Biomedical subjects
Publications and source records attributed to Shay Shabat.
The dilemma of how to treat penetrating wound injuries to the neck, which involve a combination of a common carotid artery rupture and a cervical spinal fracture, is presented in this case report.
INTRODUCTION: The theoretical advantages of intramedullary fixation for peritrochanteric fractures were lessened in practice by implant-related operative problems and postoperative complication. MATERIALS AND METHODS: Forty-nine patients were treated with a newly designed expandable proximal femoral nail (EPFN) and followed thereafter for a minimum of 6 months. RESULTS: After experience was gained in carrying out the procedure, its mean duration was limited to 43.4+/-20.2 min and total mean fluoroscopy time to 39.8+/-16.1 s. Due to minimal extent of soft tissue trauma blood loss was negligible and rate of postoperative infections reduced. Condensation of cancellous bone in the femoral head as an alternative to reaming and the blunt cone-shaped head of the peg reduced the frequency of head peg cut-out. Homogenic load distribution along the nail interface decreased the concentration of stress and thereby eliminated the risk of postoperative femoral fracture distal to the implant stem. CONCLUSION: The EPFN may be considered as a further evolution of implants designed to stabilize peritrochanteric fractures of all grades.
PURPOSE: To assess if titration of sevoflurane using the bispectral index (BIS) monitor improves the early and intermediate recovery in geriatric outpatients undergoing brief urologic procedures under general anesthesia without muscle relaxants. METHODS: After a standardized induction with propofol and fentanyl, a laryngeal mask airway was inserted and sevoflurane was administered in combination with 60% nitrous oxide in oxygen for maintenance of anesthesia in spontaneously breathing outpatients. In the Control group (n = 25), sevoflurane and fentanyl were titrated according to standard clinical practice. In the BIS-directed group (n = 25), sevoflurane was titrated to maintain a BIS value between 50 and 60, and supplemental fentanyl, 25 mug iv boluses were administered to treat tachypnea. The intraoperative anesthetic and analgesic requirements, as well as the times to eye opening, removal of the laryngeal mask airway device, response to simple commands, orientation to person and place, and postanesthesia care unit discharge eligibility (fast-track score of 14) were assessed at specific time intervals. RESULTS: The minimum alveolar concentration-hour of sevoflurane (0.25 +/- 0.15 and 0.31 +/- 0.2) and end-tidal concentrations of sevoflurane at the end of surgery (0.3 +/- 0.3 and 0.4 +/- 0.20%) did not differ significantly between the Control and BIS-directed groups, respectively. Although the percentage of patients requiring supplemental boluses of fentanyl was reduced in the BIS-directed group (16 vs 48%, P <0.05), the intraoperative BIS values and recovery times were similar in the two groups. CONCLUSION: In this non-paralyzed elderly outpatient surgery population, the use of BIS monitoring for titrating the maintenance anesthetic (sevoflurane) failed to improve the early recovery process.
We prospectively evaluated the results of plantar pressure measurement in 32 patients (43 feet) who had a proximal crescentic osteotomy of the first metatarsal with a modified McBride procedure. The procedure's effectiveness in increasing weightbearing under the first ray, decreasing pressure under the second metatarsal head, and the relationship of radiographic measurements of first metatarsal length and position to postoperative pressure measurements were evaluated. Mean followup was 29 months. Average peak pressure increased postoperatively under the second metatarsal head. Almost identical numbers of feet had first metatarsal elevation (12) or depression (11) greater than 2 mm. Radiographic evidence of first metatarsal elevation, but not shortening, was associated with diminishing peak pressure and pressure-time integral under the first metatarsal head and hallux. Five feet that had first metatarsal elevation greater than 2 mm had new second metatarsal transfer lesions develop. Eleven feet preoperatively and nine feet postoperatively had symptomatic second metatarsal pressure lesions. One lesion persisted, 10 resolved, and eight new lesions developed. Control of the crescentic osteotomy in the sagittal plane was unpredictable despite modification of the surgical technique to plantarly displace the distal segment of the first meta-tarsal. Although average second metatarsal pressure increased postoperatively, there was variability in the correlation of radiographic change and pedobarographic measurements.
