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Biomedical subjects

Yehuda Ullmann

Publications and source records attributed to Yehuda Ullmann.

At least 19 recordsLinked to original sources
PubMed2006

The sounds of music in the operating room.

BACKGROUND: Little information is available about the effect of music on the operating room (OR) staff. PURPOSE: The objective of this study was to evaluate the perception of the influence of music on physicians and nurses working in the OR. METHODS: A questionnaire was designed and 250 copies were distributed to the doctors and nurses working in the OR at three hospitals. One hundred and seventy-one returned the completed questionnaire and were included in this study. RESULTS: 63% of the participants listen to music on a regular basis in the OR. Classical music is the most requested (58%) and most of the responders do not choose the type of music according to the type of the procedure. In our study, the nurses were more likely to listen to music and the willingness is higher among the female responders. The desired volume is lower as age increases and 78.9% of the participants claimed that music in the OR makes them calmer and more efficient. CONCLUSION: According to our study, music has a positive effect on the staff working in the operating rooms.

Adult↗
PubMed2006

The oral board examination for plastic surgery: seeking a better way.

Passing written and oral certifying examinations is a prerequisite to obtaining the license required from the Ministry of Health to start practicing as a Plastic Surgeon in Israel. In recent years, residents have complained about the unfairness of the method of the oral examination in terms of questions that varied according to the examiner. Before instituting changes, the position and attitudes of plastic surgeons in Israel, both senior surgeons and residents, regarding the oral examination was investigated. A detailed questionnaire containing 20 questions was distributed among 44 senior surgeons and 17 residents who attended the Annual Meeting of Israeli Plastic and Reconstructive Surgery Association in November 2001. The answers were analysed using the Pearson chi square test. According to this survey, a majority of responders agreed that the format of the oral examination should be changed. Although significant differences were found among the senior surgeons and the residents, the approach of the residents was found to be more acceptable. Reflecting the literature, the residents felt that the oral examination should be built of standardized questions and the anticipated answers should be pre-determined. The examination should cover a wide spectrum of subjects, with a restricted amount of time for each answer. A majority, 77% of the seniors and 64% of the residents, agreed that there was something to be learned about the abilities of the examinee from the presentation of a few case studies, and it was felt that this should be added to the revised examination. Only competent examiners should participate and each should rate the examinee independently. An observer from the same program was preferred. The majority of the responders also preferred a high quality and valid examination and did not like to view the examination as a barrier to entering the profession.

Attitude of Health Personnel↗
PubMed2006

Effect of hyperbaric oxygen on survival of composite grafts in rats.

Most treatment with hyperbaric oxygen (HBO) in plastic surgery is for wounds, burns, crush injuries, and infections. We aimed to find out if HBO increases the survival of composite grafts in rats. Twenty Sprague-Dawley rats were randomly assigned to two equal groups (treatment and control). A template 30 x 30 mm was placed on the skin and a composite graft taken from the upper back was harvested and then resutured to the fascia in situ. The treated group was placed in a hyperbaric chamber set at 202 kPa and 100% oxygen for 90 minutes daily for two weeks. Control animals were given no treatment. After death the mean surviving internal surface area of the graft was 372.5 (117.9) mm2 in the control group and 561.3 (85.7) mm2 in the experimental group (p=0.001). Treatment with HBO improved the surviving area of composite grafts in rats, and the beneficial effect was prominent only on the inner surface of the graft.

Animals↗
PubMed2006

Multiple periorbital dermoid cysts, clefting and mental retardation: a new malformation syndrome?

We report a child with multiple anomalies that was born to healthy nonconsanguineous parents after an unremarkable pregnancy. The female infant had bilateral cleft lip and palate, bilateral toe syndactyly (second and third with no bony fusion), multiple bilateral periorbital tumors, ectropion, lagophthalmos, strabismus and prominent eyes. High frontal hairline and everted lower lip were also noted. Soon after delivery, she was referred to the 'Cleft Clinic' where she underwent cleft lip and palate repair. Seven dermoid cysts were also removed from both periorbital areas. Follow-up documented moderate developmental retardation, hypothyroidism and hydronephrosis. Although some features of our patient overlap with those described in ectrodactyly, ectodermal dysplasia and cleft lip/palate, Martinez, Zlotogora-Ogur, Filippi, Freihofer and Blepharocheilodontic syndromes, our patient has a combination of features not previously reported.

