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Ashkenazi I, Olsha O, Kessel B, Krausz MM, Alfici R. Uncommon acquired fistulae involving the digestive system: summary of data. Eur J Trauma Emerg Surg 2011; 37:259-67. [PMID: 26815108 DOI: 10.1007/s00068-011-0112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 04/16/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Most gastrointestinal fistulae commonly occur following surgery. A minority is caused by a myriad of other etiologies and is termed by some as "uncommon fistulae". The aim of this study was to review these fistulae and their treatment. METHODS A literature review was carried out. Searches were conducted in Pubmed and related references reviewed. RESULTS Except for Crohn's disease and diverticulitis, "uncommon fistulae" are described in case reports or very small case series. Most of the patients were treated by surgery. CONCLUSIONS The anatomic features of the fistula and the etiology usually dictate the approach. Most patients will eventually need surgery to resolve this pathology.
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Olsha O, Shemesh D, Carmon M, Sibirsky O, Abu Dalo R, Rivkin L, Ashkenazi I. Resection margins in ultrasound-guided breast-conserving surgery. Ann Surg Oncol 2010; 18:447-52. [PMID: 20734147 DOI: 10.1245/s10434-010-1280-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few published studies have shown the benefits of intraoperative ultrasound in avoiding inadequate margins in breast-conserving surgery. The aim of this study is to quantify intraoperative ultrasound margin size and assess its relationship to tumor size, multifocality, palpability, histology, and presence of intraductal component. METHODS Patients with breast cancer undergoing breast-conserving surgery in whom the operating surgeon visualized the tumor by ultrasound were included. Ultrasound margins measured intraoperatively were prospectively recorded and compared with pathology margins. RESULTS Forty-five patients with 48 tumors were included. Twenty five patients (56%) had palpable tumors. Pathologic mean tumor size was 1.9 cm [95% confidence interval (CI) 1.6-2.2 cm, range 0.5-4.8 cm]. There was good correlation between closest margins recorded by ultrasound and pathology margins (r = 0.4674, P < 0.0008). Fourteen patients (31%) had margins re-excised intraoperatively, 12 of them in the direction of the closest pathological margin. Three patients (7%), all of whom had intraoperative re-excision, had a second operation for involved margins without residual cancer on pathological examination of the reoperative specimens. Ultrasound margins ≥0.5 cm achieved adequate pathology margins of ≥0.2 cm in 95% of margins. Overestimation of pathology margins by ultrasound measurement was significantly affected by multifocality (P = 0.0473). Tumor size, palpability, invasive lobular histology, and presence of ductal carcinoma in situ (DCIS) did not cause significant overestimation of pathology margins by ultrasound. CONCLUSIONS Intraoperative ultrasound may help maintain a low level of reoperation after breast-conserving surgery. Ultrasound margins <0.5 cm should be re-excised intraoperatively. Reliability of ultrasound in predicting the closest pathology margins was diminished in patients with multifocal tumors.
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Kopelman Y, Marmor S, Ashkenazi I, Fireman Z. Value of EUS-FNA cytological preparations compared with cell block sections in the diagnosis of pancreatic solid tumours. Cytopathology 2010; 22:174-8. [PMID: 20482717 DOI: 10.1111/j.1365-2303.2010.00766.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is performed in order to achieve a definite tissue diagnosis of pancreatic lesions. This in turn is a guide to the appropriate treatment for the patient. Tissue samples collected by the same needle for cytological preparations and cell block histological sections (often referred to as FNA-cytology and FNA-biopsy, respectively) are handled differently. The specific contribution of each of these tests was evaluated. METHODS One hundred and two consecutive patients underwent EUS-FNA while being investigated for pancreatic solid lesions. Diagnosis was made by cytology, cell block sections or both. The diagnosis was confirmed by clinical outcome. RESULTS Male/female ratio was 61/41. Mean age was 65±12 years (range, 22-94). Mean lesion size was 3.1±1.8 cm (range, 0.6-10 cm); 68% were >2 cm and 75% were located in the pancreatic head. The average number of needle passes was two (range, 1-4 passes). Final tissue diagnosis was malignant in 66 (65%) patients. Sensitivity, specificity and accuracy were 73%, 94% and 81%, respectively, for cytology alone, and 63%, 100% and 78%, for cell blocks alone. Eighty-two patients (80%) had cytology and cell blocks, which matched in 64 (78%) patients. EUS-FNA results that relied on both techniques had 84% sensitivity, 94% specificity and 88% accuracy. Cytology revealed 13 malignancies not diagnosed on cell blocks, while cell blocks revealed five malignancies not diagnosed by cytology. Malignant lesions were more common in men; they were larger in size and located in the pancreatic head. CONCLUSION EUS-FNA cytology was more sensitive than cell blocks but less specific for the diagnosis of solid pancreatic lesions. The two methods are complementary and implementing both improves the diagnostic value of EUS-FNA.
