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Biomedical subjects

S C Shapira

Publications and source records attributed to S C Shapira.

At least 37 records · Page 2Linked to original sources
PubMed1996

Use of alfentanil for in vitro fertilization oocyte retrieval.

STUDY OBJECTIVES: To determine alfentanil levels with a specific radioimmunoassay in serum and ovarian follicular fluid. DESIGN: Observational study. SETTING: University hospital. PATIENTS: 14 ASA status I women undergoing oocyte retrieval for in vitro fertilization. INTERVENTIONS: General anesthesia was induced with alfentanil 15 micrograms/kg and midazolam 2 mg and maintained with alfentanil 0.5 mg, 60% nitrous oxide (N2O) in oxygen (O2) and midazolam up to a total of 4 mg. Oocyte retrieval was performed using a transvaginal ultrasound guided technique, 34 to 36 hours after human chorionic gonadotrophin administration. MEASUREMENTS AND MAIN RESULTS: Mean procedure time for oocyte retrieval was 18 +/- 2.4 (SEM) minutes. All patients were fully awake within 5 minutes and all patients except one were able to move from the operating table to the stretcher with minimal help. Mean total protein concentration in the follicular fluid was 3.8 +/- 0.4 mg%. Maximal serum alfentanil concentrations (Cmax) were attained 5 minutes after start of the procedure (tmax) and were 92 +/- 20 ng/ml. In contrast, alfentanil concentrations in the follicular fluid increased constantly throughout the procedure up to 8.9 +/- 0.8 ng/ml at 15 minutes. Clinical pregnancy rate was 3 of 14 patients. CONCLUSION: It is evident that during the oocyte retrieval procedure, the alfentanil concentrations in the follicular fluid are about ten-fold smaller than the serum alfentanil concentrations at the same time points. Similar pharmacokinetics have been shown when propofol was used as anesthetic. The low accumulation of alfentanil in the follicular fluid increases the attractiveness of alfentanil for anesthesia during oocyte retrieval for in vitro fertilization.

Adult↗
PubMed1996

Accurate anatomical location of war injuries: analysis of the Lebanon war fatal casualties and the proposition of new principles for the design of military personal armour system.

In this study we present a new approach to the design of the military personal armour system (MPAS). This approach is based on a computerized analysis of the exact anatomical location of 405 penetrating war injuries (290 shrapnel and 115 bullet injuries) in 164 soldiers killed in the Lebanon war. All the penetrating injuries (hits) were plotted on a computerized image of the human body. About 90 per cent of all hits were to the front of the body; 55 per cent of all hits were to the left side. About 45 per cent of all hits were to the torso, which is slightly more than the torso's proportion of total body-surface area (36 per cent). Of all hits to the torso, 64 per cent of the shrapnel hits and 73.3 per cent of the bullet hits were limited to the front mid torso (T4 to T9). The head at the level of the helmet received 9 per cent of all hits, most of which were over the frontal bones (72.4 per cent). The body part with the greatest density of penetrating injuries was the face, with 22.2 per cent of all penetrating wounds, and in particular the mid face, from the level of the lips to the level of the zygomatic bones, was especially vulnerable, sustaining 10 per cent of all the penetrating wounds. These findings suggest several possible modifications in the standard MPAS: an additional protective device over the front mid torso may be incorporated; the face may be protected by a transparent and lightweight face-shield; a horizontal margin added to the standard helmet may protect the upper face from missiles from above; a chin cover may protect the lower face.

Blast Injuries↗
PubMed1996

The Abbreviated Injury Scale. A valuable tool for forensic documentation of trauma.

Anatomic trauma scoring systems are fundamental to trauma research. The Abbreviated Injury Scale (AIS) and its derivative, the Injury Severity Score (ISS), are the most frequently used scales. We assessed the applicability of the AIS and the ISS systems for postmortem forensic documentation of trauma. In a prospective study, all trauma autopsies performed between January 1 and June 30, 1993, were coded according to the AIS and ISS method. All cases were reviewed by a consultant in forensic medicine and a traumatologist. Cases were grouped in three categories according to ISS values: 0-14, 16-66, and 75. These categories represent minor, major, and incompatible-with-life injuries, respectively. All autopsy findings in which ISS was < or = 14 were peer-reviewed to establish mechanism and cause of death. In the 6-month period, 279 trauma-related autopsies were studied. Age at death averaged 37.1 +/- 18.7 (mean +/- SD). Eighty-six percent of the victims were male. Penetrating trauma was the mechanism of injury in 67%. ISS was 0-14 in 19 cases, 16-66 in 150 cases, and 75 in 110 cases. In conclusion, AIS and ISS scoring systems are applicable to trauma forensic documentation. Using these methods for coding postmortem findings may help in establishing a database for trauma research, and this information could constitute a major part of continuous quality improvement of trauma management. Low ISS values may serve as a warning, sometimes indicating preventable death.

Abbreviated Injury Scale↗
PubMed1996

Blast injuries: bus versus open-air bombings--a comparative study of injuries in survivors of open-air versus confined-space explosions.