Abnormalities, Multiple↗
PubMed2006

A side-by-side prospective study of intense pulsed light and Nd:YAG laser treatment for vascular lesions.

Recently, lasers and light systems are used more for the treatment of vascular lesions due to their noninvasiveness, ease of use, and short recovery time. This side-by-side prospective study compares results, satisfaction, and complications after intense pulsed light (IPL) and Nd:Yag laser treatment of small vascular lesions. Twenty-five patients with telangiectases, leg veins, or cherry angiomas underwent treatment of the same category of lesion in the same area. One year after completing treatment, patients were asked to report their satisfaction level after comparing digital photos before and after treatment; 72% felt they had good to excellent results after Nd:Yag treatment, while only 48% felt the same after IPL. The most common side effect after Nd:Yag was hyperpigmentation. Satisfaction level was significantly higher after Nd:Yag than after IPL. Patients with telangiectases, cherry angiomas, or leg veins <1 mm were more satisfied after IPL, while those with leg veins >1 mm were more satisfied after Nd:Yag. Overall, satisfaction with treatment of vascular lesions was greater with Nd:Yag although this method was more painful.

Adult↗
PubMed2006

The revised "reconstructive ladder" and its applications for high-energy injuries to the extremities.

In this report, we tried to evaluate the merits of the classic "reconstructive ladder" and other reconstructive tools, such as acute shortening followed by distraction osteogenesis and a vacuum-assisted closure device, for the treatment of high-energy injuries. Thirty-seven patients suffering from high-velocity injuries to the extremities caused by war weapons and blast terror attacks were treated at our institution. The fractures were initially stabilized by the Association for the Study of Internal Fixation (AO/ASIF) unilateral tubular external fixator, which was changed 2-3 days later to a circular Ilizarov frame for 19 patients. Temporary acute shortening was performed for 5 patients. Skin grafts were performed for 21 patients, local or regional flaps for 14 patients, and free flaps for 6. Vacuum-assisted closure was selected for 8 patients. The wounds were successfully closed in all the patients. Two patients with upper-limb injuries had nonunion. Motor nerve injuries recovered in 7/10 patients. Due to hypergranulating tissue, 2 patients treated with vacuum-assisted closure (VAC) had to stop treatment early. Their wounds were closed with skin graft or local flap. The classic reconstructive ladder, starting from direct closure and ending with a free flap, should be extended for limb traumas and include acute shortening with or without angulation, followed by distraction osteogenesis and the VAC system on the same step as the free flap.

Adult↗
PubMed2006

Fas pulls the trigger on psoriasis.

Fas/FasL signaling is best known for induction of apoptosis. However, there is an alternate pathway of Fas signaling that induces inflammatory cytokines, particularly tumor necrosis factor (TNF)-alpha and interleukin (IL)-8. This pathway is prominent in cells that express high levels of anti-apoptotic molecules such as Bcl-xL. Because TNF-alpha is central to the pathogenesis of psoriasis and psoriatic epidermis has a low apoptotic index with high expression of Bcl-xL, we hypothesized that inflammatory Fas signaling mediates induction of psoriasis by activated lymphocytes. Noninvolved skin from psoriasis patients was grafted to beige-severe combined immunodeficiency mice, and psoriasis was induced by injection of FasL-positive autologous natural killer cells that were activated by IL-2. Induction of psoriasis was inhibited by injection of a blocking anti-Fas (ZB4) or anti-FasL (4A5) antibody on days 3 and 10 after natural killer cell injection. Anti-Fas monoclonal antibody significantly reduced cell proliferation (Ki-67) and epidermal thickness, with inhibition of epidermal expression of TNF-alpha, IL-15, HLA-DR, and ICAM-1. Fas/FasL signaling is an essential early event in the induction of psoriasis by activated lymphocytes and is necessary for induction of key inflammatory cytokines including TNF-alpha and IL-15.

