1
|
Rosenthal A, Goldbart Nahmias A, Heller L, Hadad E. Silicone Lymphadenopathy Following Augmentation Mammoplasty With Silicone Implants. Aesthet Surg J 2024:sjae113. [PMID: 38762900 DOI: 10.1093/asj/sjae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Silicone implants claim the predominant share in global implant usage for breast augmentation. Despite technological advancements, complications persist, with silicone lymphadenopathy (siliconoma) being a noteworthy concern. This phenomenon has been inadequately addressed in the existing literature. OBJECTIVES To characterize axillary siliconomas and identify potential risk factors to help reduce their occurrence. METHODS The authors conducted a retrospective observational cross-sectional study spanning between 2011 to 2021 at the Shamir-Assaf Harofeh Medical Center. Preoperative ultrasound examination was conducted, categorizing patients into those with siliconomas and those without. RESULTS A total of 614 women (1209 breasts) met the inclusion criteria. The incidence of siliconomas was 13.6% (165 breasts). In univariate analysis, older age (age 47 years vs. 43 years, P < 0.001), older implant age (12.2 vs. 11 years, P = 0.026), ruptured implants (59.4% vs 17.7%, P < 0.001), subpectoral placement (P = 0.019), severe capsular contracture, and the use of Mentor implants (Irvine, CA; P = 0.007) and Poly Implant Prothèse implants (PIP; La Seyne-sur-Mer, France; P = 0.001) correlated significantly with the presence of siliconomas. In a multivariate analysis, implant rupture (OR = 6.342), and implant manufacturer - Mentor (OR = 3.047) and PIP (OR = 3.475), were identified as independent risk factors associated with a higher incidence of siliconomas. Severe capsular contracture was associated with higher incidence of siliconomas as well (OR = 1.65). CONCLUSIONS Surgeons should inform candidates about the potential risk of silicone migration. Patients with ruptured implants, significant capsular contracture, Mentor and PIP implants face an increased risk for developing siliconomas. Closer monitoring for the detection of siliconomas in the axilla for these patients is advisable, potential prophylactic replacement or removal of implants may be warranted to mitigate siliconoma risk.
Collapse
Affiliation(s)
- Adaya Rosenthal
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
| | | | - Lior Heller
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
| | - Eran Hadad
- Department of Plastic Surgery, Shamir Medical Center, Zerifin, Israel
| |
Collapse
|
2
|
Govrin-Yehudain Y, Hadad E, Heller L. Updated trends of breast implant surgeries: An Israeli analysis. J Plast Reconstr Aesthet Surg 2024; 88:517-523. [PMID: 38103534 DOI: 10.1016/j.bjps.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Breast augmentation remains one of the most prevalent procedures in plastic surgery. While most patients experience high satisfaction with the outcomes, a subset may encounter various complications or dissatisfaction with achieved results necessitating subsequent surgical intervention including implant removal or exchange. MATERIALS AND METHODS We collected information from three pivotal private medical centers in Israel where a considerable number of breast surgeries are performed. We examined the number of breast augmentations, implant exchange and implant removal surgeries with or without breast lift that were performed on a biannual basis for each center for the period 2018-2022. Trends in surgery types were analyzed and compared to registries in other countries. RESULTS Between the years 2018 and 2022, 20,075 surgeries were done in three main private medical centers in Israel. Data show a gradual increase in implant removal surgeries from 2018 (n = 80, 2.9%) to 2019 (n = 269, 9.9%), followed by a significant increase in 2020 (n = 1436, 27.3%), and a gradual decline between 2021 (n = 1019, 22.8%) and 2022 (n = 916, 18.5%). The overall number of breast implant insertion procedures (breast augmentation procedures and exchange procedures) was 2659 in 2018 (97%), 2424 in 2019 (90.0%), 3816 in 2020 (72.6%), 3437 in 2021 (77.1%), and 4019 in 2022 (81.4%). SUMMARY We present updated trends in breast implant surgeries in Israel. 2020 was a key year in which the rate of explantations was the highest, and the percentage rate of implantations was the lowest and a year in which the trend changed. These patterns partly align with trends seen in other countries worldwide.
