[Surgery for emphysematous giant bullae].

We address 3 important keys to obtain successful outcomes in surgery for emphysematous giant bullae. It is the 1st step to select patients who might benefit from bullectomy based on functional imaging. The chest computed tomography (CT) and pulmonary perfusion scintigram provide information regarding with pulmonary vascular beds which could be recruited by bullectomy. In addition, dynamic-magnetic resonance imaging (MRI) during breathing can show a patient with paradoxical inflation of giant bulla during expiration, which means impairment of ventilation of the adjacent normal parenchyma, and is a promising sign for successful outcome of bullectomy. Second, it should be emphasized to perform a proper procedure in bullectomy. If a giant bulla has a wide bottom, it should be recommended to open the bulla and to plicate it by sutures without injury of vessels on the bottom of the bulla rather than simple bullectomy with staples. Finally, it is important to keep inflated lung avoiding atelectasis following operation by minimum pressure of suction. We show here sequential bullectomies on a 41-year-old male with chronic obstructive pulmonary disease (COPD) GOLD IV due to bilateral giant bullae and poor vascular reserve, and address our strategy described above.

Fertility of Palestinian women between national perspective and social reality.

"This paper investigates the social content of fertility patterns in four Palestinian conglomerations, viz., the West Bank, Gaza Strip, Galilee and Jerusalem, on the basis of an analysis of fertility data derived from official sources and field work conducted by Palestinian demographers. It seeks to identify meaningful relationships between these data and variables related to the household's place of residence, social class, and vocational and educational background. The paper also reviews the demographic history of Arab citizens in the occupied territories since 1948 to determine the effect on fertility trends.... The paper finally touches on the impact of the Palestinian intifada...."