Adoptive Transfer↗
PubMed2006

Prophylactic external fixation and extensive bone debridement for chronic osteomyelitis.

There is universal agreement that treatment of osteomyelitis should consist of debridement, obliteration of dead space, tissue coverage and antibiotic therapy, with debridement as the most important factor for therapeutic success. Four patients, 27 to 72 years old, with chronic osteomyelitis after a fracture of the femur (two), or of the tibia (two), were included in this study. The patients had already undergone 5 to 15 (mean: 9) surgical procedures. The same surgical technique was used in all of them: sinuses were carefully excised down to the bone, and necrotic bone was aggressively resected until normal bleeding was seen. A prophylactic circular external fixation frame, built on one proximal and one distal ring connected to the bone by thin wires and half pins, was used to protect and support the limbs, significantly weakened by radical debridement. Bone grafting or distraction osteogenesis was not necessary. All wounds healed without complications, and the infection did not recur. The average follow-up period was 43 months (range: 38 to 54).

Adult↗
PubMed2005

Controversies in fluid resuscitation for burn management: literature review and our experience.

The purpose of this review is to summarise the commonly used formulae for fluid resuscitation in major burns and to discuss the controversy surrounding the use of protein-based colloids as a component of these types of formulae. Fluid resuscitation in major burns is one of the most critical steps in managing this type of injury. In practice, a wide variety of formulae for fluid resuscitation has been suggested. Some propose only the use of crystalloids, while others combine the colloids together with crystalloids. A review was performed of the literature addressing fluid resuscitation formulae and our experience using our formula is presented. At the authors' burn centre a unique formula is in use, which combines plasma and crystalloids. Our experience using this specific formula extends over a period of 15 years and 356 patients with major burns have been resuscitated using this protocol. At our centre, 27 deaths were recorded, 19 of which had third degree burns of more than 80% total body surface area (TBSA). The protein-based colloids are included in most of the formulae and the beneficial effect is considered to be higher than the potential side effects. We are in favour of administering colloids during the resuscitation period for major burns, starting in the early period after injury.

Adult↗
PubMed2005

Extreme bone lengthening using distraction osteogenesis after trauma: a case report.

We are reporting herein the result of a 22 cm tibial lengthening after using an acute shortening technique with acute temporary angulation for salvage of a posttraumatic lower limb injury. The patient was referred to our center 2 weeks after a Gustilo IIIB open complex injury to the lower limb that included bone and soft-tissue loss. After surgical debridement, the tibial gap was 22 cm and the soft-tissue defect on the anterior aspect of the calf measured 12 x 20 cm. An acute shortening using a 50 degrees angulation (apex posteriorly) of the tibia in an Ilizarov frame was done after a full assessment of all reconstructive surgical options. After complete wound healing, a progressive correction of the angulation was done. Bilevel tibial distraction at a rate of 1.75 mm/day restored the original lower limb length. The 22 cm tibial elongation included 17 cm proximal lengthening and 5 cm distal lengthening. The fractures consolidated after 371 days, all wounds had closed, and no signs of osteomyelitis were present. Good aesthetic and functional results were obtained. The patient had no leg discrepancy compared to his normal limb and he returned to his previous occupation as a garage mechanic and to his favorite sport, boxing. To our knowledge, this is the first report in the English literature of tibial lengthening of this magnitude following acute trauma.

Adult↗
PubMed2005

The effect of interleukin-8 on the viability of injected adipose tissue in nude mice.