Collapse
Affiliation(s)
- Yoad Govrin-Yehudain
- Department of Plastic Surgery, Shamir Medical Center, Tel Aviv University, Zerifin, Israel.
| | - Eran Hadad
- Department of Plastic Surgery, Shamir Medical Center, Tel Aviv University, Zerifin, Israel.
| | - Lior Heller
- Department of Plastic Surgery, Shamir Medical Center, Tel Aviv University, Zerifin, Israel.
| |
Collapse
|
3
|
Averbuch Sagie R, Wiser I, Heller L, Klein D, Hadad E. Pregnancy Reverses Abdominoplasty Aesthetic Outcome: Myth or Misconception? A Cross-Sectional Study. Aesthet Surg J 2022; 42:NP20-NP26. [PMID: 34622279 DOI: 10.1093/asj/sjab356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The common recommendation for female abdominoplasty candidates is to conclude family planning before undergoing the procedure. However, no evidence demonstrates a correlation between aesthetic outcome compromise, risk for fetal complications, or risk for maternal complications when abdominoplasty is followed by pregnancy. OBJECTIVES The aim of this study was to evaluate maternal, fetal, and aesthetic outcomes among pregnant females with a history of abdominoplasty. METHODS The authors conducted an online survey among women who became pregnant after having an abdominoplasty. Participants were recruited via social media groups related to abdominoplasty. The survey included demographic-, aesthetic outcome-, and pregnancy-related questions utilizing a score from 1 (no effect) to 10 (worst effect) to assess abdominal aesthetic outcome compromise. RESULTS Thirty-two participants completed the online survey, 15 (46.8%) of which reported their pregnancy was unplanned. Pregnancy-related findings included 5 (15.6%) late premature births (between gestational week 35 and 37), 1 miscarriage, and 1 emergency C-section. Compromised aesthetic outcomes following pregnancy included new abdominal stretch marks (50%, N = 16), widened abdominoplasty scar (28%, N = 9), abdominal skin excess (37.5%, N = 12), and abdominal bulge (25.8%, N = 8). A new hernia was reported by 2 participants (6.3%). The average abdominal aesthetic severity score was 2.7 (range, 1-8), and only 3 scores were above 5 (9.3%). Two women (6.2%) underwent abdominoplasty revision, and 18 (56.2%) stated they would recommend others to undergo abdominoplasty before pregnancy (56.3%). CONCLUSIONS This survey shows there is room to reevaluate whether future pregnancy should be considered a relative contraindication for undergoing abdominoplasty. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- Roni Averbuch Sagie
- Department of Plastic and Reconstructive Surgery, Shamir Medical Center, Zrifin, Israel
| | - Itay Wiser
- Mount Sinai Elmhurst Hospital, New York, NY, USA
| | - Lior Heller
- Department of Plastic and Reconstructive Surgery, Shamir Medical Center, Zrifin, Israel
| | - Doron Klein
- Department of Plastic and Reconstructive Surgery, Shamir Medical Center, Zrifin, Israel
| | - Eran Hadad
- Department of Plastic and Reconstructive Surgery, Shamir Medical Center, Zrifin, Israel
| |
Collapse
|
4
|
Kouniavski E, Hadad E, Heller L. Breast Implantation Rates in Israel: Is There a Change in Trend? Isr Med Assoc J 2021; 23:735-739. [PMID: 34811991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Breast implant illness (BII) is a rising concern among many patients. Although not fully understood, a connection between silicone breast implants and systemic diseases may be present. This connection may influence the types of breast surgeries performed. OBJECTIVES To evaluate changing trends in breast surgeries in Israel over time, with regard to implantation, explantation, and implant exchange surgeries. METHODS In this ecological study, we presented data from four private medical centers in Israel regarding the number of breast implant surgeries performed in the years 2018-2019. Data were collected bi-yearly. The types of surgeries included breast implantation, explantation, and breast implant exchange. RESULTS When we summed and compared the yearly data, we saw that the number of implantations in 2018 was 2267 (80.1% of breast implant procedures that year), and 1929 (68.9%) in 2019. The number of implant exchanges in 2018 and 2019 was 482 (17.0%) and 608 (21.7%), respectively. In 2018, 80 (2.8%) explantations were performed and 262 (9.4%) in 2019. CONCLUSIONS There appears to be a trend in the rise of implant removal surgeries in addition to a decrease in breast implantations. One possible reason may be patient concerns of BII. Another reason may be the increased public interest and discussion about systemic effects of breast implants. More research is needed in this field to achieve better understanding of the phenomenon, the reasons behind it, and the possible solutions and ways of treatment.
