august2014

לשחקן המתקדם 13 . אם לא, המבצע ישליך מפסידים מידו על ♠A או ♦ A הסדרה שכבר פיתחתם עבורו. על מנת להתגונן מהאפשרות הסבירה שלשותף אין אס, . ומה ♥ A- עליכם להעניק חיתוך, לפני שתשחררו את ה ? צריך לקחת זאת בחשבון. הובלה ♦ K- באשר להובלה ב זו תיתן לכם לקיחה או שתיים, אך ייתכן שזה לא יספיק כדי להעניק לכם תוצאה טובה. לפניכם החלוקה כולה: ♠ ♥ ♦ ♣ KT3 KJ954 AT7 J5 ♠ ♥ ♦ ♣ 76 AT863 KQ2 T74 ♠ ♥ ♦ ♣ 954 - J9653 A9862 ♠ ♥ ♦ ♣ AQJ82 Q72 84 KQ3 נקודות; 5 - ♥ A- ; ב נקודות 10 מעניקה ♥ 10- הובלה ב נקודות. 2 - ♦ K- וב אינה מאפשרת למבצע להשלים את ♥ 10- ההובלה ב החוזה. מזרח יחתוך ויחזור בדיאמונד. , והמבצע לא יספיק להשליך ♥ A- ברשותכם עדיין ה דיאמונד מידו על ההארטים מהדומם. מאפשרים ♥ 10- והמשך ב ♥ A- כדאי לראות כי הובלה ב וימשוך ♦ A- לדרום לבצע את החוזה. לאחר שיזכה ב שליטים, הוא ישליך דיאמונד מידו על הארט גבוה. סוף לנחירות! ולדום נשימה בשינה קלה ובינונית באמצעות מייצב לשון רפואי מסיליקון FDA באישור ומשרד הבריאות הישראלי )אמ"ר( מסיכות מבד BPAP ו- CPAP ל- הכי נוחה בעולם FDA באישור ומשרד הבריאות הישראלי )אמ"ר( Œ BPAP ƒ CPAP Š ˜ƒ‰‡Œ ‡~ƒ’– ƒ—Š ”‡‡Œ ˆŠ— ‹‡‡‡ ˜ƒ~‡–‚ ˜ƒŽŒ„‚ƒ ‘ƒŽ ‡ŒŠ 050-6867777 ƒ’Š† www.MedShop.co.il 60850 ‹‚ƒ— 1741  ˜ Œ> ‚‡’‡Œ ˜–… ‡Š ~ƒ‡ ‹Šƒ‚…ƒŽ‡‰‚Œ BPAP :ƒ CPAP Š‚‰‡Œ ˜”‡–’ ~‡‚ ‚‰–‚ ‚ ˜‰Œ ‡—Œ˜—ŒŠ ˜‡Ž‰’‚Œ ‚~”Œ‚ƒ ˜‡–ƒ•Œ ˆ– ‚‰Œ‚ Š— ƒ”‡‚ƒ ˜ƒ‡˜–‡”‡ CPAP . CPAP ƒ BPAP  ‹‡—Œ˜—Œ‚ ˜ƒ…ƒŽŠ ‚…ƒŽ Š•—Œ ‚Š• ˜‰Œ ‚Ž‡— –—’~Œ ˜ƒ’‡Š ˜ƒ…’ –˜ƒ‡ ‚†•— –˜ƒ‡ •‡†Š’ ˜ƒ‰Œ ˜ŒƒŠ €‚ Š ‹€ƒ ‹‡”‚ Š ‹‡Šƒ…Š— –˜ƒ‡ …– ƒƒ€ŒŠ ‹‡~˜Œƒ ƒ•‡Š‡ƒ ? ˜‰‡ŒŠ ‹‡‡Š ˜ƒŽƒ–˜‡ ‚Ž‡—‚ Œ„ –‡ƒƒ~ ˜’‡Š ˜ƒ…’ ˜ƒ‰–ƒ ˜ƒ…ƒŽ ~Š ‚Ž‡— ˜ƒ…ƒŽ˜ ‹‡Ž’ “…Š ‡ŽŒ‡ ~ŠŠ ˜‡‡Œ —– ~ŠŠ –ƒ ‡‡ƒ–€ ~ŠŠ ˜ƒŠ€ƒŒ “…Š ‡”’ƒ “…Š ‡ŽŒ‡ –ƒ ‡‡ƒ–€ ˜‡ŽŒŠ "ƒ ‚„ ˆ‡~ ‰Šƒ…’Ž˜Œ‚ —‡Œ€‚ ƒŠ‚ ƒ–• ƒŒ‰ –˜ƒ‡ ‚ƒ† ‚Œ‡†~ ‚Ž•Œ  ˜‰‡Œ ‹~ Š— ‹ƒŠ‡” ~ŠŠ ‚~–Œ ƒ—Š‚ ”‡‡Œ ‹ƒ…–‡ƒ~‚ ‡˜Ž ‡‰ • ‚Ž‡—‚ Œ„ ƒ—Š‚ ˜…‡Ž” ‹~ Š— ‹ƒŠ‡” ƒ—Š‚ ”‡‡Œ ‹ ‡‰ ‚~–Œ …ƒ˜’ –‡ƒ~‚ ‡˜Ž ‚Ž‡—‚ Œ„ ƒ•‡Š‡Œ –”ƒ‡Œ ‡~ƒ’– ƒ—Š ”‡‡Œ ˜ƒ–‡…Ž‚ ˜‡‡Š –˜ƒ‡ Š‡‡ ƒ–˜’ ~ƒ‚ ‡~ƒ’– —Š˜Œ ”‡‡Œ‚ –ƒ…~Š ƒ—Š‚ ˜…‡Ž”Œ ˜ƒƒŽ‚ ƒ—Š‚Œ ŽƒŒƒ ƒ—Š‚ Š— ‡Œ• •Š…‚ Š ‚–ƒ” –’—Œ ƒ–€‚ ‡–ƒ…~Š…ƒŽ”Š ‘~‚ ˆ– ‚Œ‡—Ž‚ƒ ‚Ž‡—‚ ˜ƒ‰‡~ ˜~ ˜‡˜ƒŒ—Œ ˜ƒ– ˜ƒ‡ –„ŒŠ ‡‡Œƒ ‹‡”Œ Š’†Š FDA : ‚ ‡‡ Š –—ƒ~Œ ’ƒ~ ˜ƒ–‡…Žƒ ‡ŽƒŽ‡  Š• ‚Œ‡—Ž ‹ƒ Š— ‹‡‡Ž—Šƒ’ ‹‡…ƒ˜‡Ž ~ŠŠƒ ˜ƒ’ƒ–˜ ~ŠŠ Š‡‡ ‹‡‡Ž‡— ‡Ž•˜‚ ‘‡Š…‚Š ‡ƒ—ƒ ‹‡–•‡ƒ ‹‡~ƒ‰ ˜‡Ž‡Š• ˜…‰ƒŒ‚ ƒ˜ƒŠ‡‡ Š— CPAP ƒ ‹‡–•‡ CPAP Š ˜‡…‡ –‡‚ ƒ–‡…Œƒ —ƒŒ‡—‚ ˜ƒ…ƒŽ ‹‡‡Ž‡— ‡~’ƒ– Š”~ ‹‡—Ž‚ ‹‡‡Š†Ž ‹‡Ž•˜‚ƒ ‚–‡… Š‰ ƒ‡Š ‹‡”‡ŠŒŒ ‹‡~’ƒ–‚Œ ‹‡– Š• ‚Œ‡—Ž ‹ƒƒ ˜ƒ–‡…Ž Šƒ’‡†Š ‚’‡ƒ ‚Žƒ—~– ‡ŽƒŽ‡  Œ BPA ƒ CPAP Š ˜ƒ‰‡Œ ‡~ƒ’– ƒ—Š ”‡‡Œ ˆŠ— ‹‡‡‡ ˜ƒ~‡–‚ ˜ƒŽŒ„‚ƒ ‘ƒŽ ‡ŒŠ 050-6867777 ƒ’Š† www.MedSho p.co.il 60850 ‹‚ƒ— 1741  ˜ Œ> ‚‡’‡Œ ˜–… ‡Š ~ƒ‡ ‹Šƒ‚…ƒŽ‡‰‚Œ B :ƒ CPAP Š‚‰‡Œ ˜”‡–’ ~‡‚ ‚‰–‚ ‚ ˜‰Œ ‡—Œ —ŒŠ ˜‡Ž‰’‚ ‚~”Œ‚ƒ ˜‡ ƒ•Œ ˆ– ‚‰Œ‚ Š— ƒ”‡‚ƒ ˜ƒ‡˜–‡”‡ CPAP . C ƒ BPAP  ‹‡—Œ —Œ‚ ˜ƒ…ƒŽŠ ‚…ƒŽ Š•—Œ ‚Š• ˜‰Œ ‚Ž‡— –— ~Œ ’‡Š…’ –˜ƒ‡ ‚†•— –˜ƒ‡ •‡† Š’ ƒ‰Œ ˜ŒƒŠ  ‚ Š ‹€ƒ ‹‡”‚ Š ‹‡Šƒ…Š— ˜ ‡ …– ƒƒ€ŒŠ ‹‡~˜Œƒ ƒ•‡Š‡ƒ ? ˜‰‡ŒŠ ‹‡‡Š ˜ƒŽƒ–˜‡ ‚Ž‡—‚ Œ„ –‡ƒƒ~ ’‡Š…’ ˜ƒ‰–ƒ ˜ƒ…ƒŽ ~Š ‚Ž‡— ˜ƒ…ƒŽ˜ ‹‡Ž’ “…Š ‡ŽŒ‡ ~ŠŠ ˜‡‡Œ —– ~ŠŠ –ƒ ‡‡ƒ–€ ~ŠŠ ˜ƒŠ€ƒŒ “…Š ‡”’ƒ “…Š ‡ŽŒ  –ƒ ‡ƒ–€ ˜‡ŽŒŠ "ƒ ‚„ ˆ‡~ ‰Šƒ…’Ž˜Œ —‡Œ€‚ ƒŠ‚ ƒ–• ƒŒ‰ –˜ƒ‡ ‚ƒ† Œ‡†~ ‚Ž•Œ  ˜‰‡Œ ~ Š— ‹ƒŠ‡” ~ŠŠ ‚~–Œ ƒ—Š‚ ”‡‡Œ ‹ƒ…–‡ƒ~‚ ‡˜Ž ‡‰ • ‚Ž‡—‚ Œ„ ƒ—Š‚ ˜…‡Ž” ~ Š— ‹ƒŠ‡” ƒ—Š‚ ”‡‡Œ ‹ ‡‰ ‚~–Œ …ƒ˜’ –‡ƒ~‚ ‡˜Ž ‚Ž‡—‚ Œ„ ƒ•‡Š‡ –”ƒ‡Œ ‡~ƒ’– ƒ—Š ” ˜ƒ–…Ž‚ ˜‡‡ Š –˜ƒ‡ Š‡‡  –˜’ ~ƒ‚ ‡~ƒ —Š˜Œ ”‡‡Œ‚ –ƒ…~Š ƒ—Š‚ ˜…‡Ž”Œ ˜ƒƒ ƒ—Š‚Œ ŽƒŒƒ ƒ Š‚ Š— ‡Œ• •Š…‚ ‚–ƒ” –’—Œ  –€‚ ‡–…~Š…ƒŽ ‘~‚ ˆ– ‚Œ‡—Ž ƒ ‚Ž —‚ ˜ƒ‰ ~ ˜~ ˜‡˜ƒŒ— ˜ƒ ˜ƒ‡ –„ Š ‡‡ ‹‡”Œ Š’†Š FDA : ‚ ‡‡ Š –—ƒ~Œ ’ƒ~ ˜ƒ–‡…Žƒ ‡ŽƒŽ‡  Š• ‚Œ‡—Ž ‹ƒ Š ‹‡‡Ž—Šƒ’ ‹‡…ƒ˜‡Ž ~ŠŠƒ ˜ƒ’ƒ–˜ ~ŠŠ Š ‹‡‡Ž‡— ‡Ž•˜ ‘ Š…‚Š ‡ƒ— –•‡ƒ ‹‡~ ‡Ž‡Š• ˜…‰ƒŒ‚ ƒ˜ƒŠ‡‡ Š— CPAP ƒ ‹‡– CPAP Š ˜‡…‡ ‚ ƒ–‡…Œƒ —ƒŒ‡—‚ ˜ƒ… ‹‡‡Ž‡— ‡~’ƒ– Š”~ ‹‡—Ž‚ ‹‡‡Š†Ž ‹‡Ž•˜ ‚–‡… Š‰ ƒ‡Š ‹‡”‡ŠŒŒ ‹‡~’ƒ–‚Œ ‹‡ Š• ‚Œ‡—Ž ‹ƒƒ ˜ –‡…Ž Šƒ †Š ’‡ƒ ‚Žƒ— ‡ŽƒŽ‡ לפרטים נוספים והזמנות חברת מדיפדיה בע"מ 03-9794711 טל': www.aveotsd.co.il ו באתר: לפרטים נוספים והזמנות חבר ת מדיפדיה בע"מ 03-9794711 טל': www. CPAPAONLINE .info ובאתר: מייצב לשון מסיליקון רפואי למניעת נחירות ודום נשימה בשינה, מוצר לא פולשני, ידידותי למשתמש, לא יקר ויעיל למניעת נחירות ולדום נשימה בשינה, מייצב הלשון מסיליקון רפואי. מסכת הבד הרכה היא פריצת דרך מקורית והמצאה .CPAP מהפכנית למשתמשי המסיכות קלות במשקל ונוחות מאוד מונעות דליפות ומאפשרות שינה על הצד וגם על הגב. סוף לאף סתום ולנחירות! לפרטים נוספים והזמנות חברת מדיפדיה בע"מ 03-9794711 טל': www. MEDSHOP .co.il ו באתר: Œ BPAP ƒ CPAP Š ˜ƒ‰‡Œ ‡~ƒ’– ƒ—Š ” ‹Šƒ‚…ƒŽ‡‰‚Œ BPAP :ƒ CPAP Š‚‰‡Œ ˜”‡–’ ~‡‚ ‚‰–‚ ‚ ˜‰Œ ‡—Œ˜—ŒŠ ˜‡Ž‰’‚Œ ‚~”Œ‚ƒ ˜‡–ƒ•Œ ˆ– ‚‰Œ‚ Š— ƒ”‡‚ƒ ˜ƒ‡˜–‡”‡ CPAP . CPAP ƒ BPAP  ‹‡—Œ˜—Œ‚ ˜ƒ…ƒŽŠ ‚…ƒŽ Š•—Œ ‚Š• ˜‰Œ ‚Ž‡— –—’~Œ ˜ƒ’‡Š ˜ƒ…’ –˜ƒ‡ ‚†•— –˜ƒ‡ •‡† ’ ˜ƒ‰Œ ˜ŒƒŠ €‚ Š ‹€ƒ ‹‡”‚ Š ‹‡Šƒ…Š— –˜ƒ‡ …– ƒƒ€ŒŠ ‹‡~˜Œƒ ƒ•‡Š‡ƒ ? ˜‰‡ŒŠ ‹‡‡Š ˜ƒŽƒ–˜‡ ‚Ž‡—‚ Œ„ –‡ƒƒ~ ˜’‡Š ˜ƒ…’ ˜ƒ‰–ƒ ˜ƒ…ƒŽ ~Š ‚Ž‡— ˜ƒ…ƒŽ˜ ‹‡Ž’ “…Š ‡ŽŒ‡ ~ŠŠ ˜‡‡Œ —– ~ŠŠ –ƒ ‡‡ƒ–€ ~ŠŠ ˜ƒŠ€ƒŒ “…Š ‡”’ƒ “…Š ‡ŽŒ‡ –ƒ ‡‡ƒ–€ ˜‡ŽŒŠ "ƒ ‚„ ˆ‡~ ‰Šƒ…’Ž˜Œ‚ —‡Œ€‚ ƒŠ‚ ƒ–• ƒŒ ‰ –˜ƒ‡ ‚ƒ† ‚Œ‡†~ ‚Ž•Œ  ˜‰‡Œ ‹ ‚~–Œ  ‹ƒ…–‡ • ƒ ‹ ƒ—Š ‡‰ ‚~–Œ …ƒ˜’ ƒ•‡Š‡Œ –”ƒ‡Œ ‡~ƒ’– ˜ –‡…Ž‚ ‡‡ – ‡ Š‡‡ ƒ–˜ —Š˜Œ ”‡‡Œ‚ –ƒ…~Š ƒ—Š‚ ˜… ƒ—Š‚Œ ŽƒŒƒ ƒ—Š‚ Š— ‡Œ• ‚–ƒ” –’—Œ ƒ–€‚ ‡ ‘~‚ ˆ– ‚Œ‡—Ž‚ƒ ‚Ž‡—‚ ˜ƒ‰‡~ ˜ ˜ƒ– ˜ƒ‡ ‹‡”Œ Š’†Š FDA : ‚ ‡‡ Š –— ’ƒ~ ˜ƒ–‡…Žƒ ‡ŽƒŽ‡  Š• ‚Œ ‹‡‡Ž—Šƒ’ ‹‡…ƒ˜‡Ž ~ŠŠƒ ˜ƒ’ƒ–˜ ‹‡‡Ž‡— ‡Ž•˜‚ ‘‡Š…‚Š ‡ƒ—ƒ ‹ ˜‡Ž‡Š• ˜…‰ƒŒ‚ ƒ˜ƒŠ‡‡ Š— C CPAP Š ˜‡…‡ –‡‚ ƒ–‡…Œƒ — ‹‡‡Ž‡— ‡~’ƒ– Š”~ ‹‡—Ž‚ ‹‡‡Š† ‚–‡… Š‰ ƒ‡Š ‹‡”‡ŠŒŒ ‹‡~ Š• ‚Œ‡—Ž ‹ƒƒ ˜ƒ–‡…Ž Šƒ’‡†Š ‚’ Œ BPA ƒ CPAP Š ˜ƒ‰‡Œ ‡~ƒ’– ƒ— ‹Šƒ‚…ƒŽ‡‰‚Œ BP P :ƒ CPAP Š‚‰‡Œ ˜”‡–’ ~‡‚ ‚‰–‚ ‚ ˜‰Œ ‡—Œ —ŒŠ ˜‡Ž‰’‚Œ ‚~”Œ‚ƒ ˜‡ ƒ•Œ ˆ– ‚‰Œ‚ Š— ƒ”‡‚ƒ ˜ƒ‡˜–‡”‡ CPAP . C ƒ BPAP  ‹‡—Œ˜—Œ‚ ˜ƒ…ƒŽŠ ‚…ƒŽ Š•—Œ ‚Š• ˜‰Œ ‚Ž‡— –— ~Œ ’‡Š…’ –˜ƒ ‚†•— –˜ƒ‡ •‡†Š’ ˜ƒ‰Œ ˜ŒƒŠ  ‚ Š ‹€ƒ ‹‡”‚ Š ‹‡Šƒ…Š— ˜ƒ‡ …– ƒƒ€ŒŠ ‹‡~˜Œƒ ƒ•‡Š‡ƒ ? ˜‰ Œ ‹‡‡Š ˜ƒŽƒ–˜‡ ‚Ž‡—‚ Œ„ –‡ƒƒ~ ’‡Š…’ ˜ƒ‰–ƒ ˜ƒ…ƒŽ ~Š ‚Ž‡— ˜ƒ…ƒŽ˜ ‹‡Ž’ “…Š ‡ŽŒ‡ ~ŠŠ ˜‡‡Œ —– ~ŠŠ –ƒ ‡‡ƒ–€ ~ Š ˜ƒŠ€ƒŒ “…Š ‡”’ƒ “…Š ‡ŽŒ  –ƒ ‡‡ƒ–€ ˜‡ŽŒŠ "ƒ ‚„ ˆ‡~ ‰Šƒ …’Ž˜Œ‚ —‡Œ€‚ ƒŠ‚ ƒ–• ƒŒ‰ –˜ƒ‡ ‚ƒ† Œ‡†~ ‚Ž•Œ  ˜‰‡Œ ƒ•‡Š‡ –”ƒ‡Œ ˜ƒ–…Ž‚ ‡‡ Š –˜ƒ‡ — ˜Œ ”‡‡Œ‚ –ƒ…~Š ƒ— ƒ—Š‚Œ ŽƒŒƒ ƒ Š‚ Š ‚–ƒ” –’—Œ ‘~‚ ˆ– ‚Œ‡—Ž ƒ ‚Ž —‚ ˜ƒ – ‹‡”Œ Š’†Š FDA : ‚ ‡ ’ƒ~ ˜ƒ–‡…Žƒ ‡ŽƒŽ‡  ‹‡‡Ž—Š ’ ‹‡…ƒ˜‡Ž ~ŠŠƒ ‹‡‡Ž‡— ‡Ž•˜ ‘ Š…‚Š ‡ ‡Ž‡Š• ˜…‰ƒŒ‚ ƒ˜ƒŠ‡‡ Š CPAP Š ˜‡…‡ ‚ ƒ– ‹‡‡Ž‡— ‡~’ƒ– Š”~ ‹‡—Ž ‚–‡… Š‰ ƒ‡Š ‹‡”‡ŠŒ Š• ‚Œ‡—Ž ‹ƒƒ ˜ –‡…Ž Šƒ Œ BPAP ƒ CPAP Š ˜ƒ‰‡Œ ‡~ƒ’– ƒ—Š ‹Šƒ‚…ƒŽ‡‰‚ Œ BPAP :ƒ CPAP Š ‚‰‡Œ ˜”‡–’ ~‡‚ ‚‰–‚ ‚ ˜‰Œ ‡—Œ˜—ŒŠ ˜‡Ž‰’‚Œ ‚~”Œ‚ƒ ˜‡–ƒ•Œ ˆ– ‚‰Œ‚ Š— ƒ”‡‚ƒ ˜ƒ‡˜–‡”‡ CPA P . CPAP ƒ BPAP  ‹‡—Œ˜—Œ‚ ˜ƒ…ƒŽŠ ‚…ƒŽ Š•—Œ ‚Š• ˜‰Œ ‚Ž‡— –—’~Œ ˜ƒ’‡Š ˜ƒ…’ –˜ƒ‡ ‚†•— –˜ƒ‡ ‚~ ‹ƒ ‡‰ ƒ•‡Š‡Œ –”ƒ‡Œ ‡~ ˜ƒ–‡…Ž‚ ˜‡‡Š –˜ƒ‡ Š‡‡ —Š˜Œ ”‡‡Œ‚ –ƒ…~Š ƒ—Š‚ ƒ—Š‚Œ ŽƒŒƒ ƒ—Š‚ Š— ‚–ƒ” –’—Œ ƒ– ‘~‚ ˆ– ‚Œ‡—Ž‚ƒ ‚Ž‡—‚ ˜ƒ‰ ˜ƒ– ˜ ‹‡”Œ Š’†Š FDA : ‚ ‡‡ Š Œ BPA ƒ CPAP Š ˜ƒ‰‡Œ ‡~ƒ’– ‹Šƒ‚ …ƒŽ‡‰‚Œ B :ƒ C PAP Š‚‰‡Œ ˜”‡–’ ~‡‚ ‚‰–‚ ‚ ˜‰Œ ‡—Œ —ŒŠ ˜‡Ž‰’‚Œ ‚~”Œ‚ƒ ˜‡ ƒ•Œ ˆ– ‚‰Œ‚ Š— ƒ”‡‚ƒ ˜ƒ‡˜–‡”‡ CPAP . CPA ƒ BPAP  ‹‡—Œ —Œ‚ ˜ƒ…ƒŽŠ ‚…ƒŽ Š•—Œ ‚Š• ˜‰Œ ‚Ž‡— –—’~Œ ’‡Š…’ –˜ƒ‡ ‚†•— –˜ƒ‡ ƒ•‡Š‡ –”ƒ‡Œ ˜ƒ–…Ž‚ ˜‡‡ Š –˜ƒ —Š˜Œ ”‡‡Œ‚ –ƒ…~ ƒ —Š‚Œ ŽƒŒƒ ƒ Š ‚–ƒ” –’—Œ ‘~‚ ˆ– ‚Œ‡—Ž ƒ ‚Ž ‹‡”Œ Š’†Š FDA : איירמקס - HellingsandNolstTrenité PNIFvaluesbyAirmax®was176.1±59.6%. Nodi erences inabsolutePNIFvalueswere foundbetween maleand