Search PubMed⌕ Search

Biomedical subjects

R Shafir

Publications and source records attributed to R Shafir.

At least 55 records · Page 3Linked to original sources
PubMed1993

Orthodox Jews have a lower incidence of malignant melanoma. A note on the potentially protective role of traditional clothing.

The incidence of malignant melanoma (MM) in orthodox and non-orthodox Jews in Israel during the years 1970-1982 was compared through an assessment of incidence rates in the orthodox and non-orthodox neighborhoods in the city of Jerusalem and by a comparison of the rates in 2 cities on the outskirts of Tel Aviv, one of which has a strongly orthodox population. Within the city of Jerusalem the incidence of MM for the European-American born in the orthodox neighborhoods was significantly lower than in the rest of the city in males, and of borderline significance in females. A similar pattern was seen upon comparison of the orthodox city of Bnei Brak to its neighbor city, Givatayim. The findings are consistent with the role of sun exposure in the etiology of malignant melanoma.

Clothing↗
PubMed1991

Are malignant melanoma patients at higher risk for a second cancer?

This study tests whether malignant melanoma (MM) patients are at higher risk of having an unrelated second cancer by comparing the observed incidence of a second cancer in a given population of MM patients with the expected number in an age-matched and sex-matched group of healthy people followed for a similar period. The analysis was based on the person-years method in which the main consideration is the follow-up period after the diagnosis of MM. Of 370 patients with histologically confirmed MM, 27 (7.3%) had a second noncutaneous invasive cancer, diagnosed either simultaneously (within 6 months, five patients) or after the diagnosis of MM (22 patients). The follow-up period for the entire MM group was 1253 person-years, a period during which the expected number of cancer cases in the normal population, according to the Israel Cancer Registry, was 6.6. The observed-expected ratio or the relative risk (RR) was 4.1 (P less than 0.01). After excluding the five patients with simultaneous diagnosis of MM and a second cancer, analysis of the remaining 22 patients in whom MM definitely preceded the second cancer showed an RR of 3.3 (P less than 0.01). For the entire group, there were nine patients with breast cancer, five with head and neck cancer (two with thyroid and three with oral cavity cancer), five with gynecologic cancer (one with uterine and four with ovarian cancer), five myeloproliferative malignancies (one with lymphoma, three with chronic lymphocytic leukemia, and one with myeloma), three gastrointestinal carcinomas (two with colon and one with stomach cancer), and two soft tissue sarcomas. When the differential analysis according to gender and age was done, it was found that the RR was higher for women (5.5, P less than 0.01) than for men where the RR was 2.2 (P less than 0.05). Differential analysis for various age groups showed that the trend for second cancer was consistent in all age groups, with a slight increase in the younger ones. None of the variables of MM, such as location of the primary tumor, level of invasion, or stage, were predictive for a second cancer. Furthermore, the RR for a second cancer did not relate significantly with the treatment given to the MM patient. Concerning the type of second cancer, it was found that the RR was especially high for breast cancer--6.6. These data indicate that MM patients may be at higher risk for having a noncutaneous invasive cancer compared with the general population.

Adolescent↗
PubMed1991

Repair of the severely contracted socket with meshed skin graft and semi-rigid conformer.

Nine severely contracted sockets were reconstructed using a meshed skin graft in conjunction with a semi-rigid conformer-stent. Particularly useful following unsuccessful surgery with mucosal grafting, or in cases where for some reason mucosal grafts cannot be obtained, this technique is superior to current procedures utilizing nonmeshed split-thickness skin grafts.

Adolescent↗
PubMed1990

Emotional and psychosocial adjustment of women to breast reconstruction and detection of subgroups at risk for psychological morbidity.

Thirty-four women who had undergone breast reconstruction after mastectomy for breast cancer were evaluated as to their emotional and psychosocial adjustment. Standardized psychological tests and a self-report questionnaire were used, along with the surgeon's evaluation of the aesthetic success of the reconstruction. Two psychodiagnostic tests were found to be of use in identifying maladjusted women who do not gain optimal benefit from the reconstruction: a questionnaire that evaluates the level of depression (Beck) and another that assesses the level of optimism (Cantrill). No correlation was observed between the surgeon's evaluation of the reconstruction's aesthetic success and the women's satisfaction. It was found that there are two groups of emotional-high-risk women: single women and women receiving adjuvant therapy. It is suggested that emotional-high-risk patients be given psychological support concerning the importance of the mastectomy and their reaction to breast reconstruction.

