PubMed Health⌕ Search

Biomedical subjects

Eyal Winkler

Publications and source records attributed to Eyal Winkler.

14 recordsLinked to original sources
PubMed2006

Nitrous oxide administered by the plastic surgeon for repair of facial lacerations in children in the emergency room.

BACKGROUND: The purpose of this study was to investigate a means of providing pain relief during repair of facial lacerations in children in the emergency room. METHODS: This study was conducted in the emergency room of a tertiary care, university-affiliated hospital. Fifty percent nitrous oxide was administered by the surgeon who sutured the laceration. A nurse monitored the child throughout the procedure. At the end of the procedure, pain scores were evaluated by the surgeon and nurse using the FLACC (face, legs, activity, cry, and consolability) scale, a structured observational-behavioral scale for measurement of pain. RESULTS: Sixty patients between the ages of 1 and 16 years participated in the study. Of these, 15 were sutured using standard care (lidocaine infiltration), and 45 children received nitrous oxide in addition to lidocaine infiltration. Nitrous oxide was administered for an average of 11.9 +/- 5.1 minutes (range, 4 to 30 minutes). Forty-three children recovered to preprocedure activity in less than 1 minute. Two children recovered in less than 3 minutes. Average FLACC scores during infiltration and suturing were significantly lower in the nitrous oxide group compared with controls (infiltration, 1.9 of 10 versus 9.7 of 10; suturing, 2 of 10 versus 8.8 of 10). Forceful restraining was necessary in all the controls, whereas in the nitrous oxide group mild force was required in only 15 percent. Seventy percent of the children receiving nitrous oxide had no side effects. Vomiting and nausea were the most common (17 percent), transient side effects. No respiratory or cardiovascular side effects occurred. CONCLUSIONS: Nitrous oxide can be safely administered by plastic surgeons while suturing facial lacerations in the emergency room. The fast onset and rapid recovery characteristics of nitrous oxide provide a convenient environment for performing short surgical procedures. This safe method for provision of analgesia and anxiolysis may be appealing to plastic surgeons for ambulatory procedures (e.g., suture removal, expander inflation, Botox injection, injection of various fillers) in pediatric and adult populations.

Adolescent↗
PubMed2006

Stensen duct rupture (sialocele) and other complications of the Aptos thread technique.

BACKGROUND: The Aptos thread technique is a mode of uplifting the flabby soft tissue of the aging face. Permanent suture material made of polypropylene monofilament with dents is used in this technique. This procedure is gaining popularity throughout the world. According to the literature, several hundred Aptos procedures have been performed, and no major complications have been reported yet. METHODS: Two adult women presented shortly after the Aptos thread insertion. They sustained devastating results. A close study was performed to understand and learn the potential complications. RESULTS: The authors present two major complications, a rare case of Stensen's duct laceration and a case of chronic inflammation mandating surgical treatment. CONCLUSIONS: Describing complications may teach plastic surgeons more about this method and how to avoid similar devastating side effects in the future.

Diagnosis, Differential↗
PubMed2006

Terror-inflicted thermal injury: A retrospective analysis of burns in the Israeli-Palestinian conflict between the years 1997 and 2003.

BACKGROUND: Terror attacks have changed in the past decade, with a growing tendency toward explosives and suicide bombings, which led to a rise in the incidence of thermal injuries among victims. The Israeli-Palestinian conflict of October 2000 marked a turning point when an organized terror campaign commenced. This article presents data of terror-associated burns from the Israeli National Trauma Registry (ITR) during the years 1997 to September 2000 and October 2000 to 2003. METHODS: We analyzed demographic and clinical characteristics of 219 terror-related burn patients and 6,546 other burn patients admitted to hospitals in Israel between 1997 and 2003. Data were obtained from the ITR. RESULTS: Burns contributed about 9% of all terror related trauma and about 5% of all other trauma (p < 0.0001). These percentages have not changed significantly before and after October 2000. Terror-related burns afflict Jewish males more than predicted by their percentage in the population, whereas other burns afflict non-Jewish males more than predicted. Adults and young adults (15-59 years) are the predominant group in terror-related burns (80%), whereas children younger than 15 years are the predominant group in other burns (50%). Large burns (20% to 89% total body surface area) are more common in terror casualties, with greater mortality (6.4% in terror-related versus 3.4% in others; p = 0.0258). CONCLUSION: Although the incidence of burns has risen because of an organized campaign, this change was noticeable in other trauma forms as well in similar proportions. Terror-related burns afflict a targeted population, and generally take on a more severe course with greater mortality rates, thus requiring appropriate medical treatment.

