Biomedical subjects
R Shafir
Publications and source records attributed to R Shafir.
Complications of liquid nitrogen cryosurgery for verrucae over bony prominences.
Liquid nitrogen cryosurgery is the most frequently used surgical treatment for verrucae. Its success rate is high and complications are rare. However, liquid nitrogen should be used with great care over bony prominences where skin and subcutaneous tissues are thin. We present 3 patients in whom the treatment of simple warts over bony prominences by liquid nitrogen resulted in full-thickness loss of skin. In 2 of them, extensor tendons of fingers were exposed and had to be covered with flaps. We conclude that expertise of the physician is of paramount importance in preventing similar complications in cryosurgery of verrucae.
Complication with the elastic tubed net bandage.
A case is presented in which inappropriate application of extensible tubed net bandage to a finger caused local skin necrosis. Only one comparable complication of this dressing material has been reported previously.
Cosmetic and reconstructive surgery of the breast.
Explore the source record for details and available documents.
A team work model in a burn unit with the integration of a clinical psychologist.
This paper describes team work in a burn unit in Tel Hashomer Hospital, Israel, which is intended to answer the problems which arise during the period in hospital following burning injury. The model was constructed after observing the emotional reactions of patients, which disturbed not only their ability to cope efficiently, but also caused additional suffering to themselves, their families and the hospital staff. The main emphasis is on: (1) the recognition and treatment of both the physical and emotional requirements of the patient; (2) involvement of the family in the treatment; and (3) active cooperation between all those who have a professional interest in the patient's treatment, welfare and recovery. The coordinator and integrator of these elements is the clinical psychologist.
Preoperative ultrasonic measurements of the thickness of cutaneous malignant melanoma.
Preoperative measurements of the thicknesses of pigmented skin lesions by high-resolution sonography have been studied. Fourteen nevi and 15 malignant melanomas were examined and their thicknesses compared with those measured on both paraffin and frozen sections. Linear regression coefficients of r2 = 9.22 and r2 = 9.23, respectively, were found. This good correlation suggests that sonography may be of value as a guide in predicting prognosis and in determining the proper course of treatment for patients with malignant melanoma.
Various approaches to burn care in the Lebanon War, 1982.
All soldiers severely burned during the Lebanon War, 1982, were hospitalized in one of four facilities, in each of which different methods of burn care are practiced. These methods represent the various approaches to burn care in different centers in the world and in the literature. Resuscitation was adequate in all facilities. Oral hyperalimentation, although administered in different ways, is recognized as a main factor in preventing infections and enhancing healing in burn victims. The main aspect in which opinions differ is the care of the wound itself. However, it was clear after examining many of the patients from the different centers that tangential excision is superior to delayed excision, and certainly to conservative treatment. The difficulties in comparing different methods of treatment are discussed. Early and continuous psychological surveillance is necessary for the successful recovery and rehabilitation of burn patients; a special teamwork model was developed to promote this approach.
Burn injury and prevention in the Lebanon War, 1982.
Measures taken during the Lebanon War, 1982, to prevent and minimize the extent and severity of tank-crew combat burns proved to be of value. Since 98% of tank crewmen who were burned were wearing fireproof suits at the time, only 12% sustained abdominal burns; 77% had facial burns, as none of them were wearing fireproof masks. Only 9% of the burned soldiers who wore fireproof gloves sustained hand burns, compared with 75% who did not wear the gloves. A comparison of the extent of tank-crew burns in the Lebanon War and the October 1973 War revealed that 51% of the burns in 1982 were minor, compared with 21% in 1973. Of the burns sustained in 1973, 29% covered greater than 40% of the body surface area, compared with 18% in 1982.
Pitfalls in frozen section diagnosis of malignant melanoma.
The importance of obtaining an intraoperative diagnosis and measurement of thickness of a malignant melanoma has emerged since the change in the surgical approach towards thin melanomas (0.75 mm). In experienced centers, both diagnosis and thickness, can be established on frozen section. Eighty-four pigmented lesions were examined on frozen section. Thirty of 31 were correctly diagnosed as malignant melanomas. The one not diagnosed was a regressing melanoma. The frozen section diagnosis of a regressing melanoma is difficult, and this should be deferred until paraffin sections are examined. In 29 consecutive skin melanomas thickness was measured on frozen section and was found to be 0.1-0.4 mm more than that measured on paraffin sections of the same specimens. It is therefore suggested that tumors measuring up to 0.85 mm on frozen section should be included in the group of thin melanoma.
