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Biomedical subjects

A Barak

Publications and source records attributed to A Barak.

At least 37 records · Page 2Linked to original sources
PubMed2000

The incidence of hepatitis C virus positive serological test results among cornea donors.

Purpose. We have noticed that the incidence of positive serological tests of hepatitis C virus (HCV) among cornea donors in our eye bank is higher than expected. The purpose of this study was to determine the incidence of these positive findings and identify the contributory risk factors.Methods. All corneas procured between June 1993 and June 1997 were included in this retrospective study. In all cases a routine work-up, including serological testing of donors' sera and evaluation of the procured corneas, was performed prior to corneal transplantation. Donors found to be positive for HCV antibodies were compared to our general population of corneal donors, with respect to the demographic, serological and ophthalmological data obtained during the transplantation work-up.Results. All 851 corneas procured from 438 donors were included. Antibodies to HCV were found in 29 donors (6.6%). Following positive test results, 57 corneas (6.7%) were discarded. The time from donors' death to cornea procurement was significantly longer among HCV-positive patients than in the general donor population (12.3 vs. 9.3 h, p<0.0003). No other differences were detected between the two groups.Conclusion. Delay in harvesting of donated corneas may give rise to false positive HCV-antibodies test results, which may be partially responsible for the high rate of positive findings among cornea donors, with consequent tissue wastage.

Journal Article↗
PubMed2000

Reaching the diagnosis of cystic fibrosis--the limits of the spectrum.

BACKGROUND: Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in Caucasians. Typically it is a multisystem disease diagnosed by increased chloride levels on sweat testing, with mortality due mainly to progressive respiratory disease. The clinical spectrum of CF has recently been much expanded. Genetic testing for mutant CF transmembrane regulator has revealed atypical cases where sweat test results are borderline or normal. In other patients, genetic mutations cannot be identified but abnormal CFTR function is shown using nasal potential difference measurement. OBJECTIVES: To highlight the diagnostic and therapeutic dilemmas in cases of atypical cystic fibrosis. METHODS: We reviewed patients with atypical CF and widely varying phenotype who are managed at Schneider Children's Medical Center of Israel. RESULTS: Two patients had severe lung disease but little expression in other organs. Accurate diagnosis was essential to enable aggressive therapy in a specialized center. Four other patients are in excellent general health but have symptoms limited to male infertility, heat exhaustion, pancreatitis or transient liver dysfunction, while lung disease is minimal. For these patients, careful counseling is needed to avoid unnecessary upheaval, inappropriately aggressive management, and the psychosocial implications of a CF diagnosis. These dilemmas have increased considerably in our center, as in others worldwide. CONCLUSION: It is our obligation as clinicians--at the level of both primary physician and referral center--to maintain an ever higher index of suspicion for CF, tempered by a rational program of counseling and management appropriate to the individual.

Adult↗
PubMed1999

Striae distensae of augmented breasts after oral contraceptive therapy.

A case of striae distensae (SD) of bilateral augmented breasts following oral contraceptive therapy is presented. Striae maturation and the prevention of additional skin marks was achieved with immediate cessation of oral contraceptive pill therapy and long-term daily topical application of tretinoin cream. It is suggested that patients who are candidates for breast augmentation surgery should be informed of the possible risk of developing SD if they are taking or planning to take the contraceptive pill.

Adolescent↗
PubMed1999

Forming clinical impressions during the first five minutes of the counseling interview.

The influence of earlier formed clinical impressions of the client on later judgments within a counseling session were examined. It was predicted that redundancy in judgments of counselors' clinical impressions of the client after 5 min. and after 30 min. of an interview would be greater for counselor-trainees who are (a) more self-confident about their judgments and (b) lower in cognitive complexity, than other counselor-trainees. A stimulus tape in which a male counselor conducted an initial 30-min. interview with a depressed female client was shown to 80 counselor-trainees. At the 5- and 30-min. marks, the tape was stopped, and the counselor-trainees indicated their clinical impressions of the client. These impressions included written thoughts and ratings of clinical characteristics of the client. Analyses showed that both their self-confidence and cognitive complexity were not associated with differences in redundant judgments.

