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Biomedical subjects

Y Wolf

Publications and source records attributed to Y Wolf.

At least 37 records · Page 2Linked to original sources
PubMed1998

Scorched eyelashes--do we treat them right?

Scorched eyelashes and burned eyelids are a common finding in facial burns, though the eye itself is often spared. Affected patients often complain of foreign body sensation and ocular discomfort in the absence of objective physical findings, other than scorched eyelashes and burned eyelash particles in the conjunctival sacs. This study was designed to evaluate the efficacy of prophylactic trimming of scorched eyelashes as a treatment for these findings and complaints. Eleven consecutive facial burn patients with bilateral eyelash scorching and no accompanying ocular damage were included. The eyelashes of one eye were trimmed, and those of the fellow eye served as untreated controls. Ophthalmic examinations were performed and eye-related complaints noted every other day for 10 days. We found that symptoms of foreign body sensation and discomfort occurred at a lower rate in the treated eyes (P<0.002) and no scorched eyelash particles were found in their conjunctival sacs (P<0.004) as compared to the untrimmed side. Conjunctival hyperemia was reduced. We suggest that shedding of scorched eyelash particles is a major cause of the ocular complaints in facial burn patients. Trimming the eyelash affords a simple and effective method of prophylactic treatment.

Conjunctiva↗
PubMed1998

Rubber foam and staples: do they secure skin grafts? A model analysis and proposal of pressure enhancement techniques.

The significance of even pressure application and protection against shearing forces using a tie-over dressing of skin grafts has been stressed previously. Several methods for pressure enhancement have been described with no quantification or comparison between the different techniques. Rubber foam and metal staples are commonly used for simple and quick application of the dressings. We developed a model for analyzing the contact interface of the dressing with the skin graft and the pressure exerted by it. A stapled rubber foam tie-over dressing was compared with the original silk thread tie-over dressing. Six different embodiments were also analyzed, all constructed using only rubber foam and metal staples. Imprint and maximal projection analyses of the undersurfaces were performed. The original silk thread tie-over dressing exerted a relatively low pressure but was uniformly distributed. A regular stapled tie-over dressing applied a ring-shaped pressure with minimal projection. Other methods are described providing different contact areas with the grafts and different pressures.

Bandages↗
PubMed1998

Preoperative thallium scanning, selective coronary revascularization, and long-term survival after carotid endarterectomy.

BACKGROUND AND PURPOSE: Long-term survival in patients after carotid endarterectomy (CEA) is determined mainly by their concomitant cardiac disease. We tested to determine whether preoperative thallium scanning (PTS) and subsequent selective coronary revascularization (CR), by either percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG), improve long-term survival after CEA. METHODS: Two hundred twenty-six of 255 consecutive patients (88%) undergoing CEA from 1990 to 1996 had PTS. Those with significant reversible defects on PTS were referred for coronary angiography and possible CR. Patients who had undergone PTS were divided into the following 4 groups: group 1, normal or mild defects on PTS; group 2, moderate-severe fixed and/or reversible defects in patients who did not undergo CR; group 3, patients who had CR secondary to their PTS results; and group 4, patients who had CR in the past that was not related to the PTS. Perioperative data were prospectively recorded, and data on long-term survival and cardiac and neurological complications were collected. RESULTS: Seventy-seven patients (34%) had preoperative coronary angiography, and 42 (19%) had subsequent CR: preoperative PTCA or CABG in 24, combined CEA+CABG in 10, and post-CEA CABG in 8 patients. No deaths resulted from the coronary angiography, CR, or CEA. Six patients had perioperative nonfatal myocardial infarction and 8 had stroke. During the follow-up (40+/-23 months), 47 patients (18%) died, 31 (66%) from cardiac disease and 4 (8.5%) from stroke. Independent predictors of long-term overall mortality were diabetes mellitus, preoperative T-wave inversion on ECG, lower-extremity arterial disease, and history of neurological symptoms [exp(beta)=3. 5, 3.4, 2.5, and 2.4; P=0.0003, 0.0004, 0.01, and 0.04, respectively]. In addition, preoperative moderate-severe thallium defect without CR (group 2) independently predicted long-term cardiac mortality [exp(beta)=2.8; P=0.04]. Patients with preoperative CR (group 3) had long-term survival rate similar to that of group 1 and significantly better than that of group 2 (P=0. 02). CONCLUSIONS: PTS predicts long-term survival, and selective CR based on the thallium results improves the survival rate of patients undergoing CEA.

Aged↗
PubMed1998

Successful treatment of advanced interstitial pregnancy with methotrexate and hysteroscopy. A case report.

