Biomedical subjects
A Eldad
Publications and source records attributed to A Eldad.
Skin surface proteolytic activity. Partial characterization and identification.
Skin surface proteolytic activity in the living animal was determined by a sensitive, non-invasive methodology developed in our laboratory. A non-leaky well was constructed on the shaved back of an anesthetized guinea pig. The well contained the reaction mixture including the substrate 125I-S-carboxymethylated insulin B-chain (ICMI). The proteolytic activity was shown to be time-dependent. The activity was strongly inhibited by pepstatin A, indicating the involvement of aspartic proteinase(s) such as cathepsin D and/or E. Pretreatment of the skin with propylene glycol blocked the proteolytic activity. The present study demonstrates the presence of proteolytic activity located on skin surface using a unique, non-invasive method for in situ proteinase determination in the living animal.
[Nutritional support for burn casualties].
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Noninvasive procedure for in situ determination of skin surface aspartic proteinase activity in animals; implications for human skin.
The present study demonstrated a noninvasive procedure for in situ determination of stratum corneum aspartic proteinase in the living animal. A non-leaky well, containing [125I]S-carboxymethylated insulin B-chain (ICMI) as a substrate, was constructed on the shaved back of anesthetized guinea pigs and rats. The enzymatic activity was determined by measuring the radiolabeled trichloroacetic acid soluble material. We demonstrated pepstatin-sensitive proteinase activity bound to the skin surface indicating the involvement of aspartic proteinase(s) such as cathepsin D and/or E. Aged rats had about six fold lower activity than young animals. The proteinase activity was inhibited by the alkylating agent mechlorethamine and by the cosmetic propylene glycol. A similar procedure was carried out with intact human skin pieces obtained during plastic surgery. The activity was inhibited by antihuman cathepsin D antibodies. Cathepsin D was immunohistochemically localized in the corneal and granular layers of the epidermis. Skin surface aspartic proteinase/cathepsin D activity may serve as a marker for skin aging or for certain skin disorders leading to a new approach to their medical treatments.
[Use of topical anesthesia--EMLA cream].
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Assessment of physician competence in prehospital trauma care.
In an attempt to develop a model to measure the competence of physicians providing emergency care under difficult field conditions, 75 Israeli army medical corps physicians were evaluated through the use of four instruments: a debriefing interview, peer assessment, self-assessment and written examination. The special on-site assessment model was designed to examine actual events, enabling an assessment of performance in real situations rather than simulated cases. Significant positive correlations were found between the results of the written examination and the peer evaluation on two of four measures (r = 0.36, P = 0.001; r = 0.23, P = 0.05) as well as on the two measures regarding self-evaluation and peer evaluation (r = 0.54, P = 0.001; r = 0.38, P = 0.05). It was found that those physicians who were trained in the army's medical officer course scored significantly higher on the written examination (P = 0.001) and were rated more highly by their senior peers (P = 0.048) than those who did not receive such training. It was concluded that it is advantageous to use a combination of knowledge (written examination) and performance (peer assessment or self-assessment) measures in order to arrive at a more comprehensive assessment of competence. In addition, the written examination format should be expanded and developed to include more clinical vignettes requiring treatment decisions, making this instrument a more clinically oriented measure of physician competence in trauma care.
[The National Skin Bank of Israel].
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Terrorist bombing with a 'Molotov cocktail' inside travelling cars: an old weapon for a new burn syndrome?
The 'Molotov cocktail' terrorist weapon which is thrown into a travelling car has given a new type of injury to people who sustain massive smoke inhalation together with disfiguring burns of face, thighs, hands and chest, and post-traumatic psychological disorder. The combination of petrol ignition with the synthetic fumes inside the care is a unique occurrence with a high morbidity and mortality which is difficult to treat and to manage. We propose to show that the combination of all the above components can be defined as the 'Molotov cocktail' burn syndrome.
Cyclosporin A treatment failed to extend skin allograft survival in two burn patients.
Prolongation of skin allograft survival by immunosuppression of burn casualties has been reported sporadically during the past two decades. Recently cyclosporin A (CycA) has been used effectively for such an indication. We report here two paediatric patients with extensive burns (85-95 per cent BSA) treated with fresh, family-related skin allografts that were rejected during CycA treatment after 14-18 days. One of these children survived while the other died with candida sepsis.