femalepatientsatbaseline (82.7±18.6and89.0±7.3 l/min, respectively),norafter theapplicationof thedevice (143.3 ±7.7and138.2±10.8 l/min, respectively).Similarly,nodi eren- ceswereobserved inPNIFvaluesbetweenpatientsyoungerand older than50yearsofage,orbetween previouslyo peratedand non-operatedpatients (datanot show n). Patients’preference forcontinuationof theendonasal dilator Of the30patientswith subjective improvementofnasalbre- athingby theAirmax®deviceatbaselinevisit,19outof30pa- tients (63.3%)expressed thepreference to furtheruse thedevice after the4w trialperiod. In the lattergroup, themeanbaseline increase inPNIFvalues (85.2±34.8 l/min)wasnotdi erent from thegroup thatdidnotwant tocontinueusing thedevice 3/11mentioned inappropriate sizewith lossofdeviceduring sleeporexerciseasbothersome factor,2/11 reported local ir- ritation in thenasalcavityby thedevice,2/11expressedadesire foraestheticnasalcorrectionat the timeof functional impro- vement,and the remaining4/11wantedade nite solution for theirnasalobstructionproblemby surgery rather thananon- surgical, temporary solution. Discussion Weheredemonstrate thebene ciale ectsof theAirmax® endonasaldilator ina real-lifeclinical setting.Allpatientswith externalvalvedysfunction showedmajorbene t from thedila- tor,asevaluatedby theabsoluteand relative increase inPNIF in allpatients.After the4w trialperiod,19of30patientswere sa- tis edwith theAirmax®nasaldilator,expressing thepreference tocontinuewearing thedevice. This study raises several interesting issues regarding the thera- peuticapproachofnasalvalvedysfunction.Firstly, this study o ers the rst step inevaluating the successof theendonasal dilatorasanalternative for surgery.Atpresent,patientswith nasalvalvedysfunctionarebeingproposed toundergoeither correctivevalve surgeryoraconservativeapproachusingnasal dilators,without surgeonsbeingable togiveanestimated suc- cess rateof theconservativeapproach.Bothexternal (Breath Right®)andaswellasendonasal (Nozovent®orAirmax®)dila tors havebeen reported tobehelpful in snorers, sportsmenand pa- tientswithnasalobstruction,withoutdataon subjectiveev alua- tionby thepatient (9-12) .Here,we show that19outof30 selected patientswithexternalvalveproblemsbeing the reason