Adipose tissue injection as a free graft for the correction of soft-tissue defects is a widespread procedure in plastic surgery. The main problem in achieving long-term soft-tissue augmentation is partial absorption of the injected fat and hence the need for overcorrection and re-injection. The purpose of this study was to improve the viability of the injected fat by the use of interleukin-8. The rationale for the use of interleukin-8 was its abilities to accelerate angiogenesis and attract inflammatory cells and fibroblasts, providing the injected adipocytes more feeding vessels and a well-established graft bed to enhance their viability. Human adipose tissue, obtained by suction-assisted lipectomy, was re-injected into the subcutis in the scalp of nude mice. Interleukin-8 (0.25 ng) was injected subcutaneously to the scalp as a preparation of the recipient site 24 hours before the fat injection and was added to the fat graft itself (25 ng per 1 cc of injected fat). In the control group, pure fat without interleukin-8 was injected and no interleukin-8 was added for the preparation of the recipient site. One cubic centimeter of fat was injected in each animal in both the study and control groups. There were 10 animals in each group. The animals were euthanized 15 weeks after the procedure. Graft weight and volume were measured and histologic evaluation was performed. In addition, triglyceride content and adipose cell sizes were measured as parameters for fat cells viability. Histologic analysis demonstrated significantly less cyst formation in the group treated with interleukin-8. No significant differences were found between the groups with regard to graft weight and volume or the other histologic parameters investigated. No significant differences were demonstrated in adipose cell sizes and their triglyceride content. In conclusion, less cyst formation, indicating improved quality of the injected fat, can be obtained by the addition of interleukin-8. Further studies of various dosages of interleukin-8 and their long-term effect are required before these encouraging results could be applied clinically.

Absorption↗
PubMed2005

Hair removal using intense pulsed light (EpiLight): patient satisfaction, our experience, and literature review.

Applications for intense pulsed light (IPL) for hair removal are gaining favor among other methods, including lasers, because of its noninvasive nature, versatility regarding different skin and hair types, safety, and ease of use. Hair removal using IPL was performed from January 2002 to December 2003 on 108 consecutive patients. Eighty of these patients answered a questionnaire and were enrolled in the study group. The investigated parameters were hair and skin type, number of pulses, fluence, pulse duration, pulse delay, the filters used, and the treated area. The patient assessment of improvement (satisfaction) rate was graded from 1 to 5 points: 1, worse; 2, no improvement; 3, mild improvement; 4, good result; and 5, excellent result. The patients had between 1 and 13 treatments most of them during 2 to 6 sessions. Sixty-seven percent of the patients reported no complications. Prolonged erythema for more than 7 days was reported by 16.25%, blisters by 6.25%, temporary hyperpigmentation by 8.75%, leukotrichia was present in 1 case, and 1 case of persistent hypopigmentation was noted in a young girl. An increased number of complications and a decreased satisfaction rate were noted with higher skin types, but it was not statistically significant. Patients who underwent fewer treatments (1-3 treatments) were more satisfied compared with those who had more than 7 treatments (P < 0.02). Sixty percent of the patients rated their satisfaction to be good to excellent and 65% would ill recommend this treatment to their friends. To minimize the complication rate the authors found that the preset parameters should be adjusted at every treatment session according to the skin response at the previous one. Permanent hair removal cannot be guaranteed and it is not possible to predict the improvement rate. Nevertheless, based on patient satisfaction rate in this study, the authors recommend using IPL for hair removal.

Adolescent↗
PubMed2005

Multimodality gynecomastia repair by cross-chest power-assisted superficial liposuction combined with endoscopic-assisted pull-through excision.

Numerous methods of gynecomastia repair have been described to accomplish removal of breast tissue. Our multimodality surgical approach for the treatment of gynecomastia combines the use of power-assisted superficial cross-chest liposuction with direct pull-through excision of the breast parenchyma under endoscopic supervision. Seventeen patients, aging 17-39, underwent this multimodality approach. According to Simon's grading, 3 patients had grade 1, 5 had grade 2a, 6 had grade 2b, and 3 had grade 3 gynecomastia. Power-assisted liposuction was performed with a 3- or 4-mm triple-hole cannula inserted through the contralateral periareolar medial incision to suction the contralateral prepectoral fatty breast. At the end of the liposuction, the fibrous tissue was easily pulled through the ipsilateral stab wound and excised under endoscopic control. Follow-up time ranged from 6 to 34 months. The amount of fat removed by liposuction varied from 100-800 mL per breast, and the amount of breast parenchyma removed by excision varied from 20-110 g. All patients recovered remarkably well. No complications were recorded. All patients were satisfied with their results. This technique enables an effective treatment of both the fatty and fibrous tissue of the male breast and avoids skin redundancy due to skin contraction. A smooth masculine breast contour is consistently achieved without the stigma of this type of surgery.

