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Biomedical subjects

G Tamir

Publications and source records attributed to G Tamir.

18 recordsLinked to original sources
PubMed2000

Standard and nonstandard applications of sentinel node-guided melanoma surgery.

Identification and histologic study of the sentinel node (SN) is an acceptable, yet not firmly established, guide for treating intermediate-thickness melanoma. This study widens the range of applications of this technique. We included 97 patients with intermediate-thickness melanoma lesions or lesions for which there is no standard treatment. Fifty-six underwent preoperative lymphoscintigraphy, and all underwent intraoperative lymphatic mapping (IOLM) using blue dye, followed by frozen section study and total node processing by serial sections. Elective lymph node dissection was performed in cases of metastasis to the sentinel node or technical failures with high risk. Four categories were defined: (A) intermediate-thickness lesions (mean 2.27 mm) (n = 45); (B) thin lesions (mean 1.14 mm) with risk factors of regional failure (n = 27); (C) lesion thickness close to but more than 4 mm (n = 10); and (D) lesions of undetermined thickness (n = 15). Median follow-up was 30 months (range 13-51 months). Intraoperative lymphatic mapping successfully identified the sentinel node (SN) in 93% of basins explored. Metastases were detected in 11 SNs. There were three lymph basin recurrences in patients with previously negative SNs, all salvaged by therapeutic lymph basin dissection and are NED (no evidence of disease). Two SN(+) patients had systemic recurrences; one died of his disease, and the other is alive with disease. One SN(-) patient died NED owing to other cause. This technique spared 83% of category A patients from lymph node dissection. It allowed better staging and better decision making for treatment in categories B and D; and it prevented early regional recurrences in category C patients. Intraoperative lymphatic mapping with SN guidance is a novel, lo

Adult↗
PubMed2000

Osteomyelitis of the ribs in the antibiotic era.

A total of 106 cases of rib osteomyelitis were reviewed, including 2 cases described in detail. Mycobacterial and bacterial infections accounted for 47 cases each. Fungal rib osteomyelitis occurred in 11 cases and 1 case was caused by Entamoeba histolytica. Most cases occurred in children and young adults. The mean duration of symptoms before diagnosis was 16, 26 and 32 weeks for bacterial, mycobacterial and fungal rib osteomyelitis, respectively. Common clinical signs were fever (73%), soft tissue mass (64%) and chest pain (60%). Route of infection was defined in 85 cases: 62% from contiguous spread and 38% via haematogenous route of infection. Eighty-nine percent had a favourable outcome after antimicrobial therapy with or without surgery. In conclusion, rib osteomyelitis is a rare infection of various aetiologies. The majority of cases occur in children and young adults and its diagnosis is usually delayed for several weeks.

Adult↗
PubMed1999

Synchronous appearance of keratoacanthomas in burn scar and skin graft donor site shortly after injury.

Skin malignancies can originate in burn scars (Marjolin's ulcer). The most common is squamous cell carcinoma, usually appearing years after injury. Split-thickness skin graft donor sites as a source of malignant transformation are far less frequent and demonstrate a shorter interval between surgery and tumor onset. Keratoacanthomas have rarely been reported to arise in such scars. We describe the simultaneous occurrence of keratoacanthomas on a spontaneously healed second-degree burn on the flank and in the scar of a skin graft donor site on the thigh, 4 months after a 40% total body surface area burn.

Burns↗
PubMed1999

Mohs' surgery as an approach to treatment of multiple skin cancer in rhinophyma.

BACKGROUND: Skin cancer arising within a rhinophyma is rare, less than would be expected from the coexisting chronic active inflammatory process. In rhinophyma, multiple coexisting tumours of different histologic types present an unusual challenge and have never been described in the literature. OBJECTIVE: The treatment approach to multiple tumours occurring in rhinophyma, utilizing Mohs' surgery, is reported and discussed. PATIENT: The case of a 64-year-old farmer with basal cell carcinoma, squamous cell carcinoma, and basosquamous carcinoma occurring in the setting of longstanding rhinophyma is described. CONCLUSION: Skin cancer, especially basal and squamous cell carcinoma, diagnosed simultaneously in a rhinophyma creates a challenge; the enlarged, inflamed, and hypertrophied tissue masks their margins. In our opinion, Mohs' micrographic surgery is the treatment of choice and should be primarily considered in view of the malignant potential of these tumours, as is shown by the substantial tumour extension in the case described.

Basal Cell Carcinoma↗
PubMed1999

Three point-advancement closure for skin defects.

