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1.
World J Surg ; 40(9): 2117-22, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27255939

ABSTRACT

BACKGROUND: Field hospitals have been deployed by the Israel Defense Forces (IDF) Medical Corps in numerous disaster events. Two recent deployments were following earthquakes in Haiti in 2010 and in Nepal in 2015. Despite arrival in similar timetables, the mode of operation was different-independently in Haiti and in collaboration with a local hospital in Nepal. The pathology encountered in the two hospitals and the resultant treatment requirements were significantly different between the two events. The purpose of this study was to analyze these differences and their implications for preparation and planning of future deployments. METHODS: Data were obtained from IDF records and analyzed using SPSS™ software. RESULTS: 1686 patients were treated in Nepal versus 1111 in Haiti. The caseload in Nepal included significantly less earthquake-related injuries (26 vs. 66 %) with 28 % of them sustaining fractures versus 47 % in Haiti. Femoral fractures accounted for 7.9 % of fractures in Nepal versus 26.4 % in Haiti with foot fractures accounting for 23.8 and 6.4 %, respectively. The rate of open fracture was similar at 29.4 % in Nepal and 27.5 % in Haiti. 18.1 % of injured patients in Nepal underwent surgery, and 32.9 % of which was skeletal compared to 32 % surgical cases (58.8 % skeletal) in Haiti. 74.2 % of patients in Nepal and 34.3 % in Haiti were treated for pathology unrelated to the earthquake. CONCLUSIONS: The reasons for the variability in activities between the two hospitals include the magnitude of the disaster, the functionality of the local medical system which was relatively preserved in Nepal and destroyed in Haiti and the mode of operation which was independent in Haiti and collaborative with a functioning local hospital in Nepal. Emergency medical teams (EMTs) may encounter variable caseloads despite similar disaster scenarios. Advance knowledge of the magnitude of the disaster, the functionality of the local medical system, and the collaborative possibilities will help in planning and preparing EMTs to function optimally and appropriately. However, as this information will often be unavailable, EMTs should be capable to adapt to unexpected conditions.


Subject(s)
Cooperative Behavior , Earthquakes , Health Resources , Orthopedic Procedures , Wounds and Injuries/therapy , Disasters , Female , Haiti , Hospitals , Humans , Male , Nepal , Young Adult
2.
Clin Ophthalmol ; 8: 843-6, 2014.
Article in English | MEDLINE | ID: mdl-24812491

ABSTRACT

A 44-year-old woman, who had undergone gold-weight implantation due to facial palsy and lagophthalmos, arrived at the ophthalmology ward with eyelid swelling and erythema, which rapidly deteriorated under intravenous antibiotics to a necrotic process involving the periocular tissues, the eye, and the anterior orbit. Despite prompt removal of the gold weight, the patient's ocular and systemic condition continued to deteriorate, necessitating evisceration and debridement of necrotic tissue. Cultures showed growth of Staphylococcus epidermidis, Staphylococcus capitis, Candida glabrata, and Candida albicans, and histopathology demonstrated an acute nonspecific necrotizing panophthalmitis. Later on, the patient was admitted to a plastic surgery ward with recurrent severe burns of her thigh, which were highly suggestive of being self-induced, raising the possibility of self-induced damage.

3.
Aesthetic Plast Surg ; 37(2): 336-40, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23377144

ABSTRACT

BACKGROUND: Short-scar breast reduction techniques have become very popular in the last two decades. These techniques cannot be used very often in patients with exceptionally large breasts because of the excessive amounts of redundant skin. In this article we describe our new approach for dealing with the extra skin remaining in patients with very large breasts so that they may also benefit from the short-scar breast reduction procedure. METHODS: In our technique the vertical suture line is divided into two separate suture lines. The first suture line follows the natural curve of the lower pole of the breast from the nipple to the chest wall. This line is elongated by elevating and anchoring the new inframammary fold higher on the chest wall with a suspensory suture and the skin is then closed in a straight line. The second suture line attaches the extra lower skin by closing the dermis to the chest wall and then closing the skin with a purse-string suture. This technique helps to deal with the extra skin resulting from the short-scar breast reduction technique. RESULTS: The technique was used in ten patients with large breasts. Patient satisfaction was excellent and there was no increase in complications. The technique also helped to obliterate the dead space beneath the breast and reduced seroma formation. CONCLUSION: We found that this new technique can be used safely and effectively in selected patients with large breasts without any increase in complications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Subject(s)
Breast/pathology , Breast/surgery , Cicatrix/prevention & control , Mammaplasty/methods , Adolescent , Adult , Breast/abnormalities , Cohort Studies , Esthetics , Female , Follow-Up Studies , Humans , Hypertrophy/surgery , Middle Aged , Patient Selection , Prospective Studies , Suture Techniques , Treatment Outcome , Wound Healing/physiology , Young Adult
4.
Head Neck ; 35(9): 1265-8, 2013 Sep.
Article in English | MEDLINE | ID: mdl-22907689

