Biomedical subjects
Publications and source records attributed to H Tsur.
A simple method to ensure penile skin graft immobilization and easy accessibility is presented. The method uses a hollow cylinder made of plaster-cast material applied to the pubis around the penis, to which the long tails of the skin graft threads are fixed. The method is inexpensive, simple to use, and comfortable both for patients and for the nursing staff.
Chronic ulceration of the legs was found in the propositus and in ten male relatives in a family of Iraqi Jews. All eleven males had juvenile onset of symptoms. Venous lesions with ulceration were found in two of the propositus' brothers and without ulceration in his three sisters. The findings suggest an autosomal dominant sex-limited genetic defect.
A 36-year-old man was treated by radiotherapy for tinea capitis many years before discovery of microcystic adnexal carcinoma (MAC). Because of patient's refusal of any surgical intervention, we were able to follow the natural course of this tumor for 13 years. This case emphasizes the typical slow development of (MAC). The implication of the association of MAC and radiotherapy are discussed.
An oro-ocular facial cleft with anophthalmia, classified as Tessier cleft no. 4, was satisfactorily corrected by a series of conservative procedures, including tube pedicle flap transfer, Z plasties, and bone grafting for orbital socket and zygomatic reconstruction. Beginning in 1975 when the patient was 4 months old, most of the reconstructions were performed before the routine tissue expansion and microsurgical tissue transfer techniques that are common today. The patient's development is normal and he is intellectually more advanced than most children his age. Correction of increasing asymmetry between growing and nongrowing regions of the skull in this young boy will probably be required.
Moh's micrographic surgery is a method by which cancer of the skin may be excised under complete microscopic control. It consistently offers the highest cure rate in the treatment of malignancy of the skin, while the least amount of uninvolved tissue is sacrificed. This, the first center for Moh's micrographic surgery in Israel, started functioning in 1989. The first 50 patients included 33 women (average age 50.7 years) and 17 men (average age 60.6 years) suffering from basal cell carcinoma of the face. 56% of the patients were referred for Moh's surgery after failure of other primary treatments, and the rest were referred due to the problematic location of the lesion or its size. 13 patients (28%) were referred after previous treatment with solcoderm (Mardi's method). In these patients the lesions were especially deep and aggressive.
Nine severely contracted sockets were reconstructed using a meshed skin graft in conjunction with a semi-rigid conformer-stent. Particularly useful following unsuccessful surgery with mucosal grafting, or in cases where for some reason mucosal grafts cannot be obtained, this technique is superior to current procedures utilizing nonmeshed split-thickness skin grafts.
Total amputation of the penis is a disfiguring, and functionally and psychologically disabling injury. We report a case of successful microvascular replantation following self-emasculation by a psychotic patient. The need for a multidisciplinary approach combining the expertise of such diverse disciplines as surgery, intensive care and psychiatry is emphasized.
Reconstruction of large scalp defects depends on the ability to cover them with hair-bearing tissue. Using expanded tissue provides sufficient skin with characteristics suitable for covering large scalp defects. We used this technique in a 2-year-old boy to reconstruct a scalp defect caused by birth trauma. Rapid expansion of the scalp, using an expander introduced under normal scalp and an external valve, is recommended whenever dealing with children.
Autohypnosis (that is performing hypnosis in the absence of the therapist) was used for adjuvant analgesic and anxiolytic therapy in 18 burn patients. It combines the advantages of hypnosis without being limited by the availability of the hypnotic therapist immediately prior to painful activities. Autohypnosis is less time and labour consuming, and therefore less expensive. Out of 180 patients treated with autogenic relaxation techniques only 48 (27 per cent) entered a state of hypnosis that enabled them to cope with their pain, and 18 (10 per cent) achieved autohypnosis. Most of these patients needed some auxiliary devices such as recorded instructions or telephone calls.
Thirty-four women who had undergone breast reconstruction after mastectomy for breast cancer were evaluated as to their emotional and psychosocial adjustment. Standardized psychological tests and a self-report questionnaire were used, along with the surgeon's evaluation of the aesthetic success of the reconstruction. Two psychodiagnostic tests were found to be of use in identifying maladjusted women who do not gain optimal benefit from the reconstruction: a questionnaire that evaluates the level of depression (Beck) and another that assesses the level of optimism (Cantrill). No correlation was observed between the surgeon's evaluation of the reconstruction's aesthetic success and the women's satisfaction. It was found that there are two groups of emotional-high-risk women: single women and women receiving adjuvant therapy. It is suggested that emotional-high-risk patients be given psychological support concerning the importance of the mastectomy and their reaction to breast reconstruction.
We describe our experience with two patients in whom total avulsion of the scalp occurred. Successful replantation was carried out by microvascular surgery, with 90 and 95% survival of the scalp. Normal hair regrowth and ability to raise the eyebrows was achieved in both cases. A single superficial temporal artery was anastomosed, providing excellent perfusion of the entire scalp. Microvascular replantation should be attempted with all scalp avulsions, regardless of appearance and mechanism of injury. The patient must be transferred to a medical center with comprehensive microvascular surgery capabilities. The avulsed scalp should be cooled to 4 degrees C immediately, but prolonged ischemia time does not preclude a successful result.
3 patients with invasive basal cell carcinoma of the skin which necessitated orbital exenteration are reported. In all 3 treatment was delayed, primary therapy was inadequate and the tumor had reached massive size. Excision of the orbital contents is a radical, mutilating procedure, but in advanced cases of malignant orbital tumors it offers the only chance for survival. The temporalis muscle flap is adaptable, well supplied with blood, and contains a large mass of tissue. Its utilization provides a simple, uncomplicated and effective technique for orbital reconstruction following massive resection. It gives a relatively effective result which is usually acceptable to the patient.
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Trans-sexualism is a psychiatric disorder characterized by the conviction that one's gender identity does not conform to one's biological sex. The current Diagnostic and Statistical Manual of Mental Disorders gives 5 diagnostic criteria for trans-sexualism which most health care professionals accept. Although many trans-sexuals derive some gratification from assuming roles appropriate to their desired gender, a substantial number are convinced that only sexual transformation can bring meaningful relief of their feelings of despair. Approximately 2/3 of trans-sexuals who undergo sex reassignment procedures are improved at follow-up. A relatively advanced age and secondary trans-sexualism (transvestites and effeminate homosexuals) are risk factors for poor prognosis in those requesting sex reassignment. In recent decades the demand for sex reassignment has increased, as have the number and variety of psychological, hormonal and surgical treatments proposed. The operative procedures currently employed for sex reassignment give reasonably good esthetic and functional results, and in 1986 the Israel Ministry of Health permitted its government hospitals to perform them. A 23-year-old male trans-sexual is reported who underwent successful surgery for sex change and now, 1 year later, is satisfied with the result.
An unusual complication using an inflatable silicon implant for removing postburn scarred tissue of the neck and face is described. The appearance of a fibrotic band along the inflating tube caused neck contracture. The purpose of this article is to present this uncommon complication and to emphasize the technical error when using the tissue expander in the neck region.
Keloids are commonly seen as a complication of earlobe piercing. As biopsies are usually not performed routinely in many instances, some of the lesions might, in fact, represent other entities, such as cutaneous pseudolymphoma. Contrary to keloids, for which surgery alone is not recommended, a simple excision or superficial x-ray is sufficient in such cases.