Collapse
Affiliation(s)
- Elizaveta Kouniavski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Plastic and Reconstructive Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Eran Hadad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Plastic Surgery, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Lior Heller
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Plastic Surgery, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| |
Collapse
|
5
|
Hadad E, Klein D, Seligman Y, Wiser I, Heller L. Sub-muscular plane for augmentation mammoplasty patients increases silicone gel implant rupture rate. J Plast Reconstr Aesthet Surg 2018; 72:419-423. [PMID: 30616906 DOI: 10.1016/j.bjps.2018.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/10/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast augmentation is one of the most common aesthetic procedures performed worldwide. One of the worst associated complications is implant rupture, a topic that will be addressed in the present study. The risk of developing silicone gel breast implant rupture following breast augmentation is associated with multiple factors, including: older generation implant, increased implant age, implant type, specific manufacturer, severe capsular contracture (Baker grade III or IV), and the presence of local symptoms. We hypothesize that the plane of the implant placement may also play a role in the development of implant rupture due to differences in opposing forces upon the implant between submuscular and subglandular planes. OBJECTIVES To assess the effect of potential risk factors on breast prosthesis rupture rate, focusing on implant pocket selection, capsular contracture and implant volume. METHODS A retrospective cohort study was performed on patients with silicone breast implants in either subglandular or submuscular plane, who underwent an elective breast implant exchange, with or without mastopexy, between January 2012 and June 2017. Data collected included patient's age, implant age, implant pocket, implant volume, capsular contracture grade, and implant status (ruptured or intact). RESULTS Data was collected on 362 women (700 breasts). A total of 284 women (542 breasts) met the inclusion criteria. The average age of the subjects was 43.4 ± 10.4 years. Average implant age during exchange was 10 ± 6.1. There was no difference between the characteristics of the submuscular group and the subglandular group, except from patient age. In a univariant analysis, patient's age (46.4 vs. 41.8, p < 0.001) and implant age (12.2 vs. 8.92 years, p < 0.001) were associated with significantly higher rupture rate. Among ruptured implants, the relative proportion of submuscular to subglandular implants was 64%, compared to 48% among non-ruptured implants (p < 0.0001). When controlling for potential confounders, submuscular pocket (OR = 0.1835, CI95% 1.25-2.69, p = 0.002) as well as implant size (OR = 1.004, CI95% 1.001-1.007, p = 0.005) were found to be a risk factor for implant rupture. CONCLUSION A sub-muscular implant pocket was identified as a significant risk factor for implant rupture. The prevailing theory that larger size implant carries an increased risk of complications, is also reinforced in this study. Large prospective studies are needed to further clarify risk factors for implant rupture.
Collapse
Affiliation(s)
- Eran Hadad
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
| | - Doron Klein
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel
| | - Yaakov Seligman
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel
| | - Itay Wiser
- Department of Epidemiology and Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Heller
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel
| |
Collapse
|
6
|
Hadad E, Wiser I, Rosenthal A, Landau G, Ziv E, Heller L. Suction drains in esthetic breast implant exchange are associated with surgical site infections: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2017; 70:1635-1640. [DOI: 10.1016/j.bjps.2017.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/14/2017] [Accepted: 06/25/2017] [Indexed: 10/19/2022]
|
7
|
Shalom A, Friedman T, Schein O, Hadad E. A novel short-scar breast reduction technique in large breasts. Aesthetic Plast Surg 2013; 37:336-40. [PMID: 23377144 DOI: 10.1007/s00266-012-9980-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 07/17/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Short-scar breast reduction techniques have become very popular in the last two decades. These techniques cannot be used very often in patients with exceptionally large breasts because of the excessive amounts of redundant skin. In this article we describe our new approach for dealing with the extra skin remaining in patients with very large breasts so that they may also benefit from the short-scar breast reduction procedure. METHODS In our technique the vertical suture line is divided into two separate suture lines. The first suture line follows the natural curve of the lower pole of the breast from the nipple to the chest wall. This line is elongated by elevating and anchoring the new inframammary fold higher on the chest wall with a suspensory suture and the skin is then closed in a straight line. The second suture line attaches the extra lower skin by closing the dermis to the chest wall and then closing the skin with a purse-string suture. This technique helps to deal with the extra skin resulting from the short-scar breast reduction technique. RESULTS The technique was used in ten patients with large breasts. Patient satisfaction was excellent and there was no increase in complications. The technique also helped to obliterate the dead space beneath the breast and reduced seroma formation. CONCLUSION We found that this new technique can be used safely and effectively in selected patients with large breasts without any increase in complications. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Avshalom Shalom
- Department of Plastic Surgery, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.
| | | | | | | |
Collapse
|
8
|
Ran Y, Hadad E, Daher S, Ganor O, Yegorov Y, Katzenell U, Ash N, Hirschhorn G. Triage and air evacuation strategy for mass casualty events: a model based on combat experience. Mil Med 2011; 176:647-51. [PMID: 21702381 DOI: 10.7205/milmed-d-10-00390] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Management of combat casualties should optimize outcomes by appropriate patient triage, prehospital care, and rapid transport to the most capable medical facility, while avoiding overwhelming individual facilities. METHODS Planning the medical support for the campaign was done by the medical department of the IDF Southern command in cohort with the medical department of the Homefront command. Data collection and analysis were done by the Trauma Branch of the Medical corp. RESULTS 339 soldiers were injured, among them were 10 fatalities. Five hospitals received casualties, although the 2 regional hospitals received 84% of the primary evacuation load. The majority of urgently injured soldiers (90%) were evacuated by air, as opposed to 59% of non-urgently injured soldiers. CONCLUSIONS In a cross border setting, airlifting the urgent casualties to farther away level I trauma centers provides appropriate care for them, while not crossing the "surge capacity" line for the near-by medical centers.
