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Biomedical subjects

A Eldad

Publications and source records attributed to A Eldad.

At least 19 recordsLinked to original sources
PubMed1999

Prehospital blood transfusion in prolonged evacuation.

BACKGROUND: Prehospital blood transfusion for hemorrhaging trauma patients has been used infrequently and is controversial. Currently, there is no satisfactory nonsanguineous fluid therapy for use during prolonged transport, such as in military or rural trauma. METHODS: We retrospectively reviewed prehospital data and hospital charts of all trauma patients in Israel who had received prehospital blood transfusion during a period of 30 months. RESULTS: Forty patients received 60 U of Rh-positive type O packed red blood cells. Mean time from injury to hospital admission was 120 minutes. Twenty-one of 31 patients admitted to the hospital alive (68%) received additional blood transfusions during the initial resuscitation phase, justifying the prehospital transfusion. Of nine documented admissions with hemoglobin of less than 7 g/dL, one patient died of exsanguination. There was one case of a minor adverse reaction that could be attributed to prehospital transfusion. CONCLUSION: Prehospital blood transfusion is justified in certain trauma patients, especially when long prehospital transport is required. Blood may be safely maintained and used by physicians with little experience in care of major trauma.

Adolescent↗
PubMed1998

Superoxide dismutase (SOD) for mustard gas burns.

Mustard gas (MS) has been used in chemical warfare since World War I. The blistering skin lesions are slow to heal. Secondary inflammation might occur, as well as damage to organs distant from the original wound. Presently there is no specific antidote for burns and poisoning by MS. This study examined treatment modalities with free oxygen radical scavengers, copper-zinc, and manganese superoxide dismutase (SOD), for MS skin burns in an experimental guinea pig model. Each of the SOD compounds reduced dramatically burn lesion area when administered intraperitoneally/intralesionally (i.p./i.l.) before wound infliction. The protective action of the SODs was also evident in the significantly higher histopathological score of biopsies obtained on day 7 from local tissue, caused with the lower dose of MS. When the SOD compounds were administered i.p. 1 hour after burn infliction, and repeated daily for 7 days, no protective effect could be detected under the present experimental conditions.

Animals↗
PubMed1998

Early nonsurgical removal of chemically injured tissue enhances wound healing in partial thickness burns.

Chemical burns are slow healing injuries and their depth is difficult to assess. Tissue destruction continues as long as active material is present in the wound site. The routine therapy for treatment of full thickness chemical burns is early excision; it shortens hospitalization and reduces morbidity. However, presently there is no specific treatment for chemical burns of partial thickness. This study examined several treatment modalities for partial thickness chemical burns: surgical excision; laser ablation and chemical debridement with Debridase or trypsin-linked to gauze. Chemical burns were inflicted with nitrogen mustard (NM -- a nitrogen analog to sulfur mustard -- mustard gas) in an experimental guinea pig model. Debridase was most effective and reduced significantly lesion area of burns after 'humid' exposure to 2 mg NM. The healing action of Debridase was also evident in the significantly higher histopathological score of biopsies from local tissue obtained on day 5. Laser ablation was most effective and accelerated healing of burn lesions after 'dry' exposure to 5 mg NM. The histopathology score of the laser treated burns was higher on day 4 compared to untreated controls. It is concluded that for partial thickness chemical burns early nonsurgical removal of the damaged tissues accelerates wound healing.

Administration, Topical↗
PubMed1998

Skin surface proteolytic activity. Partial characterization and identification.

Skin surface proteolytic activity in the living animal was determined by a sensitive, non-invasive methodology developed in our laboratory. A non-leaky well was constructed on the shaved back of an anesthetized guinea pig. The well contained the reaction mixture including the substrate 125I-S-carboxymethylated insulin B-chain (ICMI). The proteolytic activity was shown to be time-dependent. The activity was strongly inhibited by pepstatin A, indicating the involvement of aspartic proteinase(s) such as cathepsin D and/or E. Pretreatment of the skin with propylene glycol blocked the proteolytic activity. The present study demonstrates the presence of proteolytic activity located on skin surface using a unique, non-invasive method for in situ proteinase determination in the living animal.

Animals↗
PubMed1997

Noninvasive procedure for in situ determination of skin surface aspartic proteinase activity in animals; implications for human skin.

The present study demonstrated a noninvasive procedure for in situ determination of stratum corneum aspartic proteinase in the living animal. A non-leaky well, containing [125I]S-carboxymethylated insulin B-chain (ICMI) as a substrate, was constructed on the shaved back of anesthetized guinea pigs and rats. The enzymatic activity was determined by measuring the radiolabeled trichloroacetic acid soluble material. We demonstrated pepstatin-sensitive proteinase activity bound to the skin surface indicating the involvement of aspartic proteinase(s) such as cathepsin D and/or E. Aged rats had about six fold lower activity than young animals. The proteinase activity was inhibited by the alkylating agent mechlorethamine and by the cosmetic propylene glycol. A similar procedure was carried out with intact human skin pieces obtained during plastic surgery. The activity was inhibited by antihuman cathepsin D antibodies. Cathepsin D was immunohistochemically localized in the corneal and granular layers of the epidermis. Skin surface aspartic proteinase/cathepsin D activity may serve as a marker for skin aging or for certain skin disorders leading to a new approach to their medical treatments.

