Biomedical subjects
Publications and source records attributed to A Eldad.
During the summer of 1987 the shores of Israel were infested by waves of jellyfish. Thirty patients, mainly children, suffering various degrees of painful injuries to different parts of their bodies were treated in our emergency ward. A typical case is reported and the appropriate treatment recommended.
There were 70% more burns in the October 1973 war than in the Six Day War of 1967. This increase caused great concern and emphasized the need for better personal and crew protection against burns. Some of these measures were already implemented by the outbreak of the 1982 war in Lebanon. Analysis of the burn injuries of this war is the subject of this short report.
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The aim of the study was to determine the fate of cultured skin allografts in patients with burns. In situ DNA hybridisation with a Y probe (pHY 2.1) was used to detect cells carrying the Y chromosome (the probe being visualised by the alkaline phosphatase-antialkaline phosphatase method) in biopsy specimens taken from cultured allografts derived from donors of the opposite sex to the recipients (20 patients with burns). Specimens were taken within a week, between one and three weeks, between four and six weeks, and more than six weeks after grafting. Only two of the 27 biopsy specimens contained cells that were the same sex as the donor; both were taken within a week after grafting. In the 25 other specimens the epithelial cells were the same sex as the recipient. Cultured skin allografts showed no evidence of survival in patients with burns, which suggests that they are probably not suitable for long term management of burns but may be useful as short term biological dressings.
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We present our preliminary experience using Surfasoft, a new dressing material, in the management of burns following skin grafting. It was found to be a useful dressing in awkward sites where conventional dressings have many disadvantages.
Twenty-five burn patients with full or partial thickness skin loss received cultured epithelium (CE), allografts or autografts as part of their treatment. Overall, a 30 per cent graft 'take' was achieved irrespective of whether the CE was autograft or allograft, fresh or frozen. In the case of deep dermal burns this figure improved to 50 per cent. The surviving grafts merged with split thickness skin grafts (SSG) and advancing wound edges. When full thickness skin loss was grafted, only a patchy take could be achieved and the surviving islands of CE tended not to spread across the wound. No rejection of CE allograft was recorded either clinically or histologically up to 6 months. The technical problems and clinical implications are discussed.
Eighteen months of experience with a new synthetic temporary skin substitute (Omiderm, Omikron Scientific Ltd., Rehovot, Israel) is presented. The substitute is a thin, transparent, flexible membrane. It is used when a biological dressing would otherwise have been used. Our experience consists of laboratory studies and 75 clinical cases including donor sites application, chronic wounds, ulcers, partial thickness and full thickness burns. The membrane is very elastic, permitting free movement and physiotherapy during the healing process. The material protects the wound and prevents either the accumulation of fluid under it or wound desiccation. It does not interfere with the normal healing process. It reduces pain, prevents bacterial invasion and is very easy to handle. Complications, such as haematoma formation or infection, were quite few. We recommend its use in routine daily practice.
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Amniotic membrane dressings were tested in the treatment of 30 patients. Fifteen of them had burns, 5 had chronic varicose ulcers, and 10 had decubitus ulcers or other open infected wounds. No effort was made to separate the chorion from the amnion. Dressings were changed every 48 hours, and treatment was, in some cases, partially ambulatory. Good results were obtained in the treatment of 2nd- and 3rd-degree burns and of other open, infected wounds, both in the preparation of the patients for autografting and in consequent treatment.
Omiderm (Omikron Scientific Ltd., Rehovot, Israel), a new synthetic wound covering based on hydrophilized polyurethane, was found to be highly permeable to water. Values in the region of 5000 g/m2 24 h were found for the water permeability of Omiderm in comparison to 1400 and 500 g/m2 24 h for Biobrane (Hall, Woodroof Inc., Santa Ana, CA) and OP site (Smith and Nephew Ltd.), respectively. Permeabilities of antibacterial agents through Omiderm were found to be two to three orders of magnitude greater than those through Biobrane. The in vitro effectiveness of various antibacterial agents in lowering bacterial growth of different bacterial strains were applied to seeded agar plates through Omiderm membrane was investigated. NBH ointment (1% Neomycin, 1% Bacitracin, and 0.5% Hydrocortisone) was found to be the most effective material in inhibiting bacterial growth, except for Pseudomonas aeruginosa where silver sulfadiazine was superior. In in vivo experiments bacterial counts of infected wounds covered with Omiderm and topically treated with NBH were lowered to less than 10(3) organism/g tissue after one day of treatment.