Collapse
Affiliation(s)
- Yuval Ran
- Trauma Branch, Israel Defence Force, 02149
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Hadad E, Westreich M, Friedman T, Shalom A. Effect of aspirin pre- and postburn on survival of experimental intermediate burns in rats. J Cutan Med Surg 2011; 15:111-4. [PMID: 21477559 DOI: 10.2310/7750.2011.10016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Burns are a major health care problem. Early treatment increases survival of intermediate burn zones, thus decreasing morbidity, mortality, surgery, and hospitalization. Previously, aspirin was shown to improve burn perfusion and increase failing flap survival. OBJECTIVE Owing to similarities between failing flaps and intermediate burn zones, we conducted this study to evaluate the effect of aspirin on intermediate burn zone survival. METHODS An intermediate burn was created in 30 rats randomly divided into three experimental groups: pre- and postburn aspirin groups and a control group. Final burn survival was evaluated on day 7. RESULTS No statistical difference was observed between the test and control groups. Both aspirin regimens failed to improve intermediate burn survival. CONCLUSION Presumably, administration of aspirin could not prevent the noxious tissue events of burn injury that cause cell death. Possibly, different dosages or modes of administering aspirin could have a beneficial effect on burn wound survival.
Collapse
Affiliation(s)
- Eran Hadad
- Department of Plastic Sugery, Assaf Harofeh Medical Center, Zerifin, Israel
| | | | | | | |
Collapse
|
10
|
Kramer E, Hadad E, Westreich M, Shalom A. Lack of Complications in Skin Surgery of Patients Receiving Clopidogrel as Compared with Patients Taking Aspirin, Warfarin, and Controls. Am Surg 2010. [DOI: 10.1177/000313481007600103] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clopidogrel, a new antiplatelet agent that irreversibly inhibits platelet aggregation, is widely used today. This prospective work was conducted to evaluate the safety of performing skin surgery on patients taking clopidogrel. Patients undergoing surgery for excision of skin or subcutaneous lesions under local anesthesia taking clopidogrel were the study group. The control group comprised 2073 historical patients who had undergone a similar procedure. Data collected included: age, sex, past medical history, medications, and late complications. Follow-up was done at 1 to 2 weeks and 3 to 6 months. There were 32 patients on clopidogrel, having 38 lesions removed. Of these, seven patients were on aspirin and clopidogrel combined. The groups taking clopidogrel, aspirin, and warfarin had significantly more males, were older, and had significantly more comorbid medical conditions. There was no significant difference in the incidence of any of the complications in any of the groups. This study shows that patients taking clopidogrel before skin surgery, though older and with more associated medical conditions, do not experience a greater rate of complications. We conclude that patients undergoing minor excisional cutaneous surgery should continue taking clopidogrel because there is no apparent risk for increased complications when good meticulous surgical techniques are used.
Collapse
Affiliation(s)
- Eyal Kramer
- Department of Plastic Reconstructive and Aesthetic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Eran Hadad
- Department of Plastic Reconstructive and Aesthetic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Melvyn Westreich
- Department of Plastic Reconstructive and Aesthetic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Avshalom Shalom
- Department of Plastic Reconstructive and Aesthetic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| |
Collapse
|
11
|
Kramer E, Hadad E, Westreich M, Shalom A. Lack of complications in skin surgery of patients receiving clopidogrel as compared with patients taking aspirin, warfarin, and controls. Am Surg 2010; 76:11-14. [PMID: 20135932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Clopidogrel, a new antiplatelet agent that irreversibly inhibits platelet aggregation, is widely used today. This prospective work was conducted to evaluate the safety of performing skin surgery on patients taking clopidogrel. Patients undergoing surgery for excision of skin or subcutaneous lesions under local anesthesia taking clopidogrel were the study group. The control group comprised 2073 historical patients who had undergone a similar procedure. Data collected included: age, sex, past medical history, medications, and late complications. Follow-up was done at 1 to 2 weeks and 3 to 6 months. There were 32 patients on clopidogrel, having 38 lesions removed. Of these, seven patients were on aspirin and clopidogrel combined. The groups taking clopidogrel, aspirin, and warfarin had significantly more males, were older, and had significantly more comorbid medical conditions. There was no significant difference in the incidence of any of the complications in any of the groups. This study shows that patients taking clopidogrel before skin surgery, though older and with more associated medical conditions, do not experience a greater rate of complications. We conclude that patients undergoing minor excisional cutaneous surgery should continue taking clopidogrel because there is no apparent risk for increased complications when good meticulous surgical techniques are used.
