Assaf feh Medical Center


Assaf feh Medical Center

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Tamir E.,Assaf feh Medical Center | Tamir E.,Tel Aviv University | Tamir E.,Maccabi Health Services | Vigler M.,Maccabi Health Services | And 6 more authors.
Foot and Ankle International | Year: 2014

Background: Foot ulcers have been implicated as a causative factor in diabetic foot amputations. The purpose of this study was to evaluate treating foot ulcers in patients with diabetes by percutaneous tenotomy. Methods: We retrospectively reviewed the computerized medical files of 83 patients treated for foot ulcers by percutaneous tenotomies. Results were analyzed on the basis of indication and per patient. Results: The 83 patients had 160 tenotomies for 4 indications: 103 tip-of-toe ulcers (treated by flexor digitorum longus tenotomy), 26 cock-up/dorsal ulcers (extensor digitorum longus tenotomy), 21 kissing ulcers (extensor digitorum longus and/or flexor digitorum longus tenotomies), and 10 plantar metatarsal ulcers (extensor digitorum longus with or without flexor digitorum longus tenotomy). Healing at 4 weeks was 98%, 96%, 81%, and 0%, respectively. The complication rate was very low, with the exception of ?transfer lesions,? where an adjacent toe became involved and needed subsequent tenotomy in 8% of tip-of-toe ulcers. Conclusions: Percutaneous tenotomy was an effective and safe method for treating toe ulcers in neuropathic patients. It was not effective in treating plantar metatarsal ulcers. Level of Evidence: Level IV, case series. © 2013 Reprints and permissions:.

PubMed | The Chaim Sheba Medical Center, Kaplan Medical Center, Assaf feh Medical Center and Rabin Medical Center
Type: Journal Article | Journal: JSLS : Journal of the Society of Laparoendoscopic Surgeons | Year: 2014

Laparoscopic nephrectomy (LN) is likely the most common laparoscopic procedure performed by general urologists without formal laparoscopic training. The traditional technique is cumbersome because it entails making an early approach to the hilum with the risk of bleeding and need for conversion. We perform a different technique that we believe is simpler to learn and to teach. It consists of a complete dissection of the inferior and posterior aspects of the kidney, followed by en bloc stapling of the renal hilum. The present report is a detailed description of our technique including outcomes and complications.Perioperative data of 129 consecutive patients who underwent LN between November 2003 and September 2007 were prospectively collected and retrospectively reviewed. Complications were reported using the Clavien classification system, and follow-up was performed according to our institutions protocol and included physical examination, blood count, blood chemistry, and renal function tests at every visit, in addition to abdominal computed tomography scan six months after surgery. Additional imaging was scheduled according to disease stage and grade.Mean patient age, tumor size, and operative time were 6315.6 years, 6.32.4 cm, and 12841.4 minutes, respectively. Median estimated blood loss was 0 mL (0.200). Conversion to open surgery occurred in 3.1% of patients, and 8% of the patients had a blood transfusion. Complications were recorded in 26% of the patients; 91% of them had Clavien grade scores of 1 or 2.We present a standardized technique for LN. Its main advantage is that postpones any manipulation of the hilum to a later step during the procedure when it is easy to identify and control. This decreases early bleeding and main vascular complications.

Atesok K.,St Michaels Hospital | Doral M.N.,Hacettepe University | Whipple T.,Orthopaedic Research of Virginia | Mann G.,Meir Medical Center | And 6 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2011

Purpose: The purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation. Methods: Published investigations to date were analyzed by classifying them according to joints that were involved with intra-articular fractures including: knee, ankle, hip, shoulder, elbow, and wrist joints. The results were studied to assess the feasibility, efficiency, and outcomes of arthroscopy-assisted fracture fixation. Results: Arthroscopy-assisted techniques have been used successfully for the treatment of fractures of the tibial plateau, tibial eminence, malleoli, pilon, calcaneus, femoral head, glenoid, greater tuberosity, distal clavicle, radial head, coronoid, distal radius, and scaphoid. The major advantages of arthroscopic fracture fixation over open methods are direct visualization of the intra-articular space, decreased invasiveness, and the possibility for multitask interventions through which fixation of the fracture, and repair of the soft tissues and the cartilage can be performed simultaneously. The time-consuming and technically demanding nature of the procedures with a prolonged learning curve and limited fixation alternatives are the main disadvantages of this technique. Conclusion: Arthroscopic fixation is increasingly utilized for certain intra-articular fracture types due to the minimally invasive nature of the procedures and high accuracy. Randomized controlled trials are needed to justify wider use of arthroscopy-assisted techniques for treatment of intra-articular fractures. © 2010 Springer-Verlag.