ABSTRACT

BACKGROUND: Studies have focused on enhancing flap viability using superoxide dismutase (SOD), but only a few used SOD from human origin, and most gave the compound systemically. We evaluated the ability of SOD to improve random skin flap survival using human recombinant copper-zinc superoxide dismutase (Hr-CuZnSOD) in variable doses, injected intradermally into the flap. METHODS: Seventy male Sprague Dawley rats were randomly assigned into 4 groups. Cephalic random pattern flaps were elevated on their backs and intradermal injections of different dosages of Hr-CuZnSOD were given 15 minutes before surgery. Flap survival was evaluated by fluorescein fluorescence. Analysis of variance (ANOVA) and t test statistical analyses were performed. RESULTS: Flap survival in all treated groups was significantly better than in the controls. CONCLUSIONS: The beneficial effect of HR-CuZnSOD on flap survival is attained when it is given intradermally into the flap tissue. Theoretically, Hr-CuZnSOD delivered with local anesthetics used in flap elevation may be a valuable clinical tool.


Subject(s)
Graft Survival/drug effects , Skin/drug effects , Superoxide Dismutase/pharmacology , Surgical Flaps , Animals , Humans , Injections, Intradermal , Male , Rats , Rats, Sprague-Dawley , Recombinant Proteins
6.
J Plast Surg Hand Surg ; 46(2): 91-4, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22471256

ABSTRACT

The maintenance of vascular patency is one of the key points to be considered after a pedicled transverse rectus abdominis myocutaneous (TRAM) flap has been raised and when closing the anterior rectus fascia to avoid a hernia. In this study we describe a new approach to closing the most superior part of the fascia to help insure vascular patency. Forty patients who had their breasts reconstructed with TRAM flaps made up the study group. The new back cut technique was used in 25 patients. Of the remaining 15 patients, four required early revision on the day of operation for severe venous congestion or ischaemia. None of the patients who had the back cut technique required early revision. We found the back cut technique to be safe and easy, and we think that it can reduce the incidence of flap ischaemia and still achieve tight fascial closure.


Subject(s)
Mammaplasty/methods , Rectus Abdominis/transplantation , Subcutaneous Tissue/surgery , Surgical Flaps/blood supply , Transplant Donor Site/surgery , Aged , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Cohort Studies , Female , Follow-Up Studies , Hernia, Ventral/etiology , Hernia, Ventral/prevention & control , Humans , Israel , Mammaplasty/adverse effects , Mastectomy/methods , Middle Aged , Rectus Abdominis/blood supply , Rectus Abdominis/surgery , Regional Blood Flow/physiology , Retrospective Studies , Risk Assessment , Suture Techniques , Tensile Strength , Treatment Outcome
7.
J Appl Toxicol ; 32(6): 409-16, 2012 Jun.
Article in English | MEDLINE | ID: mdl-21861267

ABSTRACT

Organophosphate intoxication induces neural toxicity as demonstrated in histological analysis of poisoned animals. Diffusion-weighted magnetic resonance imaging (DWMRI) enables early noninvasive characterization of biological tissues based on their water diffusion characteristics. Our objectives were to study the application of MRI for assessment of paraoxon-induced brain damage and the efficacy of antidotal treatments. Seventy-six rats were poisoned with paraoxon followed by treatment with atropine and obidoxime. The rats were then divided into five treatment groups consisting of midazolam after 1 or 30 min, scopolamine after 1 or 30 min and a no anticonvulsant treatment group. Five untreated rats served as controls. Animals underwent MRI on days 1, 8, 15, 29 and 50 post poisoning. Histological evaluation was performed on representative rat brains. Acute DWMRI effects, such as enhancement of temporal brain regions, and chronic effects such as ventricular enlargement and brain atrophy, depicted on T2-weighted MRI, were significantly more prominent in late anticonvulsant treatment groups. There was no significant difference between the neuroprotective effects of midazolam and scopolamine as shown by DWMRI. Early MRI abnormalities were found to correlate significantly with histological analysis of samples obtained 15 days post treatment. In conclusion, our results demonstrate the feasibility of using DWMRI for depiction of early cytotoxic response to paraoxon and T2-weighted MRI for later changes, thus enabling assessment of early/late brain damage as well as treatment efficacy in rats. The ability to depict these changes early and noninvasively may be applied clinically in the acute phase of organophosphate poisoning.


