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Biomedical subjects

I Braverman

Publications and source records attributed to I Braverman.

At least 37 records · Page 2Linked to original sources
PubMed1996

[An unusual bronchial foreign body: a fragment of a tracheostomy tube].

A fragment of a fractured tracheostomy tube as a foreign body in the bronchus is very unusual. We report an 18-year old male with Hunter's syndrome who presented with fever and bronchorrhea. He had worn a tracheostomy tube for 2 years without its being removed for cleaning. Chest X-ray showed an opaque foreign body in the right main bronchus which was removed through a flexible bronchoscope and found to be a piece of the broken edge of the outer cannula of a tracheostomy tube. We suggest regular examination of tracheostomy tubes for signs of wear-and-tear and recommend their periodic renewal before they become worn out.

Adolescent↗
PubMed1996

Audiovestibular findings in patients with deafness caused by a mitochondrial susceptibility mutation and precipitated by an inherited nuclear mutation or aminoglycosides.

OBJECTIVE: To characterize the audiological and vestibular changes associated with a mitochondrial DNA mutation in an Arab-Israeli family and in other families with mitochondrial predisposition to aminoglycoside-induced hearing loss. DESIGN: Evaluation of audiological (pure tone thresholds, speech reception thresholds, speech discrimination, tympanometry, acoustic reflex thresholds, tone decay, and auditory brain-stem evoked response recording) and vestibular (complete history, physical examination, and 2-channel electronystagmography) systems. In 5 patients, structural evaluation of the inner ear was done by magnetic resonance imaging. PATIENTS: Fifteen members of an Arab-Israeli family, and 1 Chinese woman with the same mitochondrial DNA mutation who experienced hearing loss after short-term exposure to streptomycin. RESULTS: Most of the patients had a profound hearing loss due to cochlear involvement. The hearing loss usually was not accompanied by notable peripheral vestibular dysfunction. In the patient with severe hearing loss after exposure to aminoglycoside, the vestibular function was completely normal. CONCLUSIONS: In most of the Arab-Israeli patients with congenital deafness, the vestibular system function was normal, in contrast to the frequency of vestibular abnormality among deaf children, which was described in the literature. This may be related to genetic predisposition to aminoglycoside-induced deafness.

Adult↗
PubMed1996

Mucosal melanoma following autologous stem cell transplantation for non-Hodgkin's lymphoma (NHL).

The incidence of secondary malignancy following autologous stem cell transplantation (ASCT) is increasing. We describe a patient with stage IVB Hodgkin's disease who developed primary amelanotic malignant melanoma of the tongue 18 months following autologous stem cell transplantation. She was treated by partial glossectomy and supra-omohyoid neck dissection followed by cytokine-mediated immunotherapy. Malignant melanoma of the skin is a frequent secondary solid tumor seen in patients undergoing stem cell transplantation. However, mucosal melanoma which is rare by itself (0.2-8%) has never been reported in NHL patients following ASCT. Early diagnosis and initiation of combined local and systemic treatments including immuno-therapy may improve the outcome of this rare but lethal complication.

Adult↗
PubMed1995

Reproducible measurements to quantify cutaneous involvement in scleroderma.

BACKGROUND AND DESIGN: Because the current assessment of scleroderma through clinical skin scoring is subjective and imprecise, we devised fully quantitative measures of cutaneous involvement. First, we developed image analysis software for calculating the density of dermal collagen from 58 scleroderma and 327 control biopsy specimens. Second, using a durometer gauge, we obtained measurements of skin hardness over 12 body regions for 13 patients with scleroderma and 100 controls. We obtained serial durometer measurements at 2-cm intervals over the arms of four patients with scleroderma, correlating them with blinded assessments of skin score. Third, we produced two-dimensional laser Doppler maps of cutaneous blood flow over the dorsal aspect of the hands of 10 patients with scleroderma and 16 controls and, with software, we determined the mean red blood cell flux, density of arteriolar islands, and percentage of avascular area at each measured site. RESULTS: Average collagen density was significantly higher in patients with scleroderma (88.5% +/- 6.9%) compared with that in controls (75% +/- 9.3%) (P < .001). Durometer measurements were significantly greater for patients with scleroderma (P < .05) over the finger, hand, wrist, forearm, and ventral aspect of the arm. In individual patients, the measurements paralleled with skin score. In patients with scleroderma, mean red blood cell flux (483.2 +/- 421.2 mV) and arteriolar island density (1.4 +/- 0.5/cm2) were significantly greater than were the control averages (276.3 +/- 146.3 mV [P < .03] and 1.0 +/- 0.5/cm2 [P < .013], respectively). CONCLUSIONS: Dermal collagen density and durometer measurements of skin hardness accurately quantify skin sclerosis in scleroderma and permit the determination of sclerotic borders, respectively. Increased cutaneous red blood cell flux and greater use of microvascular reserve reflect defects in vascular regulation inherent to the disease. These reproducible measurements will allow us to more precisely monitor the progression of scleroderma, evaluate its response to experimental treatments, and investigate its pathogenetic origins.

