compared to nine patients in the no-DMgroup (12% vs 14%; p = 0.72). Conclusions: Post-transplant diabetes is a common complication in lung transplant patients receiving tacrolimus-based immunosuppression. The risk for developing PTDM is greatest among older recipients, those obese, and among recipients with more rejections episodes. more...
- Published
- 2007
44. Computer-enhanced thoracoscopic thymectomy with the Zeus telemanipulation surgical system
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Bernardo A. Vidne, Milton Saute, Marius Berman, and Alon Stamler
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Range of movement ,Mediastinal mass ,Zeus (malware) ,Surgery ,ZEUS robotic surgical system ,Thoracoscopy ,Medical imaging ,Medicine ,Thoracoscopic thymectomy ,Cardiology and Cardiovascular Medicine ,business ,Robotic arm - Abstract
Recent years have witnessed important progress in the use of minimally invasive robotic-enhanced surgical systems in cardiac and general thoracic interventions. We report the first-ever successful use of the Zeus robotic surgical system (Computer Motion, Inc, Goleta, CA) for the excision of an anterior mediastinal mass. Proper positioning of the thoracic ports for the robotic arms to permit a wide range of movement, is the key to the application of the system for intrathoracic cage operations. Other advantages of the system include three-dimensional voice controlled imaging, low-heat surgical field, and good exposure of the structures. more...
- Published
- 2007
45. Minimally invasive thoracoscopic sympathectomy for palmar hyperhidrosis via a transaxillary single-port approach
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Georgios P, Georghiou, Marius, Berman, Viacheslav, Bobovnikov, Bernardo A, Vidne, and Milton, Saute
- Abstract
The aim of this retrospective study was to evaluate the mid-term outcome (average follow-up 10 months, range 6-18 months) and value of transaxillary single-port thoracic sympathectomy using a thoracoscope with an operating channel for the treatment of hyperhidrosis. Between December 1992 and October 2002, 176 consecutive patients (94 men, 82 women, mean age 21 years) with hyperhidrosis underwent thoracoscopic sympathectomy via a 12-mm single-port approach. Data on postoperative morbidity and outcome were analyzed to validate the technique. Mean operative time per side was 9 min; there was no conversion to an open procedure. Ninety-five percent of the patients were discharged the next day. Thirty-day mortality was zero. Complications included unilateral transient Horner's syndrome (n=1), residual pneumothorax requiring chest drainage from the port entry (n=4), and segmental atelectasis of the lung (n=4) which was treated conservatively. Complete relief of symptoms was observed in all patients at the 6-month follow-up; 45% experienced compensatory hyperhidrosis. Single-port thoracoscopic sympathectomy produces excellent medical and cosmetic results in patients with hyperhidrosis, and is associated with a short hospital stay and a low risk of complications. Overall satisfaction is high. A few patients may experience compensatory symptoms. more...
- Published
- 2007
46. Lung transplantation in patients with cystic fibrosis: the Israeli experience
- Author
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Dario, Prais, Yael, Raviv, David, Shitrit, Alon, Yellin, Gideon, Sahar, Danielle, Bendayan, Yaacov, Yahav, Ori, Efrati, Nira, Reichart, Hannah, Blau, Ilana, Bakal, Gila, Buchman, Milton, Saute, Bernardo, Vidne, and Mordechai R, Kramer more...