Aging↗
PubMed1995

Assessment of physician competence in prehospital trauma care.

In an attempt to develop a model to measure the competence of physicians providing emergency care under difficult field conditions, 75 Israeli army medical corps physicians were evaluated through the use of four instruments: a debriefing interview, peer assessment, self-assessment and written examination. The special on-site assessment model was designed to examine actual events, enabling an assessment of performance in real situations rather than simulated cases. Significant positive correlations were found between the results of the written examination and the peer evaluation on two of four measures (r = 0.36, P = 0.001; r = 0.23, P = 0.05) as well as on the two measures regarding self-evaluation and peer evaluation (r = 0.54, P = 0.001; r = 0.38, P = 0.05). It was found that those physicians who were trained in the army's medical officer course scored significantly higher on the written examination (P = 0.001) and were rated more highly by their senior peers (P = 0.048) than those who did not receive such training. It was concluded that it is advantageous to use a combination of knowledge (written examination) and performance (peer assessment or self-assessment) measures in order to arrive at a more comprehensive assessment of competence. In addition, the written examination format should be expanded and developed to include more clinical vignettes requiring treatment decisions, making this instrument a more clinically oriented measure of physician competence in trauma care.

Clinical Competence↗
PubMed1994

Terrorist bombing with a 'Molotov cocktail' inside travelling cars: an old weapon for a new burn syndrome?

The 'Molotov cocktail' terrorist weapon which is thrown into a travelling car has given a new type of injury to people who sustain massive smoke inhalation together with disfiguring burns of face, thighs, hands and chest, and post-traumatic psychological disorder. The combination of petrol ignition with the synthetic fumes inside the care is a unique occurrence with a high morbidity and mortality which is difficult to treat and to manage. We propose to show that the combination of all the above components can be defined as the 'Molotov cocktail' burn syndrome.

Adolescent↗
PubMed1994

Cyclosporin A treatment failed to extend skin allograft survival in two burn patients.

Prolongation of skin allograft survival by immunosuppression of burn casualties has been reported sporadically during the past two decades. Recently cyclosporin A (CycA) has been used effectively for such an indication. We report here two paediatric patients with extensive burns (85-95 per cent BSA) treated with fresh, family-related skin allografts that were rejected during CycA treatment after 14-18 days. One of these children survived while the other died with candida sepsis.

Burns↗
PubMed1993

The cost of an extensive burn survival.

A 17-year-old male sustained 95 per cent body surface area burns (87 per cent full thickness skin loss). He was hospitalized in the Department of Plastic Surgery that also treats burns. After 232 days he was discharged home when he was functionally independent. He had 16 surgical procedures for excision of burn eschar and skin grafting; received a total of 128 units of blood; 899 units of fresh frozen plasma and had enteral hyperalimentation for 175 days. About 1000 physician-hours, 3000 nurse-hours, 1000 physiotherapy and occupational therapy-hours and about 250 dietician-hours were needed for his treatment. More than 1850 laboratory tests and 120 X-rays were performed, and more than 600 kg of ointment and creams were used, as well as half a ton of topical antimicrobial solutions. Ten different antibiotics were used for a total of 85 treatment days. Some 8500 m of dressing were applied with more than 6000 pieces of petroleum jelly gauze dressing. Hospitalization costs were found to be US$141,750, only 37.5 per cent of which were salaries. An analysis of these costs is given.

Adolescent↗
PubMed1993

Case study: full thickness chemical burn of the abdomen and chest.

An 81 year old patient, suffering from Alzheimer's disease sustained a full thickness HCI Acid burn of her abdomen and chest wall due to leakage of gastric content from her gastrostomy feeding tube. The controversial management of such a patient is discussed and early surgical treatment is recommended.

Abdominal Injuries↗
PubMed1993

The clinical assessment of femoral stress fractures: a comparison of two methods.

In a prospective study among 667 recruits, the incidence of asymptomatic femoral stress fractures was compared using a new expanded stress fracture clinical examination (SFCA) versus an older stress fracture examination. There was a statistically significant difference (p = 0.0001) between the percentage of femoral stress fractures that were asymptomatic in the group evaluated by SFCA (26%) and those evaluated by the older stress fracture examination (80%). By using the SFCA, many of the femoral stress fractures previously classified as asymptomatic are in fact recognized as symptomatic.

Femoral Fractures↗