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Biomedical subjects

A Rivkind

Publications and source records attributed to A Rivkind.

At least 37 records · Page 2Linked to original sources
PubMed1997

Fracture of the occipital condyles and associated craniocervical ligament injury: incidence, CT imaging and implications.

Thin section contiguous axial computer tomography (CT) was used to demonstrate fractures of the occipital condyle and craniocervical ligament injury. During a 12-month period, 55 consecutive patients who had sustained high energy blunt trauma to the head or upper cervical region were examined (38 male and 17 female, age range 3-80 years, median 24 years). If occipital condyle fracture was suspected clinically, CT was performed from C2 to the foramen magnum with two dimensional sagittal, coronal, and curvilinear reconstructions and employing bone and soft tissue windows. Occipital condyle fractures were classified according to Anderson and Montesano types 1, 2 or 3. Injury to the internal craniocervical ligaments was described. Nine of 55 patients had occipital condyle fractures (16.4%). Injury of the alar ligaments was demonstrated in four and tectorial membrane injury in two patients. Three of the nine patients had associated fractures of cervical vertebrae. Five of nine patients had a normal Glasgow coma scale on admission (55%) and in two patients the occupital condyle fracture was the only significant injury. Plain cervical radiographs were non-diagnostic. Two patients had significant pain and limited motion of the craniocervicum several months following injury. In conclusion, CT should be performed where there is a high clinical suspicion of occipital condyle fracture, that is based mainly on the mechanism of injury.

Adolescent↗
PubMed1997

Emergency preparedness and response in Israel during the Gulf War.

We examined the effect of the emergency response on medical and public health problems during the 1991 Gulf War in Israel. On the first day of the conflict, the number of deaths from suffocation, asphyxiation, aspiration, myocardial infarction, cardiac arrest, and cerebrovascular accident increased abruptly, as did the number of sudden deaths associated with the use of tight-fitting masks with filters in sealed rooms. Much of the excess risk for death from cardiorespiratory complications during the first alert may have been a consequence of its duration (140 minutes). Mass evacuation and concrete buildings are believed to have kept the death toll from trauma down, and mask use may have protected against facial and upper-airway injuries. Falls and hip fractures, airway irritation from exposure to bleach, carbon monoxide intoxication from open kerosene heaters in sealed rooms, and self-injection with atropine syringes were also noted. A measles epidemic and increased death rates from automobile crashes were other preventable causes of death. Protection against biological warfare was limited to surveillance of trends for pneumonia and gastroenteritis. Emergency planners failed to anticipate the need for better mask fit, hands-on training in the use of masks, and special guidelines for older persons to prevent deaths from suffocation and other cardiovascular-respiratory problems in the first minutes of use. If masks are to be distributed as a protection against chemical warfare, a simpler model including the use of shrouds for whole-body skin protection might help avoid cardiorespiratory complications. Public health problems not adequately dealt with in the predisaster period are apt to emerge with greater severity during a crisis.

Accidents, Traffic↗
PubMed1997

The impact of advanced trauma life support course on graduates with a non-surgical medical background.

The aim of this study was to assess advanced trauma life support (ATLS) and combat trauma life support (CTLS) skills implementation among general practising physicians, its perceived utility in their routine daily practice as well as in their potential army combat assignments. One hundred and ten physicians, graduates of ATLS and CTLS courses, from the subspecialties of geriatrics, psychiatry and family medicine, were surveyed by telephone, to answer a specially designed questionnaire. The response rate was 82%. Professional distribution was: 6.6% geriatrics; 46.7% family physicians; and 46.7% psychaitrists. The number of trauma events treated by these physicians in their post-course practise was: geriatrics-three; family physicians-30; psychiatrists-18. We believe that a properly designed ATLS course, executed and applied to general practitioners, can be highly beneficial to trauma victims.

Adult↗
PubMed1997

The accumulated experience of the Israeli Advanced Trauma Life Support program.

BACKGROUND: Between January 1990 and May 1995 one faculty in Israel taught Advanced Trauma Life Support (ATLS) courses to 3,700 physicians. Two types of courses were given to three subpopulations. We studied the influence of demographic variables on students' achievements in the course and compared students' achievements as a function of their course type. STUDY DESIGN: This study was conducted as a concurrent longitudinal study. RESULTS: Achievements of 3,700 students were analyzed. The precourse grade, type of course, and their interaction were found to have a significant effect on the postcourse grades. Physicians practicing surgical subspecialties, in general, did better, as did students educated in English-speaking countries. Students who took part in the Combat Trauma Life Support (CTLS) course, which included the entire ATLS course and additional lectures and exercises, also ended with better scores. CONCLUSIONS: Physician's country of origin and clinical subspecialty have a significant effect on the cognitive achievement in the ATLS course provided in Israel. An expanded ATLS course (CTLS), to include additional military trauma topics as well as additional skill station training, can improve the results of the postcourse grades.