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Yaacobi E, Steiner Z, Ashkenazi I, Kessel B, Alfici R. Solid pseudopapillary tumor of the pancreas: raising awareness of a not so rare pancreatic tumor affecting young females. Eur J Pediatr Surg 2010; 20:62-5. [PMID: 19548196 DOI: 10.1055/s-0029-1216343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jeroukhimov I, Ashkenazi I, Kessel B, Gaziants V, Peer A, Altshuler A, Nesterenko V, Alfici R, Halevy A. Selection of patients with severe pelvic fracture for early angiography remains controversial. Scand J Trauma Resusc Emerg Med 2009; 17:62. [PMID: 19943960 PMCID: PMC2790433 DOI: 10.1186/1757-7241-17-62] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 11/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe pelvic fractures represent about 3% of all skeletal fractures. Hemodynamic compromise in unstable pelvic fractures is associated with arterial hemorrhage in less than 20% of patients. Angiography is an important tool in the management of severe pelvic injury, but indications and timing for its performance remain controversial. METHODS Patients with major pelvic fractures [Pelvic Abbreviated Injury Score (AIS) >or= 3] admitted to two high volume Trauma Centers from January 2000 to June 2005 were identified and divided into two groups: Group I patients did not undergo angiography, Group II patients underwent angiography with/without embolization. Demographics, hemodynamic status on admission, concomitant injuries, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), pelvic AIS, blood requirement before and after angiography, arterial blood gases and mortality were evaluated. Patients with an additional reason for hemodynamic instability were excluded. RESULTS Charts of 106 patients were retrospectively reviewed. Twenty nine patients (27.4%) underwent angiography. Bleeding vessel embolization was performed in 20 (18.9%) patients. Patients who underwent angiography had a significantly higher pelvic AIS and a lower Base Excess level on admission. A blood transfusion rate of greater than 0.5 unit/hour was found to be a reliable indicator for early angiography. CONCLUSION A high pelvic AIS, amount of blood transfusions and decreased BE level should be considered as an indicators for early angiography in patients with severe pelvic injury.
