Ilan Bar

Assaf Harofeh Medical Center, Ayun Kara, Central District, Israel

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Publications (13)14.49 Total impact

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    ABSTRACT: We present a case of right pneumonectomy after induction chemotherapy complicated by a large bronchopleural fistula and empyema two weeks after surgery. The patient was treated surgically by transsternal transpericardial bronchopleural fistula closure and open window thoracoplasty. Thereafter, two new fistulae developed, one in the right main bronchial stump and one in the accessory tracheal bronchus. The two Amplatzer devices that were originally designed for transcatheter closure of cardiac defects were successfully used for closure of the bronchopleural fistulae.
    Heart Lung &amp Circulation 03/2013; · 1.25 Impact Factor
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    ABSTRACT: Until the last decade, lobectomy by thoracotomy (TL) was the "gold standard" for treatment of patients with operable lung carcinoma. Today, video-assisted thoracic surgery lobectomy (VATS-L) has become accepted as a safe and effective procedure to treat early-stage lung cancer. We analyzed and compared postoperative complications, hospital stay, morbidity, and mortality after TL and VATS-L in patients with non-small cell lung carcinoma (NSCLC). Between February 1998 and December 2007, we performed 326 TLs in patients with NSCLC. From December 2007, VATS-L was preferentially performed, and 63 cases of NSCLC patients underwent surgery using this method. Comorbidities were scaled according to the Charlson Comorbidity Index, and propensity scores between the TL and VATS-L patients were compared. Postoperative complications occurred in 142 TL patients (43.6%) and 17 VATS-L patients (27%), with 3.6% and 1.6% intrahospital mortality, respectively. There were no significant differences between the TL and VATS-L patients in Charlson Comorbidity Index or propensity scores, which led us to compare complications between TL and VATS-L groups and discovered that VATS-L patients had a shorter median length of stay (P < 0.001) and VATS-L was associated with a reduction in the occurrence of atrial fibrillation (P = 0.011) and offered benefits for patients with more significant comorbidities, for example, congestive heart failure patients (P = 0.042). Our clinical impression is that VATS-L offers advantages over TL in terms of lower morbidity, fewer and less serious complications, shorter hospital stays, and the possibility to operate on patients with more comorbidities.
    Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery 01/2012; 7(1):15-22.
  • The Israel Medical Association journal: IMAJ 07/2011; 13(7):440-1. · 0.98 Impact Factor
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    ABSTRACT: BackgroundA study was undertaken to compare the physiologic and clinical effects of Under Water Seal (UWS) versus Heimlich Valve (HV) pleural drainage systems in the treatment of patients following pulmonary resection. MethodsTwenty patients post pulmonary resection (lobectomy - 13, wedge resections - 6, bullectomy - 1) were studied. The relative intrapleural pressures were measured by a flow meter that was subsequently connected to a UWS and to an HV through straight and curved chest tubes. The quantity of the air leak, if present, was also gauged by a flow meter, and the degree of lung expansion was recorded by chest radiography. ResultsAt resting tidal volume the relative intrapleural pressures measured when using an HV were more negative than those measured when using a UWS. The differences between end-inspiratory and endexpiratory relative intrapleural pressures were greater with a UWS than with an HV. The forced endexpiratory pressures were higher with an HV than a UWS. ConclusionsThe HV maintains more negative intrapleural pressure than a UWS, promotes more effective removal of excess air from the pleural space and ensures more complete expansion of the lung. The HV is superior to a UWS in physiologic postoperative conditions, and may also be preferable in the management of patients with an air leak and residual spaces.
    Indian Journal of Thoracic and Cardiovascular Surgery 12/2010; 25(4):183-187.
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    ABSTRACT: Cardiac resynchronisation therapy using a branch of the coronary sinus is the technique of choice for left ventricular (LV) pacing in patients with poor LV function. An alternative option is the surgical implantation of an epicardial LV lead under direct vision. We describe our initial experience with epicardial LV lead implantation. The records of 10 patients undergoing epicardial LV lead implantation at our institution were retrospectively reviewed. Epicardial leads were implanted on the LV free wall using video-assisted thoracoscopic surgery techniques. Ten patients (seven men; three women; mean age 66.9 years) underwent surgery. All 10 patients suffered from congestive heart failure (CHF) and had a mean LV ejection fraction of 25%. All patients failed endocardial LV lead implantation via the coronary sinus because of lack of adequate branches or inability to cannulate the coronary sinus. There were no intraoperative complications, intrahospital or late deaths. The mean hospital stay was 5.2 days. Follow-up showed reversal of ventricular asynchrony and improvement in functional class in all patients. Thoracoscopic epicardial LV lead implantation is a safe and feasible procedure in a population of high risk patients who need resynchronisation therapy after endocardial LV lead placement has failed.