Adult↗
PubMed1997

Combat trauma life support training versus the original advanced trauma life support course: the impact of enhanced curriculum on final student scores.

BACKGROUND: Within a military framework, the trauma course student, a young medical officer, is trained to become a trauma team leader and the first provider of medical aid. By adding battlefield medicine-related subjects to the basic Advanced Trauma Life Support (ATLS) course, as well as exercises tailored to the distinctive demands of military medicine, we could develop a special teaching unit: Combat Trauma Life Support (CTLS). The curriculum is basically the complete unchanged ATLS course of the American College of Surgeons enriched with lectures and practicums to fill the gap between the essentially civilian emergency department character of the ATLS course and the military tasks of the medical officer. PURPOSE OF STUDY: To compare the cognitive knowledge achievements of trauma course participants in the Israel Defence Force Medical Corps and to delineate the impact of the course type on students' written test results. DESIGN: A retrospective comparison analysis of pre- and post-course written test scores of 2,614 physicians who had participated in the ATLS and CTLS courses in the Israel Defence Force School of Military Medicine between 1990 and 1993. RESULTS: The analysis indicated that students who undertook the CTLS course achieved statistically better results in written tests (87.9 +/- 8.7 vs. 79.6 +/- 11.4, R2 = 0.33). CONCLUSIONS: We conclude that the CTLS comprehensive curriculum provides an improved training basis for the complex task of army battlefield trauma care support.

Curriculum↗
PubMed1996

Stab wounds associated with terrorist activities in Israel.

OBJECTIVE: To describe injuries resulting from terrorist-associated knife stabbings. DESIGN: Retrospective case series. SETTING: Israel (population 5.5 million). SUBJECTS: Israeli victims (N=154) of knife stabbings on nationalistic basis (the intifada) between July 1987 and April 1994. RESULTS: A total of 125 men and 29 women sustained stab wounds associated with terrorist activities. The median age was 28 years (range, 12-92 years), and 99 victims were aged 18 to 35 years. Seventy percent (108 patients) of the stabbing events occurred between 7 AM and 11 AM. The 154 victims sustained a total of 327 stab wounds, the median number of injuries was 2 per person (range, 1-28), and 68 individuals (44%) sustained more than 1 stab wound. The chest was the most commonly involved site (146 wounds), with the right posterior chest stabbed in 71 patients. The knife penetrated the heart in 20 patients and penetrated the peritoneal cavity in 29 patients. Overall, 29 patients (19%) had superficial injuries, 86 (56%) had internal organ injuries that mandated operative interventions, and 39 died (overall mortality, 25.3%). CONCLUSIONS: Unlike other civilian stabbings, wounds resulting from terrorist-associated stabbings represent severe and highly lethal injuries.

Adolescent↗
PubMed1996

Conservative treatment of a traumatic tear of the left hepatic duct: case report.

Injury to the extra-hepatic biliary system in blunt abdominal trauma is rare and difficult to diagnose. In adults, all reported cases were treated surgically. We report a case of a traumatic tear of the left hepatic duct that was treated successfully by endoscopic retrograde cholangiopancreatography and stenting.

Abdominal Injuries↗
PubMed1996

Blunt injury of the small intestine and mesentery--the trauma surgeon's Achilles heel?

Eighteen patients with small intestine or mesenteric injury following blunt abdominal trauma were operated over a 34-month period. Early diagnosis and surgery, less than 6 hours after admission, was achieved in 10 patients (56%), seven of whom had haemorrhagic shock and had positive diagnostic peritoneal lavage or ultrasonography on admission. Three haemodynamically stable patients had a diagnostic abdominal computed tomography. Diagnosis was delayed in eight patients (44%) resulting in a gap between admission and surgery that varied from 20 hours to 46 days. The delay was related to lack of suspicion of injuries in haemodynamically stable patients despite a seat-belt sign, or false negative abdominal computed tomography. Diagnosis was delayed in six of seven patients (86%) where the only injury on admission was an isolated intestinal or mesenteric injury. In 11 patients there were associated abdominal or other system injuries. Late diagnosis was associated with an increased morbidity and longer hospital stay, relating to intestinal and mesenteric injury. In conclusion, a seat belt sign is highly suspicious of intestinal or mesenteric injury. Computed tomography was unreliable in diagnosing blunt intestinal and mesenteric injuries, and if equivocal, should be followed by diagnostic peritoneal lavage if nonoperative management is selected. Delayed diagnosis is often related to isolation of intestinal and mesenteric injury and results in increased morbidity and hospital stay. Every attempt should be made to reach a diagnosis within six hours of admission to the trauma unit. A management algorithm is proposed.

