Biomedical subjects
Publications and source records attributed to A Eldad.
Congenital double lip is a rare entity. During the last 10 years, we performed surgery on 5 patients with this deformity. The patients are reported with a special mention of the embryology, and the relevant literature is reviewed.
Structural and functional aspects of modifications in the composite skin graft consisting of cultured keratinocytes and cryopreserved dermis were determined. Cryopreserved human cadaveric dermis separated from skin by short and mild trypsinization was compared with dermis obtained by prolonged incubation in medium and with fresh dermis obtained by the same methods. All types of dermis were shown to retain normal ultrastructure and topographic organization, as detected by scanning and transmission electron microscope and immunofluorescence analysis. However, in fresh skin, the layers were more firmly attached, mechanical separation was more difficult, and residual epidermis often remained attached to the dermis. Keratinocytes attached better, began replication earlier, and generally reached higher cell numbers when cultured on trypsinized dermis than on medium-treated dermis. The performance of several modifications in the reconstitution and grafting procedures of the composite skin graft after transplantation to athymic mice was examined. Cultured epidermis combined onto trypsinized or medium-treated whole and meshed dermis, dermis pregrafted and allowed to take before transplanting epidermis on top, and keratinocytes grown into multiple epithelia on top of trypsinized meshed or whole dermis prior to grafting. The best grafting results were obtained with an "instant" reconstituted skin model: multiple epithelia grown in vitro combined immediately before grafting onto meshed trypsinized dermis. The transplantation results of this modification were significantly better than those of all the other modifications, including initial growth of keratinocytes into multiple epithelia on top of trypsinized dermis prior to grafting.
In a randomized prospective study among 390 recruits, the hypothesis that improved shoe shock attenuation could lessen the incidence of overuse injuries was tested. During the 14 weeks of training, 90% of the recruits sustained overuse injuries. Recruits training in a modified basketball shoe had a statistically significant lower incidence of metatarsal stress fractures and foot overuse injuries, compared with standard infantry boots, but their overall incidence of overuse injuries was not reduced. The effect of improved shoe shock attenuation was limited to those overuse injuries resulting from vertical impact loads.
In a prospective study of the effect of the appropriateness of foot-shoe fit and training shoe type on the incidence of overuse injuries among infantry recruits, it was found that three shoe widths for each shoe length size were necessary to adequately accommodate the recruit population's foot anatomy. Recruits compensated for the lack of available shoe widths by choosing larger shoe sizes. However, this compensation did not result in an increase in the incidence of overuse injuries. Recruits who trained in basketball shoes had a lower incidence of overuse injuries of the feet than recruits who trained in infantry boots (p = 0.0001), but the overall incidence of overuse injuries was the same in both groups.
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The technique of burying small pieces of skin under old granulation tissue after recurrent failure of conventional skin grafting is described in a patient with 95 per cent full skin thickness burns. This method of treatment, which was described in the past and neglected, is of value for massive burns or grafting in difficult areas. The technique is described again and the relevant literature reviewed.
White phosphorous burns were inflicted on 44 Wistar (CR) rats. All animals of the control (C1) group (untreated white phosphorous burns) died within 48 h while those of the control (C2) group (wound only, no white phosphorous burns) survived at least 6 days. Copper sulphate, either as a solution or as an emulsion, proved lethal even without white phosphorous burns. Water irrigation alone proved to be a life-saving procedure for the white phosphorous burned rats.
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Thirty deep dermal burns were inflicted on six domestic pigs. On the treated animals, the epidermis was removed and immediately replaced with Omiderm, Xeroform or Mettalin dressings. Burns in which the blister was left intact or not dressed after epidermis removal, served as controls. Macroscopic and microscopic assessment of the healing process was then carried out. Surprisingly, the no-epidermis controls healed somewhat faster than did the untreated controls (those with blister intact). On day 7, 83 per cent of the treated lesions showed initiation of epidermal regeneration, compared with 58 per cent in the no-treatment and no-epidermis controls. All dressing materials were found equal in this model, and differences between control and treatment groups were not significant after 12 days.
Burn wounds which require skin grafts are often heavily contaminated. Conventional methods of skin grafting demand bulky dressings and immobilization for 3-5 days. During this period, we cannot treat the wound topically, but can only hope that the skin graft will win the battle against infection and survive on the wound. The concept of an interface that has emerged in the past few years allows us to treat the wound topically through a transparent, permeable membrane that covers the skin graft without disturbing it. Omiderm, a hydrophilic polyurethane film that was developed as a burn dressing, has been used as an interface on 10 patients. Skin grafts on problematical areas and heavily contaminated wounds were covered with 1:1.5 non-expanded meshed Omiderm. An external layer of dressing with a topical antimicrobial agent was changed 8-24 h postoperatively and then at regular intervals. About 75 per cent 'take' was achieved, which was better than expected with other dressings under similar conditions.
A 20-year-old soldier sustained 35 per cent body surface area burns by open flames. He was treated with topical application of 1 per cent silver sulphadiazine (SSD) twice daily. Four days postburn he developed acute haemolytic anaemia. Withdrawal of SSD was followed by complete recovery. A glucose-6-phosphate dehydrogenase (G6PD) deficiency was proven by pathological Motulski tests. Although the hazards of SSD are well indicated by the manufacturers, there appear to be no written reports of haemolysis induced by this drug in G6PD-deficient patients.
A simple method to ease the removal of stitches in hair-bearing areas is presented. The method consists of applying a depilatory cream to remove the masking hair.
The strange case of a 37-year-old modern, Western woman who presented with a giant black mass on her inner right thigh is presented. She was treated 10 months before this present admission by an excision of a nodular melanoma, and she was treated, thereafter, by a homeopathic practitioner until she came late to follow-up. The woman is discussed with special attention to the fact that alternative medicine does not always constitute good advice, and the relevant literature is reviewed.
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In a prospective study of risk factors for lateral ankle sprain among 390 male Israeli infantry recruits, a 18% incidence of lateral ankle sprains was found in basic training. There was no statistically significant difference in the incidence of lateral ankle sprains between recruits who trained in modified basketball shoes or standard lightweight infantry boots. By multivariate stepwise logistic regression a statistically significant relationship was found between body weight x height (a magnitude which is proportional to the mass moment of inertia of the body around a horizontal axis through the ankle), a previous history of ankle sprain, and the incidence of lateral ankle sprains. Recruits who were taller and heavier and thus had larger mass moments of inertia (P = 0.004), and those with a prior history of ankle sprain (P = 0.01) had higher lateral ankle sprain morbidity in basic training.
In order to answer the question of why the stress fracture morbidity rates among Israeli infantry recruits are so high, we prospectively evaluated 392 infantry recruits for risk factors for stress fractures. Prior to training, each recruit underwent a detailed evaluation. Using multivariate analysis, five risk factors for tibial fractures were identified: shorter tibial length (p less than 0.0001); relatively greater valgus knee alignment (p less than 0.002); right leg dominance (p less than 0.02); external rotation of the hip greater than 65 degrees (p less than 0.02); and training in specific subunits (p less than 0.0002., 0.03). No risk factors for femoral stress fracture were found by multivariate analysis.
A prospective study of 390 infantry recruits revealed that the medial tibial intercondylar distance and that the isometric strength of the quadriceps, tested at 85 degrees of flexion of the knee, had a statistically significant correlation with the incidence of patellofemoral pain caused by overactivity. Increased medial tibial intercondylar distance and increased strength of the quadriceps were therefore deemed to be risk factors for this syndrome.