Subject(s)
Antidotes/pharmacology , Brain Diseases/chemically induced , Brain/drug effects , Cholinesterase Inhibitors/toxicity , Magnetic Resonance Imaging/methods , Paraoxon/toxicity , Animals , Atropine/pharmacology , Brain/pathology , Brain Diseases/diagnosis , Brain Diseases/metabolism , Cholinergic Antagonists/pharmacology , Cholinesterase Reactivators/pharmacology , GABA Modulators/pharmacology , Male , Midazolam/pharmacology , Obidoxime Chloride/pharmacology , Rats , Rats, Sprague-Dawley , Scopolamine/pharmacology
8.
Ann Plast Surg ; 68(1): 72-3, 2012 Jan.
Article in English | MEDLINE | ID: mdl-21629104

ABSTRACT

Basal cell carcinoma (BCC) is the most common malignant tumor in the world. Total tumor ablation is the gold standard of treatment. Our aim in this study was to evaluate the effectiveness of a new clinical method, we dubbed the "stretch test," in reducing the incidence of incomplete excision of BCC. All BCCs excised between October 2001 and June 2007, by 1 plastic surgeon, served as the treatment population. Until September 2004, BCCs were excised in the traditional manner and this group served as a control. From October 2004, the stretch test was used in all patients with BCC and this group served as a study group. Overall, the incomplete excision rate was 3.7% (22/596). The rate of incompletely excised BCC until 2004 was 6.4% (16/249) and it decreased significantly (P < 0.05) from 2004 to 1.7% (6/347) in the group in which the stretch test maneuver was used. We found a significant decrease in the rate of incomplete excision of BCC when the stretch test was employed. This reduces the need for reexcision, improves patient recovery, and satisfaction, and helps reduce healthcare costs.


Subject(s)
Carcinoma, Basal Cell/surgery , Diagnostic Techniques, Surgical , Skin Neoplasms/surgery , Skin/pathology , Aged , Carcinoma, Basal Cell/pathology , Female , Humans , Male , Skin Neoplasms/pathology , Treatment Outcome
9.
Harefuah ; 149(4): 219-21, 264, 263, 2010 Apr.
Article in Hebrew | MEDLINE | ID: mdl-20812493

ABSTRACT

BACKGROUND: Many patients undergoing cutaneous surgery are treated with aspirin due to its proven advantages. Discontinuation of aspirin prior to surgery is still controversial. We conducted a large-scale, prospective study to evaluate the safety of dermatologic surgery in patients receiving aspirin. OBJECTIVES: The authors' objectives were to evaluate the complication rate in patients undergoing cutaneous surgery while treated with aspirin. METHODS: All patients operated on solely by one plastic surgeon were included in the study. The study group included all patients receiving aspirin during surgery, while the rest of the patients comprised the control group. Demographic data, surgery type and complication rate were collected. Complications were classified as major or minor hematoma, wound infection and dehiscence. Statistical significance was calculated using the Student's t-test and Chi test. RESULTS: During the study period 7259 patients underwent minor cutaneous surgery (without local flaps or skin grafts). A group of 115 patients taking either Plavix (Clopidrogel) or Coumadin (Warfarin) were excluded. The study group consisted of 1088 patients who were taking aspirin regularly while 6056 patients comprised the control group. A statistically significant change was found between the two groups regarding sex, age, background chronic diseases and in the distribution of lesions across the body. No significant change was found regarding the peri-operative complications. CONCLUSIONS: In this large-scale prospective study, dermatologic surgery on patients receiving aspirin was found to be safe, as no statistically different complication rate was found between the study and the control groups. This statement is further emphasized due to the significantly statistically older age, chronic illness rate and the head and neck location of the lesions in the study group.