BACKGROUND: Data concerning medical treatment of interstitial ectopic pregnancies are scarce. These pregnancies are characterized by late and serious clinical manifestations. We report a case of advanced interstitial pregnancy treated successfully by combining methotrexate (MTX) and hysteroscopy. CASE: A routine ultrasonic evaluation of a 10-week pregnancy revealed a right interstitial gestational sac 58 mm in diameter and containing an embryo with a crownrump length of 29 mm and embryonic heartbeats. Serum beta-human chorionic gonadatropin (hCG) level was 97,950 mIU/mL. The patient was treated with a systemic MTX/leucovorin regimen. At the end of the one-week course, no embryonic cardiac activity was detected, and a decrease in beta-hCG levels commenced. Persistent trophoblastic tissue, manifested by a low (26 mIU/mL) beta-hCG level in plateau, was successfully removed by way of hysteroscopy. CONCLUSION: Early detection of interstitial pregnancy may facilitate conservative medical treatment.

Abortifacient Agents, Nonsteroidal↗
PubMed1997

Cervical dilatation during ovum pick-up in patients with cervical stenosis: effect on pregnancy outcome in an in vitro fertilization-embryo transfer program.

OBJECTIVE: To evaluate the results of cervical dilatation during an ovum pick-up session in patients with cervical stenosis who participated in an IVF-ET program. DESIGN: A retrospective study. SETTING: In vitro fertilization-ET unit. PATIENT(S): Forty-one treatment cycles in 22 patients with known cervical stenosis. In all patients previous transcervical ET had been either extremely difficult or impossible. INTERVENTION(S): Cervical dilatation under general anesthesia during an ovum pick-up session, 48 hours before transcervical ET. MAIN OUTCOME MEASURE(S): Ease of ET procedure and clinical pregnancy rate (PR). RESULT(S): Cervical dilatation was performed in 41 IVF-ET cycles and resulted in easier transcervical ET in 39 cycles, but only one clinical and one extrauterine pregnancy. CONCLUSION(S): Cervical dilatation during the ovum pick-up session leads to easier ET in patients with cervical stenosis, but PRs after this procedure are very low.

Adult↗
PubMed1997

Comparison of transmyometrial and transcervical embryo transfer in patients with previously failed in vitro fertilization-embryo transfer cycles and/or cervical stenosis.

OBJECTIVE: To compare ultrasound-guided transmyometrial and transcervical ET in patients with cervical stenosis or in patients who failed to conceive after at least three previous IVF-ET cycles. DESIGN: A prospective, randomized study. SETTING: The IVF-ET Unit at Serlin Maternity Hospital. PATIENT(S): Forty patients undergoing IVF-ET. INTERVENTION(S): Ultrasound-guided transvaginal, transmyometrial, versus transcervical ET. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate. RESULT(S): Transmyometrial ET was performed in 20 patients and resulted in one clinical pregnancy. Transcervical ET, performed in another 20 similar patients, resulted in three clinical pregnancies. CONCLUSION(S): No benefit was derived by electing transmyometrial ET in preference to transcervical ET in patients who had failed to conceive in previous cycles.

Adult↗
PubMed1997

Uterine metastasis from vulvar malignant melanoma. A case report.

BACKGROUND: Malignant melanoma is the second most common vulvar malignancy. The superficial inguinal lymph nodes are the main site of metastases. Endometrial metastasis of vulvar malignant melanoma has not been previously reported. CASE: Vulvar malignant melanoma was diagnosed in a 60-year-old, postmenopausal woman. Immunohistochemical stains were positive for vimentin and S-100 protein and negative for HMB-45. Six months following vulvectomy, right inguinal lymphadenectomy and immunotherapy, curettage was performed due to postmenopausal bleeding. Histologic and immunohistochemical examinations revealed metastatic malignant melanoma with the same staining reactivity as the primary vulvar neoplasm had. Hysterectomy and bilateral salpingo-oophorectomy was performed, disclosing invasion of the endometrium and the inner two thirds of the myometrium. CONCLUSION: Only 10 other cases of endometrial metastases from malignant melanoma have been previously reported. All those cases involved a primary tumor occurring in the trunk and extremities. This is presumably the first report on endometrial and myometrial metastases from vulvar malignant melanoma.

Female↗
PubMed1996

Elevation of eyeglasses from the nasal bridge--a simple solution.

Wearing eyeglasses following nose surgery is a problem faced by many patients who require glasses for clear vision. The solutions offered for this seemingly minor problem are unsatisfactory and usually mandate special spectacle frames. We developed a simple apparatus, using a baseball cap and a tie clip, that enables suspension of eyeglasses with no pressure on the nasal bridge. This solution utilizes readily available components and maintains clear vision with possible frequent readjustment of the glasses. It also avoids contact of the glasses with any part of the face, namely the operative site, dressing, and wound discharge. We find this technique a simple and useful solution for a disturbing problem in plastic surgery.

Aged↗
PubMed1996

[Treatment of concomitant coronary and carotid disease].