- Subjects
Adult ,Male ,Adolescent ,Cystic Fibrosis ,Survival Analysis ,Medical Records ,Actuarial Analysis ,Forced Expiratory Volume ,Humans ,Female ,Israel ,Bronchiolitis Obliterans ,Lung Transplantation ,Retrospective Studies - Abstract
Lung transplantation is a well-established therapeutic option for end-stage lung disease in cystic fibrosis. Although it confers a clear survival advantage, outcome differs among centers according to local experience, patient selection, transplantation procedure, and postoperative care.To evaluate the national Israeli experience with lung transplantation in patients with CF.We reviewed the medical charts of all CF patients who underwent lung transplantation between January 1996 and June 2005 at the two Israeli centers that perform this procedure.Eighteen transplantations were performed in 17 patients. Mean patient age at transplantation was 25.3 +/- 9.1 years, and mean duration of follow-up in survivors (n=14) was 37.2 months (range 1-113 months). The actuarial survival rate was 88% at 1 year and 74% at 5 years. Pulmonary function, expressed as percent of predicted normal forced expiratory volume in 1 sec, improved from 22.4 +/- 8.1% to 76 +/- 16.8% at one year after transplantation. Bronchiolitis obliterans syndrome was diagnosed in 5 patients (29%), of whom 2 died and 2 are currently candidates for retransplantation. Median time to onset of BOS was 34.2 months (range 17-64 months).In Israel, the early and intermediate-term results of lung transplantation for cystic fibrosis are encouraging. BOS remains a major complication that threatens long-term outcome. more...
- Published
- 2006
47. Spinal cord ischemia following thoracotomy without epidural anesthesia
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Efrat Saraf-Lavi, Leonid A. Eidelman, Milton Saute, Aharon Avramovich, and Aeyal Raz
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Anesthesia, Epidural ,medicine.medical_specialty ,Cord ,Lung Neoplasms ,medicine.medical_treatment ,Population ,Ischemia ,Postoperative Complications ,Anesthesiology ,Carcinoma, Non-Small-Cell Lung ,medicine ,Humans ,Thoracotomy ,education ,Aged ,Paraplegia ,education.field_of_study ,business.industry ,Spinal Cord Ischemia ,General Medicine ,Perioperative ,medicine.disease ,Spinal cord ,Magnetic Resonance Imaging ,Surgery ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Anesthesia ,Female ,business - Abstract
Purpose: Paraplegia is an uncommon yet devastating complication following thoracotomy, usually caused by compression or ischemia of the spinal cord. Ischemia without compression may be a result of global ischemia, vascular injury and other causes. Epidural anesthesia has been implicated as a major cause. This report highlights the fact that perioperative cord ischemia and paraplegia may be unrelated to epidural intervention. Clinical features: A 71-yr-old woman was admitted for a left upper lobectomy for resection of a non-small cell carcinoma of the lung. The patient refused epidural catheter placement and underwent a left T5–6 thoracotomy under general anesthesia. During surgery, she was hemodynamically stable and good oxygen saturation was maintained. Several hours following surgery the patient complained of loss of sensation in her legs. Neurological examination disclosed a complete motor and sensory block at the T5–6 level. Magnetic resonance imaging (MRI) revealed spinal cord ischemia. The patient received iv steroid treatment, but remained paraplegic. Five months following the surgery there was only partial improvement in her motor symptoms. A follow-up MRI study was consistent with a diagnosis of spinal cord ischemia. Conclusion: In this case of paraplegia following thoracic surgery for lung resection, epidural anesthesia/analgesia was not used. The MRI demonstrated evidence of spinal cord ischemia, and no evidence of cord compression. This case highlights that etiologies other than epidural intervention, such as injury to the spinal segmental arteries during thoracotomy, should be considered as potential causes of cord ischemia and resultant paraplegia in this surgical population. more...
