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Biomedical subjects

M Michaelson

Publications and source records attributed to M Michaelson.

At least 19 recordsLinked to original sources
PubMed2000

[Prioritizing suspected diagnosis of both brain and abdominal injuries--is it a problem?].

Current guidelines for management of suspected head and abdominal injuries are based on retrospective studies like that of Wisner & al, Following a recent review in this journal by Y. Kluger & al, which was based on non-Israeli data, we decided to define the current status at our trauma center. We compare our data of 18 months of hospital admissions for acute trauma in which head CTs were done with those of 5 articles advocating specific protocols for decisions in pre-laparotomy diagnosis. In the 861 cumulated cases, compared with the 800 of Wisner & al, craniotomy was required in 15% vs 7% (p < 0.05); laparotomy was much less frequent, 2.7% vs 12.9% (p < 0.05). The chance of finding a case requiring both craniotomy and laparotomy was 1 in 300. As the clinical condition of multiple trauma involving the head and abdomen is becoming less frequent and includes diverse situations, a comprehensive algorithm might be inaccurate. Good clinical judgment of the clinician and teamwork are therefore preferable.

Abdominal Injuries↗
PubMed2000

Cryohemostasis of uncontrolled hemorrhage from liver injury.

Uncontrolled hemorrhage is the primary cause of death in both blunt and penetrating liver trauma. Cryohemostasis was attempted in the past for elective liver surgery but did not gain popularity. During past decades, cryoequipment was refined and successfully used for tumor ablation. The purpose of the present study was to assess the efficacy of cryosurgery as a potential adjuvant hemostatic technique in the treatment of grades III-IV liver injuries. A standard liver crush-evulsion injury was created in pigs. In the control group, the liver was left to bleed freely. In the experimental group, the severed liver surface was immediately frozen to -160 degrees C for 10 min, spontaneously thawed, and left to bleed thereafter. Blood pressure, pulse rate, urine output, and serum lactate were monitored. The total blood loss was measured 180 min after liver injury was inflicted. The volume of frozen liver parenchyma was measured. For further laboratory evaluation, three additional experimental animals were not sacrificed and recovered. Cryohemostasis significantly reduced blood loss and substantially attenuated hemorrhagic shock. The frozen liver parenchyma underwent necrosis but did not jeopardize survival. Cryosurgery may be an efficient adjuvant technique in the early control of hemorrhage in grades III-IV liver injury.

Animals↗
PubMed1998

Life-threatening complications and irreversible damage following maxillofacial trauma.

Trauma remains one of the principal causes of mortality in the western world, especially among young adults. The most serious immediate life-threatening complication following maxillofacial trauma is airway obstruction. The onset can be sudden, as with foreign body aspiration, or following soft-tissue damage that can lead at a later stage to airway-compromising oedema. The medical literature regarding facial trauma appears to support the hypothesis that maxillofacial trauma alone is rarely life threatening, or will not lead to life-threatening conditions unless associated with airway compromise. There are some causes of life-threatening complications following trauma to the maxillofacial region such as massive bleeding or undiagnosed cervical spine injury. However, there are some situations that may cause irreversible damage unless immediate operation is undertaken. The almost complete lack of reports dealing with death or irreversible damage in trauma involving the maxillofacial region prompted us to review and analyse the importance of immediate intervention following trauma to the maxillofacial region, in order to treat life-threatening complications and prevent irreversible damage.

Adolescent↗
PubMed1997

[Trauma registry database].

Trauma registry is vital for every trauma center. In 1995, data on all injured patients who reached our trauma unit were collected. 3.040 patients were hospitalized, of whom 416 were transferred from other hospitals. We describe the distribution of the patients to in-patient wards and present the relationship between mortality and injury severity score. 1102 hospitalized patients underwent a total of 1599 operations with an overall mortality of 2.63%.

Databases as Topic↗
PubMed1997

Ulnar nerve injury following midshaft forearm fractures in children.

We report three cases of ulnar nerve deficit in children following closed fractures of the forearm bones. Significant anterior angulation and displacement of the ulna was noted in all patients. Two patients were operated on at a later stage when no evidence of recovery was demonstrated; the ulnar nerve was found to be embedded in dense scar tissue. One patient was operated on at the time of injury; entrapment of the nerve on the anterior spike and partial transection was found. Early exploration is indicated in such cases and may result in full recovery.

Adolescent↗
PubMed1997

Videotaping in the admitting area: a most useful tool for quality improvement of the trauma care.