Subject(s)
Aspirin/adverse effects , Minor Surgical Procedures/standards , Skin Diseases/surgery , Surgery, Plastic/standards , Humans , Prospective Studies
10.
Harefuah ; 148(12): 820-3, 855, 2009 Dec.
Article in Hebrew | MEDLINE | ID: mdl-20088434

ABSTRACT

BACKGROUND: Skin tumors are the most common malignancies in the Western population, with surgical excision being the definitive treatment. OBJECTIVES: The authors' objectives were to compare the precision of clinical diagnosis of malignant melanomas (MM) by a plastic surgeon in a community clinic with and without the use of dermoscopy. METHODS: The control group comprised of all patients operated on solely by one plastic surgeon between 2001 and 2003, at which time dermoscopy was not used. The study group included all patients operated on by the same surgeon between the years 2007 and 2008. Clinical, dermoscopic and histological data for both groups were reviewed. The sensitivity and positive predictive value (PPV) were measured and compared using the Fisher's exact test and chi square test. RESULTS: Overall, 1806 skin lesions were excised in the control group compared to 1039 lesions in the study group. A total of 680 melanocytic lesions, 167 dysplastic melanocytic lesions and 20 MM were excised in the control group. The sensitivity for the diagnosis of melanoma was 80% and the PPV was 53%. In the study group 415 melanocytic lesions where excised, of which 63 were dysplastic lesions and 14 MM. The sensitivity for MM diagnosis was 77% and the PPV was 83%. The authors found a statistically significant improvement in the positive predictive value (P<0.05), however, no significant change in the sensitivity for MM diagnosis was observed. A significant statistical reduction in the removal of dysplastic melanocytic lesions was also observed (P<0.05). CONCLUSIONS: Dermoscopy is a simple, easy to use technique which aids the clinician in improving his accuracy of melanoma and dysplastic melanocytic lesions diagnosis thus reducing unnecessary benign excisions.


Subject(s)
Dermoscopy/methods , Melanoma/pathology , Skin Neoplasms/pathology , Diagnosis, Differential , Humans , Melanoma/surgery , Predictive Value of Tests , Sensitivity and Specificity , Skin Neoplasms/surgery , Skin Pigmentation , Surgery, Plastic/statistics & numerical data
11.
Isr Med Assoc J ; 10(11): 761-6, 2008 Nov.
Article in English | MEDLINE | ID: mdl-19070282

ABSTRACT

The relative accessibility to various chemical agents, including chemical warfare agents and toxic industrial compounds, places a toxicological mass casualty event, including chemical terrorism, among the major threats to homeland security. TMCE represents a medical and logistic challenge with potential hazardous exposure of first-response teams. In addition, TMCE poses substantial psychological and economic impact. We have created a simple response algorithm that provides practical guidelines for participating forces in TMCE. Emphasis is placed on the role of first responders, highlighting the importance of early recognition of the event as a TMCE, informing the command and control centers, and application of appropriate self-protection. The medical identification of the toxidrome is of utmost importance as it may dictate radically different approaches and life-saving modalities. Our proposed emergency management of TMCE values the "Scoop & Run" approach orchestrated by an organized evacuation plan rather than on-site decontamination. Finally, continuous preparedness of health systems - exemplified by periodic CBRN (Chemical, Biological, Radio-Nuclear) medical training of both first responders and hospital staff, mandatory placement of antidotal auto-injectors in all ambulances and CBRN emergency kits in the emergency departments - would considerably improve the emergency medical response to TMCE.


Subject(s)
Chemical Terrorism , Emergency Medical Services , Mass Casualty Incidents , Algorithms , Decontamination , Disaster Medicine , Disaster Planning , Emergency Medical Services/organization & administration , Humans , Poisoning/therapy
13.
Isr Med Assoc J ; 9(10): 750-2, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17987767

ABSTRACT

OsO4 is a powerful oxidizer. It affects mainly the skin and mucous membranes. Although unsuitable for a large-scale terrorist attack, mainly due to its scarcity, it could be used in small-scale attacks. The small quantity contained in a vial would cause irritation to the eyes, nose, throat and skin. Combining the agent with an explosive material will probably destroy most of it, chemically. Thus, releasing the chemical without using explosives may be considerably more dangerous. Medical management is mainly symptomatic. As soon as the chemical enters the body, it rapidly reacts with the tissues in contact. Medical personnel should be aware of its poisonous effects and be equally familiar with the necessary self-protection measures and the treatment protocols.


Subject(s)
Chemical Terrorism , Chemical Warfare Agents/toxicity , Environmental Exposure/adverse effects , Osmium Tetroxide/toxicity , Oxidants/toxicity , Emergency Treatment , Environmental Exposure/analysis , Humans , Mucous Membrane/drug effects , Skin/drug effects
14.
Isr Med Assoc J ; 9(9): 677-9, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17939634

ABSTRACT

Bromine is a strong and prevalent irritating agent that can spread both as liquid and as fumes. It has a characteristic reddish-brown color. The mainstay of the medical management is supportive and symptomatic therapy that should be given as soon as possible to prevent further damage. Medical personnel, especially the emergency department staff, should be familiar with its health effects, including the safety precautions needed when caring for casualties following such an exposure.