Very deep burns of the hand due to low voltage electrical laboratory equipment: a potential hazard for scientists.
A low voltage (24 V) electrical deep burn of the hand injured a professor of applied physics when performing an experiment in his laboratory. The potential hazard of the equipment is described, the injuries are reported and the literature is reviewed.
Chemical burn due to contact with soda lime on the playground: a potential hazard for football players.
Two football players were treated for chemical burns of their genitalia and medial thighs caused by contact with soda lime used to line a playground. The cases are reported and the unusual mechanism causing the injury is described.
The cost of an extensive burn survival.
A 17-year-old male sustained 95 per cent body surface area burns (87 per cent full thickness skin loss). He was hospitalized in the Department of Plastic Surgery that also treats burns. After 232 days he was discharged home when he was functionally independent. He had 16 surgical procedures for excision of burn eschar and skin grafting; received a total of 128 units of blood; 899 units of fresh frozen plasma and had enteral hyperalimentation for 175 days. About 1000 physician-hours, 3000 nurse-hours, 1000 physiotherapy and occupational therapy-hours and about 250 dietician-hours were needed for his treatment. More than 1850 laboratory tests and 120 X-rays were performed, and more than 600 kg of ointment and creams were used, as well as half a ton of topical antimicrobial solutions. Ten different antibiotics were used for a total of 85 treatment days. Some 8500 m of dressing were applied with more than 6000 pieces of petroleum jelly gauze dressing. Hospitalization costs were found to be US$141,750, only 37.5 per cent of which were salaries. An analysis of these costs is given.
Case study: full thickness chemical burn of the abdomen and chest.
An 81 year old patient, suffering from Alzheimer's disease sustained a full thickness HCI Acid burn of her abdomen and chest wall due to leakage of gastric content from her gastrostomy feeding tube. The controversial management of such a patient is discussed and early surgical treatment is recommended.
The clinical assessment of femoral stress fractures: a comparison of two methods.
In a prospective study among 667 recruits, the incidence of asymptomatic femoral stress fractures was compared using a new expanded stress fracture clinical examination (SFCA) versus an older stress fracture examination. There was a statistically significant difference (p = 0.0001) between the percentage of femoral stress fractures that were asymptomatic in the group evaluated by SFCA (26%) and those evaluated by the older stress fracture examination (80%). By using the SFCA, many of the femoral stress fractures previously classified as asymptomatic are in fact recognized as symptomatic.
[Effect of hyperbaric oxygen treatment in the management of carbon monoxide poisoning].
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[Assessment of IDF physicians in in-field trauma].
The system of care delivery of in-field trauma was assessed, leading to suggestions for improving the system and military medical training. This study reports the feasibility and validity of various methods of assessing the performance of Israel Defense Force physicians in administering trauma care. The methods included a standardized medical debriefing with filling in of a report form by a senior traumatologist, his review of the physician's performance, self-assessment by the physician, and a written test. 5 senior traumatologists with extensive experience in military trauma care were trained to assess the physicians' performance within 24-48 hours of incidents involving moderate to severe trauma injuries. 75 physicians who had been involved in the care of the in-field trauma patients during a 1-year period, November 1988 to October 1989, were assessed. Analysis of the results clearly indicated 2 areas for assessment: a) knowledge, mainly levels of comprehension and application in relevant areas of trauma and b) performance, including immediate diagnosis, treatment skills, and triage. The best method for evaluating knowledge was the written test, not peer review nor self-evaluation. However, the traumatologist's evaluation of care performance was highly correlated with the physician's self-assessment. For comprehensive assessment of in-field care it is advisable to integrate the 2 methods: performance review by a traumatologist and a comprehensive written test. Information gained from such assessment could improve the planning of in-service trauma training and the posting of physicians within the military framework.
Phosphorous pentachloride chemical burn--a slowly healing injury.
A 51-year-old chemical engineer sustained phosphorous pentachloride partial skin thickness burns over 20 per cent of his body surface area. Although macroscopically and microscopically the wound seemed to be superficial, the course of clinical healing of this injury was very slow and painful. Retrospectively this burn should have been treated by early excision and grafting.