    Heart Lung &amp Circulation 12/2010; 20(4):220-2. · 1.25 Impact Factor
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    ABSTRACT: We retrospectively analyzed the data of 119 patients who were treated for empyema thoracis from 1999 to 2007. There were 87 men with a mean age of 63.9 years (range, 19-79 years) and 32 women with a mean age 55.2 years (range, 26-78 years). The empyema was right-sided in 73 patients and left-sided in 46. The etiology was parapneumonic in 43.7% of cases, postoperative in 42.0%, posttraumatic in 11.8%, and due to other causes in 2.5%. Eight (6.7%) patients underwent surgery on admission because of unstable clinical status; all 8 survived. Fibrinolysis was used in 111 (93.3%) patients; of these, 88 (73.9%) were successfully treated by intrapleural urokinase instillation, and 23 (19.4%) failed treatment and underwent surgery. All 88 patients who had successful fibrinolytic therapy survived, they accounted for 1.8% of the morbidity. In the 23 patients who underwent surgery after failed treatment, there were 3 deaths, accounting for 2.7% overall mortality and 6.3% morbidity. Treating thoracic empyema in patients with significant comorbidities is challenging. Intrapleural urokinase administration might be beneficial in high-risk patients, but in those without significant comorbidities, early surgery may be considered.
    Asian cardiovascular & thoracic annals 08/2010; 18(4):337-43.
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    ABSTRACT: A diverting (posterior) thoracic esophagostomy is a rare, but acceptable, surgical option in some cases. The goal is to save as much esophageal length as possible with a view to future reconstructive surgery. We herein report a 41-year-old woman, in whom a posterior thoracic esophagostomy was successfully created and used for reestablishing further physiological alimentary continuity in a second stage.
    Diseases of the Esophagus 11/2009; 23(1):E12-5. · 1.64 Impact Factor
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    ABSTRACT: Synovial sarcoma constitutes 8% to 10% of all sarcomas, and most commonly it affects adults in the third to fifth decades of life. This malignancy usually involves the extremities, and although local control by curative resection and adjuvant irradiation has improved, metastases develop in 40% of patients, with lung involvement in the metastatic process in 90% of cases. A single metastasis to the lungs from synovial sarcoma is rare, and a case of a large, single metastasis is even rarer. Herein, we present two cases of patients with an enormous metastatic synovial sarcoma that were successfully removed surgically.
    The Annals of thoracic surgery 11/2009; 88(5):1697-8. · 3.45 Impact Factor
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    ABSTRACT: Accurate preoperative staging of the mediastinum is important in the treatment of non-small-cell lung cancer. Enlarged mediastinal lymph nodes on chest computed tomography are positive for malignancy on mediastinoscopy in only half of these patients. After negative mediastinoscopy, some positive nodes are found at thoracotomy. The aim of this study was to attempt to remove all lymph nodes accessible by cervical mediastinoscopic lymphadenectomy and reevaluate the same mediastinal stations at thoracotomy for missed lymph nodes. Between 1999 and 2003, 30 patients with operable non-small-cell lung cancer and enlarged mediastinal lymph nodes (>1 cm in diameter on computed tomography) that were negative on cervical mediastinoscopy underwent pulmonary resection with complete lymph node dissection. The total number of lymph nodes dissected in these 30 patients was 329 (143 at mediastinoscopy and 186 at thoracotomy); the mean numbers of nodes dissected were 4.8 at mediastinoscopy and 6.2 at thoracotomy. Ten (6.5%) residual lymph nodes were detected at thoracotomy in mediastinal stations R4, L4, and 7. The low number of missed lymph nodes demonstrates the accuracy of the technique of cervical mediastinoscopic lymphadenectomy.
    Asian cardiovascular & thoracic annals 09/2009; 17(4):357-61.