Adolescent↗
PubMed2005

Searching for the favorable donor site for fat injection: in vivo study using the nude mice model.

BACKGROUND: The use of suctioned fat grafts for correction of soft tissue defects is a widespread procedure in esthetic and reconstructive surgery. The main disadvantage of this simple and sensible procedure is the unpredictable absorption rate of the fat graft. A lot of research has been performed aiming for enhancement of the take of the fat grafts. OBJECTIVE: Our study was performed to find if there is any favorable donor site for fat harvesting. METHODS: This in vivo experiment using the nude mice model enables the study of the long-term survival of human fat in an animal model. The fat was harvested from three donor areas: the thigh, abdomen, and breast of a 48-year-old woman who came for an elective esthetic procedure. After centrifugation, 1 cc of fat was injected subcutaneously into the scalp of the nude mouse. There were 15 mice in each of the three groups, according to the selected donor sites. The animals were sacrificed 16 weeks after the procedure. The extracted fat was evaluated in terms of weight, volume, and six histologic parameters: integrity, vascularization, cyst formation, fibrosis, necrosis, and inflammation. RESULTS: This study could not find any statistically significant differences between the three investigated donor sites in the evaluated parameters. CONCLUSION: On the basis of this study, there is no favorable area for harvesting fat grafts. The donor site can be chosen according to the preference of the surgeon and the patient.

Adipose Tissue↗
PubMed2005

Enhancing the take of injected adipose tissue by a simple method for concentrating fat cells.

Injection of aspirated fat for the correction of tissue defects is a common procedure in plastic surgery. The reported rates of fat cell survival vary greatly in the medical literature, and different techniques of harvesting, processing, and reinjecting the fat cells are claimed to be responsible for these differences. However, there is no agreement concerning the best way to process the harvested fat before reinjection. The present study was initiated to examine and evaluate the effect of a simple method of isolating the fat particles on the outcome of fat graft survival. In this study, the nude mouse model was used to examine the survival and take of the fat graft concentrated before injection by the cumbersome recommended closed centrifugation technique in comparison with the authors' recommended open method, using an operating room cotton towel as a platform for concentrating the fat cells and separating them from fluids, oil, and debris. One milliliter of concentrated human fat cells preprocessed by towel separation was injected into the nuchal subcutis of 11 nude mice in the study group, and the same amount of fat that was preprocessed by centrifugation was injected into 11 control mice. Injected fat survived in both groups. No significant differences were found regarding fat graft weight and volume, although a tendency for better survival was noticed in the experimental group. Histologic evaluation of the grafts revealed significantly less fibrosis within the study group, meaning that the quality of the fat grafts was better. The authors found this method to be simple, cheap, and friendly to the surgeon in comparison with traditional processing using the centrifuge.

Absorption↗
PubMed2005

Deep phenol peeling and fat injection: treatment option for perioral wrinkles in a scleroderma patient.

BACKGROUND: Scleroderma is characterized by abnormal growth of connective tissue, often manifested with hard and tight skin. The viscous properties of the skin are impaired, and the main histologic changes include a thicker dermis, absence of pilosebaceous units, and a decreased space between collagen bundles. Often these patients have wound healing problems. OBJECTIVE: The objective was to demonstrate a case of scleroderma that had deep phenol perioral peeling and fat injection into the lips. According to our bibliographic search, this is the first report in the English literature of using these modalities in scleroderma patients. METHODS: A 64-year-old woman suffering from scleroderma for more than 20 years came for improvement of her perioral appearance. We decided to manage her deep perioral wrinkles by deep peeling using the Baker formula and concomitantly to use autologous fat injection to augment her thin lips. RESULTS: The healing of our patient after these two interventions was uneventful, and satisfactory results have been obtained. CONCLUSION: Based on our experience, this intervention may be suggested for patients suffering from scleroderma after a detailed explanation of the possible wound healing difficulties is provided to the patients.

Adipose Tissue↗