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Kessel B, Ashkenazi I, Portnoy I, Hebron D, Eilam D, Alfici R. Right-sided "trapdoor" incision provides necessary exposure of complex cervicothoracic vascular injury: a case report. Scand J Trauma Resusc Emerg Med 2009; 17:46. [PMID: 19775478 PMCID: PMC2763000 DOI: 10.1186/1757-7241-17-46] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 09/24/2009] [Indexed: 11/10/2022] Open
Abstract
Combined cervicothoracical vascular traumas are very uncommon, mostly resulting from penetrating injuries. These injuries are accompanied with very high morbidity and mortality rates. In this manuscript we present a case of hemodinamycally unstable trauma patient whose major injury was penetrating trauma of both cervical and mediastinal major vessels. The standard surgical approach of median sternotomy and neck incision was insufficient, and the patient's instability forced the authors to improvise previously not described right-sided trap-door thoracomy. Incorporation of such incision in the surgical arsenal may be very effective in selective cases
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Kessel B, Peleg K, Hershekovitz Y, Khashan T, Givon A, Ashkenazi I, Alfici R. Abdominal stab wounds in Israel, 1997-2004: significant increase in overall incidence and prevalence of severe injury. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2008; 10:135-137. [PMID: 18432027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Non-operative management following abdominal stab wounds is possible in selected patients who are both hemodynamically stable and do not have signs of peritonitis. However, the rate of failure of non-operative management is higher in Israel than in western countries. OBJECTIVES To assess the patterns of injury following abdominal stabbing. METHODS Data from the Israeli Trauma Registry were used to identify all patients with abdominal stab injury admitted to eight different trauma centers between 1997 and 2004. RESULTS The number of patients admitted per year more than doubled between 1997 and 2004, from 257 to 599. The percentage of patients with severe injury (Index Severity Score > or = 16) increased from 9.4% to 19.0%. The incidence of multiple stab injuries almost doubled, from 37% to 62%. CONCLUSIONS Review of the data in the Israeli Trauma Registry indicates an increase in both absolute rate and relative incidence of serious stab injuries. This indicates that patterns of injury following stab wounds are not necessarily similar, not even within the same geographical area over time.
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Ashkenazi I, Haspel J, Alfici R, Kessel B, Khashan T, Oren M. Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre. Emerg Med J 2007; 24:550-2. [PMID: 17652675 PMCID: PMC2660077 DOI: 10.1136/emj.2006.044461] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the effect of teleradiology upon the need for transfer of head injured victims requiring hospitalisation but referred initially to a rural level 2 trauma centre without neurosurgical capacity. METHODS Head injured patients requiring hospitalisation, admitted to a rural level 2 trauma centre between August 2003 and August 2005, were identified. A digitalised copy of the computed tomographic (CT) scan was transferred to the neurosurgical referral centre via teleradiology and was available for review by the neurosurgeon on-call, who then, together with the trauma surgeon in the rural level 2 trauma centre, decided whether to transfer the patient to the neurosurgical referral centre. RESULTS Of 209 trauma victims with neurosurgical pathology in need of hospitalisation, 126 (60.2%) were immediately transferred while 83 (39.7%) of the patients were hospitalised in the rural level 2 trauma centre for observation. Two (2.4%) failed the intent to treat locally. One patient, suffering from multi-trauma, was stabilised after damage control laparotomy only to succumb to an enlarging epidural haematoma. Another patient was transferred 2 days after admission because of difficulty in clinical evaluation due to a previously existing neurological disorder, but no active treatment was necessary. All other 81 patients recovered uneventfully. CONCLUSIONS Selective head injured patients with pathological CT scan may be safely managed in level 2 trauma centres. A committed trauma team in the rural trauma centre, neurosurgical consultation and availability of a teleradiology system are requisites. Currently existing transfer criteria should be carefully re-evaluated.
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Kessel B, Jeroukhimov I, Ashkenazi I, Khashan T, Oren M, Haspel J, Medvedev M, Nesterenko V, Halevy A, Alfici R. Early detection of life-threatening intracranial haemorrhage using a portable near-infrared spectroscopy device. Injury 2007; 38:1065-8. [PMID: 17716603 DOI: 10.1016/j.injury.2007.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 04/12/2007] [Accepted: 05/12/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether infrared spectroscopy allows early recognition of epidural and subdural haematomas among trauma patients. METHODS Injured people admitted to two trauma units were enrolled in a prospective multicentre observational study, and infrared spectroscopy was performed before computed tomography of the head as a part of their initial evaluation. Subsequent CT findings suggestive of epidural or subdural haematoma served as controls. RESULTS Over 12 months, 110 patients were enrolled; 64 (58.1%) were men and 46 (41.9%) were women. Mean age was 56.2 years, and mean Glasgow Coma Scale on admission was 12.6. Infrared spectroscopy was 90.5% sensitive and 95.5% specific for epidural and subdural haematoma. Positive and negative predictive values were 82.6% and 97.7%, respectively. CONCLUSIONS Infrared spectroscopy allows early recognition of epidural and subdural haematomas in trauma cases. Further studies are needed to evaluate whether immediate confirmation or exclusion of epidural and subdural haematomas with portable near-infrared spectroscopy devices improves the decision-making process in the treatment of severely injured people.