Collapse
Affiliation(s)
- Eyal Kramer
- Department of Plastic Reconstructive and Aesthetic Surgery, Assaf Harofeh Medical Center, Zerifin 70300, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | | | | | | |
Collapse
|
12
|
Shalom A, Hadad E, Friedman T, Kremer E, Westreich M. Effect of hyaluronic acid on random-pattern flaps in rats. Dermatol Surg 2008; 34:1212-5. [PMID: 18513292 DOI: 10.1111/j.1524-4725.2008.34260.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hyaluronic acid is a common component of the extracellular matrix, has many medical applications, and is widely used as a soft tissue filler in patients who simultaneously or eventually undergo cosmetic procedures to the areas treated. OBJECTIVE The objective was to study the effect of hyaluronic acid on wound healing and viability of random-pattern flaps in rats. METHODS AND MATERIALS Twenty-six male rats were randomly divided into two groups. A cephalically based random dorsal flap was used-14 rats received hyaluronic acid to the bed of the flap immediately after surgery; 12 served as controls. After 1 week, flap survival was evaluated by fluorescein fluorescence. A t-test statistical analysis of survival relationships was performed. RESULTS Flap viability in hyaluronic acid-treated rats was slightly better than in controls (average flap length survival 46.7 and 40.6 mm, respectively; p<.2). CONCLUSIONS Although hyaluronic acid had a slight beneficial effect on flap viability, no significant improvement in flap survival was shown. The lack of any deleterious effect of hyaluronic acid on relatively ischemic tissues is further evidence of its harmless effect during surgical intervention. Further studies should be performed to clarify the potential benefit of hyaluronic acid on random flaps. The authors have indicated no significant interest with commercial supporters.
Collapse
Affiliation(s)
- Avshalom Shalom
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | | | | | | | | |
Collapse
|
13
|
Friedman T, Klein D, Hadad E, Westreich M, Shalom A. [Diagnostic accuracy of skin lesions excised by a plastic surgeon]. Harefuah 2008; 147:305-375. [PMID: 18686810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Skin tumors are the most common malignancies in the western population, with surgical excision as the definitive treatment. OBJECTIVES The author's objectives were to estimate the precision of clinical diagnosis of skin tumors by a plastic surgeon in a community clinic. METHODS The study includes clinical and histological data of patients operated on solely by one plastic surgeon, between November 2001 to July 2003. The sensitivity and positive predictive value were measured and compared to the literature. RESULTS The study included 1640 patients. Out of 1806 excised skin lesions, 17.4% were malignancies. Basal cell carcinoma was the most common tumor, followed by squamous cell carcinomas and melanomas. Sensitivity for skin malignancy was 94%, and 76.5% for specific skin malignancy. Positive predictable value for any malignancy was 69.4%, and 72% for the basal cell carcinoma, the most common skin malignancy. CONCLUSIONS Clinical examination is the main diagnostic tool for the plastic surgeon and dermatologist in the evaluation of skin lesions. Surgical excision is considered when clinical diagnosis is not productive or when malignancy is suspected. For most malignancies, diagnostic excision is therapeutic as well. Positive predictable value is a prospective index estimating the clinical diagnostic skills of the clinician. In our opinion, new technologies such as dermatoscopy should be used more often in the evaluation of skin lesions.
Collapse
Affiliation(s)
- Tal Friedman
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | | | | | | | | |
Collapse
|
14
|
Affiliation(s)
- Daniel S Moran
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel.
| | | | | |
Collapse
|
15
|
Abstract
Sleep-deprived individuals appear to have decreased psychological and physical capabilities. Studies have shown how major psychological aspects, such as alertness, complex mental performance, and memory, are strongly affected by sleep deprivation. Military use of psychostimulants dates back many years, especially in units that operate over long hours and deprive soldiers of sleep. During prolonged military operations, pilots are regularly kept awake for hours and days without fulfilling their biological sleep requirements. This consequently affects their natural circadian rhythm. This article deals with both the benefits and the side effects of two kinds of psychostimulants, namely, dextroamphetamine, which is more popular and is most widely used, and modafinil, which is a relatively newer type. There is growing evidence that modafinil has fewer side effects, in comparison with its predecessor dextroamphetamine, while still maintaining all of the latter's beneficial characteristics.