Adaptation, Psychological↗
PubMed1990

Serious infectious complications of midsternotomy: a review of bacteriology and antimicrobial therapy.

49 patients with severe infectious complications of midsternotomy incision were treated at our referral center over a 3-year period. 43 species of microorganisms were identified in 38 patients, the most common being Pseudomonas aeruginosa (37%) and Staphylococcus aureus (30%). Most of the patients underwent aggressive debridement and chest wall reconstruction by muscle transposition in combination with antimicrobial therapy. Antimicrobial therapy was given perioperatively according to the in vitro susceptibility of the organisms. Treatment was continued beyond this period for 2-3 weeks in patients with extensive deep seated infection or in those with positive cultures from intraoperative specimens. Some patients needed a longer course of up to 6-8 weeks antimicrobial therapy because of insufficient response to the shorter course. In all, 45/49 patients had complete wound healing. 28 recovered within 2-5 weeks and 16 required a more protracted course with additional surgery in 8; 1 wound did not heal after 20 months and 4 patients died from non-infectious complications. Due to the lack of specific guidelines in the literature as to the proper choice and length of administration of antimicrobial therapy for midsternotomy wound infection, and in view of these favorable results, we recommend our protocol in the treatment of midsternotomy wound infection (in combination with appropriate surgery).

Anti-Bacterial Agents↗
PubMed1989

The danger in skin grafting the bare mediastinum after sternectomy for postcoronary bypass dehiscence.

We describe a patient who underwent coronary bypass grafting, after which severe mediastinitis and sternal osteomyelitis occurred. Repair after sternectomy was undertaken with a rectus-abdominis myocutaneous flap. The distal fifth of the flap underwent necrosis and was replaced by a meshed split-thickness skin graft. A year later, a clip marking one of the bypass grafts nearly eroded through the skin graft, endangering the bypass graft. The skin graft was removed by abrasion, and the bypass graft was covered with a pectoralis muscle flap. We recommend that skin grafting of a granulating wound over coronary artery bypass grafts be avoided if possible.

Coronary Artery Bypass↗
PubMed1989

The S nipple-areola reconstruction.

Nipple reconstruction is performed as a last stage in breast reconstruction following mastectomy. Various methods of nipple reconstruction have been described, most of them utilizing either free composite grafts or local flaps. The main problem encountered using either method is the gradual absorption and flattening of the nipple. The technique we used in reconstructing 22 nipples, in preference over the various methods accepted in breast reconstruction, achieves a long-standing, protruding nipple constructed from two large local flaps raised from an S-shape design. The technique is simple and permits freedom in choosing the height of the nipple, even in the presence of a mastectomy scar. The size of the nipple thereby constructed is in excess of what was expected. Shrinkage occurs during the first 2 months, and the resulting size is more than adequate. The areola is reconstructed by a full-thickness skin graft harvested from a nonhairy area of the upper inner thigh. The local flaps lack the necessary color, which is achieved by tattooing.

Breast↗
PubMed1989

Congenital aplasia cutis: nonsurgical treatment with a synthetic skin substitute.

A case is presented of a newborn with a large abdominal wall defect of aplasia cutis conservatively treated with a new skin substitute (Omiderm). Omiderm is a thin, transparent membrane that is relatively inelastic when dry and capable of absorbing water. This provides an optimal environment for wound healing by preventing microbial invasion. It is simple to apply and easily removed, and it adheres without glue or staples. It is transparent, permitting direct vision of the defect. By enhancing the epithelialization process, shorter hospitalization is required. The large area of aplasia cutis healed completely under the Omiderm within 6 weeks.

Abdominal Muscles↗
PubMed1988

Faulty sternotomy and complications after median sternotomy.

In 11 of 55 patients with complications of median sternotomy, a paramedian sternotomy has been detected by computed tomography or at reparative operation. The thin side of the sternum is easily broken by the closing wires, this being the cause of instability and probably dehiscence and consequent infection and osteomyelitis. Most of the 11 patients in this group had some other predisposing risk factors, such as obesity, prolonged aortic cross-clamp time, and prolonged respiratory assistance. We suggest that, if a paramedian sternotomy is diagnosed at the primary operation, special closure techniques should be undertaken. Each patient with early dehiscence of a median sternotomy should undergo a computed tomographic examination. If a paramedian sternotomy is proved, simple reclosure is inadvisable. Sternectomy and closure with muscle flaps are then indicated.

Humans↗