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Search Results: 1 - 10 of 365 matches for " Arie Soroksky "
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Goal-Directed Mechanical Ventilation: Are We Aiming at the Right Goals? A Proposal for an Alternative Approach Aiming at Optimal Lung Compliance, Guided by Esophageal Pressure in Acute Respiratory Failure
Arie Soroksky,Antonio Esquinas
Critical Care Research and Practice , 2012, DOI: 10.1155/2012/597932
Abstract: Patients with acute respiratory failure and decreased respiratory system compliance due to ARDS frequently present a formidable challenge. These patients are often subjected to high inspiratory pressure, and in severe cases in order to improve oxygenation and preserve life, we may need to resort to unconventional measures. The currently accepted ARDSNet guidelines are characterized by a generalized approach in which an algorithm for PEEP application and limited plateau pressure are applied to all mechanically ventilated patients. These guidelines do not make any distinction between patients, who may have different chest wall mechanics with diverse pathologies and different mechanical properties of their respiratory system. The ability of assessing pleural pressure by measuring esophageal pressure allows us to partition the respiratory system into its main components of lungs and chest wall. Thus, identifying the dominant factor affecting respiratory system may better direct and optimize mechanical ventilation. Instead of limiting inspiratory pressure by plateau pressure, PEEP and inspiratory pressure adjustment would be individualized specifically for each patient's lung compliance as indicated by transpulmonary pressure. The main goal of this approach is to specifically target transpulmonary pressure instead of plateau pressure, and therefore achieve the best lung compliance with the least transpulmonary pressure possible. 1. Introduction Patients with severe respiratory failure exhibiting decreased respiratory system compliance with hypoxemia or carbon dioxide retention are often difficult to ventilate and or oxygenate with current guidelines that limit applied plateau pressure. Furthermore, applying mechanical ventilation while limiting plateau pressure without assessment of respiratory system mechanics may result in application of inappropriate positive end expiratory pressure (PEEP) and inspiratory pressures. Thus, while these guidelines recommend a certain limit of plateau pressure, they do not take into consideration chest wall mechanics, which can only be assessed by partitioning respiratory system into its components by esophageal balloon and assessment of pleural pressure. Without partitioning of the respiratory system into its components, one cannot ascertain and identify the factors contributing to low respiratory system compliance. Identifying the dominant factor affecting respiratory system compliance by measuring transpulmonary pressure may better direct and optimize mechanical ventilation. Thus, instead of limiting mechanical ventilation
Severe Tetrodotoxin Poisoning after Consumption of Lagocephalus sceleratus (Pufferfish, Fugu) Fished in Mediterranean Sea, Treated with Cholinesterase Inhibitor
Julia Kheifets,Boris Rozhavsky,Zehava Girsh Solomonovich,Rodman Marianna,Arie Soroksky
Case Reports in Critical Care , 2012, DOI: 10.1155/2012/782507
Abstract: Lagocephalus sceleratus, or better known as the pufferfish, or fugu, is widespread in Asia and Indo-Pacific regions. It is a poisonous fish containing tetrodotoxin (TTX) which is a potent neurotoxin. In the Far East, fugu is considered a delicate dish, especially in Japan where it is prepared by experts. Nevertheless, poisoning from Lagocephalus sceleratus is not a rare event. Recent data from Japan indicate an incidence of 45 patients per year and a mortality rate of 11%. Mediterranean sea is not the natural habitat of Lagocephalus sceleratus. However, by now multiple reports have established a firm presence of Lagocephalus sceleratus in Mediterranean region as well. This phenomenon is explained by migration of pufferfish across the Suez Channel (lessepsian migration) (Eisenman et al., 2008, Bentur et al., 2008). With lessepsian migration came the first reports of TTX poisoning in the Mediterranean region. We report a patient with a particularly severe and life-threatening TTX poisoning caused by consumption of Lagocephalus sceleratus and treated by cholinesterase inhibitor to a complete and uneventful recovery.
Severe Tetrodotoxin Poisoning after Consumption of Lagocephalus sceleratus (Pufferfish, Fugu) Fished in Mediterranean Sea, Treated with Cholinesterase Inhibitor
Julia Kheifets,Boris Rozhavsky,Zehava Girsh Solomonovich,Rodman Marianna,Arie Soroksky
Case Reports in Critical Care , 2012, DOI: 10.1155/2012/782507
Abstract: Lagocephalus sceleratus, or better known as the pufferfish, or fugu, is widespread in Asia and Indo-Pacific regions. It is a poisonous fish containing tetrodotoxin (TTX) which is a potent neurotoxin. In the Far East, fugu is considered a delicate dish, especially in Japan where it is prepared by experts. Nevertheless, poisoning from Lagocephalus sceleratus is not a rare event. Recent data from Japan indicate an incidence of 45 patients per year and a mortality rate of 11%. Mediterranean sea is not the natural habitat of Lagocephalus sceleratus. However, by now multiple reports have established a firm presence of Lagocephalus sceleratus in Mediterranean region as well. This phenomenon is explained by migration of pufferfish across the Suez Channel (lessepsian migration) (Eisenman et al., 2008, Bentur et al., 2008). With lessepsian migration came the first reports of TTX poisoning in the Mediterranean region. We report a patient with a particularly severe and life-threatening TTX poisoning caused by consumption of Lagocephalus sceleratus and treated by cholinesterase inhibitor to a complete and uneventful recovery. 