Collapse
Affiliation(s)
- Uri Eliyahu
- Heller Institute of Medical Research, Sackler School of Medicine, Tel Aviv University, Sheba Medical Center, Tel Hashomer 52621, Israel
| | | | | | | | | |
Collapse
|
16
|
Hadad E, Pirogovsky A, Bartal C, Gilad J, Barnea A, Yitzhaki S, Grotto I, Balicer RD, Schwartz E. An outbreak of leptospirosis among Israeli troops near the Jordan River. Am J Trop Med Hyg 2006; 74:127-31. [PMID: 16407357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
An outbreak of leptospirosis that involved 7 of a team of 27 Israeli troops occurred following a military exercise in northern Israel near the Jordan River. The organism implicated in the outbreak was Leptospira interrogans serovar Hardjo. The clinical course was uncomplicated and all patients fully recovered. There were no cases of asymptomatic infection. Military personnel should be recognized as having an occupational risk for contracting leptospirosis, especially when military activity takes place near natural water sources inhabited by cattle, taking into account the local epidemiology of this disease. Moreover, outbreaks among military personnel may serve as a sentinel for leptospiral illness in areas in which civilian exposure takes place, such as the Jordan River, which is an important site that involves immersion in the context of both pilgrimage and civilian recreational activities."Bathe and you will become clean. So he went down and immersed himself seven times in the Jordan, as Elisha had told him to do. And his flesh became clean once more like the flesh of a small child."II Kings 5:14.
Collapse
Affiliation(s)
- E Hadad
- Department of Internal Medicine C, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Heled Y, Zarian A, Moran D, Hadad E. [Exercise induced rhabdomyolysis--characteristics, mechanisms and treatment]. Harefuah 2005; 144:34-8, 70. [PMID: 15719820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Rhabdomyolysis is defined as a syndrome resulting from skeletal muscle injury with release of muscle cell contents into the plasma. One of the main causes of rhabdomyolysis is eccentric exercise against high resistance. There are mechanical as well as metabolic causes in exercise induced rhabdomyolysis. The mechanical aspect includes high physical tension on the muscle fiber and the metabolic causes include lack of available ATP and disturbance in intracellular electrolyte balance, especially calcium. The clinical picture of rhabdomyolysis may include muscle soreness, reduction of the range of motion, decreased muscle strength, black urine and, in severe cases, acute renal failure. Laboratory results may include delayed high levels of muscle enzymes in the plasma, myoglobinemia and myoglobinuria, disturbance in blood electrolyte balance, and in severe cases, disturbance in coagulatory function and DIC. Compartment syndrome may also be part of severe rhabdomyolyis. The main treatment for rhabdomyolysis is fluids administration and maintaining urination, in order to preserve renal function. In severe compartment syndrome fasciotomy may be necessary. There is a wide variability in the severity of rhabdomyolysis. This variability is not completely understood but may be related to the level of physical fitness, morphometrical characteristics and gender. In order to prevent exercise induced rhabdomyolysis, a gradual training program should be maintained providing enough recovery time, preserving fluid balance, and avoiding extreme eccentric exercise and exercise in high heat load.
Collapse
Affiliation(s)
- Yuval Heled
- Military Physiology Unit and Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer.
| | | | | | | |
Collapse
|
18
|
Abstract
The prognosis of heat stroke in patients is directly related to the degree of hyperthermia and its duration. Therefore, the most important feature in the treatment of heat stroke is rapid cooling. Several cooling methods have been presented in the literature including immersion in water at different temperatures, evaporative cooling, ice pack application, pharmacological treatment and invasive techniques. This article describes the various cooling techniques in terms of efficacy, availability, adverse effects and mortality rate. Data suggest that cooling should be initiated immediately at time of collapse and should be based on feasible field measures including ice or tepid water (1-16 degrees C), which are readily available. In the emergency department, management should be matched to the patient's age and medical background and include immersion in ice water (1-5 degrees C) or evaporative cooling.
Collapse
Affiliation(s)
- Eran Hadad
- Sheba Medical Center, Heller Institute of Medical Research, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | |
Collapse
|
19
|
|
20
|
Abstract
BACKGROUND Exertional heat stroke (EHS) is one of the most serious conditions that occur when excess heat, generated by muscular exercise, exceeds the body's heat-dissipation rate. The consequent elevated body core temperature causes damage to the body's tissues, resulting in a characteristic multiorgan syndrome, which is occasionally fatal. METHODS We analyzed the fatal EHS cases that occurred in the Israeli Defence Forces during the last decade according to Minard's paradigm for evaluation of EHS predisposing factors, aiming to characterize the common features and unique circumstances leading to fatality. RESULTS Accumulation of predisposing factors, particularly those concerning training regulations, coupled with inappropriate treatment at site, were found to be strong predictors of a grave prognosis. Analysis of the pathologic findings of the fatal EHS cases on autopsy revealed a possible association between the duration and length of exercise prior to EHS occurrence and the extent of pathologic findings. CONCLUSIONS Strict adherence to existing training regulations may prevent further heat stroke fatalities.