The goal of this study was to assess the susceptibility of the sub-population of over 500,000 immigrants from the former USSR who came to Israel during 1989-94 to HAV infection, and to provide military physicians with estimates of the prevalence of HBV and HCV carriage in this sub-population. 987 males aged 17-49 and 195 females aged 17-19, reporting to military recruitment offices between December 1991 and March 1992 were tested. Anti-HAV, anti-HBV antibodies and hepatitis B surface antigen (HBsAg) were detected by using standard enzyme immunoassay (EIA) tests, and anti-HCV antibodies by a second-generation EIA and confirmed by a third-generation INNO-LIA test. It was found that in the 17-19-year age-group the prevalence of anti-HAV antibodies was 37%, anti-HBV was 12.8%, HBsAg was 3.0% and anti-HCV 1.3%. All markers were higher among males. The prevalence of anti-HAV and anti-HBs antibodies increased with age among males. That of HBsAg and anti-HCV antibodies increased with age overall. In the multiple logistic regression analysis, HAV and HBV seropositivity were significantly associated with the mother's education and republic of origin. It was concluded that the prevalence of anti-HAV antibodies is similar to that among the local population, which should not be considered at a higher risk of infection during military service. On the other hand, the higher prevalence of HBsAg and anti-HCV antibodies in this sub-population should heighten the awareness of the possibility of chronic liver pathology.
A 25-year-old female with a scarred and contracted nose following burns, because the upper limbs could not be used as donor areas, had a free dorsalis pedis flap used to reconstruct the nose 18 months post-burn. The case is reported and the literature reviewed.
Partial thickness burns (PTB) usually heal within 3 weeks. Prevention of infection and desiccation of the wounds are crucial for optimal healing. Early tangential excision of the burn eschar and allografting prevent deepening of the burns, and are therefore advocated for treatment with the best functional and aesthetic results. For superficial partial thickness burns (SPTB) conservative use of topical antimicrobial agents with frequent dressing changes are implemented. We compared the conservative treatment for PTBs and SPTBs to grafting cryopreserved cadaveric allografts with no prior excision. Twelve patients with flame PTB areas were allografted after mechanical debridement without excision of the burn wounds. The allografts were cadaveric skin cryopreserved by programmed freezing and stored at -180 degrees C for 30-48 months. Matching burns for depth and area were treated with silver sulfadiazine (SSD) one to two times daily until healing or debridement and grafting were required. It was found that 80 per cent of the cryopreserved allografts adhered well and 76 per cent of the treated areas healed within 21 days, whereas only 40 per cent of the SSD-treated burns healed within 21 days. Partial thickness burns can be treated successfully with viable human allografts (cryopreserved cadaveric skin) with no prior surgical excision. The burn wounds heal well within 3 weeks. For deep partial thickness burns (DPTB) treatment with allografts has no advantage if they have not been previously excised.
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An 11-year-old boy sustained high-voltage electrical and flame burns over 85% of his body surface area, 75% of which were full-thickness burns. After 4 months of treatment and multiple operations and skin graftings before his discharge from hospital, he exhibited irritability, hallucinations, and eventually, seizures and respiratory and cardiac arrest. He was resuscitated successfully. Diffuse bilateral brain damage was observed by means of computerized tomography and magnetic resonance imaging. Acute hypertension (up to 290/220 mm Hg) developed the following day. Recovery began 48 hours later. Most clinical symptoms and the hypertension resolved within 1 week. However, the computerized tomographic scans and magnetic resonance imaging findings persisted but were resolved within 2 months. Irritability and low tolerance for frustration were the only remaining symptoms at the time of a 12-month follow-up examination.