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Biomedical subjects

D Mendes

Publications and source records attributed to D Mendes.

8 recordsLinked to original sources
PubMed2005

Burn care standards in Israel: lack of consensus.

UNLABELLED: In recent years, the need for a national burn center based on ABA guidelines has emerged in Israel. The formation of such a center is now underway in the Chaim Sheba Medical Center. As a first step in the standardization of burn care in Israel, we have conducted a nation-wide survey among burn care personnel (physicians, nurses and other burn team members), regarding different aspects of the treatment of burn patients. METHODS: A questionnaire comprised of 30 questions regarding the severity of burns admitted, the site of initial management, wound care (both burn/skin-graft sites and donor sites), dressing changes protocols, sterility precautions, hydrotherapy, and pressure dressings was presented to 70 health-care professionals involved in the treatment of burns. RESULTS AND DISCUSSION: Seventy-seven percent of interviewed personnel participated in the survey. Consensus was found regarding most local (topical) wound care, (SSD for clean non-facial burns, Sulfamylon (mafenide-acetate) for contaminated non-facial burns, Threolone (chloramphenicol 3% and prednisolone 0.5%) or Bacitracin for facial burns, Paraffin gauzes with or without Sulfamylon for donor and graft sites). Dressing changes regimes were also agreed upon generally. However, there was no consensus regarding the ideal time for the removal of donor site dressings and this issue will need to be resolved. Other important findings are that both Edinborough University Solution of Lime (EUSOL), which has been deemed unsuitable for burn treatment due to toxic effects, and hydrotherapy, which has been proposed as a source of infection and contamination, are still widely used. We anticipate that these issues will be settled in our unified national burn care protocols (which are currently under development and revision).

Administration, Topical↗
PubMed1990

[Peripelvic tumors: approach and management].

The peripelvic area consists of the bony pelvis, hip joints and adjacent mesenchymal soft tissues. Malignant lesions in this area present unique diagnostic and therapeutic problems, in particular when tumor removal is involved. Between 1986 and 1988 we treated 7 females and a male, aged 8-75 years, for malignant tumors of this area. Diagnoses (histologic) included 4 cases of malignant fibrous histiocytoma, a malignant schwannoma, a Ewing sarcoma, a chondrosarcoma, and an osteosarcoma. Operations included marginal resection (4 cases), radical resection and reconstruction (2), radical resection (1), and modified hemipelvectomy (2). Adjuvant therapy consisted of radiotherapy in 1 case, chemotherapy in 2, and a combination of both in another 2. A patient who underwent radical resection and reconstruction of his left hemipelvis and hip joint died of local infection that progressed to generalized sepsis 2 months after operation. 2 patients died of recurrent disease, 3 and 30 months, respectively, after primary therapy. 1 died of myocardial infarction 20 months after the first and 3 months after the last of a series of marginal resections. 3 patients are alive and well 3-24 months following their first operation, and the fourth is doing well 24 months following first operation and 23 months after resection of lung metastases. Soft tissue sarcomas and osteosarcomas are the most frequent malignant tumors encountered in the pelvis and peripelvic areas. Their varying grades of malignancy and metastatic potential influence the approach on the one hand, while invalidity and compromised quality of life associated with tumor resection, influence it on the other.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Omental protection of autogenous arterial reconstruction following femoral prosthetic graft infection.

Vascular graft infections in the femoral region that require synchronous revascularization are generally reconstructed with prosthetic grafts via extra-anatomic routes. If in situ revascularization is required, then autologous tissue provides optimal results. A particular challenge in this circumstance is achieving soft tissue coverage of the reconstruction where wide and radical débridement has removed the tissues ordinarily used for this purpose. If muscle flaps are not available or possible, the use of omentum is advocated. The omentum can be easily reached from behind the inguinal ligament and transposed on its bipedicled vascular base for coverage of vital structures in the femoral triangle, thereby obliterating dead space and providing a surface for both temporary and permanent skin coverage. The procedure is quite simple, can be performed rapidly, and should be considered for use in the dire situation that requires soft tissue coverage of exposed vessels in extraperitoneal locations.

Blood Vessel Prosthesis↗
PubMed1985

Adventitial cystic disease of the popliteal artery: failure of percutaneous transluminal angioplasty as a therapeutic modality.

Adventitial cystic disease of the popliteal artery is an important cause of peripheral vascular insufficiency in the young and middle-aged man. The pathologic feature is a mucinous cyst located within the adventitia of the artery that expands and secondarily compromises the vessel lumen. Although physiologically quite different, this process is easily mistaken for arteriosclerosis. The clinical history of sudden claudication in a young nonsmoking man, combined with characteristic angiographic features, are important clues to the correct underlying pathology. Treatment generally consists of cyst evacuation or local bypass. This article was prompted by the failure of percutaneous transluminal angioplasty to achieve durable success in controlling this unique type of arterial disease. Subsequent surgical intervention proved satisfactory, lending support to this modality as the treatment of choice.