Adolescent↗
PubMed2006

Adoptive cell therapy for metastatic melanoma patients: pre-clinical development at the Sheba Medical Center.

BACKGROUND: Metastatic melanoma is an aggressive and highly malignant cancer. The 5 year survival rate of patients with metastatic disease is less than 5% with a median survival of only 6-10 months. Drugs like dacarbazin (DTIC) as a single agent or in combination with other chemotherapy agents have a response rate of 15-30%, but the duration of response is usually short with no impact on survival. Interleukin-2-based immunotherapy has shown more promising results. The National Institutes of Health recently reported that lymphodepleting chemotherapy, followed by an adoptive transfer of large numbers of anti-tumor specific tumor-infiltrating lymphocytes, resulted in an objective regression in 51% of patients. OBJECTIVES: To introduce the TIL technology to advanced metastatic melanoma patients in Israel. METHODS: We generated TIL cultures from tumor tissue, choosing those with specific activity against melanoma and expanding them to large numbers. RESULTS: TIL cultures from nine patients were established and examined for their specific activity against the patients' autologous tumor cells. Twelve TIL cultures derived from 5 different patients showed the desired anti-tumor activity, making those 5 patients potential candidates for the therapy. CONCLUSIONS: Pre-clinical studies of the TIL technology in a clinical laboratory set-up were performed successfully and this modality is ready for treating metastatic melanoma patients at the Sheba Medical Center's Ella Institute.

Adoptive Transfer↗
PubMed2006

Skin substitutes.

The role of skin substitutes in burn surgery and in the treatment of chronic wounds is constantly evolving. New products are regularly being developed and approved for clinical use. Studies on existing products demonstrate their effectiveness in different clinical scenarios. However, cost-related concerns, inadequate physician education, and the drawbacks that still accompany every skin substitute have resulted in limited application of these modalities. Today, burn surgeons still rely mostly on old-fashioned skin grafts. Only a few burn centers in the world actually use some of these products in their routine treatment of wounds. This review provides an up-to-date overview of the latest developments in the field of skin substitutes. We examine the major commercially available skin substitute products and their performance, and briefly review the technologies and products that are under development but have not yet become widely available.

Burns↗
PubMed2005

[Ultrasonic apocrine suction-lipolysis under endoscopic guidance for axillary osmidrosis].

There are several modalities to treat axillary hyperhydrosis. None of these eliminates the sweat-associated odor (Osmidrosis), which is sometimes present even despite local hygiene and use of deodorants. A technique to dissolve the axillary apocrine glands under endoscopic guidance has been described to be highly efficient, without compensatory hyperhydrosis. We describe our experience with the first 18 patients who were treated by this technique. A 1.5 cm axillary incision was used to introduce both the endoscope and the ultrasonic suction-lipolysis device. Complete disappearance of axillary sweat and odor was achieved immediately after treatment. Superficial hematoma was the only complication encountered. One-sided recurrence was observed in one patient over an 8 month follow-up period.

Adult↗
PubMed2004

Parry-Romberg syndrome and sympathectomy--a coincidence?

Parry-Romberg syndrome is a clinical entity consisting of progressive hemifacial atrophy appearing at a young age. Animal studies indicate that sympathectomy can produce hemifacial atrophy. To our knowledge, this is the first report of a patient with a possible association between Parry-Romberg syndrome and thoracoscopic sympathectomy.

