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Article ; Online: Diagnostic and therapeutic approaches in chronic mesenteric ischemia have improved.

Miklosh, Bala

United European gastroenterology journal

2020 Volume 8, Issue 4, Page(s) 369–370

MeSH term(s)	Chronic Disease/epidemiology ; Chronic Disease/therapy ; Computed Tomography Angiography ; Contrast Media/administration & dosage ; Gastroenterology/methods ; Gastroenterology/standards ; Humans ; Magnetic Resonance Angiography/methods ; Mesenteric Arteries/diagnostic imaging ; Mesenteric Ischemia/diagnosis ; Mesenteric Ischemia/epidemiology ; Mesenteric Ischemia/therapy ; Practice Guidelines as Topic ; Risk Assessment/methods ; Treatment Outcome
Chemical Substances	Contrast Media
Language	English
Publishing date	2020-05-03
Publishing country	England
Document type	Editorial
ZDB-ID	2728585-6
ISSN	2050-6414 ; 2050-6406
ISSN (online)	2050-6414
ISSN	2050-6406
DOI	10.1177/2050640620921356
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Can't intubate, can't oxygenate? What is the preferred surgical strategy? A retrospective analysis.

Nachshon, Akiva / Firman, Shimon / Batzofin, Baruch Mark / Miklosh, Bala / van Heerden, Peter Vernon

Anaesthesiology intensive therapy

2024 Volume 56, Issue 1, Page(s) 37–46

Abstract: Introduction: Cricothyrotomy (CTM) is currently recommended as the preferred method due to its ease, speed, and safety in life-threatening airway emergencies where standard tracheal intubation and mask ventilation fail.: Material and methods: This ... ...

Abstract	Introduction: Cricothyrotomy (CTM) is currently recommended as the preferred method due to its ease, speed, and safety in life-threatening airway emergencies where standard tracheal intubation and mask ventilation fail. Material and methods: This retrospective study analyzed 33 cases of "can't intubate, can't oxygenate or ventilate" (CICOV): 12 of percutaneous dilatational tracheostomy (PDT) and 21 of CTM. The CTM group was younger (median age 44) and mainly consisted of trauma patients. The PDT group was more diverse and procedures were performed by anesthesia and critical care consultants. Results: Initial success rates were 100% for PDT (12/12) and 86% for CTM (18/21), with one conversion from CTM to PDT. No perioperative complications occurred in the PDT group, while the CTM group experienced two cases of false tracts requiring re-do and three cases of bleeding. Immediate mortality within 24 hours was reported in 5/19 CTM patients and none in the PDT group. Successful liberation from mechanical ventilation at hospital discharge was achieved in 6/12 PDT patients and 11/21 CTM patients. Among the 21 CTM cases, all 16 survivors underwent subsequent tracheostomy. Tracheal decannulation occurred in 4/12 PDT patients and 10/21 CTM patients. Favorable immediate neurological outcomes (GCS ≥ 11T) were observed in 8/12 PDT patients and 8/21 CTM patients, while 3 PDT patients remained anesthetized until death and 7 CTM patients died within the first 72 hours without recovery attempts. Conclusions: In experienced hands, PDT could be a legitimate clinical option for the surgical airway in cases of CICOV. CTM may be more suitable for practitioners who encounter CICOV infrequently.
MeSH term(s)	Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Adult ; Tracheostomy/methods ; Aged ; Intubation, Intratracheal/methods ; Respiration, Artificial/methods ; Cricoid Cartilage/surgery ; Young Adult ; Airway Management/methods
Language	English
Publishing date	2024-05-13
Publishing country	Poland
Document type	Journal Article
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5114/ait.2024.138437
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Article ; Online: An analysis of 77 cases of pancreatic injuries at a level one trauma center: Outcomes of conservative and surgical treatments.