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Ashkenazi I, Ferrer K, Sekosan M, Marcus E, Bork J, Aiti T, Lavy R, Zaren HA. Papillary lesions of the breast discovered on percutaneous large core and vacuum-assisted biopsies: reliability of clinical and pathological parameters in identifying benign lesions. Am J Surg 2007; 194:183-8. [PMID: 17618801 DOI: 10.1016/j.amjsurg.2006.11.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 10/11/2006] [Accepted: 11/06/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND A review of the literature reveals conflicting evidence on whether core biopsy, complemented with concordant imaging, is sufficient in differentiating benign from malignant papillary lesions. Our objective was to evaluate whether in our patient population, commonly used clinical and pathological parameters could predict benignity, thus eliminating the need to proceed with excision. METHODS A retrospective review of clinical variables and pathologic slides of 39 patients in whom both core biopsy and excisional biopsy were available for evaluation. RESULTS Excision revealed malignancy in 44%. Risk factors for malignancy, palpability, size, or Breast Imaging Reporting and Data System (American College of Radiology, Reston, VA) did not help differentiate benign from malignant disease. Younger age and core biopsies revealing minimal or no atypia were predictive of benignity. However, 4 (25%) of 20 patients whose core biopsies were classified as probably benign were found to have malignancy on excision. CONCLUSIONS Caution should be used in recommending nonoperative management after a core biopsy revealing a papillary lesion.
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Kessel B, Sevi R, Jeroukhimov I, Kalganov A, Khashan T, Ashkenazi I, Bartal G, Halevi A, Alfici R. Is routine portable pelvic X-ray in stable multiple trauma patients always justified in a high technology era? Injury 2007; 38:559-63. [PMID: 17303137 DOI: 10.1016/j.injury.2006.12.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 11/30/2006] [Accepted: 12/19/2006] [Indexed: 02/02/2023]
Abstract
INTRODUCTION According to the Advanced Trauma Life Support, portable pelvis radiography (PXR) is mandatory in multiple trauma patients, and is performed following initial clinical evaluation. The purpose of an early PXR is to identify pelvic fractures that may have haemodynamic consequences. Today, ultrafast multi-detector CT scanners (MDCT) are readily available and widely used in the evaluation of stable trauma patients. The objective of this study was to determine the impact of PXR in stable blunt multiple trauma patients, who required CT scan for full evaluation of the abdomen and pelvis. METHODS A retrospective review of all stable blunt trauma patients, suffering from pelvic fractures was performed from January 2001 until December 2004 at two high volume Trauma Centres. Patients' demographics and Injury Severity Scores (ISS) were abstracted from our trauma registry. Two certified radiologists and two certified orthopaedic surgeons retrospectively evaluated and compared PXR films and CT angiographies (CTA) of the abdomen and pelvis. We recorded each case when the management policy was altered due to the results of imaging and compared the clinical impact of both modalities. RESULTS One hundred and twenty-nine stable blunt multiple trauma patients with pelvic fractures underwent CTA of the abdomen and pelvis during their initial evaluation. Mean ISS was 16.5. Average Glasgow Coma Scale on arrival was 13.2 (range 3-15). Compared to CTA, sensitivity and specificity of the PXR was 64.4 and 90.0%, respectively. CTA diagnosed 35.6% more pelvic fractures than PXR (p<0.05). No changes in the therapeutic policy were observed following PXR results. In 19 (14.7%) patients, CTA findings led to pelvic angiography. CONCLUSIONS PXR in stable blunt multiple trauma patients did not change the therapeutic policy in our patients. CTA of the abdomen and pelvis is the imaging modality of choice in blunt multiple trauma, regardless of the findings of PXR. Benefit of routine PXR is questionable in hospitals where MDCT is available. Based on our results, we suggest re-evaluating the current practice of routine mandatory portable pelvis radiography.