The treatment of trauma patients in the admitting area is performed under stress and requires team work. The goals of this research were to develop and analyse the implementation process of videotaping trauma care. The Rambam Medical Center is a 900-bed referral teaching hospital. It serves a population of more than 1.5 million in northern Israel. The trauma unit has focused on various activities to increase the quality of trauma care over the past few years. We installed a video camera and taped the treatment as part of a programme for the quality improvement of trauma care. Reviewing the tapes was carried out by the trauma team under guidance in order to identify deviation from treatment protocols, errors in techniques, improper usage of time, equipment failure and problems in team work. After 3 years' experience, we found that videotaping is an accurate and inexpensive way of achieving quality control in the admitting area. It now serves as a regular method in Israeli trauma centres and we encourage others to try this method.

Adult↗
PubMed1997

The trimodal death distribution of trauma victims: military experience from the Lebanon War.

INTRODUCTION: Mortality in war is traditionally divided into two categories: killed in action and died of wounds. Mortality in civilian trauma is generally divided into three categories: immediate death (50%), early death (30%), and late death (20%). Can we identify a trimodal death distribution among war victims? METHODS: We analyzed data for casualties in the Lebanon War from June 6 to September 20, 1982. During this period a total of 1,950 soldiers were injured; 351 (18%) of them died. Time of injury and time of death of the victims was determined from real-time recordings during the battle and from hospital files. RESULTS: Analyzing the time of death revealed that 329 of the soldiers (93.7%) died within the first hour after injury, 7 soldiers died 1 to 4 hours after injury (2%), and 15 soldiers died 24 hours to 75 days after injury (4.3%). The most common causes of death during the first hour after injury were central nervous system (CNS) injuries 31%, exsanguination 30%, incineration 21%, and combined CNS injury and exsanguination 10.9%. Exsanguination was the leading cause of death 1 to 4 hours after injury (86%). CNS injury was the most common cause of late death (60%). Only 1.1% of the soldiers who reached the hospital alive died of their wounds. CONCLUSIONS: A trimodal mortality distribution with different causes of death in each peak can be identified in the mortality pattern of Israeli soldiers during the Lebanon War. The relative height of the different peaks and the causes of death in the third peak are different from those found in civilian trauma. We believe that prompt medical treatment and expeditious evacuation from the battle zone led to a very low death rate among the wounded soldiers who had reached the hospital alive. The same factors may have increased the relative portion of CNS injuries as a cause of late death.

Cause of Death↗
PubMed1997

Penile intracorporeal infusion--possible access to the systemic circulation. Pressure flow studies in dogs and humans.

OBJECTIVE: To assess penile intracorporeal infusion as a simple alternative method of intravenous access during the initial phase of fluid resuscitation in male patients. DESIGN: Laboratory pressure flow studies in dogs and in humans. SUBJECTS: 5 male mongrel dogs, and 10 male patients who were being investigated for psychogenic impotence (n = 5) or organic impotence (n = 5). INTERVENTIONS: Dogs- two 19G needles were inserted into the canine corpora cavernosa, one for fluid infusion, and the other for cavernosal pressure monitoring. Ringer's lactate solution was infused into the corpora cavernosa, through an infusion pump. The dogs were then bled until systolic blood pressure reached 60 mmHg, and resuscitated by transfusion of autologous blood into the corpora cavernosa. HUMANS: Ringer's lactate solution was infused into a corpus cavernosum through a 19G scalp vein needle. Pressure monitoring was done through another 19 G needle. MAIN OUTCOME MEASURE: Fluid flow rates and in humans time taken to insert an intracorporeal needle. RESULTS: Mean (SD) infusion rate through the canine corpora was 110 (22) ml/minute for Ringer's lactate solution and 109 (18) ml/minute for autologous blood. Mean infusion rate into the human corpora was 89.7 (12) ml/minute in the psychogenic impotent patients, and 88.2 (9) ml/minute in the organic impotent patients. Mean time taken to insert the needle was 15 (7) sec. CONCLUSIONS: An intracorporeal infusion line can be established in a short period of time and adequate quantities of fluids can be infused through the human and canine corpora cavernosa.

Animals↗
PubMed1995

[Head injuries from falls in children of 2 ethnic groups].