Adult↗
PubMed1999

Improved vitality of experimental random dorsal skin flaps in rats treated with enriched cell culture medium.

A defined, serum-free cell culture medium supplemented with nonsteroidal anabolic hormones, insulin, thyroxin, and growth hormone was found to accelerate wound healing by stimulating vascularized granulation tissue formation, epithelialization, and angiogenesis. The aim of this work was to study the effect of cell culture medium on the survival rate of cephalically based random dorsal skin flaps in an animal model. A total of 77 Sprague-Dawley rats were randomized into five treatment groups: pharmacologic delay with cell culture medium, flap enhancement with cell culture medium, surgical delay, biological delay with saline, and control. Statistically significant differences in distal flap necrosis were found among all groups (p<0.003). The rats treated with cell culture medium before flap elevation showed a significant increase in flap viability: a survival rate of 83 percent, compared with the control group, which demonstrated a survival rate of only 58 percent (p<0.0001). The surgical delay and the groups treated with cell culture medium yielded similar results with no significant difference between them. This study indicates that preoperative injection of cell culture medium may play a role in decreasing skin flap necrosis.

Animals↗
PubMed1998

[Prevalence of pigmentary dispersion syndrome in Israel].

Pigmentary dispersion syndrome is a precursor of pigmentary glaucoma whose prevalence in the urban population of USA was found to be 2.45%. We evaluated its prevalence during ocular screening examinations among normal Israelis. We screened for excessive pigmentation on the corneal endothelium with the slit-lamp and determined in each patient best corrected visual acuity, intra-ocular pressure (after mydriasis), condition of the anterior segment, cup-disk ratio, posterior segment abnormalities and questioned about history of any ocular disease and family history of glaucoma. 374 patients (mean age 49 +/- 11) were examined on 10 consecutive days. In 5.9% excessive corneal endothelial pigmentation was found. Intra-ocular pressure (after mydriasis) averaged 15.52 +/- 1.93 mm Hg as compared to 14.73 +/- 2.04 among the rest of our study population, (p = 0.01). The prevalence of suspected pigmentary dispersion syndrome among young adults in Israelis is high.

Adolescent↗
PubMed1998

Partial breast necrosis after MIDCABG via small anterolateral thoracotomy.

We report a case in which partial breast necrosis developed after minimally invasive direct coronary artery bypass grafting using an IMA Retractor (Cardio-Thoracic Systems Inc, Cupertino, CA). We suggest that during minimally invasive direct coronary artery bypass grafting in the presence of a large breast, it is advisable to reduce the intraoperative additive forces of pressure and traction caused by the retractor arm on the breast tissue, thus avoiding further excessive compression on the partially compromised blood circulation of the breast.

Breast↗
PubMed1998

Hyperbaric oxygen therapy for deep second degree burns: an experimental study in the guinea pig.

Most previous animal studies reporting improved epithelialisation and healing of burn wounds under hyperbaric oxygen (HBO) did not include the conventional treatment with topical antibiotics as part of the protocol, and did not compare the effectiveness of HBO therapy with that of normobaric 100% oxygen (NO). The purpose of our study was to compare the results of combined treatment with HBO + silver sulfadiazine (SS) and those of treatment with NO + SS or SS alone. Deep second degree burns were produced on the depilated backs of 54 guinea pigs using a validated burn protocol. The animals were assigned to three treatment groups: HBO + SS, NO + SS, and SS. Dressings were changed daily. HBO was administered at 2 atmospheres absolute (ATA) for 90 min BID, and NO for 90 min BID. The parameters compared among the groups were laser Doppler flowmetry, and burn wound contracture and re-epithelialisation data derived from computerised planimetry of photographs of the wound. No differences in laser Doppler flowmetry results or the magnitude of contracture were found between the groups. Significantly increased re-epithelialisation was observed under NO + SS starting 10 days after the burn (P = 0.02, ANOVA). This significance stems from the difference between the HBO + SS and NO + SS groups (Tukey test). These data indicate that excessively high levels of tissue PO2 might compromise burn healing, and explain our results. A further study comparing combined treatment using a milder HBO protocol + SS and NO + SS is indicated in the search for the optimal HBO regimen.

