Biomedical subjects
Publications and source records attributed to T Kaufman.
A one-stage procedure is described for restoring the scrotum in a patient who suffered from Fournier's gangrene. The proximal superiomedial-based thigh flaps employed are most likely arterial flaps. These flaps are also well innervated, which makes them ideal for the purpose of scrotal reconstruction.
The 10th reported case of tuberculosis of the subdeltoid bursa is described. A 45-year-old Caucasian woman presented with a 30-year clinical history of subdeltoid bursitis, with typical physical signs, but with normal X-rays of the shoulder-joint region and lungs. The diagnosis was made by needle aspiration and was later confirmed by bacteriologic and histological examination of the surgical specimen. Following surgery and chemotherapy, the patient has remained free of any active tuberculosis disease for the past five years.
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We present a series of ten patients consecutively admitted to the hospital after swallowing 12 household sewing needles. Ten of these needles, one in each patient, had perforated either the stomach or the duodenum, but in no case did the perforation cause any abdominal symptoms or signs. Immediately after arrival in the emergency ward, the diagnosis was made in most cases by means of a diatrizoate meglumine swallow, which showed the tip of the needle protruding outside the gastrointestinal tract. In the first few cases, the diagnosis was made by finding the needle in the same position after repeated plain abdominal roentgenograms. This method, however, served to delay the diagnosis of perforation. All patients were operated on immediately after the diagnosis of perforation was made, except for two who had an additional ingested needle. Operation was delayed in these patients until the second needle was spontaneously eliminated. Perforation was confirmed by operation in all cases in the present series, the operative extraction of the needle was simple, and recovery was uneventful. The fact that patients may remain asymptomatic despite perforation of their stomach or duodenum by sharp, fine foreign bodies is no cause for procrastination of surgery, as severe complications may subsequently result.
Eight severely burned young patients were maintained on an oral hyperalimentation regimen of about 7,000 calories--including 314 proteins, 600 g carbohydrates and 336 g fats, containing greater than 8 g cholesterol--based mainly on a daily ingestion of 35 eggs. Serum cholesterol and protein, and plasma lipoprotein levels were measured during period of 30 days on the diet. The mean serum cholesterol level prior to the egg-rich diet was low [108 +/- 42 (SD) mg/dl] and it remained within the normal range during the study. The initial mean serum total protein level of 4.1 +/- 0.5 (SD) rose to 6.5 +/- 0.7 g/dl by the 19th day and stayed high throughout the remainder of the study. Plasma lipoprotein levels, assessed by nephelometry and reported as concentrations of large, medium and small particles, were not increased. It is assumed that the high demand for energy during recovery from burns prevented abnormal rises in plasma lipid levels on fat-rich diet.
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A series of 7 young, healthy persons suffering severe vascular trauma and acute ischaemia of their limbs is presented. Standard vascular repair, although technically successful, failed to achieve satisfactory restoration of the circulation and the limbs remained severely ischaemic. Hyperbaric oxygen treatment at 2-8 atm (approximately 290 kPa) prevented the development of gangrene in all cases. This treatment is considered to be a very useful adjuvant to reconstructive vascular surgery in cases which come to repair late after injury.
In order to evaluate some of the physical properties of the Haifa Occlusive Dressing, which is in use in our Department, temperature, moisture and the transfer of gases were measured. The Haifa Occlusive Dressing does not significantly raise the temperature of the covered burn, nor does it hinder the diffusion of gases, even when wet. Measurements taken from a patient suffering from a deep second degree burn showed that the amount of secretion over a 9-h period was 270 cm3 and the rate of secretion/unit area was 0.0125 cm/h.
A regime involving the dietary management of 8 severely burned patients has been described, the main feature of this diet being the high egg intake. The eggs were given in a variety of forms without any untoward effects and without any distaste being developed. No pathological levels of serum lipoproteins or cholesterol were attained. Serum proteins from an initial low level reached normal values within a relatively short time. It is felt that a high egg diet is a valuable and safe addition in the management of severely burned patients.
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In the present study, Aloe vera gel (AVG) was applied to experimental second-degree burns in guinea pigs, and its effects on epithelialization, wound contraction, newly formed granulation tissue, and regeneration of hair follicles was compared with that effected by 1% silver sulfadiazine cream (AgSD). Epithelialization (%mean +/- SEM) on postburn day 8, 16, and 24 of the AVG-treated wounds was 38.72% +/- 2.71%, 60.34% +/- 3.28%, and 92.46% +/- 2.26%, respectively, while that of the AgSD-treated burns was 53.35% +/- 2.65%, 94.84% +/- 2.65%, and 100%, respectively (P less than .001). Contraction of the AVG-wounds was significantly higher than that of the AgSD-treated burns during 24 days of the study (P less than .001). The thickness of the newly formed granulation tissue was higher in the AVG-treated wounds (P less than .001), while the hair follicles count was significantly lower (P less than .001) compared with the AgSD-treated burns. It is concluded that this preparation of Aloe vera gel hindered the healing process of the present burn wound model when compared with 1% silver sulfadiazine cream.
A simple, sterile splint to ensure skin take and to immobilize joints in burned children who have grafted wounds is described. It consists of sterile tongue depressors placed 2 to 3 cm apart on the circumference of the limb and entwined at various layers with wrapped Kerlix. In our practice this device is advantageous because of its evaporative properties; it is lightweight and easily removed.
Toxic epidermal necrolysis (TEN) is characterized by extensive exfoliation of the epidermis, mucosal ulcerations and fever, after a recent intake of a new drug. TEN developed in an 8-year-old girl after she ingested sulfonamides and sustained skin injuries of 90% total body surface area. In addition to her critical care management, local treatment consisted of Iodoplex cream (Biosearch Laboratories, Haifa, Israel), a long-acting antimicrobial agent from which iodine is slowly released over 48 hours. Healing was observed within 8 to 17 days after initial application. Iodoplex cream is an additional topical agent for the local treatment of TEN when porcine heterografts or allografts might not be feasible.
A case of acute gastric dilatation due to massive aerophagy in a patient who had previously had a laryngectomy is reported. Excitement during regional analgesia was responsible. The pathophysiology of this mechanism is discussed and suggestions are made about its prevention.
Manula compression of the common carotid artery after a complication of the posterior approach to the internal jugular vein resulted in progressive AV block and cardiac arrest. Electrocardiographic monitoring is advocated as a routine.
Most phosphorus burns are of limited extent. First aid consists of vigorous irrigation with water or saline followed by application of soaked dressings. At the Rambam Medical Center Burn Unit, washing of the wounds with 1% copper sulfate and 5% sodium bicarbonate solutions occurs before removal of phosphorus particles. In selected patients, prompt excision of the injured tissue and skin grafting are recommended. Fluid replacement and close monitoring of ECG, serum calcium, phosphorus, and electrolytes are recommended for all patients with such burns.
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