Angioplasty, Balloon↗
PubMed1984

Improved patient selection for enzymatic lysis of peripheral arterial and graft occlusions.

Intraarterial thrombolysis by remote intravenous or direct intraarterial infusion of streptokinase is possible. The latter may be more effective with a lesser potential for systemic hemorrhagic complications because of the smaller dose administered directly in the area. Fifty patients with prosthetic graft, embolic, and renal artery occlusions were evaluated. Embolic occlusion responded dramatically, particularly since lytic therapy was initiated at an early stage. Patients with severe ischemia or those with simple localized occlusion were best treated by surgical means. Successful thrombolysis was also obtained with renal artery occlusions combined with percutaneous transluminal angioplasty. The management of patients with prosthetic graft occlusion by lytic therapy is complex. Optimal results can be obtained in patients presenting with occluded grafts after the immediate postoperative period and in those in whom previous satisfactory runoff has been demonstrated. Failure of lysis in this group is associated with a high incidence of limb loss due to unreconstructable obliterative disease. Successful lysis of occluded prosthetic grafts will often require corrective angioplasty or surgical revision.

Adult↗
PubMed1984

Lysis of arterial clot by intravenous or intra-arterial administration of streptokinase.

Intra-arterial thrombolysis with streptokinase was studied in 38 patients. The indications were peripheral thromboembolism in nine patients (group 1), postreconstruction graft thrombosis in 26 patients (group 2) and renal artery thrombosis in three patients (group 3). The intra-arterial route was used for the first and third groups and in 16 of the second group. The intravenous route was used in the remaining ten patients. Lysis was achieved in all of the group 1 and 3 patients. The latter were also treated with percutaneous transluminal angioplasty after dissolution of thrombus of the renal artery. In group 2 patients, lysis was achieved in eight of 16 patients in whom lytic therapy was instituted within seven days of graft closure. There was no lysis in all ten patients in whom elapsed time was more than seven days. Postlytic angiographic visualization of etiologic mechanisms for thrombosis enabled subsequent successful correction in three of five patients in group 2. Attempts to correct graft failure by surgical treatment when lysis had failed were often unsuccessful (12 of 17). Lytic therapy is most effective for acute embolic occlusion and for thrombosis of less than seven days duration. Although there is no difference in drug efficacy by route of administration, a lesser number of complications (such as, fever and hematoma) occurred with intra-arterial infusion. The effectiveness of lysis is also directly related to the collateral circulation and runoff beyond the occlusion. Lysis is not indicated for severe acute ischemia if surgical treatment is an alternative or if it may cause distal embolism as with complete axillofemoral graft thrombosis. Lytic therapy is least effective for graft thrombosis with pre-existent poor runoff.

Aged↗
PubMed1983

Distal arteriovenous fistula as an adjunct to maintaining arterial and graft patency for limb salvage.

Sixty-one distal arteriovenous fistulas (dAVFs) were constructed as adjuncts to tibial and peroneal vascular reconstructive procedures in 58 patients threatened with imminent limb loss. Specific indications for dAVF construction were absent or deficient pedal arches, usually associated with small, calcareous crural vessels. Conventional bypasses had been previously performed in 35 patients. Cumulative graft patency rates were 56%, 39%, and 18% at 6, 12, and 24 months, respectively. For the same intervals, the figures were 56%, 52%, and 52% (P less than 0.001 at 24 months) for nonAVF reconstructions (n = 49). The corresponding cumulative limb salvage rates were 62%, 52%, and 40% for the dAVF group and 78%, 72%, and 72% for the nonAVF group (P less than 0.05 at 24 months). The perioperative mortality rate was 7% (four of 61). Twenty-four amputations were required, of which 16 were below the knee and six despite patent grafts. There was no significant morbidity attributable directly to the dAVF. Cardiac output showed no deviations from normal values. Primary causes of early failure were infection (n = 4), absence of satisfactory veins (n = 6), and inappropriate case selection (n = 7). Intimal hyperplasia led to dAVF closure and graft failure in 13 patients. This study shows that dAVFs can maintain graft patency by diversion of the overload on a high-resistance vascular bed and, secondarily, by augmentation of inflow. Immediate survival of the limb still depends on the arterial runoff, as retrograde venous flow caused by venous valvular incompetence is a delayed development. Adjunctive dAVF is justified in selected cases where conventional bypass failure has occurred or is predictable by increased pedal vascular resistance.

Adult↗