The optimal surgical treatment for concomitant carotid and coronary artery disease is controversial. Between 1991 and 1995 we performed 34 procedures for combined disease of the carotid and coronary arteries. The first 8 operations were carotid endarterectomies followed by coronary artery bypass grafting (staged procedure). The next 26 operations were performed during a single anesthesia (combined procedure). The patients were 28 men and 6 women, aged 58-81 years (mean 68). 80% were in functional class III or IV. In 40% ventricular function was moderately or severely reduced. There was an average of 3.6 grafts per patient, and in all except 3 patients the left internal thoracic artery was used as a conduit for coronary artery bypass grafting. 30% had symptomatic carotid stenosis; there was no perioperative mortality. In the staged procedure group, 2 patients had postoperative cardiac complications: in 1 acute coronary insufficiency and acute myocardial infarction in the other. 1 had postoperative, transient, amaurosis fugax. In the combined procedure group, 1 had a myocardial infarction and 1 a minor occipital stroke. During follow-up, 1 patient died 4 months after operation of myocardial infarction, and 1 had a minor stroke. The results suggest that the combined procedure is safe and carries low risk of both mortality and morbidity. Whenever cardiac disease is stable and there is no main coronary artery disease, a staged procedure should be considered. In any other situation we continue to perform the combined procedure.

Aged↗
PubMed1996

Unilateral vulvar edema associated with paracentesis in patients with severe ovarian hyperstimulation syndrome. A report of nine cases.

BACKGROUND: Severe ovarian hyperstimulation syndrome is a life-threatening complication of ovulation induction. The clinical picture includes ovarian enlargement, accumulation of ascites and pleural effusion, increased coagulability and electrolyte disorders. Accumulation of ascites increases the intraabdominal pressure so that breathing difficulties ensue. Paracentesis is the only treatment that can immediately prevent respiratory deterioration. CASES: Nine women with severe ovarian hyperstimulation syndrome were treated by paracentesis for the drainage of massive ascites. Unilateral vulvar edema developed in all cases in which the lower abdomen was the puncturing site. This phenomenon was not observed when paracentesis was carried out through the upper abdomen. The edema resolved spontaneously over the subsequent 10 days. CONCLUSION: Apparently the puncturing needle created a fistulous tract through which the ascitic fluid was forced, by the increased intraabdominal pressure, into the subcutaneous tissues, presenting as unilateral vulvar edema. This can be prevented by using one of the abdominal hypochondriac regions as the puncturing site. This phenomenon is self-limited and causes only mild discomfort without late sequelae.

Adult↗
PubMed1996

Endometriosis in abdominal scars: a diagnostic pitfall.

Endometriosis is ectopic endometrial tissue that responds to hormonal stimulation and is found in 8 to 15 per cent of all menstruating women. Endometrioma in a surgical scar is rare and appears in 0.1 per cent of women who have undergone cesarean section; 25 per cent of these women have concomitant pelvic endometriosis. Endometrioma in a scar can present as a painful swelling on the scar that worsens during cough and effort, with the patient's complaints resembling those of a postoperative hernia occurring in a scar. It can also mimic other lesions of the abdominal wall, such as hematomas, granulomas, abscesses, and tumors. Four cases of endometriomas in a cesarean section scar are described. Two were diagnosed preoperatively as postoperative ventral hernias, and the other two presented with an abdominal wall mass causing pain and discomfort. All patients underwent surgery, and the error of their preoperative diagnosis was revealed by histology, which confirmed endometrioma. We contend that endometrioma in scarring is a diagnostic pitfall that should be considered in the differential diagnosis of postoperative ventral hernias and various abdominal wall masses.

Abdominal Muscles↗
PubMed1996

Female breast burns: conservative treatment with a reconstructive aim.

We retrospectively reviewed 421 burn patients treated in our burn unit in the past 3 years, focusing on breast burns in female patients. The aim of our study was to review the epidemiology, establish the mechanism of breast burn occurrence, and review the treatment plan. We evaluated 138 female burn patients, 38 (9%) of whom had non-isolated breast burns. In this group 25 burns (66%) were caused by scalds and 13 (34%) by fire. Scalds were responsible for first- to second-degree burns (50%), and cooking oil and fire for second- to third-degree burns (50%). A statistically significant difference was noted in the incidence of breast burns, which occurred mainly in late summer and fall (P = 0.03). There was a direct correlation between burn depth and duration of hospitalization, with average hospitalization time of 1.45 days for each percent of burn. Most breast burns were domestic, with children constituting the majority of the victims. Most breast burn patients were treated conservatively. Breast deformity on recovery varied in severity from minor deformity correctable with simple breast reduction surgery in older patients to severe deformity requiring further reconstructive surgery in infants.

Adolescent↗
PubMed1995

Gigantomastia complicating pregnancy. Case report and review of the literature.

Gigantomastia, or Gravidic macromastia, during pregnancy is a diffuse increase in size of the breasts over and above their physiologic size. It is a rare disorder of undetermined etiology, that may be due to hormonal excess or to hypersensitivity of the target organ. The histologic appearance is of glandular hyperplasia with an increase in connective tissue. Treatment during pregnancy is supportive and pharmacologic; once the patient has delivered surgical treatment is usually indicated. We present herewith a case report of gigantomastia during pregnancy, with a discussion of the treatment and a review of the literature.

Adult↗