BACKGROUND: Circular skin defects are common following Mohs' surgery. Traditional closure (primary, flap, or graft) may involve extensive surgery. Multidirectional advancement closures such as the purse-string closure have been advocated as another useful tool in such cases. OBJECTIVE: To describe a variation on purse-string closure that, in certain cases, is an excellent alternative to other reconstructions, and will provide good cosmetic and functional outcome. METHOD: A three-point anchoring suture is placed after undermining to advance the surrounding tissue toward the centre, creating a "Mercedes Benz" or tripod closure following removal of "dog-ears." RESULTS: Circular wounds in designated areas can be more easily closed, creating well-tolerated, favourable scars. CONCLUSION: Large wounds may be closed with the advantage of avoidance of larger flaps, of decreased wound healing compared to second intention, and of minimizing removal of healthy tissue. An initial trial of closure with this method does not limit subsequent use of other repairs should it be less than satisfactory.

Anesthesia, Local↗
PubMed1996

Cutaneous malignant melanoma in young adults under age 30.

Epidemiologic and clinicopathologic features of malignant melanoma in 129 patients (44 males, 85 females) aged < or = 30 years between 1961 and 1992 were investigated. The number of new young melanoma patients (29 of 216 during the 1960's) declined to 52 of 676 during the 1980's. Predominant sites were legs among females, and head, neck and back among males. Nodular type lesions (56.6%) outnumbered superficial spreading tumors (38.8%). Thirty-one patients (24%) died of melanoma (median survival 2.9 years), with higher male mortality. A decrease in mortality rate was observed over the decades. The relationship between various parameters was analyzed. Nodular lesions were smaller and thicker than superficial spreading lesions, occurred more frequently in males, and carried a worse prognosis (34% mortality) than superficial spreading type tumors (14%); mortality rate was higher for thick (>4 mm) and for large tumor volumes (>300 mm3) vs. thin and small sized lesions, respectively (P = 0.000 for each). Average tumor thickness and volume declined throughout the last three decades. From the data obtained, a typical profile of a young melanoma patient is drawn.

Adolescent↗
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

[Epidemiology and prognostic factors in cutaneous malignant melanoma].

207 patients with primary cutaneous malignant melanoma were admitted between August 1, 1988 and July 31, 1992 for local excision and treatment. The female to male ratio was 1.4:1 and the peak age was in the seventies. The most frequent site in males was the back and in females the legs. Superficial spreading melanoma was the most frequent type (40%); there was also a high rate of nodular melanoma (20%), particularly in males. Thin melanomas accounted for most of the cases. On follow-up 27 (13%) developed metastases in transit or in regional lymph nodes and 10 (5%) developed distant metastases; 2 (1%) had locally recurrent melanoma and 2 died of metastatic melanoma. There was a significant positive correlation between Breslow thickness, Clark's level of invasion, histopathological ulceration, nodular and acral lentiginous type of lesion and development of metastases. These data may be valuable for public and professional education and in the prediction of outcome of melanoma.

Aged↗
PubMed1995

Parenchymal leiomyoma of the breast. Report of a case and clinicopathological review.

We describe a 42-year-old woman with a solid breast mass of smooth muscle cell origin. Breast leiomyoma is an extremely rare benign tumour, with only 11 cases reported thus far. Various explanations have been offered with regard to its origin, such as hamartoma, embryonal migration from the nipple tissue, multipotent mesenchymal cells or the presence of myoepithelial cells originating from the breast ducts. The differential diagnosis for breast leiomyoma usually includes benign fibrous breast lesions, but leiomyosarcoma should definitely be ruled out. Surgical treatment consists of tumour excision with free margins. We discuss the tumour's clinical, pathological and immunohistochemical features, and review the current literature.

Adult↗
PubMed1995

Malignant fibrous histiocytoma of the breast.

Primary malignant fibrous histiocytoma of the female breast (MFH) occurs very rarely, and only 22 cases have been reported so far. We describe a 42-year-old female in whom MFH of the breast was diagnosed, and review the available literature. In accordance with knowledge concerning the biological and clinical behaviour of breast MFH, either wide local excision or mastectomy combined with axillary lymph nodes dissection is recommended, due to the high rate of recurrence and metastatic potential of this tumour.

Adult↗
PubMed1994

The effect of allopurinol on experimental island skin flap survival under prolonged periods of arterial ischaemia.

The aim of this study was to assess the effect of allopurinol on rat groin flaps rendered ischaemic by selectively occluding the feeding femoral artery and reperfused by means of microsurgical anastomosis. For the establishment of the critical arterial ischaemia time, the femoral artery of 29 rat groin flaps isolated on the inferior epigastric pedicle was occluded for 10, 12 and 14 h. Following 12 h or more of ischaemia, 5.25% of the flaps survived, compared to 40% survival after 10 h (p = 0.04). In the second stage of the study, 34 rat groin flaps were subjected to arterial ischaemia for 12 h. Of these, 12 rats received allopurinol solution I.V. 30 min prior to reperfusion, 10 received the vehicle solution (control) and 12 underwent no treatment (control). After 7 days, survival of the groin flaps was observed in 41.7%, 0 and 8.3% of the groups, respectively (p = 0.0164). This study suggests that systemic administration of allopurinol has a beneficial effect on rat arterial ischaemic groin flaps and may prolong their critical ischaemia time.