OBJECTIVES: To compare injury patterns resulting from explosions in the open air versus within confined spaces. METHODS: Medical charts of 297 victims of four bombing events were analyzed. Two explosions occurred in the open air and two inside buses. Similar explosive devices were applied in all four incidents. The incidence of primary blast injuries, significant penetrating trauma (Abbreviated Injury Scale score > or = 2), burns, Injury Severity Score, Revised Trauma Score, and mortality were compared between the two populations. RESULTS: A total of 204 casualties were involved in open-air bombings, 15 of whom died (7.8%). Ninety-three victims were involved in bus bombings, 46 of whom died (49%). The difference in mortality rate was highly significant, p < 0.00001. Primary blast injuries were observed in 25 and 31 victims (34.2% and 77.5% of admitted victims), respectively (p = 0.00003). Median Injury Severity Score was 4 versus 18, respectively (p < 0.0001). CONCLUSION: Explosions in confined spaces are associated with a higher incidence of primary blast injuries, with more severe injuries and with a higher mortality rate in comparison with explosions in the open air.

Adolescent↗
PubMed1996

Traumatic arm amputation, an uncommon parachuting injury.

Parachuting is a unique method of deploying troops. Accidents in parachuting are common, but usually carry minimal risk for severe injury. Most accidents occur during landing and injuries often affect the lower limbs and spine. Traumatic amputation of a limb is an extremely rare event in parachuting. We present a case of a parachutist who suffered a traumatic amputation of the left hand during jumping off the plane.

Accidents, Aviation↗
PubMed1995

Electrical injuries: current concepts.

Electrical injuries are often dramatic accidents and are potentially fatal. The systemic involvement which characterizes many of these injuries, requires familiarity with the broad spectrum of clinical manifestations and possible complications. While many victims of electrocution are killed before help can be provided, survivors may suffer severe injuries that need proper treatment. The pathophysiological aspects of electrical injuries and therapeutic principles are therefore discussed in this review as well as preventive measures.

Cardiovascular System↗
PubMed1995

The role of an anaesthetist in a field hospital during the cholera epidemic among Rwandan refugees in Goma.

In 1849 John Snow, already the leading anaesthetic practitioner and innovator of his day, made a historic contribution to the epidemiology of infectious disease by his famous study of the distribution of cholera around the area of Broad Street in London. We report on our experience as anaesthetists in a field hospital, dispatched as part of the international rescue effort to Goma, Zaire, to help combat the effects of cholera among the Rwandan refugees.

Ambulatory Care Facilities↗
PubMed1995

Assessment of pain threshold and pain tolerance in women in labour and in the early post-partum period by pressure algometry.

The changes in the pressure pain threshold (PPThr) and pressure pain tolerance (PPTol) in 41 parturients have been studied during the active phase of labour and in the early post-partum period. The sensitivity to pressure stimuli was examined with an electronic pressure algometer placed on the sternum during the interval between painful contractions, after extradural analgesia and 24 h after childbirth. Prior to extradural analgesia, mean (+/- SD), PPThr and PPTol were 4.9 +/- 1.6 kg 0.25 cm-2 and 6.9 +/- 1.8 kg 0.25 cm-2, respectively. Similar values were recorded 1 h after induction of the extradural block when the pain of labour was abolished. At 24 h post-delivery, a significant decrease in both PPThr and PPTol was noted (P < 0.001). The lack of influence of extradural analgesia on pressure algometry values, and the elevated sensitivity to pain in the early post-partum period, may be related to the influence of pregnancy and labour on the appreciation of pain.

Adult↗
PubMed1994

[Medical kits in Army physicians' vehicles].

Physicians' medical kits (PMK) were distributed to 50 physicians, graduates of an advanced trauma life support course. The kits were always to be present in the physicians' designated vehicles, enabling them to provide advanced life support at the earliest possible stage (the "golden hour"). The kits have equipment for advanced airway intervention and management, chest trauma management (chest tube insertion, etc.) and fluid administration. To help assess the impact of the PMK and its cost effectiveness, questionnaires were sent to the physicians involved, of whom 35/50 responded. The questions included 2 subjects: the presence of the kit in the car and details of its use for injuries. The kit was present at all times in the cars of all except 1 of 31 physicians. 7 (22.5%) of them used the kit in 50 incidents which involved 74 injured persons. The injuries were caused by road accidents in 54 cases, in 17 by terrorist activity, and 3 cases involved heart attacks and cardiac resuscitation. Distribution of the PMK among army physicians appears to be valuable in the field, and before hospitalization.

Automobiles↗
PubMed1994

Bupivacaine wound infiltration in thyroid surgery reduces postoperative pain and opioid demand.

Control of postoperative pain is an important element in preventing the modification of the excitability of the dorsal horn neurons. We studied the efficacy of bupivacaine 0.5% wound infiltration for postoperative pain management following thyroid surgery. Forty consecutive ASA I-II patients, scheduled for thyroidectomy, were assigned randomly to two groups. Group I (n = 20) consisted of patients receiving bupivacaine 0.5% (10 ml) wound infiltration at the end of surgery and group II (n = 20 included patients without infiltration. The patients did not know whether the wound had been anaesthetized or not. All patients received balanced inhalational anaesthesia, including fentanyl (a total dose of up to 4 micrograms.kg-1). Postoperative pain medication included morphine IV or IM, as needed. Twenty-four hours after surgery the worst pain was recorded using a visual analogue scoring system, from 0 to 10. Twenty-four hour postoperative morphine requirement was recorded. Groups did not differ in demographic data. Pain scores significantly different in the two groups. In group I, the mean pain score was 3.7 +/- 1.6 compared with 6.9 +/- 1.7 in group II (P < 0.05). Only six patients (30%) in group I received opioids and only one of these (5%) had a pain score above 5. In comparison, 18 patients (90%) in group II received morphine during the first postoperative day. The local injection of bupivacaine corresponds to a block of the superficial branches of the cervical plexus. This study demonstrated a simple, efficient and safe way to reduce pain perception following a thyroidectomy.

Adolescent↗