Abdominal Injuries↗
PubMed1995

p53 expression in patients with cirrhosis with and without hepatocellular carcinoma.

BACKGROUND: Mutated p53 acts as a dominant oncogene, whereas the wild type (wt) p53 gene product suppresses cell growth. Abnormalities in the p53 gene are reported in more than 50% of malignant tumors. Recently, an allelic loss of chromosome 17p, where the p53 gene is located, was found to be more frequent in hepatocellular carcinoma (HCC) cell lines and human tumors. In addition, in half of the cases of HCC from endemic areas for hepatitis B virus and aflatoxin, a hot spot point mutation at codon 249 was detected, as previously reported. Missense mutations in p53, mdm-2 complex formation, and other unknown mechanisms may lead to stabilization of the gene product, thus rendering it detectable by immunohistochemistry. METHODS: To assess the relationship between p53 status at a premalignant stage and in HCC, the authors studied the immunohistologic expression of p53 in HCC and in the adjacent nontumorous resected liver tissue, using monoclonal antibody to wt and mutated p53. RESULTS: Twelve of the 14 patients with liver tumors had HCC. Of the 12 patients with HCC and underlying cirrhosis, 8 (67%) had increased p53 expression in HCC cells. Eight of the 12 patients with p53-positive HCC cells had p53 overexpression in the nontumorous hepatocytes within regenerative nodules adjacent to HCC tissue. Three of 21 cirrhotic livers without a detectable tumor had increased p53 expression in the regenerative nodules. None of the 12 patients with chronic active hepatitis without cirrhosis or the 13 with a normal liver histology had increased p53 expression. CONCLUSION: p53 overexpression in some cirrhotic livers and in nontumorous livers of patients with HCC may indicate a normal p53 gene response to cellular stress or, alternatively, to an abnormally or mutated p53 gene, and could occur before the development of HCC.

Adolescent↗
PubMed1995

[Kidney transplantation from living, related donors].

Kidney transplantation is the best treatment for selected end-stage renal patients. The shortage of cadaveric organs for transplantation has led to the development of a protocol for kidney transplantation from living, related donors. In the past 20 years, 58 living, related kidney transplantations were done in our department. Mean patient age was 30 +/- 10 (SD) years and mean donor age was 36 +/- 10. There were 34 transplantations between brothers or sisters, 15 from parent to child, 4 between cousins, 4 between spouses and 1 from son to father. Mean follow-up time was 4 years. 1 and 5 years after transplantation, patient survival rates were 85% and 80%, respectively, graft survival rates were 85% and 75%. The introduction of cyclosporin-A as an immunosuppressive agent in 1985 led to improvement in graft survival rates: from 77% and 51% after 1 and 5 years, respectively, to 88% and 84%. No correlation between HLA match or patient's age and graft survival rates was found. We conclude that living, related donor transplantation is effective for suitable cases of end-stage renal disease. It should be recommended to patients who have a healthy, interested family member.

Adult↗
PubMed1995

Pancreaticojejunostomy versus controlled pancreaticocutaneous fistula in pancreaticoduodenectomy for periampullary carcinoma.

