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Biomedical subjects

Y Kluger

Publications and source records attributed to Y Kluger.

At least 37 records · Page 2Linked to original sources
PubMed2000

Posterior urethral disruption secondary to a penetrating gluteal injury.

We report a case of a complete posterior urethral injury secondary to a penetrating gluteal injury. Posterior urethral injury usually occurs in male patients with pelvic trauma. The reported incidence of urethral injury with pelvic fracture ranges from 1.6% to 25% (mean 10%), with 66% of them being complete posterior urethral ruptures. Causes of posterior urethral disruptions include blunt trauma, such as occur in road traffic accidents or falls from heights, and high velocity penetrating and crush injuries. Penetrating gluteal injuries that cause posterior urethral damage are extremely rare. This report presents the first case of a complete urethral injury due to a gluteal stab wound. Furthermore, this case demonstrates that any sign of injury to the lower urinary tract, regardless of the cause or weapon implicated, warrants an immediate evaluation.

Adult↗
PubMed2000

Impairment of aortal tone by no flow-reflow conditions and its partial amelioration by mannitol.

BACKGROUND: Although postischemic cardiac or pulmonary dysfunction can relate to the impact of remotely generated oxygen stress mediators on the heart, their direct effect on the vascular bed remains unresolved. Thus, we tested these remote effects in an ex-vivo double organ model. METHODS: After stabilization With Krebs-Henseleit solution, isolated rat livers were either perfused or made ischemic for 2 hours. Aortic rings were stabilized, immersed in postischemic liver perfusates and their functions were tested. Some organs originated from donors fed with tungstate, whereas others had mannitol (0.25 g/kg) in the buffer. RESULTS: Incubation of aortic rings with postischemic hepatic effluent resulted in protracted contraction. Spasm was slightly lesser when the livers were pretreated with tungstate or exposed to mannitol, but worse in pretreated rings. The return to basal tone was abrupt in all ischemia-reperfusion aortae. The response of the rings to phenylephrine under the influence of the ischemia-reperfusion hepatic effluent was deficient. Mannitol prevented most abnormal responses. CONCLUSIONS: Aortal tone impairment can occur by direct influence of the ischemia-reperfusion liver. It cannot be attributed entirely to xanthine oxidase, but also to other hepatic-released factors.

Animals↗
PubMed2000

Anaesthesia and critical care considerations in nerve agent warfare trauma casualties.

Nerve agents (NA) (tabun, sarin, suman, VX) have been stocked around the world for some time and still present a major threat to civilian as well as to military populations. Since NA can be delivered through both an aerial spray system and a ballistic system, victims could suffer both NA intoxication and multiple trauma necessitating urgent surgical intervention followed by intensive care. These patients can be expected to be extremely precarious neurologically, respiratorily and haemodynamically. Moreover, their clinical signs can be misleading. Further exacerbating the problem is the fact that interactions of NA with the pharmacological agents used for resuscitation and/or during anaesthesia can aggravate organ instability even more and possibly cause systemic collapse. There are no protocols for perioperative critical care and early assessment or for the administration of anaesthesia for surgical interventions in such combined multiple trauma and intoxicated casualties. We propose a scheme for the administration of critical care and anaesthesia based on the scant anecdotal reports that have emerged after the occurrence of local accidents involving NA intoxication and on the neuropharmacological knowledge of the pesticide organophosphate poisoning database, these compounds being related chemical substances.

Anesthetics↗
PubMed2000

Structural proteomics of an archaeon.

A set of 424 nonmembrane proteins from Methanobacterium thermoautotrophicum were cloned, expressed and purified for structural studies. Of these, approximately 20% were found to be suitable candidates for X-ray crystallographic or NMR spectroscopic analysis without further optimization of conditions, providing an estimate of the number of the most accessible structural targets in the proteome. A retrospective analysis of the experimental behavior of these proteins suggested some simple relations between sequence and solubility, implying that data bases of protein properties will be useful in optimizing high throughput strategies. Of the first 10 structures determined, several provided clues to biochemical functions that were not detectable from sequence analysis, and in many cases these putative functions could be readily confirmed by biochemical methods. This demonstrates that structural proteomics is feasible and can play a central role in functional genomics.

Cloning, Molecular↗
PubMed2000

Reduction in formation of peritoneal adhesions by methylene blue in rats: a dose response study.

OBJECTIVE: To find out if the ability of methylene blue given intraperitoneally to reduce surgically-induced adhesions in rats is concentration dependent. DESIGN: Random, controlled prospective study. SETTING: Teaching hospital, Israel. ANIMALS: Seventy female Wistar rats. INTERVENTIONS: Intraperitoneal adhesions were generated in rats by scraping the anterior wall of the uterine horn. They were then given either saline or serially diluted methylene blue intraperitoneally. Additional rats received identical treatments, but without the serosal damage. OUTCOME MEASURES: Graded formation of adhesions, two weeks later. RESULTS: In the rats treated with methylene blue 1%, adhesion formation was similar to that in sham operated rats and was significantly lower (p < 0.001) than in all other groups. CONCLUSION: Methylene blue 1%, and to lesser degree 0.5%, had the best anti-adhesion potential. Lower methylene blue concentrations were only partially effective, and much high concentrations may cause adverse effects.