1. Case Report An otherwise healthy 52-year-old man presented to the emergency room with nausea and vomiting accompanied by acute dyspnea. Two hours earlier the patient who was a recreational fisherman reported on consumption of liver and gonads extracted from a fish which he just captured at sea (Figure 1). Figure 1: Lagocephalus sceleratus (Pufferfish, fugu) cought by a local recreational fisherman off the cost of Tel Aviv. Several minutes after consumption he complained of perioral paraesthesias with worsening limb muscle weakness. Shortly after admission to the ER, the patient developed an acute respiratory failure with bradypnea. This was accompanied by bradycardia which quickly deteriorated to cardiac arrest. After a short resuscitation, including tracheal intubation and mechanical ventilation, the patient returned to sinus rhythm. On examination, shortly after patient was stabilized, signs of complete paralysis with absence of motor responses and lack of pupil reactions were noted. Patient was noted to be in deep coma with GCS of 3. At this point, possible poisoning by paralyzing agent was suspected. Patient was transferred to the intensive care unit and treated by supportive measures. Several hours after his ICU admission, patient’s family approached the medical stuff with a fish claimed to be consumed by the patient just two hours prior to his hospital admission. A diagnosis of tetrodotoxin (TTX) poisoning was suggested by typical
Clinical review: Humidifiers during non-invasive ventilation - key topics and practical implications
Antonio M Esquinas Rodriguez, Raffaele Scala, Arie Soroksky, Ahmed BaHammam, Alan de Klerk, Arschang Valipour, Davide Chiumello, Claude Martin, Anne E Holland
Critical Care , 2012, DOI: 10.1186/cc10534
Abstract: The human airway has an important role in heating and humidifying inspired gas, and recovering heat and moisture from expired gas. The amount of water vapor in a gas mixture can be measured as absolute humidity (AH) or relative humidity (RH) in relation to the temperature. AH is the total water present in the gas (mg H2O/L) and RH is the amount of water present expressed as the percentage of maximum carrying capacity at a given temperature [1]. The human airway must provide gas at core temperature and 100% RH at the alveolar surface in order to optimize gas exchange and protect lung tissue [2].Non-invasive ventilation (NIV) is a mechanical ventilation modality that does not utilize an invasive artificial airway (endotracheal tube or tracheostomy tube) [3]. NIV is usually delivered through a nasal or oro-nasal mask so the inspired gas passes through the upper airway where it is conditioned. Like during spontaneous breathing, patients under NIV require adequate humidification and heating of the inspired air (that is, gas conditioning) [3]. NIV delivers inspired air at high flow rates, which may overwhelm the usual airway humidification mechanisms. Inadequate gas conditioning has been associated with anatomical and functional deterioration of nasal mucosa (ciliary activity, mucus secretion, local blood flow, nasal resistance). In addition, there are also negative effects on tolerance to NIV when a patient breathes inadequately humidified air [1,3-5] (Table 1).Metaplastic changes and keratinization of the nasal epithelium and submucosa have been reported in patients on home-NIV when the level of humidification was inadequate for long periods [5]. These histopathological findings were confirmed by our recent survey, which found similar structural changes of the nasal mucosa in four patients with acute respiratory failure treated for 7 days with NIV without a humidification system added (unpublished data; Figure 1). This suggests that changes in the nasal mucosa occur rel
Unmanned Airborne Magnetic and VLF Investigations: Effective Geophysical Methodology for the Near Future  [PDF]
Lev Eppelbaum, Arie Mishne
Positioning (POS) , 2011, DOI: 10.4236/pos.2011.23012
Abstract: Airborne geophysical investigations are now recognized as a powerful tool for geological-geophysical mapping, mineral prospecting, environmental assessments, ecological monitoring, etc. Currently, however, there are two main drawbacks to effective application of these investigations: (a) the difficulty of conducting geophysical surveys at low altitudes, (b) heightened danger for the aircraft crew, especially in regions with a rugged topography. Unmanned or so-called Remote Operated Vehicles (ROV) surveys are not bound by these limitations. The new unmanned generation of small and maneuvering vehicles can fly at levels of a few (even one) meters above the Earth’s surface, and thus follow the relief, while simultaneously making geophysical measurements. In addition, ROV geophysical investigations have extremely low exploitation costs. Finally, measurements of geophysical fields at different observation levels can provide new, unique geological-geophysical information. This chapter discusses future geophysical integration into ROV of measurements of magnetic and VLF electromagnetic fields. The use of GPS with improved wide-band Kalman filtering will be able to provide exact geodetic coordinates. A novel interpreting system for complex environments is presented that includes non-conventional methods for localizing targets in noisy backgrounds, filtering temporary variations from magnetic and VLF fields, eliminating terrain relief influence, quantitative analysis of the observed anomalies and their integrated examination. This system can be successfully applied at various scales for analysis of geophysical data obtained by ROVs to search for useful minerals, geological mapping, the resolution of many environmental problems, and geophysical monitoring of dangerous geological phenomena.
Retinal hemorrhage as a unique ophthalmic manifestation of cerebral hyper perfusion syndrome  [PDF]
Eitan Heldenberg, Arie Bass
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.34053
Abstract: Cerebral hyperperfusion syndrome (CHPS) is a rare, complication of carotid artery revascularization. Acute retinal hemorrhage is a very rare entity previously described as a manifestation of CHPS following carotid artery stenting (CAS), but to the best of our knowledge, not yet described as a complication of carotid surgery. An Ascending Aorta to bilateral Carotid bypass was performed in a 35-year-old woman with active Takayasu arteritis and 95% symptomatic stenosis of both common carotid arteries. Severe retinal hemorrhage appeared on the second post operative day combined with high blood pressure, brain edema on CT scan and grand mal seizures. It seems that fundoscopic examination following carotid revascularization of tight can be helpful in identifying those patients who develop symptoms suggesting of CHPS.