Collapse
Affiliation(s)
- Moshe Rav-Acha
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Israel.
| | | | | | | | | |
Collapse
|
21
|
Abstract
Rapid and efficient cooling is the most important therapeutic objective in patients with heat stroke (HS). This article reviews the mechanism of action and rationale for the use of dantrolene as a potential supportive cooling method in the treatment of HS. Relevant studies were included to support discussion of the role of dantrolene for the treatment of HS. In some studies dantrolene was shown to accelerate cooling rate when administered after the development of exertional HS. Dantrolene was also found to be effective in reducing the extent of HS signs when given as pretreatment in an animal model. Accumulated data do not support the routine use of dantrolene as an adjuvant cooling technique in HS, but administration of this drug in severe cases, or in which no improvement is observed, appears rational. Further trials are needed in order to assess the true effectiveness of dantrolene in HS.
Collapse
Affiliation(s)
- Eran Hadad
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yoav Cohen-Sivan
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yuval Heled
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yoram Epstein
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
22
|
Abstract
OBJECTIVE To evaluate the effect of radiant warmers on skin barrier function in preterm infants. METHODOLOGY Transepidermal water loss (TEWL) and stratum corneum hydration were measured in 30 preterm infants (birth weight 825 to 2220 g) in seven body areas: forehead, upper back, cubital fossa, palms, soles, abdomen, and inguinal region. Measurements were performed under radiant warmer and incubator conditions. Each patient served as his/her control. RESULTS TEWL was significantly higher in the radiant warmer compared to the incubator condition in only two areas: forehead and back. The overall mean difference in percentage TEWL between the conditions was 15%. Stratum corneum hydration was not affected by the radiant warmer. CONCLUSIONS The use of radiant warmers does not significantly decrease barrier function in the preterm infant.
Collapse
Affiliation(s)
- A Maayan-Metzger
- Department of Neonatology, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petah Tikva 49-202, Israel
| | | | | | | |
Collapse
|
23
|
Hadad E, Rosen E, Heled Y, Moran DS, Schindel Y. [Exercise induced hyponatremia]. Harefuah 2004; 143:342-7, 391. [PMID: 15190845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A normal water-electrolyte balance is essential for normal function of body systems during physical activity. During recent years, awareness of the importance of drinking amongst athletes and Israeli Defense Force (IDF) soldiers, in particular, has been highlighted. A large number of athletes tend to drink prior to, during and after their exercise in order to enhance physical abilities and to prevent heat casualties and dehydration. However, excessive water consumption combined with sweat induced electrolytes loss during physical activity, may cause hyponatremia in extreme cases. Recently, several cases of exercise induced hyponatremia were reported in the IDF, resulting from improper water consumption. In this article, we describe a clinical case of exercise-induced hyponatremia in a soldier and a review of the literature, including the etiology, clinical characterization and recommended treatment. Moreover, water consumption recommendations with regard to physical activity are presented. The application of such recommendations may prevent future events of exercise-induced hyponatremia.
Collapse
Affiliation(s)
- Eran Hadad
- Heller Institute of Medical Research, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | | |
Collapse
|
24
|
Hadad E, Ben-Ari Z, Heled Y, Moran DS, Shani Y, Epstein Y. Liver transplantation in exertional heat stroke: a medical dilemma. Intensive Care Med 2004; 30:1474-8. [PMID: 15105986 DOI: 10.1007/s00134-004-2312-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 03/29/2004] [Indexed: 01/27/2023]
Abstract
BACKGROUND Exertional heat stroke (EHS) is a life-threatening condition caused by an extreme elevation in core body temperature. Hepatic involvement is one of the hallmarks of heat stroke, affecting nearly all heat stroke patients. It is usually manifested by increased serum levels of liver enzymes, but acute liver failure has also been reported. Liver transplantation has been proposed as a potential treatment in cases of severe liver failure, but there are no unanimous criteria pointing to the right stage in which to conduct the transplantation. CASE PRESENTATION We report a case of an 18-year old patient who suffered heat-induced liver failure. The patient was referred for orthotopic liver transplantation (OLT) but spontaneously recovered completely with conservative treatment. CONCLUSIONS This case demonstrates the complexity of the decision for liver transplantation in EHS. The various prognostic criteria of acute hepatic failure and their relevance to EHS are critically reviewed, with an aim to assess their application for such a condition.