Subject(s)
Bromine/toxicity , Chemical Terrorism , Burns, Chemical/etiology , Burns, Chemical/therapy , Emergency Treatment , Environmental Exposure/adverse effects , Eye Injuries/chemically induced , Eye Injuries/therapy , Gastrointestinal Diseases/chemically induced , Gastrointestinal Diseases/therapy , Humans , Respiratory Distress Syndrome/chemically induced , Respiratory Distress Syndrome/therapy
15.
Mil Med ; 172(6): 607-10, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17615841

ABSTRACT

OBJECTIVE: On March 20, 1995, sarin gas was used in Tokyo by members of the Japanese "Uhm-Shinrikiu" cult, killing 12 and injuring >5,500 innocent people. Most of the casualties were mildly injured. This article reviews the neurological follow-up data for some of the victims over the past decade. METHODS: We reviewed the published literature regarding neurological follow-up of the victims, dividing the data according to the time elapsed after the attack. RESULTS: The digit span test, finger-tapping test, and computerized posturography were the only performance tests that showed statistically significant differences between the victims and the control groups in some of the surveys. The main sequela 7 years after the attack was post-traumatic stress disorder. CONCLUSIONS: The results emphasize the need for a national preparedness program for such mass casualty events, led by national health systems. This should include long-term, neurological, follow-up monitoring with performance tests and a post-traumatic stress disorder screening test.


Subject(s)
Brain Diseases/etiology , Chemical Terrorism , Chemical Warfare Agents/toxicity , Cognition Disorders/etiology , Sarin/toxicity , Stress Disorders, Post-Traumatic/etiology , Brain Diseases/chemically induced , Case-Control Studies , Cognition Disorders/chemically induced , Emergency Service, Hospital/statistics & numerical data , Follow-Up Studies , Health Surveys , Humans , Japan , Surveys and Questionnaires , Survivors , Time Factors , Transportation
16.
Harefuah ; 146(3): 228-34, 244, 2007 Mar.
Article in Hebrew | MEDLINE | ID: mdl-17460933

ABSTRACT

Although the use of cyanides as warfare agents has not been documented since the Iran-Iraq war in the 1980s, there are rising fears of cyanide being used by terrorists. An Al-Qaeda terror plot to use cyanide gas in the London Underground was foiled in 2002. The threat of similar events becomes more imminent in light of the terror attacks in our country and worldwide, accompanied by statements and threats by fundamentalist leaders to employ chemical weapons. Therefore, mass-intoxication with cyanides is not merely a hypothetical scenario. The treatment of cyanide poisoning is under constant evaluation and there is no international consensus on the subject. The medical treatment of victims at the scene and in hospitals should be rapid and efficient. Current treatment dictates establishing an intravenous line and a slow rate of administration of antidotes. Both demands are not feasible in this specific mass casualty event. The clinical signs of cyanide poisoning are complex, variable and not necessarily obvious for the medical team. There is great interest in reconsidering the existing treatment protocols for cyanide intoxication in light of current research. This review describes the mechanisms of cyanide toxicity, clinical signs of exposure, and current treatment protocols in use worldwide. On the basis of this evidence we suggest a medical treatment protocol for a mass casualty event caused by cyanide.


Subject(s)
Chemical Warfare , Cyanides/poisoning , Antidotes/administration & dosage , Antidotes/therapeutic use , Humans , Infusions, Intravenous , Israel , Terrorism , Warfare
17.
Crit Rev Toxicol ; 37(3): 279-85, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17453935

ABSTRACT

Organophosphate poisoning may precipitate complex ventricular arrhythmias, a frequently overlooked and potentially lethal aspect of this condition. Acute effects consist of electrocardiographic ST-T segment changes and AV conduction disturbances of varying degrees, while long-lasting cardiac changes include QT prolongation, polymorphic tachycardia ("Torsades de Pointes"), and sudden cardiac death. Cardiac monitoring of organophosphate intoxicated patients for relatively long periods after the poisoning and early aggressive treatment of arrhythmias may be the clue to better survival. We present here a review of the literature with a focus on late cardiac arrhythmias (mainly "Torsades de pointes"), possible mechanisms, and treatment modalities, with special emphasis on postpoisoning monitoring for development of arrhythmias.


Subject(s)
Heart Diseases/chemically induced , Heart Diseases/therapy , Long QT Syndrome/chemically induced , Long QT Syndrome/therapy , Organophosphate Poisoning , Torsades de Pointes/chemically induced , Torsades de Pointes/therapy , Animals , Humans
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