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PubMed1985

Toxoplasma gondii infection of cats in Beirut, Lebanon.

The prevalence of serum antibodies to Toxoplasma gondii was determined by the indirect fluorescent antibody (IFA) test in cats of Beirut, Lebanon from September 1980 to July 1983 (35 months). Testing revealed that 253/324 (78.1%) cats had antibodies in the IFA test. While the prevalence of Toxoplasma antibodies in stray cats was considerably greater than in owned cats at the beginning of the study, this difference diminished over time, and prevalence was similar by the end of the study. Faecal shedding of Toxoplasma-like oocysts was found in 31/313 (9.9%) of cats, while 38/313 (12.1%) shed other Isospora spp. oocysts. The occurrence of dual infections was statistically significant.

Animals↗
PubMed1985

Cardiovascular and thoracic battle injuries in the Lebanon War. Analysis of 3,000 personal cases.

This report comprises 3,000 casualties of the Lebanon War whom I operated upon for cardiovascular-thoracic injuries in twelve Lebanese hospitals between January, 1969, and July, 1982. These patients were studied retrospectively through 1978 and prospectively thereafter. The logistics, weapons, wounds, and operative results in this study were unique. The patients' injuries can be categorized as follows: primarily thoracic, 1,251 (42%); peripheral vascular, 1,008 (34%); cardiac, 285 (9%); and thoracic mixed, 456 (15%). The male to female ratio was 3.6:1, the mean age 20 years, and the military to civilian ratio 1.7:1. The mean transport distance was 2 miles in 1,740 patients (58%). In patients with thoracic wounds, the incidence of cardiac involvement (14%) was higher than in World War II and Vietnam. The overall survival rate in casualties with cardiac injuries was 73%--best in pericardial, coronary, and right atrial wounds and dropping to 46% in left ventricular wounds, wherein pump failure was also a factor. A 13% (seven deaths) mortality for patients with injuries to the thoracic great vessels contrasted with the 1.2% (14 deaths) mortality for the rest of the patients with noncardiac thoracic wounds. Open thoracotomy in 818 operations (55%) reflected massive wounds and logistics. Pulmonary resection (310 operations) carried a 1.9% (five deaths) mortality and tube thoracostomy (683 operations) for lesser injuries, 0.7% (four deaths.) Thoracoabdominal injuries were 1.5 times more lethal. Fifty percent (504) of nonthoracic vascular wounds occurred in the femoral-popliteal area as a result of sniper attacks. Subintimal damage averaged 8 cm and mandated saphenous vein grafts in 72%. The mortality for injury to the aorta was 60% (12 deaths), contrasted with 1% (three deaths) for injury to extremity vessels. Hemorrhage and cardiac rupture were the most frequent causes of death. Early, proficient, open surgical control after or concomitant with intensive resuscitation proved successful in this special military conflict.

Adolescent↗
PubMed1985

[Anesthesiologic treatment of 3,665 patients in Red Cross hospitals in Thailand, Lebanon, Pakistan and Indonesia].

Between the end of 1979 and the beginning of 1984, the authors served as anaesthetists for Red Cross missions in surgical field hospitals on the Thai-Cambodian and the Afghan-Pakistan borders, in Lebanon, and in Indonesia. A total of 3665 civilian emergency patients were anaesthetised. 643 were operated on under local anaesthesia; 639, under regional anaesthesia, in most cases spinal anaesthesia. In spite of principal preference for local and regional anaesthetic techniques, 65% of the patients (2383 patients) were managed under general anaesthesia, which was maintained with halothane in 947 cases and ketamine in 1345 cases. 877 general anaesthesias with ketamine were performed with spontaneous breathing of ambient air; endotracheal anaesthesia was necessary in 1238 patients. In spite of the high risk for the patients and of the operative interventions and in the light of the simple and sometimes even primitive working conditions, no anaesthesia-related fatalities occurred. Postoperative lethality was 2%. In all cases, the duties of the anaesthesist involved more than performance of anaesthesia, which was sometimes assigned to paramedics. Other duties included preoperative examination, postoperative intensive care, consultation services in nonsurgical emergency cases, resuscitation, and training of local assistants.

Anesthesia↗
PubMed1985

Rehabilitation outcome of combat head injuries: comparison of October 1973 War and Lebanon War, 1982.