Retinal hemorrhage as a unique ophthalmic manifestation of cerebral hyper perfusion syndrome  [PDF]
Eitan Heldenberg, Arie Bass
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.33045
Abstract:

Cerebral hyperperfusion syndrome (CHPS) is a rare disease with complications of carotid artery revascularization. Acute retinal hemorrhage is a very rare entity that has been previously described as a manifestation of CHPS followed by the carotid artery stenting (CAS), but to the best of our knowledge, not yet described as a complication of carotid surgery. An Ascending Aorta to bilateral Carotid bypass was performed in a 35 years old woman with active Takayasu arteritis and 95% symptomatic stenosis of both common carotid arteries. Severe retinal hemorrhage appeared on the second post operative day combined with high blood pressure, brain edema on CT scan and grand mal seizures. It seems that fundoscopic examination followed by the carotid revascularization of tightness can be helpful in identifying those patients who develop symptoms suggesting of CHPS.

Simultaneous One-Step Approximations of Real and Reactive Power Flow  [PDF]
Arie Ten Cate
Journal of Power and Energy Engineering (JPEE) , 2014, DOI: 10.4236/jpee.2014.210004
Abstract:

This paper presents two new non-iterative approximations of the power flow in a network. Real and reactive power are simultaneously modelled in complex equations. Also, resistances are not set to zero. This is a generalization of the DC approximation, where only real power is modelled with zero line resistance. Hence the proposed approximations are more accurate than the DC approximation. The voltage lag over a link in a short, low voltage, network link is ten times as accurate as with the DC approximation. In the Appendix a new mathematical constant is introduced.

Applying the Conceptual-Model of Progressive Development to the Contaminated Aquifer Underlying Israel’s Coastal Plain  [PDF]
Yakov Livshitz, Arie S. Issar
Journal of Water Resource and Protection (JWARP) , 2010, DOI: 10.4236/jwarp.2010.25046
Abstract: The last ten years of moderate to low precipitation rates in Israel may be a confirmation of the forecast, based on historical data, that recent, repeated droughts are a function of global warming. In this case the conventional policy of “Sustainable Development” is not sufficient to avert the impact of diminution of precipitation on Israel’s water supply. Instead, a policy of “Progressive Development” is proposed, which aims to exploit, stage by stage, first the water resources most available and at lowest cost until they are ex-hausted. Once this stage is under execution, progressive steps are taken to develop more costly resources by advanced methods of exploitation. A case study of such a development plan is the controlled deterioration of the water quality of the coastal plain aquifer of Israel.
The Possible Dimension, Additional to Space-Time, which Physicists Ignore  [PDF]
Arie S. Issar, Shaul Sorek
Journal of Modern Physics (JMP) , 2010, DOI: 10.4236/jmp.2010.11009
Abstract: In response to Wheeler’s challenge to find an element that is: “something that itself has no localization in space and time…pure knowledge … an atom of information” we suggest to account for Information as a di-mension. Its degrees of freedom are arithmetical (+-) and logical (if-then) forward and backward steps. While Space refers to gaps in distance, Time refers to change in instances, Information refers to a sequence of notions measured by the number of steps made (or bytes used) by a computer in order to perform (de-scribe or solve) a certain logical sentence or a sequence of logical sentences. In the attempt to quantifiably formulate the incorporation of Information into physical laws, we refer to Hamiltonian extended stationary principle in terms of Space, Time and an additional degree of freedom, suggested as an information state. The obtained Euler equation is demonstrated for the case of a thin rod under longitudinal vibrations, investi-gated by dimensionless analysis. It is shown that depending on the value of information and its rate, one may obtain dominant forms conforming to Poison’s equation in Space vs Information, wave equation in Time vs Information and the expected wave equation in Time vs Space.
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