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Alfici R, Ashkenazi I, Kounavsky G, Kessel B. Total pulmonectomy in trauma: a still unresolved problem--our experience and review of the literature. Am Surg 2007; 73:381-4. [PMID: 17439033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Emergency pneumonectomy for trauma is associated with very high mortality. Despite significant improvement of the intensive care resources, results of this procedure have not been improved during the last 20 years. When performed because of hemorrhagic shock, pneumonectomy is almost always fatal. We present a series of four patients who underwent total pneumonectomy in our trauma center. The main purpose of this study was to describe pathophysiologic changes and to discuss possible therapeutic alternatives based on the literature review after this operation.
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Alfici R, Ashkenazi I, Kessel B. Management of victims in a mass casualty incident caused by a terrorist bombing: treatment algorithms for stable, unstable, and in extremis victims. Mil Med 2007; 171:1155-62. [PMID: 17256673 DOI: 10.7205/milmed.171.12.1155] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Bombs aimed at civilian populations are the most common weapon used by terrorists throughout the world. Over the last decade, we have been involved in the management of more than 20 mass casualty incidents, most of which were caused by terrorist bombings. Commonly, in these events, there may be many victims and many deaths. However, only a few of the survivors will suffer from life-threatening injuries. Appropriate and timely treatment may impact their survival. Due to the complex mechanism of injury seen in these scenarios, treatment of victims injured by explosions is somewhat different from that exercised in blunt and penetrating trauma from other causes. The intention of this article was to outline the initial medical treatment of the injured victim arriving at the emergency department during a mass casualty incident caused by a terrorist bombing. Treatment protocols for stable, unstable, and in extremis patients are presented.
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Farraj M, Kessel B, Ashkenazi I, Alfici R. Damage control on the combat field: old philosophy, new concept. THE ISRAEL MEDICAL ASSOCIATION JOURNAL : IMAJ 2007; 9:132. [PMID: 17348491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Risin E, Kessel B, Lieberman N, Schmilovich M, Ashkenazi I, Alfici R. New technique of direct intra-abdominal pressure measurement. Asian J Surg 2006; 29:247-50. [PMID: 17098657 DOI: 10.1016/s1015-9584(09)60097-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine the efficacy of 14-Fr PVC round drain in the direct measurement of intra-abdominal pressure. METHODS Fifty consecutive patients undergoing elective laparoscopic surgery in a tertiary teaching hospital were included in this pilot study. Patients underwent laparoscopic cholecystectomy, appendectomy, splenectomy, colectomy and Nissen fundoplication. After creation of pneumoperitoneum and insertion of the trocars as indicated by the operation, a 14-Fr PVC round drain was inserted into the abdominal cavity via one of the laparoscopic ports. It was then connected under sterile conditions to the invasive blood pressure measurement system. Intra-abdominal pressure was gradually increased. Intra-abdominal pressures as measured through the round PVC drain were compared to those measured by the laparoscopic insufflator at 5, 8, 12 and 24 mmHg. RESULTS Two hundred measurements using each of the two methods were performed and correlated. The correlation coefficient was 0.996. No complications were observed with this new technique. CONCLUSION Direct measurement of intra-abdominal pressure using 14-Fr PVC round drain is a newly described technique that is simple, fast and credible. Future investigation will be needed to confirm the reliability of this method during postoperative follow-up of intra-abdominal pressures in selected patients.