fornasal obstruction intended tocontinue touse thedilatorAirmax®.This argumentcanbeused ineverydayclinic toexplain thepatients the subjectivebene tof theAirmax®dilator. Until recently,weonlyhad limitedobjectivedataon the impro- vementofnasalbreathingbynasaldilators (9-12) .The reported improvementofnasal owby thedilatorswasperformedbyei- theracustic rhinometry (9,10) or rhinomanometry (11,12) .Regarding thedi erent techniques formeasuringnasal ow,aEuropean consensusgroup recently stated thatPNIFmeasurementsare superior toothermeansofevaluationofnasal owdue to the fact thatPNIFdatacorrelatewith the subjective feelingof nasalobstructionand that thenasal ow ismeasuredwithout distortionof thenasalvalveareabyanozzle (2) .Therefore,PNIF Figure1.Frontal (upperpanel)and inferior (lowerpanel)viewson the nosewith (righpanel)andwithout (leftpanel) thenasaldilator, showing an increase innasaldiameterat the levelof theexternalnasalvalvearea. Corrected proof Helin sandNolstTre ité P IFval esbyAirm x®was176.1±59.6%. Nodi er ces ina sol teP IFval eswer foundb tw malean femalep ti ntsatb s lin (82.7±18.6and89.0±7.3 l/ in, r s e tively),noraft r theap lic tionof th devic ( 43.3 ±7.7and138.2±10.8 l/ in, r s e tively).Simil rl ,nodi er - ceswereo s r ed inP IFval esb tw enp tientsyoun ran ol r t an50yearsofag ,orb tw e npreviouslyo eratedan o -o eratedp ti nts ( atanot show ). Patie ts’pr f re c forco tinuatio of theendon s l dil t r Of the30p ti ntswith subje tiv i r m ntofn s lbr - thingb theAirm x®deviceatb s linevisit,19outof30p - ti nts (63.3%)ex r ssed theprefer c t furt rus th devi aft r the4w tri lp riod. In th la t rgroup, th m anb s li incr s inP IFval es (85.2±34.8 l/ i )wasnotdi er t fr thegroup t tdidnotw nt t co tin eusing th devi /1 m ntio e i p ropriate siz wit lo sofdevicedurin sl eporexerciseasb t ers me factor,2/1 r porte local ir- rit tio in then s lca it b th devic ,2/11ex r ssedadesir foraest ticn s lco re tionat the timeof fun tional i r - m nt,and th remaining4/1 w tedad nite solutio f r theirn s lobstru tionproble by s r ery r t er t anano - s rgical, te p rary solutio . Di cus i W her de ons rat th b ci le ectsof theAirm ® ndo s ldil tor ina real-lifeclinical settin .Alp ti ntswit xt rn