Allopurinol↗
PubMed1993

[Malignant peritoneal mesothelioma].

Public attention has recently been devoted worldwide to malignant mesotheliomas and their relation to exposure to industrial materials, especially asbestos and its products. The more common form of the disease is the pleural type, while the peritoneal variant is rare, with an estimated incidence of less than 1:1,000,000 new cases per year. In contrast to the pleural type, the relationship of malignant peritoneal mesothelioma to exposure to asbestos is unclear. The differential diagnosis, based on clinical appearance and imaging techniques, is broad and the diagnosis is inconclusive, so that the diagnosis must be confirmed by histologic examination. Treatment is a combination of surgery, chemotherapy and irradiation. Contrary to occasional reports, the malignancy is fatal, death occurring within a few months of diagnosis. We present a 65-year-old man in whom malignant peritoneal mesothelioma was diagnosed. The presenting symptoms were a large abdominal mass involving the colon, and ascites. He died 5 months after the diagnosis was made.

Aged↗
PubMed1993

Epidemiology of burns in the Tel Aviv area.

Between 1 August 1988 and 31 January 1992, 421 burn patients were admitted to the Burn Unit at Beilinson Medical Center. Name, age, sex, month of the year, cause of burn, area and degree of burn and duration of stay in hospital were recorded. Of these patients, 37 per cent were treated surgically and the remainder were treated conservatively. The male to female ratio was 2:1. Burns occurred most frequently in July and January; the peak average age was the first decade of life. The most frequent cause in children was scalding (domestic burns), and in adults open fires (work accidents). Patients treated by early tangential excision and skin grafting (204 operations on 157 patients) had a shorter stay in hospital than conservatively treated patients. In accordance with others, we suggest that early surgery of burn injuries decreases morbidity and mortality and leads to better aesthetic results and improved motor function. Secondly, burn injury can be prevented in children and the elderly by increasing safety measures at home, and in adults by enforcing strict safety measures at work.

Adolescent↗
PubMed1993

Double-opposed Z plasty for upper eyelid entropion correction.

Recurrent cicatricial entropion of the upper eyelid creates a surgical problem. We present a 53-year-old patient with complicated postsurgical fibrotic and scarred upper eyelid entropion. Double-opposed Z-plasty incisions were used at the anterior approach. The outer Z incision included the skin and the orbicularis oculi muscle underneath, whereas the inner Z incisions included the tarsal plate and conjunctiva, in a mirror-image fashion. Two goals were achieved, i.e., release of the vertical traction vector of the conjunctiva and balance of forces between the anterior and posterior layers of the lid. Symptomatic and clinical improvement was observed, and there was no recurrence 2 years after surgery.

Entropion↗
PubMed1992

[Implanted subcutaneous venous catheter for prolonged intravenous treatment].

Subcutaneous venous catheter devices were implanted in 104 patients between January 1989 and June 1991. In 90% the implantation was performed under local anesthesia as an ambulatory procedure. In 85% the catheter was implanted for long-term chemotherapy and in 15% for intravenous feeding, antibiotic treatment or dialysis. There were postoperative complications in about 10%, the most frequent being infection of the surgical wound or of the catheter canal. Venous thrombosis, cutaneous necrosis and catheter occlusion were observed in only 5%. The main advantages of the method are its convenience for the patient, ease of installation and low rate of complications. From our experience we conclude that the implanted subcutaneous venous catheter is a simple and effective procedure for prolonged intravenous treatment.

Ambulatory Surgical Procedures↗
PubMed1990

[Oculopharyngeal muscular dystrophy].

A rare case of progressive bilateral ptosis with dysphagia in a 70-year-old man is presented. There were similar symptoms in other members of the family. The patient was diagnosed as having oculopharyngeal muscular dystrophy, a rare autosomal dominant disorder involving progressive muscular dystrophy, one of the chronic external ophthalmoplegic syndromes. There had been slowly progressive bilateral ptosis and there was almost no levator palpebra muscular activity left, resulting in extreme head tilt. A sling suspension operation for the ptotic lids, using autogenous fascia lata, was successful. Oculopharyngeal muscular dystrophy is essentially a myogenic disorder. Affected muscles are usually those of the pharynx, causing dysphagia, and the levator palpebra muscles. Rarely are other skeletal muscles involved. The sling operation gives direct support to the dystrophic malfunctioning levator muscles by using the frontalis muscles to raise the ptotic lids, thus improving visual ability.

Aged↗
PubMed1990

Successful treatment of a 95 per cent body surface area burn.

Survival after sustaining a 95 per cent body surface area burn is uncommon. We report the successful treatment of a 21-year-old patient who sustained such an extensive burn injury. This report stresses the importance of early aggressive excision of the burn eschar and early coverage with allografts (homografts) and later coverage with autogenous keratinocytes.

Adult↗