Animals↗
PubMed1997

["CHARGE" association].

CHARGE association represents a group of congenital anomalies with no clear etiology. The broad array of abnormalities, which involves several systems, has been the basis for the acronym CHARGE: coloboma, heart anomaly, choanal atresia, retarded growth and development, hypoplastic genitalia and ear malformation. We present 3 children with CHARGE association to illustrate the phenotypic variability and note the multidisciplinary treatment they received. It is recommended that this entity be approached in an interdisciplinary, integrated way to allow for faster diagnosis and better prognosis.

Abnormalities, Multiple↗
PubMed1997

Temperature-controlled CO2 laser tissue welding of ocular tissues.

Lasers can be used for binding tissues by welding, but the clinical application of this method has been limited by the difficulties in defining and maintaining the optimal conditions. Fiberoptic radiometry allows accurate remote temperature measurements for control of laser tissue welding. We evaluated the use of a temperature-controlled tissue welding system to close corneal and corneoscleral wounds. Eighty ex vivo bovine eyes were used for the determination of welding parameters optimal for corneal wound closure. A 4 mm central corneal cut was closed with use of a CO2 laser (600 mw, 0.9 mm spot size), with tissue temperatures ranging from 45-70 degrees C and welding time ranging from 1-30 seconds. Wound strength was measured as burst pressure of the sealed wound. The welding parameters found to cause the strongest wound binding were used to weld a limbal incision of 4 mm in 10 adult albino rabbits. The fellow eye of each animal was used as a control, and the same wound was closed with one 10/0 mersilen suture. Two animals were killed immediately after the procedure, and the eyes were sent for histologic examination. Eight rabbits were followed for 1 month. Clinical examination and refraction were done 1 day, 1 week, 2 weeks, and 1 month after the procedure. Corneal topographic evaluations were done 1 week after the procedure. After 1 month the animals were killed and the eyes were examined histologically. The optimal results of wound binding by laser welding in the enucleated bovine eyes were achieved with 55-60 degrees C and at a welding time of 12-20 seconds. At these parameters the burst pressure of corneal wounds was 70 mm Hg. All laser-welded limbal wounds in the rabbits were tightly closed at the end of procedure and during the follow-up period. The refractive results after laser welding were equal to those of the controlled suture-closed wound. Laser tissue welding combined with tissue temperature monitoring can be used to close corneal wounds.

Animals↗
PubMed1997

Intraoperative expansion of the palate by the tumescent technique.

Intraoperative rapid expansion of soft tissue of the palate is reported. Tissue is recruited by repeated injections of an isotonic solution in a tumescent-like technique, thus producing increasing swelling of the palatal soft tissue. Straight direct closure of palatal clefts and fistulas is achieved with minimal scarring at the midline, no secondary healing of raw surfaces, and satisfactory and encouraging results.

Anesthesia, General↗
PubMed1997

Measurement of head-turn in ocular torticollis.

There is a need for a simple and accurate method to measure head-turn in patients who suffer from torticollis secondary to ocular disease. In the technique described here, a fixation object is moved from a point in front of the patient to a point at which the patient's face is straight. The distance that the object is moved is proportional to the amount of head-turn the patient has. With a simple mathematical calculation, the angle of head-turn can be determined, even during a routine clinical evaluation.

Head Movements↗
PubMed1997

Intraocular pressure increments after cataract extraction in glaucomatous eyes with functioning filtering blebs.