There is an increased rate of lumbar spinal operations in elderly patients due to lumbar spinal stenosis. Many factors affect the decision of the patient and surgeon to perform the operation, among which are the age of the patient, comorbidities and willingness to undergo surgery. However, the gender of the patient is rarely taken into consideration as a factor for performing the operation. The satisfaction of the patient is an important factor to assess the operative success retrospectively. Therefore, we assessed the differences caused by gender on the satisfaction of elderly patients following lumbar spinal surgery. Three hundred and sixty-seven elderly patients (>65 years) treated in our institution from 1990 to 2000 for lumbar spinal stenosis and who underwent laminectomy without fusion filled in a questionnaire prior to operation regarding their gender, demographic status, comorbidities, activities of daily living (ADL) using the Barthel index, and pain according to visual analogue scale. At follow-up, a telephone interview on 298 patients was structured and included the same pre-operative questions and additional questions regarding the satisfaction rate from surgery. Two hundred and ninety-eight patients responded to our telephone interview with a minimum follow-up of 1 year (mean: 64 months). After surgery, both women and men showed improvement in their ADL, and reduction in pain perception. The number of very satisfied patients was similar in both groups, but women were significantly more dissatisfied with the operation. The surgical parameters, including complications, did not differ between the groups. Gender differences were found to influence the satisfaction rate of lumbar spinal stenosis surgery. Women tend to have less satisfactory results than men. The reasons for that are probably multifactorial and are not related to the surgery per se.
Injuries around the elbow joint in children can be difficult to diagnose on the basis of findings on physical examination and radiographs. We present the case of a 4-year-old girl with a probable subluxation of the radial head, based on the findings on physical examination and radiographs. Radiography raised the possibility of a radial head subluxation. Sonography demonstrated displacement of the cartilaginous head of the radius away from the capitellum in the affected elbow. The child underwent corrective surgery. During fluoroscopy, results of an ulnar stress test were positive for lateral ligament tears. The patient's arm was put in a cast for 6 weeks. At 1-year follow-up, the patient had full range of motion of the elbow without pain. We present the findings of sonographic studies used to confirm the diagnosis.
STUDY OBJECTIVE: To assess the effect of regional vs general anesthesia on transcranial cerebral oxygen saturation (rSo2). DESIGN: Prospective, randomized, open-label study. SETTING: Large referral hospital. PATIENTS: Sixty American Society of Anesthesiologists physical status I, II, and III geriatric patients at least 60 years of age, undergoing surgical fixation of the neck of femur. INTERVENTIONS: Patients were randomized to receive either general (group GA) or spinal (group S) anesthesia. In all cases, frontal rSo2 was measured for a 10-minute preoperative control period, throughout the surgical procedure, and for 10 minutes postoperatively. MEASUREMENT AND MAIN RESULTS: The frequency of a decrease in rSo2 below baseline preoperative levels was significantly (P < .0001) higher in group S. However, the number of patients in whom at least one dip below baseline was recorded was similar between the groups. By contrast, general anesthesia was associated with a significantly higher rSo2 when compared with spinal anesthesia. Logistic regression revealed no correlation between changes in blood pressure, heart rate, or peripheral oxygen saturation and the frequency of rSo2 dips below baseline. CONCLUSION: Cerebral oxygen saturation is likely patient specific and independent of the anesthetic technique administered. Spinal anesthesia is associated with a higher incidence of cerebral desaturation. However, the number of patients in whom at least one dip below baseline was recorded was similar between the groups.
