Biomedical subjects
Publications and source records attributed to M Krasna.
Significant airway stenosis occurs in 7% to 14% of lung transplant recipients. The use of permanent, nonadjustable, wire mesh stents can be of concern in the transplant recipient with nonmalignant stricture. We report the replacement and repositioning of an expandable wire mesh stent in a double lung transplantation with distal bronchial stenosis.
A new technique for pericardial resection is described using thoracoscopy. With the advent of newer videolaparoscopic techniques allowing better visualization and the use of new endoscopic staplers, a whole spectrum of surgical procedures can now be performed through the thoracoscope.
Small lung nodules undiagnosed by percutaneous needle biopsy have traditionally gone to thoracotomy for diagnosis. We describe a technique using computed tomographic needle/wire lung localization of these nodules, to be resected using video-assisted thoracoscopy. This is less invasive and less painful than thoracotomy and provides for cost-effective definitive diagnosis.
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Thoracoscopy is useful for diagnosing and treating pleural and parenchymal intrathoracic disease. The role of thoracoscopy is especially evident in patients who pose a high risk for thoracotomy. Although used in the past for diagnosis and occasional treatment of pleural adhesions, it is not a frequently used procedure. With double lumen endotracheal tubes for selective collapse of one lung, there seems to be an increasing role for thoracoscopy in diagnosis and management of pleural disease. With the use of new endoscopic linear staples, treatment as well as diagnosis of intrathoracic diseases will be possible in the future.
Recent advances in rigid endoscopic imaging capabilities, light sources, and instrumentation have dramatically expanded the potential role of laparoscopic and thoracoscopic surgery. The recent introduction of an endoscopic linear stapling device has made possible thoracoscopic pulmonary resection. A 28-year-old woman with a history of recurrent pneumothorax, diffuse interstitial fibrosis, and left apical microblebs underwent thoracoscopic lung resection using this new stapling device. A 3 x 5 cm segment of involved lung tissue was removed. Postoperatively, the patient manifested no evidence of air leak and was discharged 48 h after surgery.
Heat stress (WBGT index) in the cockpits of agricultural spray pilots, and its physiological and subjective effects, were measured for 9 pilots flying in hot weather for a large Israeli aerial spray company. There was concern that heat exposure may be one of the factors involved in a recent increase in the fatal and non-fatal crash rate among Israeli spray pilots. WBGT index calculations were based on sequential cockpit wet bulb, dry bulb, and globe temperatures read when aircraft landed. The WBGT was always above 25 degrees C and exceeded 26.7 degrees C in 70% of observations. In pilots, a daily weight loss of 0.6-1.2% of total body weight was usual, as were rectal temperature increases of 0.5 degrees C. Daily water intakes ranged from less than 100 ml to 2000 ml per workshift. Questionnaires indicated that 42 of 45 pilots said they would drink more fluids if they were provided between flights by ground crews. An unresolved problem was whether conventional threshold standards for heat exposure were set at levels that may produce insidious impairments in pilot psychomotor performance. Cockpit air cooling is suggested as a measure for preventing heat stress in hot climates. However, appropriate filter technologies would be needed to prevent pesticide exposures during flight. Engineering and other measures to prevent heat stress and dehydration should rank high as part of a comprehensive program to protect the health and performance levels of agricultural spray pilots.