A comparative study between two series of penetrating head injuries that occurred during the October 1973 (Yom Kippur) War and the Lebanon War, 1982, was conducted following the clinical impression that patients wounded in 1982 experienced shorter periods of unconsciousness. Patients in both series were of similar age and educational levels. Duration of coma was shorter, transfer to rehabilitation hospitals quicker and the overall hospital stay shorter, all significantly so, in the 1982 series. Other significant differences were the abundance of associated chest and abdominal injuries in the 1982 series and the fact that not a single patient underwent tracheostomy in the later series, in contrast to 64% of the 1973 patients. No differences were noted with regard to neurological sequelae, independence in activities of daily living, and high mental functions. Rehabilitation outcome, as evaluated by actual work placement, differed significantly in favor of the 1982 series. This was probably due to faster patient transfer to rear hospitals for definitive interventions, thus reducing secondary brain damage and resulting in shorter periods of unconsciousness.

Adolescent↗
PubMed1978

Studies on naturally occurring filarial infections in dogs in Lebanon. I. Dipetalonema reconditum.

A survey for filarial parasites was carried out on dogs in Lebanon. The peripheral blood was examined for microfilariae and the skins and carcasses for adult worms. Three methods were used for blood examination: (a) thick blood films stained with Giemsa; (b) a modified Knott's technique (Methylene Blue stained); (c) sodium citrate technique. Two species of filarial worm were found, Dipetalonema reconditum and another species of Dipetalonema which will be described in a later paper. The morphology of microfilariae and adults of D. reconditum is described. The microfilariae of D. reconditum showed a nocturnal sub-periodicity. Attempts were made to find vectors by feeding Aedes aegypti, Aedes phoeniciae, Culex pipiens molestus and Clenocephalides felis on an infected dog. Developing and infective stages were recovered only from C. felis.

Animals↗
PubMed1983

The bacterial flora of fruits and vegetables in Lebanon and the effect of washing on the bacterial content.

Washed and unwashed vegetables and fruit specimens including radish, lettuce, mint, carrots, parsley, strawberries, green almond, akadinya, green-gages, cherries, plums, peaches, pears, and apples were investigated for their bacterial content. Tested specimens had a high content of bacteria belonging to the genera Enterobacter, Citrobacter, Klebsiella, Proteus, Pseudomonas, Providencia, Escherichia, Staphylococcus, and Salmonella. The washing procedure followed was effective in reducing the number of bacteria, but did not eliminate them. Enterobacter agglomerans was present in most specimens tested, and 11 out of 28 E. coli isolates were serotypable and may be enterotoxigenic or enteropathogenic. These findings are of concern in view of the fact that food-borne illnesses including "Traveler's diarrhea" are common in Lebanon.

Bacteria↗
PubMed1984

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.

Burns↗
PubMed1978

Wilder Penfield Lecture: nature and management of penetrating head injuries during the Civil War in Lebanon.

During the recent war in Lebanon- at one hospital one fifth of all casualty admissions were patients with skull injuries associated with penetrating brain damage. Wounds inflicted by high velocity missiles carried the greatest mortality. The patient's state of consciousness afforded the best guide to prognosis. Craniotomy, when feasible, was found preferable to the accepted technique of crainectomy in the management of these cases. Thorough débridement and complete hemostasis are essential, and when these have been accomplished, deeply placed bony fragments may be left in situ with impunity. Traumatic aneurysms develop by no means rarely and therefore postoperative arteriography is advisable.

Adult↗
PubMed1983

Survey of neuromuscular disorders in Lebanon. I. Profile of the genetically determined muscular dystrophies.

The clinical and laboratory profiles of 130 cases of muscular dystrophy in Lebanon collected over 35 years (1947-1982) are presented. Data collection included hospital records; registries in the department of pathology, hospital laboratories, electron microscopy facility and electromyography laboratory; and records from a private hospital neurosurgical unit. The yield from each of these sources is presented. The data was fed into an Apple II computer and analyzed using thirty seven parameters. The results are discussed and compared with three other similar studies from India and America.

Adolescent↗
PubMed1984

Medical air evacuation during the Lebanon War, 1982.