The highly prevalent problem of falls, the main cause of head injury in children, responds to preventive intervention. To aid in designing fall-prevention programs, we defined the pre- and post-hospitalization characteristics of children of 2 predominant Israeli ethnic groups: Jews (Group A) and non-Jews (Group B). In a prospective study conducted over a 10-month period in our emergency room during the morning shift, data from 274 patients aged 0-14 who presented with head injury due to a fall were collected. In Group B falls and damage were significantly more severe. Based on these differences in injury and in referral patterns between the 2 groups, a high-risk profile for head injury from falls in children was compiled to aid in designing an effective prevention program.

Accidental Falls↗
PubMed1994

Evidence for hypoxia-induced, programmed cell death of cultured neurons.

Apoptosis, a form of cell death ("programmed" cell death) in which the nucleus and cytoplasm shrink and often fragment, serves to eliminate excessive or unwanted cells during remodeling of embryonic tissues, during organ involution, and in tumor regression. In acute pathological states, such as ischemia, the cells tend to swell and lyse--a process called necrosis. We hypothesize that the delayed neural death clinically associated with hypoxia may, in part, represent apoptosis. A tissue culture model of 24 hours of hypoxia was employed using sympathetic neurons. Pretreatment with an endonuclease inhibitor (aurintricarboxylic acid) decreased cell death by 53%, depolarizing conditions (55 mM potassium chloride) decreased cell death by 33%, and an RNA synthesis inhibitor (actinomycin D) by 26% (all have been shown to prevent apoptosis). Pretreatment with antisense c-myc had no effect. Fluorescent staining with propidium iodide (a DNA marker) demonstrated chromatin condensation and agarose gel electrophoresis demonstrated a DNA "ladder." These data suggest that apoptosis may play a role in hypoxic cell death and that in this paradigm, expression of c-myc is unnecessary. This would suggest a new approach to our understanding of hypoxia and open new strategies to lessen neuronal damage secondary to this process.

Animals↗
PubMed1993

Injury severity scoring and length of stay in hospital of war casualties--demonstration of an association and possible selection bias.

The Injury Severity Score (ISS) is a widely used measure of anatomical injury. It is the sum of squares of the highest scores on the Abbreviated Injury Scale (AIS) in each of the three most severely injured body regions. This study was designed to describe the relationship between ISS and length of stay (LOS) in hospital. The ISS was independently determined by four physicians who studied 491 war casualties, excluding dead on arrival and non-trauma patients. The study demonstrates non-linear and non-homogeneous relationships between ISS and LOS. Exclusion of fatalities resulted in biased (higher) estimates of LOS among those with ISS scores of 25-66. The patients could be grouped into five categories according to their maximal AIS (MAIS): (1) Slight injury--i.e. those with injuries appropriate for AIS scores 1 or 2 that lead to an LOS of median 5 days; (2) Moderate injury--i.e. those with injuries appropriate to AIS scores of 3, with an expected median LOS of 10 days; (3) Severe injuries--i.e. those with injuries appropriate to AIS scores of 4, with expected median LOS of about 17 days; (4) Very severe injuries--i.e. those with one injury appropriate to an AIS score of 5; and (5) Multiple severe injuries--those who are severely wounded in two or more body regions, i.e. those with two or more injuries appropriate to AIS scores of 5 and 4, with a median LOS of 39 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

Control of intractable spasticity with intrathecal morphine sulfate.

Three years ago we reported our preliminary results regarding treatment of intractable spasticity with use of intrathecal morphine. This paper is a follow-up report of 12 patients who underwent implantation of a pump or reservoir for delivery of intrathecal morphine sulfate for control of spasticity. Our primary concern initially was that patients would ultimately become drug tolerant and lose the beneficial effect of the morphine. Only one of these 12 patients has developed drug tolerance. The longest follow-up period has been 4.3 years, and this patient has maintained excellent control of his spasticity with a stable dose of 2 mg of morphine daily.

Drug Tolerance↗
PubMed1989

[Casualties of the Peace for Galilee operation].

Most casualties of the Peace for Galilee operation were hospitalized at the Rambam Medical Center. Data from the medical records of 864 casualties of the first 15 weeks of the conflict were analyzed. 75% of them were battle casualties, and the rest were injured in accidents. Since this is the major central hospital of northern Israel, most of the severe, and about a third of the minor casualties were hospitalized here. Half of the cases reached hospital within 3 hours and 20 minutes of the time of injury. The overall mortality of all casualties, battle and accident, was 2.9%. The mortality among battle casualties who arrived at the hospital alive, was 3.4%.

Accidents↗