- Published
- 2006
48. Takotsubo cardiomyopathy: expanding the differential diagnosis in cardiothoracic surgery
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Bernardo A. Vidne, Milton Saute, Leslie Paul-Kislin, Marius Berman, Alexander Kogan, Mordechai Vaturi, and Eyal E Porat
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Pulmonary and Respiratory Medicine ,Coronary angiography ,medicine.medical_specialty ,Acute coronary syndrome ,business.industry ,Cardiomyopathy ,Creatinine phosphokinase ,Syndrome ,medicine.disease ,Diagnosis, Differential ,Ventricular Dysfunction, Left ,Cardiothoracic surgery ,Internal medicine ,medicine ,Cardiology ,Humans ,Surgery ,Female ,Differential diagnosis ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies ,Aged - Abstract
We describe a case of takotsubo cardiomyopathy in a 69-year-old woman after right upper lobectomy, without cardiac antecedents. The immediate course of recovery was uneventful. On the first postoperative day, clinical symptoms of acute coronary syndrome developed in association with ischemic electrocardiographic changes and a mild elevation in creatinine phosphokinase levels. Echocardiography showed moderate left ventricular dysfunction, with a typical takotsubo pattern. Coronary angiography revealed no abnormalities. After 2 days of supportive treatment, the patient recovered completely. The clinical presentation, instrumental findings, additional cardiac and noncardiac diseases, and the potential pathomechanism of takotsubo cardiomyopathy are described according to the current medical literature. more...
- Published
- 2006
49. Radical resection of a giant Ewing's sarcoma of the anterior chest wall
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Georgios P, Georghiou, Bernardo A, Vidne, and Milton, Saute
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Adult ,Male ,Humans ,Sarcoma, Ewing ,Thoracic Neoplasms ,Thoracic Wall ,Tomography, X-Ray Computed - Published
- 2006
50. Gastrointestinal involvement of posttransplant lymphoproliferative disorder in lung transplant recipients: report of a case
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Milton Saute, Ram Dickman, G Sahar, David Shitrit, Mordechai R. Kramer, and Ariella Bar-Gil Shitrit
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Male ,medicine.medical_specialty ,Abdominal pain ,Lymphoma, B-Cell ,Nausea ,medicine.medical_treatment ,Pulmonary Fibrosis ,Colonoscopy ,Gastroenterology ,Internal medicine ,medicine ,Lung transplantation ,Humans ,Aged ,Gastrointestinal tract ,medicine.diagnostic_test ,business.industry ,Stomach ,General Medicine ,Surgery ,Transplantation ,medicine.anatomical_structure ,Colonic Neoplasms ,medicine.symptom ,Complication ,business ,Lung Transplantation - Abstract
Lymphoproliferative disorder is a well-recognized complication of lung transplantation. Risk factors include Epstein-Barr virus infection and immuno-suppression. The gastrointestinal manifestations of posttransplant lymphoproliferative disorder in lung transplant recipients have not been fully characterized. Case presentation and 16 previously reported cases of posttransplant lymphoproliferative disorder with gastrointestinal involvement are reviewed. Patient ages ranged from 25 to 65 (median, 52) years. Median time from lung transplantation to onset of posttransplant lymphoproliferative disorder was 36 (range, 1–109) months; 35 percent of cases (6/17) occurred within 18 months; Eighty-eight percent of patients (15/17) had positive Epstein-Barr virus serology before transplantation. In five patients (29 percent), the posttransplant lymphoproliferative disorder also involved sites other than the gastrointestinal tract. The most common gastrointestinal site of posttransplant lymphoproliferative disorder was the colon, followed by the small intestine and stomach. Clinical features included abdominal pain, nausea, and bloody diarrhea. Diagnosis was based on typical pathologic changes on gastrointestinal tract biopsy obtained mainly by colonoscopy. Treatment included a reduction in the immunosuppressive regimen in 15 of 17 cases (88 percent) and surgical resection in 10 (59 percent). One patient was untreated. Seven of 16 patients (44 percent) responded to treatment and 9 patients died. Median time from onset of posttransplant lymphoproliferative disorder to death was 70 (range, 10–85) days. Posttransplant lymphoproliferative disorder with gastrointestinal involvement is a unique entity that should be considered in all Epstein-Barr-Virus-positive lung transplant recipients who present with abdominal symptoms. Although immunosuppressive modulation and resection can lead to remission, the risk of death is 50 percent. more...
- Published
- 2005
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