STUDY OBJECTIVE: To describe the frequency and timing of intravenous patient-controlled analgesia (IV-PCA) or neuraxial morphine-induced postoperative respiratory depression. DESIGN: Audit of data captured by routine quality assurance of the acute pain protocols that were implemented by nurses performing routine postoperative care. SETTING: The surgical wards of a university-affiliated, 700-bed, tertiary hospital. PATIENTS AND INTERVENTIONS: In real time, the data of all patients enrolled into our Acute Pain Service (APS) were entered and stored in the APS database. Thereafter, patients who had received IV morphine via a PCA device or neuraxial morphine between January 1999 and December 2002 were isolated. From this subset, all patients in whom a respiratory rate (RR) less than 10 breaths per minute was recorded were retrieved. MEASUREMENTS AND MAIN RESULTS: From a total of 4500 patients, IV or neuraxial morphine was administered to 1524 patients. Eighteen (1.2%) cases of an RR less than 10 breaths per minute were recorded (13 patients, 4 patients, and 1 patient in the IV-PCA, daily epidural morphine, and single-dose intrathecal morphine groups, respectively). A direct correlation between intraoperative fentanyl administration and postoperative respiratory depression was demonstrated between the IV-PCA (P = 0.03) and epidural groups (P = 0.05). The time from IV-PCA initiation or last neuraxial morphine administration until the diagnosis of respiratory depression ranged between 2 hours and 31.26 hours and 2 hours and 12.15 hours, respectively. Ten (55.6%) patients received naloxone. CONCLUSION: Morphine-induced respiratory depression may occur at any time during the APS admission. However, the optimal frequency of intermittent RR monitoring is unknown. Furthermore, because multiple variables (age, sex, prior opioid administration, site of operation) may affect morphine-induced respiratory depression, further investigation must be performed to determine the ideal monitoring protocol.
We recently proposed a chemically induced rat model for human hemolytic disorders associated with thrombosis. The objective of the present investigation was to apply a noninvasive, high-magnification X-ray analysis, the Faxitron radiography system, to characterize the protracted bone damage associated with this 2-butoxyethanol model and to validate it by histopathology. Groups of female Fischer 344 rats were given 0, 250, or 300 mg of 2-butoxyethanol/kg body weight daily for 4 consecutive days. Groups were then sacrificed 2 hours or 26 days after the final treatment. The treated animals displayed a darkened purple-red discoloration on the distal tail. Histopathological evaluation, including phosphotungstic acid-hematoxylin staining of animals sacrificed 2 hours after the final treatment, revealed disseminated thrombosis and infarction in multiple organs, including bones. The Faxitron MX-20 specimen radiography system was used to image selected bones of rats sacrificed 26 days posttreatment. Premature thinning of the growth plate occurred in the calcaneus, lumbar and coccygeal vertebrae, femur, and ilium of the treated animals. Areas of decreased radiographic densities were seen in the diaphysis of the femur of all treated animals. The bones were then examined histologically and showed a range of changes, including loss or damage to growth plates and necrosis of cortical bone. No thrombi were seen in the animals sacrificed at 30 days, but bone and growth plate changes consistent with prior ischemia were noted. The Faxitron proved to be an excellent noninvasive tool that can be used in future studies with this animal model to examine treatment modalities for the chronic effects of human thrombotic disorders.
BACKGROUND: Arthrodesis of the first metatarsophalangeal (MTP) joint is a reliable procedure for a painful hallux. Most studies focus on the surgical results rather than the functional outcome for the patient. Therefore, we examined the effects of first MTP joint arthrodesis on activities of daily living and recreational activities. METHODS: Fifty-three patients (60 feet) who had isolated arthrodesis of the first (MTP) joint using a parallel screw fixation technique were evaluated for the functional outcome after the surgery to determine the effect of the arthrodesis on the activities of daily living and on recreational sports and exercise. RESULTS: Fusion was achieved in all patients; all but three stated that they would have the surgery again. Postoperative pain scores evaluated using the Visual Analogue Scale indicated effective pain relief. High levels of function were demonstrated in this group of patients. CONCLUSION: Arthrodesis of the first MTP joint is not only a successful surgical technique for relief of pain and correction of deformity but also allows a high level of function in everyday life and in recreational activities.