BACKGROUND: Anastomotic leak of the pancreaticojejunostomy is a major cause of morbidity and mortality following pancreaticoduodenectomy. Reports have described a large variety of techniques for performing this anastomosis and managing the pancreatic stump. In an attempt to obviate the pancreaticojejunostomy, we prospectively studied the technique of ligating the pancreatic duct and using external drains to create a temporary controlled pancreaticocutaneous fistula. PATIENTS AND METHODS: Thirty-five consecutive patients who were to undergo pancreaticoduodenectomy for periampullary carcinoma were prospectively randomized to one of two groups: pancreaticojejunostomy (PJ) (n = 18) or controlled pancreaticocutaneous fistula (CPF) (n = 17). The groups were well matched for age, sex, coexisting medical illnesses, type of tumor, and preoperative condition. Except for the management of the pancreatic remnant, all patients in both groups underwent an identical procedure. Major morbidity, length of hospitalization, duration of the controlled pancreatic fistula, and mortality were analyzed over a mean follow-up interval of 26 months (range 5 months to 7.5 years). RESULTS: The CPF group experienced lower overall operative morbidity rates than the PJ group (24% versus 56%, P < 0.01). Two patients (11%) in the PJ group and none in the CPF group died (P = NS). Half the morbidity in the PJ group and both mortalities were related to anastomotic leak. The CPF and PJ groups left the hospital after mean stays of 26.4 and 42.2 days respectively (< 0.01). CONCLUSIONS: Compared to pancreaticojejunal anastomosis, creation of a temporary controlled pancreaticocutaneous fistula in patients who undergo pancreaticoduodenectomy for periampullary malignancy has no appreciable risk. It is associated with reduced morbidity and shorter length of hospitalization.

Adult↗
PubMed1995

Malignant neuroepithelioma of the colon.

A rare case of malignant peripheral neuroepithelioma originating from the right colon is presented. The patient underwent right hemicolectomy followed by combination chemotherapy and there has been no evidence of tumour recurrence or metastases during three years of follow up. Emphasis is given to the extremely unusual location of this tumour and the favorable clinical outcome.

Adult↗
PubMed1995

Hepatitis C virus viremia in SCID-->BNX mouse chimera.

Chimpanzees are currently the only nonhuman animal model for reproducible propagation of hepatitis C virus (HCV). A chimeric mouse model was used for the induction of hepatitis C viremia, using BNX (beige/nude/X-linked immunodeficient) mice preconditioned by total body irradiation and reconstituted with SCID mouse bone marrow cells. HCV-infected liver fragments from patients with HCV RNA-positive sera were transplanted under the kidney capsule of the chimeric mice. HCV-specific RNA sequences were detected by reverse transcriptase nested polymerase chain reaction (RT-PCR) in serum of approximately 50% of grafted animals. In addition, normal liver specimens were incubated with HCV serum and transplanted into chimeric mice, leading to viremia in approximately 25% of animals. Sequential histologic evaluation of the liver implants, from day 2 to week 14 after transplantation, revealed loss of lobular architecture within the implants. However, viremia persisted for 10-50 days after transplantation. These results offer a new HCV model.

Animals↗
PubMed1995

Torture rhabdomyorhexis--a pseudo-crush syndrome.

Two patients who were systematically tortured and deprived of any oral intake presented with acute renal failure several days later. Unlike the classical crush syndrome, we describe a clinical entity wherein repeated direct muscle injury from blunt trauma, in addition to forced dehydration, led to myoglobinuria and renal failure. The literature is reviewed, and biochemical indices predicting severity of injury, pathophysiology, and management protocol are described. This pseudo-crush syndrome caused by rhabdomyorhexis in addition to rhabdomyolysis is an unusual entity, in part related to extreme sociopolitical factors.

Adult↗
PubMed1995

Diagnosis of traumatic rupture of the thoracic aorta using dynamic rapid sequence axial computerized tomography.

The use of intravenous contrast enhanced rapid sequence (dynamic) computerized tomography (CT) of the chest led to the successful diagnosis and treatment of traumatic rupture of the thoracic aorta in three patients. Early diagnosis of this often fatal injury may result in a favorable outcome; and in the hemodynamically stable patient with multisystem injury a well-performed CT may preclude the use of more invasive techniques. When aortic disruption is suspected, dynamic rapid sequence axial CT of the chest may not only exclude but also confirm the diagnosis, in addition to accurately detecting other major intrathoracic injuries.

Adult↗
PubMed1994

[Pulmonary embolism despite inferior vena cava filter].

The Greenfield filter is an effective and safe means of preventing postoperative pulmonary embolism in high-risk patients. However, it does not give absolute protection. We report a 69-year-old man who presented with deep vein thrombosis. Medical work-up revealed pancreatic tumor (Trousseau's sign). The Greenfield filter was placed in the inferior vena cava before operation. 11 days after total pancreatectomy clinical signs of pulmonary embolism appeared and the diagnosis was confirmed by ventilation-perfusion scan; anticoagulant therapy was instituted. The incidence of pulmonary embolism following interruption of the inferior vena cava by introducing the Greenfield filter is low (2.2%). Nevertheless, the diagnosis of pulmonary embolism should be considered in any patient with appropriate clinical signs, regardless of whether a filter was inserted.

Aged↗