Milgrom C.,Hebrew University of Jerusalem | Burr D.B.,Indiana University | Finestone A.S.,Assaf feh Medical Center | Voloshin A.,Lehigh University
Bone | Year: 2015

Previous human in vivo tibial strain measurements from surface strain gauges during vigorous activities were found to be below the threshold value of repetitive cyclical loading at 2500 microstrain in tension necessary to reduce the fatigue life of bone, based on ex vivo studies. Therefore it has been hypothesized that an intermediate bone remodeling response might play a role in the development of tibial stress fractures. In young adults tibial stress fractures are usually oblique, suggesting that they are the result of failure under shear strain. Strains were measured using surface mounted unstacked 45° rosette strain gauges on the posterior aspect of the flat medial cortex just below the tibial midshaft, in a 48. year old male subject while performing vertical jumps, staircase jumps and running up and down stadium stairs. Shear strains approaching 5000 microstrain were recorded during stair jumping and vertical standing jumps. Shear strains above 1250 microstrain were recorded during runs up and down stadium steps. Based on predictions from ex vivo studies, stair and vertical jumping tibial shear strain in the test subject was high enough to potentially produce tibial stress fracture subsequent to repetitive cyclic loading without necessarily requiring an intermediate remodeling response to microdamage. © 2015 Elsevier Inc.

Vaiman M.,Assaf feh Medical Center | Olevson Y.,Assaf feh Medical Center | Habler L.,Assaf feh Medical Center | Eviatar E.,Assaf feh Medical Center | And 3 more authors.
Oncology Research | Year: 2010

In this study, the objective was to evaluate the presence of estrogen receptors α and β (ERα and ERβ) in cases of papillary carcinoma of the thyroid gland and to assess the practicality of this test. Immunohistochemical stains were performed for both ERα and ERβ, for evaluation of immunoreactivity in 90 papillary carcinomas. Three variables were evaluated in each sample: the intensity of the staining both nuclear and cytoplasmatic, and the spread of the stain over the sample. None of the histological samples showed immunoreactivity for ERα. Positive immunoreactivity results for ERβ were found in tissue samples in 66.6% (60 cases). The study shows that ERβ has no significant specification for differentiation between papillary carcinoma and other malignant lesions of the thyroid, while ERα is undetectable in this lesion. The ER testing in cases of papillary carcinoma of the thyroid gland is nonspecific and might be not necessary. Copyright © 2010 Cognizant Comm. Corp.

Moran D.S.,Heller Institute of Medical Research | Moran D.S.,Ariel University | Evans R.,U.S. Army | Arbel Y.,Heller Institute of Medical Research | And 5 more authors.
Scandinavian Journal of Medicine and Science in Sports | Year: 2013

This study aimed to measure ambulation in infantry army basic training, and to evaluate if covering more distance can explain stress fractures in a stressor-stress model. Forty-four male combat recruits (18.7±0.7 years) participated in a 6-month rigorous high intensity combat training program. Baseline data included anthropometric measurements, VO2max, and psychological questionnaires. Actual distance covered was measured using a pedometer over an 11-week training period. Psychological questionnaires were repeated after 2 months. Sixteen recruits were diagnosed with stress fractures by imaging (SFi=36.4%). Statistical analysis included comparing measured variables between SFi and those without stress fractures (NSF). The recruits covered 796±157km, twofold the distance planned of 378km (P<0.001). The SFi group covered a distance 16.4% greater than that of the NSF group (866±136 and 744±161km, respectively, P<0.01), and also demonstrated greater psychological stress. These data reveal the importance of adherence to or enforcement of military training programs. In the light of these data, the Israeli Defense Forces program needs reappraisal. A stressor-stress response might explain the susceptibility of certain recruits for injury. Using advanced technology, monitoring ambulation may prevent stress fracture development by limiting subjects exceeding a certain level. Psychological profile may also play a role in predicting stress fracture development. © 2011 John Wiley & Sons A/S.

Bar-Dayan Y.,Israel Defense Force Medical Corps | Bar-Dayan Y.,Wolfson Medical Center | Morad Y.,Israel Defense Force Medical Corps | Elishkevitz K.P.,Israel Defense Force Medical Corps | And 2 more authors.
Spine Journal | Year: 2012