lvalvedysfunction showe majorb t fr thedil - tor,asev l atedb thea sol teand rel tiv incr s inP I i alp ti nts.Aft r the4w tri lp rio ,19of30p ti ntswere s - tis e wit theAirm x®n s ldil tor,ex re sing theprefer t co tinu we ring th devi . This stud raises s veral i terestin iss es r r ing th t er - uticap r chofn s lvalvedysfun tio .Firstly, this stu o ers the rst step inev l ting the s ce sof theendo s l il torasanalt r tiv for s r er .Atpr s nt,p ti ntswit s lvalvedysfun tionar beingpr p sed toun rgoeit r co re ti evalve s r eryoraco serv tiveap r chusingn s l il tors,without s r onsbeingabl togiveanestimated s - cess rateof theco serv tiveap r c .B thext rnal ( re t Right®)andaswelasendo sal (N z nt®orAirm x®)dil tors v b en r ported tob hel ful i sn rers, sportsme and p - ti ntswithnas lobstructio ,withoutdataon subje tiveev l - tionb thep ti t (9-12) .Her ,we show t t19outof30 select ti ntswithext rn lvalveproblemsbeing th r so forn s l obstru tio i t n ed t co tinu tous thedilatorAirmax®.This rg m ntcanbeuse ineverydayclini toexplain thep tients the subje tiv b tof theAirm x®dil t r. Until r ntl ,weonlyhad li itedobje tivedataon th i r - m ntofn s lbre thingbyn s ldil tors (9-12) .Th r port i r m ntofn s l o b thedil torswaspe f rmedbyei- t ra usti rhin metr (9,10) or rhin m nometr (11,12) .R r ing thedi er nt t h iq es form suringn s l ow,aE ro o s susgroup r ntly stated t tP I m s r m ntsar su rior toot rm nsofev l tionofn s l o du t th fact t tP IFdatacorrelat wit the subje tiv fe lingof s lobstru tio and t t then s l ow ism s re witho t dis ortionof then s lvalveareabyan zle (2) .T eref r ,P I Figure1.Frontal ( p rpanel)an inf rior (low rpanel)viewso t nosewith (righpanel)andwit out (leftpanel) thenasaldilator, s o in an incr ase innasaldiameterat the levelof theexternalnas lvalv ar a. r ected p עם איירמקס HellingsandNolstTrenité PNIFvaluesbyAirmax®was176.1±59.6%. Nodi erences inabsolutePNIFvalueswere foundbetween male nd femalepatientsa b seline (82.7±18.6and89.0±7.3 l/min, respectively),norafter heapplication fthed vice (143.3 ±7.7and138.2±10.8 l/min, respectively).Simlarly,nodi eren- ceswereobserv d inPNIFvaluesbetweenpatientsyoungerand older than50yearsofage,orbetweenpr eviouslyope