Collapse
Affiliation(s)
- Eran Hadad
- Heller Institute of Medical Research, Sheba Medical Center, 52621 Tel Hashomer, Israel
| | | | | | | | | | | |
Collapse
|
25
|
Hadad E, Moran DS, Epstein Y. Cooling heat stroke patients by available field measures. Intensive Care Med 2003; 30:338. [PMID: 14647885 DOI: 10.1007/s00134-003-2084-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2003] [Accepted: 11/05/2003] [Indexed: 11/29/2022]
Affiliation(s)
- Eran Hadad
- Heller Institute of Medical Research, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Daniel S Moran
- Heller Institute of Medical Research, Sheba Medical Center, 52621, Tel Hashomer, Israel
| | - Yoram Epstein
- Heller Institute of Medical Research, Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| |
Collapse
|
26
|
Abstract
Body thermoregulation can be violently offset by drugs capable of altering the balance between heat production and dissipation. Such events may rapidly become fatal. The drugs that are involved in the eruption of such syndromes include inhalation anaesthetics, sympathomimetic agents, serotonin antagonists, antipsychotic agents and compounds that exhibit anticholinergic properties. The resultant hyperthermia is frequently accompanied by an intense skeletal muscle hypermetabolic reaction that leads to rapidly evolving rigidity, extensive rhabdomyolysis and hyperkalemia. The differential diagnosis should, however, rule out non-drug-induced causes, such as lethal catatonia, central nervous system infection or tetanus, strychnine poisoning, thyrotoxic storm and pheochromocytoma. Prompt life-saving procedures include aggressive body temperature reduction. Patients with a suspected drug (or non-drug) hypermetabolic reaction should be admitted into an intensive care area for close monitoring and system-oriented supportive treatment. We present six conditions, in decreasing order of gravity and potential lethality, in which hyperthermia plays an essential role, and suggest a clinical approach in such conditions.
Collapse
Affiliation(s)
- Eran Hadad
- Department of Anesthesiology and Critical Care Medicine Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | |
Collapse
|
27
|
Ben-Abraham R, Hadad E, Weinbroum AA, Efrati O, Paret G. Vasopressin in cardiac arrest and vasodilatory shock: a forgotten drug for new indications. Isr Med Assoc J 2003; 5:272-6. [PMID: 14509133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Vasopressin is a potent endogenous vasoconstrictor that increases blood pressure and systemic vascular resistance. The administration of exogenous vasopressin during closed and open cardiopulmonary resuscitation in humans was shown to be more effective than optimal doses of epinephrine in several clinical studies. We summarize here the recent experimental and clinical data on the use of vasopressin in cardiopulmonary resuscitation and septic shock. As the use of vasopressin in human resuscitation is now in its early stages, it is expected that accumulated future experience will shed more light regarding the risk-benefit aspects of its use.
Collapse
Affiliation(s)
- Ron Ben-Abraham
- Department of Anesthesiology and Critical Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | | |
Collapse
|
28
|
Ben-Abraham R, Hadad E, Sokolov T, Weinbroum A. [Diagnostic and resuscitative aspects of pediatric nerve agent intoxication]. Harefuah 2002; 141:709-12, 761. [PMID: 12222135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Chemical warfare and the use of nerve agents are still a threat to the civilian population in the 21st century. Modern history of chemical warfare began in 1915 in the battle of Ypres when German troops used chlorine against the French army. Since then, the arsenal of such agents has included asphyxiates, burn-causing and nerve paralytic agents. Nerve gases are considered the most dangerous of all chemical weapons with little known about the treatment of the civilian population especially children. Management of the civilian population injured by these agents may be a tremendous challenge, especially in children, due to lack of previous data regarding pediatric resuscitation. This review emphasizes resuscitation issues of the child who suffers from multiple trauma and nerve agent poisoning, mainly based on data from reports concerning episodic civilian exposure to organophosphates.
Collapse
Affiliation(s)
- Ron Ben-Abraham
- Department of Anaesthesia and Critical Care Medicine, Post Anaesthesia Care Unit, Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | | | | | | |
Collapse
|
29
|
Abstract
TEWL and skin hydration was measured in 7 body areas before and during phototherapy in 31 preterm infants (gestational age 25 to 36 weeks). Each patient served as his/her own control. There was a mean increase of 26.4% in TEWL during phototherapy. Most prominent increases were recorded in the cubital fossa (45.9%), groin (36.4%), and back (29%). There were no significant differences in stratum corneum moisture in six of the seven body areas before and during phototherapy. This study provides a better understanding of skin physiology during phototherapy in preterm infants and has important implications for the estimation of fluid replacement.
Collapse
Affiliation(s)
- A Maayan-Metzger
- Department of Neonatology, Schneider Children's Medical Center of Israel, Petah Tiqva
| | | | | | | |
Collapse
|