Adolescent↗
PubMed2004

Genetics in melanoma.

Melanoma is the leading cause of death from skin tumors worldwide, with an annual increase in incidence over the past decade. The molecular mechanisms involved in melanoma pathogenesis are beginning to be unraveled. While a family history of melanoma and exposure to ultraviolet irradiation have been known for years as risk factors in melanoma development, the precise genes involved in inherited predisposition were defined only in the past decade. Germline mutations in two genes that play a pivotal role in controlling cell cycle and division--CDKN2A and cyclin-dependent kinase 4 (CDK4)--have been detected in autosomal, dominant, high penetrance familial melanoma cases. In addition to these two highly penetrant genes, germline mutations and polymorphisms in a few low penetrance genes have been reported in familial melanoma cases: melanocortin-1 receptor, epidermal growth factor, glutathione s-transferase M1, cytochrome p450 debrisoquine hydroxylase locus (CYP2D6) and vitamin D receptor.

Cytochrome P-450 CYP2D6↗
PubMed2003

[Silicone breast implants with silicone gel and autoimmune disease--are they related?].

Silicone breast implants are used for breast reconstruction and breast augmentation. In the late 80's anecdotal literature describing a possible connection between silicone gel filled breast implants and autoimmune disease accumulated. Emerging concern about the safety of silicone gel implants had led the FDA to restrict their use. The continued use of the implants in postmastectomy reconstruction was allowed, as was their use in a small number of breast augmentation patients who were willing to enroll in long-term studies. In recent years, large meta-analyses established the fact that there is no association between silicone gel breast implants and autoimmune disease. We review the current literature, emphasizing the most important epidemiologic studies.

Autoimmune Diseases↗
PubMedDate not supplied

The use of video capture virtual reality in burn rehabilitation: the possibilities.

We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToy is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToy as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for the patient to immerse himself or herself in an alternate reality while undergoing treatment, thereby reducing the pain and discomfort he or she experiences. This simple, affordable technique may prove to heighten the level of patient cooperation and therefore speed the process of rehabilitation and return of functional ability.

Burns↗
PubMedDate not supplied

Combined Iliazarov and free flap for severe recurrent flexion-contracture release.

This article discusses the treatment of recurrent flexion-contracture of the knee after circumferential burns involving the entire limb. A two-team approach to surgery is used: the orthopedic team widely excises the scar tissue and releases tendons, muscles, and adjacent soft tissue that limit joint movement. The microsurgery team covers the exposed popliteal neurovascular elements with a latissimus dorsi free flap. However, full range of the knee is still limited by the short neurovascular bundle. Therefore, the orthopedic team applies a circular hinged Iliazarov external-fixator-frame to achieve gradual correction, until full range of the knee is achieved. Intensive physiotherapy and continuing use of extension splints for additional 6 months until the scars are deemed stable compliment the treatment regimen and prevent the recurrence of contractures. Between the years 2002 and 2003, we treated four patients (totaling five knee joints) with recurrent severe flexion-contractures after circumferential burns of the entire lower extremity. A significant limitation was caused by the abnormal scarring, which left the patients confined to a wheelchair. In all our patients, previous attempts to release the flexion-contracture failed. With the aforementioned technique, within 3 months after the procedure, all patients were able to walk. We encountered one major complication (ie, drop foot). At follow-up, all patients enjoyed a full range of motion and were able to walk. The strength of our approach comes from combining a free muscle flap with an Iliazarov external fixation and a detailed postoperative rehabilitation plan.

Adolescent↗
PubMedDate not supplied

Ten commandments for minimal pain during administration of local anesthetics.

Local anesthetic agents are administered before many ambulatory cutaneous operations. The injection of the local anesthetic agent is often the only painful aspect of the procedure. There are various factors that determine how painful the anesthetic administration may be. These include the preparation used, the size of the needle and syringe used, injection technique, depth of injection, attitude of the physician, and more. In this article, we present the different techniques we apply to achieve minimal pain during the injection of local anesthetics.

Administration, Cutaneous↗