BACKGROUND AND OBJECTIVE: The effects of cataract extraction on intraocular pressure (IOP) were studied in glaucoma patients who had previously undergone trabeculectomy. PATIENTS AND METHODS: The files of 22 patients with 25 glaucomatous eyes with functioning filtering blebs who underwent cataract extraction were retrospectively reviewed. All patients had undergone pretrabeculectomy examination and had at least 18 months of follow-up after cataract surgery. Visual acuity, IOP, status of the filtering bleb, and the number of medications applied were recorded. RESULTS: The mean increase in IOP was 3.63 mm Hg, 3.84 mm Hg, 5.4 mm Hg, and 2.8 mm Hg at 3, 6, 12, and 18 months after cataract extraction, respectively. This elevation was statistically significant 3 months postoperatively (P < .001) and remained relatively constant thereafter. The postoperative IOP was still significantly lower than the pretrabeculectomy IOP (P < .001). CONCLUSIONS: Cataract extraction through corneal incisions in patients with functioning filtering blebs is followed by an increase in IOP. Cataract surgery in these patients does not neutralize the pressure-lowering effect achieved by the trabeculectomy, but it tends to elevate the post-trabeculectomy baseline pressure.

Aged↗
PubMed1997

Transcanalicular laser-assisted dacryocystorhinostomy.

BACKGROUND AND OBJECTIVE: Current techniques of laser-assisted dacryocystorhinostomy are mostly endonasal. In this report, the authors describe their technique of laser-assisted dacryocystorhinostomy performed through the canaliculi and the surgical results they achieved. PATIENTS AND METHODS: Fourteen patients with nasolacrimal duct obstruction underwent transcanalicular laser-assisted dacryocystorhinostomy. The bony ostium was perforated using a fiber optic-transmitting, giant-pulse Nd:YAG laser, with an energy of 0.5 to 4 J per pulse. The total energy used to create an ostium was 18 to 34 J. A silicone tube was inserted through the canaliculi and the ostium into the nasal cavity and kept in place for 5 to 7 months. Patients were observed for 18 to 22 months. RESULTS: Nine of the 14 patients (64%) reported the disappearance of epiphora following surgery. In 3 patients, no relief of epiphora was obtained. In 1 patient the operation was not completed because of severe nasal bleeding. In another, tearing began 12 months after surgery (6 months after tube removal). CONCLUSIONS: Transcanalicular laser-assisted dacryocystorhinostomy is a potentially useful method for performing dacryocystorhinostomy. Technical modifications and improvements are needed to increase the success rate.

Aged↗
PubMed1996

Early postoperative intraocular pressure pattern in glaucomatous and nonglaucomatous patients.

PURPOSE: To evaluate intraocular pressure (IOP) changes in the 24 hours following cataract extraction in glaucomatous and nonglaucomatous patients. SETTING: General Eye Service and Glaucoma Service of the Goldschleger Eye Institute, Tel Hashomer, Israel. METHODS: Twenty-six nonglaucomatous patients and 13 glaucomatous patients scheduled for routine cataract extraction and intraocular lens implantation were evaluated. In each patient, IOP was measured before cataract surgery and every 4 hours for 24 hours postoperatively. Thirteen of the nonglaucomatous patients were randomly treated with one drop of timolol maleate at the end of surgery (NG-T group). The other 13 nonglaucomatous patients (NG group) and all glaucoma patients (G group) were not treated. RESULTS: In the NG group, mean preoperative IOP was 13.9 mm Hg. Following surgery, IOP rose steadily to 22.2 mm Hg at 12 hours; it returned to almost presurgical levels at 24 hours. The IOP exceeded 35 mm Hg in only one patient. In the NG-T group, mean preoperative IOP was 16.5 mm Hg and increased to 21.2 mm Hg at 12 hours. The IOP returned to almost presurgical levels at 24 hours. In the G group, mean IOP was 18.8 mm Hg preoperatively and rose to 29.9 mm Hg at 8 hours after surgery. In seven eyes the IOP exceeded 35 mm Hg. COMMENTS: Our findings of elevated IOP emphasize the need for prophylactic treatment (medical or combined cataract and glaucoma surgery) to prevent IOP spikes in high-risk patients.

Acetazolamide↗
PubMed1996

Insulin-induced lipohypertrophy treated by liposuction.

Lipohypertrophy is one of the local side effects of repeated subcutaneous insulin injections. This case report demonstrates the successful cosmetic and therapeutic treatment of two lipohypertrophic masses in the lower abdomen of a young diabetic patient by suction-assisted lipectomy.

Adipose Tissue↗