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    ABSTRACT: Lung cancer is the commonest cause of cancer death in developed countries. Adenocarcinoma is becoming the most common form of lung cancer. Cigarette smoking is the main risk factor for lung cancer. Long-term cigarettes smoking may be characterized by genetic alteration and diffuse injury of the airways surface, named field cancerization, while cancer in non-smokers is usually clonally derived. Detecting specific genes expression changes in non-cancerous lung in smokers with adenocarcinoma may give us instrument for predicting smokers who are going to develop this malignancy. We described the gene expression in non-cancerous lungs from 21 smoker patients with lung adenocarcinoma and compare it to gene expression in non-cancerous lung tissue from 10 non-smokers with primary lung adenocarcinoma. Total RNA was isolated from peripheral non-cancerous lung tissue. The cDNA was hybridized to the U133A GeneChip array. Hierarchical clustering analysis on genes obtained from smokers and non-smokers, after subtracting were exported to the Ingenuity Pathway Analysis software for further analysis. The genes subtraction resulted in disclosure of 36 genes with high score. They were subsequently mapped and sorted based on location, cellular components, and biochemical activity. The gene functional analysis disclosed 20 genes, which are involved in cancer process (P = 7.05E-5 to 2.92E-2). Detected genes may serve as a predictor for smokers who may be at high risk of developing lung cancer. In addition, since these genes originating from non-cancerous lung, which is the major area of the lungs, a sample from an induced sputum may represent it.
    Journal of Experimental & Clinical Cancer Research 10/2008; 27:45. · 3.07 Impact Factor
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    ABSTRACT: A large solitary fibrous tumour of the pleura (SFTP) is a very rare occurrence. The aim of this study was to retrospectively review the clinical characteristics, surgical treatment and outcome of patients with a large SFTP operated on in our General Thoracic Surgery Unit. We conducted a retrospective analysis of the clinical records of six patients who underwent surgery for a huge SFTP between 1998 and 2004. Six patients (four men and two women, mean age 73.3 years) with a large SFTP (mean diameter 20.3 and mean weight 1265 g) underwent surgery during this period with full excision of the tumour. Five tumours were excised together with the implantation basis, and in one case extended resection with pneumonectomy was performed. The presentation symptoms resolved in all cases after surgery. Despite the huge size of these tumours (giant SFTP), surgical resection is an acceptable method of treatment in elderly patients with low morbidity and mortality rates.
    Heart Lung &amp Circulation 09/2007; 16(4):282-4. · 1.25 Impact Factor
  • D Stav, I Bar, J Sandbank
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    ABSTRACT: We used oligonucleotide microarrays with probe sets to 22,283 genes to analyze the gene expression profile of lung adenocarcinoma. Cancerous and noncancerous tissue samples were obtained from 23 patients with stage I or II lung cancer; 18 tissue pairs and 5 cancerous tissues. A list of 2065 genes that differentiate between cancerous and noncancerous tissues was generated using Winsorized paired t-tests. We analyzed CDK5RAP3 and CCNB2, which are involved in cell cycle progression, and RAGE. The first 2 of these 3 genes proved to be overexpressed in tumor tissue, whereas the RAGE gene was suppressed in tumor tissue. When CDK5RAP3 and CCNB2 were examined in individual patients we found that in cases where one of these genes was only slightly overexpressed the other was highly overexpressed. The combined expression of the 2 cell cycle genes was found to be statistically significant for differentiating between cancerous and noncancerous tissues. Inclusion of the data for the RAGE gene made the differentiation more powerful. The gene expression ratio gave a clear result: when CDK5RAP3 was expressed more than RAGE, the tissue was carcinomatous, and vice versa. We therefore conclude that these 3 genes may be used as a very reliable biomarker of lung adenocarcinoma.
    The International journal of biological markers 01/2007; 22(2):108-13. · 1.59 Impact Factor
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    ABSTRACT: BackgroundPenetrating cardiac injury is one of the most life-threatening conditions. Most patients die before reaching the hospital and those that arrive alive must receive immediate surgical intervention based on a high index of suspicion. MethodsA retrospective study was conducted of 14 patients with penetrating cardiac trauma who were surgically treated, eight who underwent surgery in Israel and six who underwent surgery in Gaza, The Palestinian National Authority. The factors influencing survival, morbidity and mortality were evaluated and long term follow-up, clinical and demographic data were examined. ResultsFourteen patients underwent urgent surgery due to penetrating heart injury. Twelve patients were in shock on admission, at exploration 11 out of the 14 patients were found to be suffering from cardiac tamponade, eight patients out of the 14 were treated by chest tubes preoperatively due to a hemothorax and seven of these eight patients were also found to have a cardiac tamponade at exploration. None of the 14 patients suffered damage to the coronary arteries. In all patients, bleeding from the hole in the heart was controlled by digital pressure and then closed using Vicryl pledgeted polypropylene sutures. There were no cases of mortality or late morbidity in any of the patients. ConclusionsCardiac tamponade and the absence of coronary vessel injury enabled successful early definitive management of penetrating cardiac trauma patients. Transferring the patient to the operating room without delay is the key to survival.
    Indian Journal of Thoracic and Cardiovascular Surgery 25(1):23-26.