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Degenerative or pre-degenerative processes in the tendon, which could lead to a spontaneous rupture, are well known problems, especially among athletes. Existing non-invasive diagnostic methods are mainly based on subjective analysis of static images of the tendon, but in many cases the degeneration cannot be diagnosed in time. Combining a set of existing image processing techniques, a tool for tracking the in vivo motion of a tendon imaged with dynamic ultrasound was implemented. A group of subjects that had undergone a degenerative rupture of their Achilles tendon, one subject with a traumatic rupture, and a group of control subjects were all tested. Using the motion information that was obtained from both tendons of all subjects, we developed an automatic test that examines the symmetrical properties of the tendon's motion, and defined a negative asymmetry property that could be quantified as a score. This score was found to be significantly more enhanced in the post-operative tendons (18.0 +/- 9.0) than in the contra-lateral healthy tendons of the same subjects (3.9 +/- 4.6). In the single traumatic rupture subject, this effect was not found (0.0). This leads us to believe that the negative asymmetry of tendon motion may be associated with degenerative or pre-degenerative processes in the tendon. Also, the mean degree of negative asymmetry in the healthy tendons of post-operative subjects (3.9 +/- 4.6) was found to be higher than that of healthy tendons of the control group (1.5 +/- 1.8). This finding may be associated with the fact that tendons that are contra-lateral to spontaneously ruptured tendons have a higher risk of developing degenerative processes. The method presented here is objective, low-cost, non-invasive and possibly more sensitive than existing non-invasive techniques.
BACKGROUND: The transients introduced at heel strikes were linked with increased risk for low back pain. The present study was designed to monitor the transients acting on the spinal column at gait, and to find out whether said transients are attenuated by interposition of a viscoelastic heel insoles. METHODS: A lightweight (2 g) accelerometer was held against the forehead with an elastic strap. The subject was instructed to walk naturally along an 8-m rigid walkway with a built-in, high-frequency (<500 Hz) response Kistler force plate. Seven subjects, shod in leather-soled shoes, were studied sequentially without and with viscoelastic heel insoles (Viscoheel, Bauerfeind). Ground reaction force and vertical acceleration were simultaneously recorded. The data were analog-stored and analyzed with respect to time and frequency domains. RESULTS: Under the aforementioned conditions, the heel strike introduced a transient that averaged 60% of body weight and lasted for up to 5 ms. Maximal deceleration was recorded in the order of 5G, with a frequency spectrum of 100 Hz. Interposition of silicone heel insoles attenuated the ground reaction force by one third and deceleration by two thirds, the highest frequency components having been eliminated. CONCLUSION: Viscoelastic heel insoles significantly attenuate the strain on the spinal column that is caused by walking.
BACKGROUND: Technetium (Tc) 99m bone scan is used as a diagnostic tool in cases of suspected fractures, and in differentiating between old and acute fracture. The false negative rate 72h after the injury in the under 65-year-old population is less than 5%. CASE PRESENTED: A 53-year-old motorcyclist was admitted to the emergency room after a road accident, suffering fractures of the tibia and both clavicles. A Tc 99m bone scan that was performed more than 72h after the injury, because of suspicion of an undiagnosed hip fracture, did not demonstrate increased uptake at the fracture sites. UNIQUENESS: The person involved was relatively young (53 years old), and the bone scan was performed more than 3 days after the injury. Despite these two facts, the bone scan was negative at the fracture sites.
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We recently presented a unique, chemically-induced rat model of hemolytic anemia and disseminated thrombosis. In this 2-butoxyethanol (BE)-induced model the organs developing infarction are comparable to those seen in human diseases, characterized by hemolysis and thrombosis (e.g., thalassemia, sickle-cell disease, paroxysmal nocturnal hemoglobinuria, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome). Red blood cells (RBCs) have special flow properties, namely, self-aggregability, deformability, and potential adherence to endothelial cells (ECs) of the blood vessel wall, which are essential for adequate blood flow and tissue perfusion; their alteration facilitates circulatory disorders. To examine the possible contribution of alterations in RBC flow properties to the observed thrombosis in the present investigation we determined the BE-induced changes in adherence, aggregability, and deformability of RBCs from male and female Fischer F344 rats exposed to two, three, or four daily doses of BE at 250 mg BE/kg body weight. Control animals were treated with the vehicle alone. Blood was taken on days 2, 3, 4, and 29. The administration of BE did not affect the RBCs aggregability but markedly enhanced their adherence to extracellular matrix; such enhancement was correlated with adherence to cultured ECs. RBC/EC interaction has been shown to be a potent catalyst of vascular occlusion in hemolytic hemoglobinopathies; thus the enhanced RBC adherence to EC is a likely mechanism by which thrombosis and organ infarct are induced in BE-treated rats.