Ami Barzilai

Electrocardiographic changes in traumatized patients

Traumatized patients who sustain a severe physical or psychological insult may develop myocardial ischemic changes, espicially those patients over the age of 40 years. The electrocardiogram (EKG) findings in 34 chest injury patients out of 200 multiple injury cases over a period of two years were studied. Two types of myocardial changes were found: injury pattern (of a permanent character) and ischemic pattern (of a transient nature). The first type was more frequent in the penetrating noncardiac chest injury cases, and the second more common in the blunt chest injury cases. It is necessary to make early and serial EKG tracings on traumatized patients in order to detect myocardial changes.

Nonfulminant Fat Embolism: Review of Concepts On Its Genesis and Physiopathology

The past century has seen little change in the classification and clinical descriptions of fat embolism. However, as a result of hundreds of studies, the interpretation of the signs has been modified, and knowledge of the pathogenesis has incerased. In the past 25 years the diagnosis has been easier because of better chemical, histochemical, and microscopic technics, and the prognosis has been improved because of new prophylactic and curative procedures, especially those related to respiratory therapy.

Fat Embolism: Physiopathology, Diagnosis and Management

ZusammenfassungDie Arbeit befaßt sich mit der Beschreibung der Komponenten des Komplexes des posttraumatischen Syndromes. Das pathologische Geschehen der Fettmakroglobulinämie wird eine klinische Einheit, durch Verstopfung der arteriolaren Endungen der vitalen Organe, was die Form des fettembolischen Syndromes erzeugt. Das Hauptproblem in der Physiopathologie, die Lungeninsuffizienz, die sich zu einer akuten oder subakuten Form entwickelt, ist beschrieben. Ebenfalls ist die cerebrale Embolie beschrieben. Die Symptomatologie ist verschieden und nicht charakteristisch, nach der Wichtigkeit der Symptome und Anzeichen als Minder- oder Hauptsymptome wurde sie in der Diagnose der Fettembolie aufgeteilt. Nur in der letzten Zeit ist die Behandlung der Patienten mit fettembolischem Syndrom bekannt, und sie besteht aus einer allgemeinen suportiven Therapie, Atmungstherapie und anti-inflammatorischen Therapie, hauptsächlich einer Corticoidversorgung.SummaryThis paper describes the components of the post-traumatic syndrome. The pathological state of fat macroglobulinemia by occlusion of arteriolar terminal branches of vital organs causes the fat embolic syndrome. The main physiopathological problem is pulmonary insufficiency in an acute or subacute form. The cerebral embolus is second. The symptomatology varies and is not characteristic. According to their importance they were described as minor or major in the diagnosis of fat emboli. Only recently, treatment for the fat emboli syndrome has been initiated, consisting mainly in supportive measures, respiratory care and anti-inflammatory drugs, mainly cortisone.

Fat embolism in children: Tests for its early detection

Summary In a prospective study of 18 trauma cases we found that the fat embolism syndrome developed in eight (according to biochemical evidence), although only three of these patients showed clinical symptoms. Biochemical signs of fat embolism include disturbances in the clotting factors; fat excretion; changes in fat metabolism, and hypoxemia. The presence of any of these signs should alert the surgeon to the possibility of fat embolism and we recommend routine screening of all severely traumatized patients by hematologic tests, lipids investigation, blood gas measurements, as well as roentgenographic examination.

Total intravenous hyperalimentation in the management of cecal fistulas: Report of two cases

SummaryThis article deals with clinical application of the pharmacologic inhibition of gastrointestinal secretions in the management of cecal fistulas. The use of inhibitors of digestive secretions is described. The use of intravenous hyperalimentation as a depressant of intestinal secretions in the treatment of gastrointestinal fistulas is discussed. It allows “immobilization” of the gastrointestinal tract and, at the same time, supplies high caloric intake. First mentioned in 1948 by Thomas and Ross, it was more scientifically applied in the management of fistulas by Dudricket al.,7 in 1970.Sterile preparation of the hyperalimentation regimen is presented. Two illustrative cases are described. It is concluded that the IVH should be used in the management of inflammatory processes of the gastrointestinal tract and in the management of fistulas complicating these processes.

Hepatic Necrosis – A Rare Complication of Emphysematous Cholecystitis

The case presented here is one of emphysematous cholecystitis with process extension through the gallbladder into the liver, necrosis of the liver and septicemia that caused the patient’s death. In th