Adult↗
PubMed1994

Rhinocerebral aspergillosis in patients undergoing bone marrow transplantation.

Rhinocerebral aspergillosis (RA) is becoming increasingly common in patients undergoing bone marrow transplantation (BMT). The disease can involve nearly all major head and neck structures, including the nose, paranasal sinuses, and orbits. Intracranial extension of the infection is of major concern, since this is usually a fatal complication. Our study population comprised 423 consecutive BMT patients at Hadassah University Hospital from January 1986 to August 1992. Eight patients (1.9%) developed RA, 5 of whom had underlying hematologic malignancies, and 3 of whom had severe aplastic anemia. Only 2 of the 8 patients responded completely to therapy, with a follow-up of 15 months. It appears that RA is a fatal complication in immunocompromised patients post-BMT. Early diagnosis followed by extensive surgical debridement of necrotic tissue and systemic, as well as topical, antifungal therapy with amphotericin B or its new formulations and the patient's recovery of bone marrow function may improve the outcome of this life-threatening complication.

Adolescent↗
PubMed1994

Complication of jet ventilation during microlaryngeal surgery.

Complications during jet ventilation for microlaryngoscopy, which is usually a relatively safe procedure, are rare. Those described have included hypoventilation, pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, and gastric distention. We describe herein a case of a life-threatening complication during jet ventilation with a Carden's tube that ended in laparotomy.

Esophagogastric Junction↗
PubMed1994

Aural myiasis caused by flesh fly larva, Sarcophaga haemorrhoidalis.

During the years 1990 to 1993, four cases of aural myiasis in children, caused by the flesh fly larvae of Sarcophaga haemorrhoidalis, are reported. The patients were admitted to the Emergency Room complaining of discharging ear, otalgia, and itching. Flesh fly larvae were removed after local treatment and identified as Sarcophaga haemorrhoidalis. These cases are discussed with a review of the literature.

Animals↗
PubMed1993

Traumatic macroglossia.

A case of severe macroglossia resulting from trauma (tongue biting) during eclampsia and causing respiratory obstruction is described. Despite medical treatment with steroids and antibiotics for a week, followed by tracheostomy, no significant improvement was observed. After an energetic but cautious maneuver of reducing and restraining the tongue in the oral cavity, the swelling reduced dramatically in 24 to 48 hours. Earlier manual replacement of the tongue into the oral cavity is advised in order to arrest the cycle of venous and lymphatic obstruction and congestion that leads to further edema and increased tongue swelling. The mechanism of traumatic macroglossia is discussed.

Adult↗
PubMed1993

The role of CT imaging in the evaluation of cervical esophageal foreign bodies.

Foreign bodies in the hypopharynx and cervical esophagus, such as chicken and fish bones, occur frequently and usually need radiologic work-up in order to demonstrate the presence of the foreign body and its location. Plain antero-posterior and lateral X-ray views of the neck, and if needed, a barium swallow, are the standard. When these studies fail to show the foreign body, unenhanced CT may demonstrate these small calcified esophageal foreign bodies. We evaluated 13 patients with cervical esophageal foreign bodies by CT. It is readily available and rapid and exposes the patient to less radiation than a barium swallow. CT evaluation with soft tissue and bone windows may replace the barium swallow because of its better detection of thin, small, minimally calcified foreign bodies which are often obscured by overlying tissues in the usual X-ray studies.

Adolescent↗
PubMed1992

Pseudoxanthoma-elasticum-like skin changes induced by penicillamine.

The interference of penicillamine with collagen and elastin cross-linking can lead to wrinkling and anetoderma-like lesions in flexural areas as well as fragility and hemorrhagic blisters in pressure areas. These changes are seen primarily in patients with Wilson's disease or cystinuria who are on long-term therapy. This is a report of a patient with cystinuria on long-term, high-dose penicillamine who developed pseudoxanthoma-elasticum-like lesions. Coalescent yellow papules with a 'plucked-chicken skin' appearance were seen in the axillae and on the neck while redundant skin folds were noted in the anterior axillary line and lower buttocks. By light and electron microscopy, involved and uninvolved skin demonstrated 'lumpy-bumpy' dermal elastic fibers with no calcium deposition. These histologic changes are similar to those previously described in patients with penicillamine-induced skin lesions.

Aged↗
PubMed1979

Necrolytic migratory erythema without glucagonoma.

Two patients with clinical and histologic findings consistent with necrolytic migratory erythema are presented. Unlike previously described patients with this disorder, neither patient had substantially elevated glucagon levels nor an associated pancreatic islet cell tumor. The cause of the skin disease in these patients remains unknown but may be related to the underlying small-bowel disorder present in both.

Adult↗