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Aiti T, McDunn S, Hussein L, Ashkenazi I, Jajeh A, Wang Y, Zaren HA. Race as a risk factor for developing osteonecrosis of the jaw after long term bisphosphonate therapy in patients with metastatic breast cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
596 Background: Association between osteonecrosis of the jaw (ONJ) and bisphosphonate treatment has been increasingly reported in the literature. Methods: This is a retrospective review of a single institution’s experience with patients diagnosed with bone metastasis secondary to breast cancer, who developed ONJ while treated with bisphosphonates (Zoledronic acid - Zometa; Pamidronate - Aredia), between 1.1.2001 and 10.30.2005. Presentation, age, race, and outcome were reviewed. Logistic Regression was used to test for statistical significance. Results: 161 patients with bone metastasis secondary to breast cancer treated with bisphosphonates were reviewed (82 African American, 29 Caucasians, 26 Hispanic, 15 Asian and 9 others.). ONJ developed in 6 (3.7%) patients, 5 of which were Caucasians. Logistic regression adjusting for dose shows that the odds ratio for developing ONJ comparing Caucasians with non-Caucasians is 45.7 (p=0.016). Age did not impact occurrence of ONJ. All 6 patients developed ONJ after a minimum of 31 months of treatment. Two patients had a history of previous tooth extraction. In four other patients, ONJ appeared spontaneously. One patient, who presented with an abscess, developed sepsis which resulted in the patient’s death. Two patients were treated with debridement and antibiotics and their lesions healed. Three other patients ended up suffering from a chronically exposed bone. Conclusion: ONJ is a serious complication of bisphosphonate therapy and it affected a significant proportion of our patients. Our data suggests that Caucasians may be more susceptible. Since sample size is small, determining if race is a risk factor for the development of ONJ, while on bisphosphonate therapy, will require further investigation. No significant financial relationships to disclose.
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Ashkenazi I, Kessel B, Khashan T, Haspel J, Oren M, Olsha O, Alfici R. Precision of in-hospital triage in mass-casualty incidents after terror attacks. Prehosp Disaster Med 2006; 21:20-3. [PMID: 2006133117 DOI: 10.1017/s1049023x00003277] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Proper management of mass-casualty incidents (MCIs) relies on triage as a critical component of the disaster plan. OBJECTIVE [corrected] The objective of this study was to assess the precision of triage in mass-casualty incidents. METHODS The precision of decisions made by two experienced triage officers was examined in two large MCIs. These decisions were compared to the real severity of injury as defined by the Israeli Defence Forces (IDF) classification of severity of injuries and the Injury Severity Score (ISS). RESULTS Two experienced trauma physicians triaged a total of 94 casualties into 77 mild, seven moderate, and 10 severe casualties. Based on the IDF criteria, there were 74 mild, five moderate, and 15 severe casualties. Based on ISS scoring, there were 78 mild (ISS <9), five moderate (9 < or = ISS < 16), and 11 severe (ISS <16) casualties. Of 15 severely injured victims defined by the IDF classification of injury severity, the triage officers identified only seven (47%). CONCLUSION Primary triage, even when carried out by experienced trauma physicians, can be unreliable in a MCI.
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Risin E, Kessel B, Ashkenazi I, Lieberman N, Alfici R. A new technique of direct intra-abdominal pressure measurement: A preliminary study. Am J Surg 2006; 191:235-7. [PMID: 16442952 DOI: 10.1016/j.amjsurg.2005.07.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 07/31/2005] [Accepted: 07/31/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if a 14-F polyvinyl chloride (PVC) round drain is a reliable tool for direct intra-abdominal pressure measurement. DESIGN A prospective interventional study. SETTING Department of Surgery B, intensive care unit, recovery room, Hillel-Yaffe level II trauma center. METHODS Forty patients undergoing abdominal surgery and treated postoperatively with intraperitoneal drains and intravesical catheters were included in this study. The indication for insertion of intraperitoneal drains and intravesical catheters was strictly medical. The decision of placing urinary bladder catheter and PVC round drain was done by a senior surgeon. Intra-abdominal pressures were measured simultaneously through the intraperitoneal drain and the urinary catheter. Using a sterile technique, the intraperitoneal drain was disconnected from the drainage bulb and connected to an invasive blood pressure monitoring system. Intravesical pressures were measured by inserting 50 mL into the bladder, and then the urinary catheter was connected to an invasive blood monitoring system. Measurements were done twice a day for 3 days or less if earlier removal of either the intraperitoneal drain or urinary catheters were medically indicated. RESULTS Two hundred twenty-even simultaneous measurements were performed. Pressures as measured through the intraperitoneal drain were found to be significantly correlated to pressures as measured intravesically (r = 0.962). CONCLUSIONS Direct measurement of the intra-abdominal pressure via a 14-F PVC round drain is a newly described technique. Our method is simple, safe, and credible. Future investigation is needed to confirm the reliability of this method for continuous postoperative measurement of the intra-abdominal pressure in selected patients.