Abdomen↗
PubMed2000

Return visits to the emergency room after minor trauma from motor vehicle accidents.

Most patients with minor trauma following motor vehicle accidents (MVAs) are discharged from the emergency room (ER) of a trauma centre after evaluation and observation. Some return with similar or additional symptoms. This study aimed to determine which patients returned, if any injuries had been missed, and what should be the policy of medical management. We reviewed the records of 8836 patients with minor trauma following MVAs who were examined in an inner city trauma centre during 1997. When the group of patients who returned to the emergency room (n = 160) was compared with the whole post-MVA minor trauma group, the former was found to have more males (75.6% vs. 55.9%), younger age (36.31 years vs. 39.72 years), more motorcyclists than drivers, passengers and pedestrians ( p < 0.002, for the three variables), and had more multi-site injures. During the return visits the patients stayed longer in the emergency room, were examined by more consultants and had repeated radiological evaluations and tests, compared with the initial visit. However, in none of the patients was the initial diagnosis revised nor were additional injuries found and consequently the initial management was not changed in any of them. It is concluded that the initial thorough evaluation by the primary traumatologist is adequate for MVA patients with minor trauma. These patients do not require any follow up in specialized clinics, and are best managed in the community by their general practitioners.

Accidents, Traffic↗
PubMed2000

Problematic intubation in soldiers: are there predisposing factors?

Attempts by a combat medical officer to secure the airway of a multiple-injury patient in the field may frequently end in failure. The recurrence of such failures, despite Advanced Trauma Life Support training, is perplexing; therefore, we studied the prevalence of clinical criteria that could predispose active soldiers to difficult intubation. Such known anatomical features and the Mallampati classification were assessed by experts in 250 soldiers at a military outpatient clinic of the Israel Defense Forces. It was found that most soldiers had normal airways. Limitations of head and neck movement, or in opening the mouth, were not observed. Other risk factors were noted in only a small percentage of the study population. Mallampati classes I and II were noted in 40% and 31%, respectively. No statistically significant differences between young (18-21 years) and older (40-44 years) soldiers were found. It was concluded that difficult intubations among soldiers are unlikely to be associated with anatomical causes. Complicated scenarios and deficient skills of the physicians are the most important factors that contribute to in-field failures to secure airway control. Several recommendations to remedy this situation are offered.

Adolescent↗
PubMed2000

Appendicitis in the elderly: what has changed?

BACKGROUND: The course and outcome of appendicitis in the elderly differs from that of the general population. The rates of perforated appendices, error in diagnosis, postoperative complications and mortality may be related to the time lapse between onset of symptoms and admission, and hence delay in surgery. OBJECTIVES: To evaluate if these factors have improved in recent years. METHODS: A retrospective study was carried out of all 61 patients over age 60 who underwent appendectomies in a major metropolitan hospital during 1988-98. RESULTS: We found that most patients had appendectomies within the first 24 hours of admission and within 3 days of symptoms. Rate of perforation was 43%, error 5.6%, morbidity 41%, and mortality 3.2%. CONCLUSIONS: The high rate of appendix perforation in the elderly is not due to delay. The literature reveals little improvement in the statistics of the disease over the last five decades, despite advances in imaging and surgical technique. This may be explained by the increasing inclusion of octogenarian patients.

Age Factors↗
PubMed2000

Pediatricians and the Advanced Trauma Life Support (ATLS): time for reconsideration?

BACKGROUND: General pediatricians in Israel are actively involved in the initial evaluation, resuscitation and management of traumatized children. However, pediatric trauma care is not a part of pediatric specialty training in Israel, and the few Advanced Trauma Life Support courses per year are insufficient for most pediatricians working in accident and emergency care. OBJECTIVE: To examine the value of the course in relation to the limited resources available for such training. METHODS: A telephone survey of 115 pediatricians who had taken the course between 1990 and 1994 was conducted. The responding physicians (67%) were asked to complete a specially designed questionnaire on life-saving procedures that were taught in the course. In addition, they were asked to subjectively assess the practical utility of the course. RESULTS: Forty-three (56%) pediatricians reported that they routinely treated both adult and pediatric trauma cases. Of these, 81% performed 27 life-saving ATLS procedures. Pediatric trauma was treated by only 22 (28%), of whom 72.3% performed 18 life-saving ATLS procedures. These pediatricians ranked the courses as being "very high" to "high" in impact. CONCLUSIONS: These figures indicate that an ATLS course designed specifically for pediatricians can markedly improve pediatric trauma care. To ensure standard education and patient care, such a course should be developed and made a mandatory component of residency training. Further studies to examine the objective impact of the courses on pediatric trauma care should be carried out.

Adolescent↗
PubMed2000

[Combined approach in management of penetrating injury of vertebral artery].

Penetrating injuries of the vertebral artery are not common. Although surgical control of this type of injury is well-documented, the combined approach (surgery and packing for temporary control of bleeding, followed by angiography and embolization for permanent control) is now recognized and practiced. We describe a 40-year-old man who was stabbed in the neck. He was rushed to the operating theater in hemorrhagic shock. A vertebral artery injury was identified and packed. Angiography and embolization permanently controlled the bleeding. The combined approach is safe and we recommend it in those in whom bleeding from the vertebral artery is initially well controlled with packing.

Adult↗