Background context: Back problems are reported with increasing frequency in adults and adolescents. Most information is from self-reported questionnaires or studies with small sample sizes. Reports were usually focused on specific diseases and biased toward overdiagnosis. Purpose: To assess the prevalence of common back disorders among a large cohort of 17-year-old males and females recruited by the Israel Defense Forces (IDF). Study design: A retrospective cross-sectional prevalence study. Patient sample: Seventeen-year-old Israeli male and female military recruits reporting as directed by the IDF for preinduction medical examination between January 01, 1998 and December 31, 2006. Outcome measures: Military functional limitation Grades 1 to 7 per diagnosis category. Methods: Military recruits were examined and classified based on medical and orthopedic diagnoses. They were referred for orthopedic consultation as necessary. Four orthopedic classifications were used: spinal deformity (including kyphosis and scoliosis), back pain (including neck and radicular syndromes), spondylolysis/olisthesis, and limitations resulting from trauma or spinal surgery. Data were coded into a central database, and descriptive statistics are presented. Results: The overall prevalence of back disorders among 828,171 17-year-old military recruits (61.5% male) was 16.8%. Back disorders resulting in significant functional limitation were diagnosed in 0.8% of recruits. The most prevalent diagnoses were spinal deformities (kyphosis and scoliosis, females 11.9%, males 11.5%) and back pain (females 3.0%, males 5.6%). Most of these diagnoses were rated as mild. Conclusions: When using objective criteria, overall back disorders in a large population of 17-year-old recruits were 17%, considerably lower than most reports. Back morbidity severe enough to prevent combat duty occurred at a rate of less than 1%, suggesting that serious back morbidity is not a frequent finding in this age group. Level of evidence: Symptom prevalence study, Level III. © 2012 Elsevier Inc. All rights reserved.

PubMed | AposTherapy Research Group, Assaf feh Medical Center, Sourasky Medical Center and Barzilai Medical Center
Type: | Journal: SAGE open medical case reports | Year: 2016

Conservative treatments for anterior cruciate ligament (ACL) tears may have just as good an outcome as invasive treatments. These include muscle strengthening and neuromuscular proprioceptive exercises to improve joint stability and restore motion to the knee. The Purpose of the current work presents was to examine the feasibility of a novel non-invasive biomechanical treatment to improve the rehabilitation process following an ACL tear. This is a single case report that presents the effect of this therapy in a patient with a complete ACL rupture who chose not to undergo reconstructive surgery.A 29-year old female athlete with an acute indirect injury to the knee who chose not to undergo surgery was monitored. Two days after injury the patient began AposTherapy. A unique biomechanical device was specially calibrated to the patients feet. The therapy program was initiated, which included carrying out her daily routine while wearing the device. The subject underwent a gait analysis at baseline and follow-up gait analyses at weeks 1, 2, 4, 8, 12 and 26.A severe abnormal gait was seen immediately after injury, including a substantial decrease in gait velocity, step length and single limb support. In addition, limb symmetry was substantially compromised following the injury. After 4 weeks of treatment, patient had returned to normal gait values and limbs asymmetry reached the normal range.The results of this case report suggest that this conservative biomechanical therapy may have helped this patient in her rehabilitation process. Further research is needed in order to determine the effect of this therapy for patients post ACL injuries.

PubMed | Assaf feh Medical Center
Type: Journal Article | Journal: Minerva pediatrica | Year: 2016

We aimed to evaluate efficacy and safety of the use of nifedipine gel with lidocaine in the treatment of acute anal fissures in children by reviewing the cases of 106 children with acute anal fissure treated conservatively by nifedipine gel with lidocaine between the years 2003-2012.The patients included in this study were 48 males and 58 females. Their clinical presentation consisted of constipation, rectal bleeding, anal pain, perianal itching, abdominal pain, irritability and rectal prolapse. Posterior, anterior, both anterior and posterior, multiple, both posterior and lateral locations were the main physical findings in 65, 23, 10, 7, and 1 cases.Ninety-nine patients completed the 4-week treatment course of nifedipine gel with lidocaine successfully (93.40%), with complete healing of the fissure. The recurrence rate observed was very low (6.60%).Topical 0.2% nifedipine with lidocaine appears an efficient mode of treatment for anal fissures in children, with a significant healing rate and no side effects.

PubMed | Rambam Medical Center, AposTherapy Research Group, Barzilay Medical Center and Assaf feh Medical Center
Type: | Journal: International journal of rheumatic diseases | Year: 2015

To examine the effect of a novel biomechanical, home-based, gait training device on gait patterns of obese individuals with knee OA.This was a retrospective analysis of 105 (32 males, 73 females) obese (body mass index >30kg/mEach gait parameter improved significantly at 3months and more so at 12months (P=0.03 overall). Gait velocity increased by 11.8% and by 16.1%, respectively. Single limb support of the more symptomatic knee increased by 2.5% and by 3.6%, respectively. There was a significant reduction in pain, stiffness and functional limitation at 3months (P<0.001 for each) that further improved at 12months. Pain decreased by 34.7% and by 45.7%, respectively. Functional limitation decreased by 35.0% and by 44.7%, respectively. Both the Physical and Mental Scales of the SF-36 increased significantly (P<0.001) at 3months and more so following 12months.Obese subjects with knee OA who complied with a home-based exercise program using a biomechanical gait training device demonstrated a significant improvement in gait patterns and clinical symptoms after 3months, followed by an additional improvement after 12months.

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