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Kessel B, Moisseiev E, Korin A, Soimu U, Ashkenazi I, Asquenasi A, Groissman G, Alfici R. Burkitt's lymphoma: an unusual cause of obstructive jaundice. Asian J Surg 2005; 28:301-4. [PMID: 16234085 DOI: 10.1016/s1015-9584(09)60366-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Biliary obstruction secondary to malignancy is a common clinical problem. Rarely, biliary obstruction is due to non-Hodgkin's lymphoma. Obstructive jaundice in these patients usually presents late in the course of the disease. Burkitt's lymphoma is a subtype of non-Hodgkin's lymphoma. Unlike other forms of non-Hodgkin's lymphoma, Burkitt's lymphoma presents as an extranodal disease. We present the case of a patient suffering from non-endemic Burkitt's lymphoma whose initial presenting symptom was obstructive jaundice.
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Ashkenazi I, Isakovich B, Kluger Y, Alfici R, Kessel B, Better OS. Prehospital management of earthquake casualties buried under rubble. Prehosp Disaster Med 2005; 20:122-33. [PMID: 15898492 DOI: 10.1017/s1049023x00002302] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Earthquakes continue to exact a heavy toll on life, injury, and loss of property. Survival of casualties extricated from under the rubble depends upon early medical interventions by emergency teams on site. The objective of this paper is to review the pertinent literature and to analyze the information as a practical guideline for the medical management of casualties accidentally buried alive.
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Kessel B, Eilam D, Ashkenazi I, Alfici R. Severe hydroblast intra-abdominal injuries due to high-pressure water jet without penetration of abdominal cavity. INJURY EXTRA 2005; 36:82-83. [DOI: 10.1016/j.injury.2004.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
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Kessel B, Ashkenazi I, Moisseiev E, Risin E, Khashan T, Alfici R. Sternal Fracture Should Prompt the Evaluation of the Entire Spine in Trauma Patients. EUROPEAN JOURNAL OF TRAUMA 2005; 31:57-60. [DOI: 10.1007/s00068-005-1379-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
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Kessel B, Alfici R, Ashkenazi I, Risin E, Moisseev E, Soimu U, Bartal G. Massive hemothorax caused by intercostal artery bleeding: selective embolization may be an alternative to thoracotomy in selected patients. Thorac Cardiovasc Surg 2004; 52:234-6. [PMID: 15293162 DOI: 10.1055/s-2004-821076] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Massive hemothorax is an indication for thoracotomy. We report a case of an 85-year-old debilitated patient, in whom massive hemorrhage from an actively bleeding intercostal artery was controlled by angiographic embolization. Angiographic embolization proved to be an effective alternative to thoracotomy in this patient, thus avoiding numerous postoperative complications and high mortality. Massive bleeding from an intercostal artery should be considered an indication for angiographic embolization in selected patients.
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Kantarovsky A, Portnoy I, Ashkenazi I, Kessel B, Alfici R. Gunshot Injury to the Tibioperoneal Trunk Repaired with Non-reversed Bifurcated Greater Saphenous Vein Interposition Graft: A Case Report. EJVES EXTRA 2004; 8:83-85. [DOI: 10.1016/j.ejvsextra.2004.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
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