Postoperative catheterization and prophylactic antimicrobials in children with hypospadias.
A prospective study of 78 children who underwent 84 operations for correction of hypospadias was done. Of these, 54 had a transperineal indwelling Foley catheter for ten days after surgery and 30, a transurethral catheter. Forty-five randomly selected children received prophylactic antimicrobial therapy (sulfamethoxazole), and the remaining 39 children served as controls. Incidence of urinary tract infection was significantly higher in the control group (10 of 39) as compared with the treated group (3 of 45) in spite of the higher incidence of vesicoureteral reflux in the treated group. This suggests that prophylactic antimicrobial treatment may prevent urinary tract infection from prolonged indwelling catheterization.
Microphallic hypospadias: testosterone therapy prior to surgical repair.
The surgical repair of hypospadias may be more difficult in boys with microphallus than in those with a penis of normal size. Temporary enlargement of the abnormally small penis can be achieved by local application or systemic administration of testosterone. We have studied the effect of local application of testosterone cream in seven boys with microphallic hypospadias. Serum testosterone levels and penile size were measured before, during and after treatment. The relative advantages and disadvantages of local testosterone application in comparison with injection are discussed.
Hair-bearing neck flap for upper-lip reconstruction in the male.
Reconstruction of the upper lip resulting in a hair-bearing area and a non-hair-bearing lining is described in two cases of full-thickness lip defects. A unipedicled neck flap was used in one case and a bipedicled neck flap in the other, both comprised of hair-bearing and adjacent non-hair-bearing areas. The neck flap has the advantages of providing the two layers of the lip, and the reconstructed lip is not too thick and is mobile and pliable, and the hair resembles lip hair in color, density, and quality. The multiple operative procedures can be performed under local anesthetic.
Ultrasound scanning as an aid in the diagnosis and treatment of periprosthetic hematoma after breast surgery.
Explore the source record for details and available documents.
The thin malignant melanoma: changing patterns of epidemiology and treatment.
In the past few years a change has been noticed in the behavior of cutaneous malignant melanoma, with higher cure and survival rates. A retrospective review of all cases of primary cutaneous malignant melanoma during the years 1970-1979 in Chaim Sheba Medical Center reveals a possible explanation for this. The microscopic findings were reevaluated, diagnosis confirmed, and thickness of the tumor measured in millimeters. The number of cases diagnosed rose from eight in 1970 to 45 in 1979. A constant rise in number of thin melanomas (less than 0.75 mm in depth) was noticed. The percentage of thin melanoma rose from 11.1% of all melanomas in 1970 to 57.7% in 1979. Greater public and medical awareness of the danger of pigmented cutaneous lesions has probably triggered an earlier diagnosis of melanoma. Each suspected lesion is completely excised with a 1-cm free margin. No further excision is undertaken if a thin melanoma is diagnosed (excluding the more malignant regressing melanoma) on frozen section. Of the patients seen in 1979, 57% were spared wide excision and general anesthesia.
Vesicoureteral reflux in boys with hypospadias.
Hypospadias in a congenital anomaly which in most cases has to be corrected surgically. We include micturition cystourethrography (MCU) in the preoperative workup of all these children as well as three months postoperatively. Meatal stenosis and müllerian duct remnants are known to occur in this condition, but vesicoureteral reflux (VUR) was an unexpected finding in many boys who were asymptomatic and had no evidence of urinary tract infection. Fifty-eight of 305 hypospadiacs, examined by MCU, proved to have reflux, most of them grade II. In 37, VUR was found before surgery and in the remaining 21 after surgical correction, many of them with meatal stenosis. In 10 patients reflux appeared in the postoperative period where there had been none in the preoperative study; 8 of the 10 had a postoperative stricture of the distal urethra, and VUR subsided in 4 after adequate dilatation. We conclude that vesicoureteral reflux is not uncommonly found in patients with hypospadias, even in those who are completely asymptomatic. We believe this is an additional incentive to include an MCU in the pre- and postoperative evaluation of patients with this anomaly.
Mobilization of both breasts for reconstruction of a midline anterior chest wall defect.
Explore the source record for details and available documents.