ratedand no - peratedpatients (datanot shown). Patients’preferenc forc nti uation ftheendonas l dilator Of the30patientswith subjective improvem ntofnasalbre- athingby theAirmax®deviceatb selinevisit,19outof30pa- tients (63.3%)express d thepr fer nce tofurtheruse thed vice after he4w trialperiod. In the latterg oup, themeanbaseline increas inPNIFvalues (85.2±34.8 l/min)wasnotdi erent from thegroup tha didnotwant toc nti ue sing thed vice 3/11mentioned inapprop iate sizewith lossofdeviceduring sleeporex rciseasbothersome factor,2/11 reported local ir- ritation i thenasalcavityb thed vice,2/11express da esir foraesthe icnasalcorrectionat the timeoffunctional impro- vem nt,and the r maining4/11wanteda e nite solution for theirnasalobstructionproblemby surge y ather than no - surgical, temporary solution. Discussion Weh red monstra e heb n ciale ctsoftheAirmax® endonasaldiator ina re l-lifeclinical setting.Allpatientswith ext rnalval edysfunction showedmajorben t from thedila- tor,asevalu tedby theabsoluteand relative increas inPNIF in allpatients.After he4w trialperiod,19of30patientswere sa- tis edwith t eAirmax®nasaldiator,expressing thepr fer nce toc nti uewearing thed vice. This study raises s v ral interesting issue r garding the t era- peuticapproachofnasalval edysfunction.Firstly, his study o ers the rst step inevalu ting the successoftheendonasal dilatoras n lternative forsurge y.Atpresent,patientswith nasalval edysfunctionareb ingpro sed toundergoeither corrective al e surge yoraconservati eapproachusing asal dilators,without s rgeonsbeingable togiveanestimated suc- cess rateoftheconservati eapproach.Bothext rnal (Breath Right®)andaswellasendonasal (Noz vent®orAi max®)dilato rs haveb en r ported tobeh lpful in s orers, sportsmena dpa - tientswithnasalobstruction,withoutdataon subjectiveevalu - tionby thepatient (9-12) .Here,weshow tha 19outof30select d patientswithext rnalval eproblemsbeing the r ason fornasal obstruction i te de toc nti ue touse thedilatorAi max®.This argumentcanbeused inev rydayclinic toexplain thepatients the subjectiveb n toftheAirmax®dilator. Until recently,weonlyhad limitedobjectivedataon the impro- vem ntofnasalbreathingbynasaldiators (9-12) .The r ported improvem