During the Lebanon War, 1982, 85% of the Israel Defence Forces casualties were airlifted from the battle zone by means of the aeromedical evacuation (AME) network of the Air Force. The rescue helicopter was the first point of medical contact for 4.4% of the casualties. A summary is presented of the types of aircraft used in AME and the number of casualties carried in the various flights. A brief description is also given of a new addition to the intensive care capabilities of AME helicopters: the air mobile life support unit used in combat for the first time during this war.

Aircraft↗
PubMed1984

Crush syndrome: experience from the Lebanon War, 1982.

Eight patients with crush syndrome were treated in our department during the Lebanon War, 1982. They arrived after having been trapped under fallen masonry for 4 to 28 h. They all had injuries of the lower limbs, with neurological deficiency and myoglobinuria. The local and general aspects of the syndrome are presented and discussed and a successful treatment protocol outlined.

Crush Syndrome↗
PubMed1984

Hyperbaric oxygen therapy for gas gangrene casualties in the Lebanon War, 1982.

Four gas gangrene casualties from the Lebanon War, 1982, were treated with hyperbaric oxygen (HBO). Myonecrosis was diagnosed in three and intraabdominal spread of clostridial infection in one. In all four cases, HBO treatment, in combination with meticulous but conservative surgical debridements and proper antibiotic coverage, was begun within 24 h of diagnosis. HBO therapy was terminated when bacteriostasis was attained, as evidenced by no further spread of myonecrosis and the alleviation of systemic toxic symptoms. All four patients recovered from the clostridial infection, but one died later from other causes. HBO therapy enhances the survival rate of patients with gas gangrene, lowers the anesthetic risk, allows for maximal tissue preservation and helps avoid radical mutilating surgery.

Adolescent↗
PubMed1984

Severe combat eye injuries in the Lebanon War, 1982.

The findings, treatment and follow-up of 21 severe, blunt and perforating ocular injuries that occurred during combat in the Lebanon War, 1982, are presented. The diagnostic and therapeutic approaches to complex and severe ocular injuries are discussed. The patients were followed up for 1 year and the long-term effects of the injuries on their eyesight are described.

Adult↗
PubMed1984

Acute spinal cord injuries in the Lebanon War, 1982.

Our experience with 17 patients with spinal cord injuries (SCI) acquired in the Lebanon War, 1982, is described. The SCI were due to gunshot wounds in 12 patients and to other causes in 5. Two laparotomies and one thoracotomy were performed. Corticosteroids were not seen to influence recovery, nor was laminectomy, which was performed in three cases. Complications such as pressure sores, hydronephrosis, ileus and deep vein thrombosis were rare or did not occur. Three high quadriplegics died. Based on our experience, we recommend conservative treatment and rehabilitation in acute SCI.

Adolescent↗
PubMed1984

A new type of mobile dental clinic developed following the Lebanon War, 1982.

A two-tier emergency dental services delivery system was developed following the October 1973 War, based on large mobile dental clinics (definitive restorations) and portable field units (emergency treatments). The increased demand for definitive restorations at the front lines, the mountainous terrain, and the extreme climatic conditions encountered during the Lebanon War, 1982, necessitated the development of a third alternative. A standard, compact module, either truck-mounted or helicopter-lifted, was outfitted as a fully equipped dental clinic according to Dental Corps specifications.

Dental Clinics↗
PubMed1984

Pathological evaluation of trauma in fatal casualties of the Lebanon War, 1982.

From 6 June to 20 September 1982, 271 of 376 fatal casualties sustained by the Israel Defense Forces (IDF) during the Lebanon War, 1982, were examined by pathologists of the IDF Medical Corps at a central examination center. An attempt was made to determine the nature of the weapons that caused the injuries. The examination was almost always restricted to external inspection of the body, and a complete autopsy was performed in only a few instances. X-ray facilities were used to detect foreign metallic fragments in the tissues and, where possible, these fragments were subjected to ballistic evaluation. It was found that explosions of various types were the most frequent cause of injury and death; gunshot injuries were second in frequency. Other causes, such as aircraft or traffic accidents and stab wounds, were responsible for very few of the deaths.

Humans↗
PubMed1983

Hospital dietetics and food service in developing countries: II. Lebanon.

A survey of 15 hospitals in Lebanon revealed that food service personnel in most hospitals had no training in nutrition, dietetics, or food service management. Kitchen sanitation was inadequate. Therapeutic diets were usually incorrectly planned and seldom used. The need for training food service personnel was recognized only in hospitals with some trained persons on the staff.

Data Collection↗