ntofnasal owby thedilatorswasperfo medbyei- theracustic rhinometry (9,10) orrhinomanometry (11,12) .Regarding thedi erent techniques formeasuring asal ow,aEuropean consen u group recently stated tha PNIFmeasurem ntsare superio t othermeansofevalu tion fnasal owdue to the fact tha PNIFdatacorrelat with t e subjective f lingof nasalobstructiona d tha thenasal ow ismeasuredwithout distor i n fthenasalval ear byanozzle (2) .Therefore,PNIF Figure1.Frontal (upper anel)and i ferio (l werpanel)viewsonthe nosewith (righpanel)andwithout (leftpanel) thenasaldiator, showing an increas innasaldiameterat thelevelof theext rnal salv l ear . r e ted p ols n b i x w 17 9 i r n in te we o ndbe l f al t a i . 8 89 ± . e i ra ter e n f e 3 . 13 0 m e i la n di r n we o s d N sb e a nge er a s be r e i s o e ted - e ted a t ts w ) t t ce r o t t e d s e a i h s j c i e ntof b e ngby e i x d a i it tof a . ) e d he e e en f s t e er e a d. he o p, he a a i e s in N ( . 4 /m n tdi r n e o p tha id otw t c t ue the n one r iz h lo rng e re ea b t r r n i he c e 2 e d r a c r i na e unc i na n a the ai g4 e o tion f r a o s r ti npro l m su h a - c t p r o tion. o o s e e s e i x ona d in l e n et g. p i h r c i n s w j be e - ev d y e te re e s in N t r e a d, a e a- h e i x n d e i the e e en c t ue i g the u y es s v al e s g i e r n the he - c c f v c i n. r y t is u y e e g the u s e ona a n s re pa i h v c i na ingpro se ounde g e he r i u a o s at c s a w houts s nga gi t t d s a e e s at c t e r th ht ) a we en ona ( A x l e r tobe pfu i r s r m n pa t i hna o s r cti n, houtda o s j c i nby e , h w a tof ele t i he t r o l ms ng the s f na s r ti n i e e oc t ue us t e A x h g m n c e y ln e he u j c i f e i x d l e y w ly t bj c i the n of b e thngby d T e r e n of e a p d y inom t , r inom n m t , ) r ng r n t iq e f m a ng a aE e s o p re y t d ha N a n r e t oth a n f e ha N r e h e u j c i of o s r ti na tha e a hout n f e v z e . r for NF u . (u n and wer n views e h n and i h f n t nas iato s wn i r a n s iam tt level ft ex s r e t d בלי איירמקס FDA באישור ( CE ומשרד הבריאות האירופאי ) איירמקס נמצא יעיל ביותר גם בשיפור ביצועי ספורטאים היות והוא מאפשר נשימה טוב יותר דרך האף ומונע את הצורך במעבר לנשימה דרך הפה.