Khalayleh, Harbi / Imam, Ashraf / Cohen-Arazi, Oded / Yoav, Pikkel / Helou, Brigitte / Miklosh, Bala / Pikarsky, Alon J / Khalaileh, Abed

Annals of hepato-biliary-pancreatic surgery

2022 Volume 26, Issue 2, Page(s) 190–198

Abstract: Backgrounds/aims: Traumatic pancreatic injury (TPI) is rare as an isolated injury. There is a trend to perform conservative treatment even in patients with complete duct dissection and successful treatment. This study reviewed our 20 years of experience ...

Abstract	Backgrounds/aims: Traumatic pancreatic injury (TPI) is rare as an isolated injury. There is a trend to perform conservative treatment even in patients with complete duct dissection and successful treatment. This study reviewed our 20 years of experience in the management of TPI and assessed patient outcomes according to age group and treatment strategy. Methods: A retrospective analysis of patients diagnosed and treated with TPI at a level-I trauma center from 2000-2019. Patients were divided into two groups: adults and pediatrics. Conservative treatment cases were subjected to subgroup analysis. Level of evidence: IV. Results: Of a total of 77 patients, the mean age was 24.89 ± 15.88 years. Fifty-six (72.7%) patients had blunt trauma with motor vehicle accident. Blunt trauma was the predominant mechanism in 42 (54.5%) patients. Overall, 38 (49.4%) cases had grade I or II injury, 24 (31.2%) had grade III injury, and 15 (19.5%) had grade IV injury. A total of 30 cases had non-operative management (NOM). Successful NOM was observed in 16 (20.8%) cases, including eight (32.0%) pediatric cases and eight (15.4%) adult cases. Higher American association for the surgery of trauma (AAST) grade of injury was associated with NOM failure (16.7% for grade I/II, 100% for grade III, and 66.7% for grade IV injury; Conclusions: High AAST grade TPI is associated with a high rate of NOM failure in both pediatric and adults.
Language	English
Publishing date	2022-04-07
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	3012179-6
ISSN	2508-5859 ; 2508-5778
ISSN (online)	2508-5859
ISSN	2508-5778
DOI	10.14701/ahbps.21-144
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Article ; Online: Abdominal injury patterns in patients with seatbelt signs requiring laparotomy

Seema Biswas / Mohamed Adileh / Gidon Almogy / Miklosh Bala

Journal of Emergencies, Trauma and Shock, Vol 7, Iss 4, Pp 295-

2014 Volume 300

Abstract: Aims: We analyzed our series of patients with seatbelt signs (bruising) that underwent laparotomy in order to correlate injury pattern with clinical course and outcome. Materials and Methods: Retrospective analysis of patients with seatbelt signs ... ...

Abstract	Aims: We analyzed our series of patients with seatbelt signs (bruising) that underwent laparotomy in order to correlate injury pattern with clinical course and outcome. Materials and Methods: Retrospective analysis of patients with seatbelt signs presenting to the level 1 Trauma Unit between 2005 and 2010 was performed. We evaluated the nature of injuries during laparotomy associated with seatbelt signs and their treatment and complications. Results: There were 41 patients, 25 (61%) male, with a median age of 26 years. Median injury severity score (ISS) was 25 (range 6-66) and overall mortality was 10% (four patients). Patients were classified into three groups according to time from injury to surgery. Median time to surgery for the immediate group (n = 12) was 1.05 h, early group (n = 22) was 2.7 h, and delayed group (n = 7) was 19.5 h. Patients in the immediate group tended to have solid organ injuries; whereas, patients in the delayed group had bowel injury. Patients with solid organ injuries were found to be more seriously injured and had higher mortality (P < 0.01) and morbidity compared with patients with the "classic" bowel injury pattern associated with a typical seatbelt sign. Conclusion: Our data suggest that there is a cohort of patients with seatbelt injury who have solid organ injury requiring urgent intervention. Solid organ injuries associated with malpositioned seatbelts lying higher on the abdomen tend to result in hemodynamic instability necessitating immediate surgery. They have more postoperative complications and a greater mortality. Seatbelt signs should be accurately documented after any car crash.
Keywords	Bowel injury ; laparotomy ; seat belt ; seat belt sign ; solid organ injury ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610 ; 616
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Older age, comorbid illnesses, and injury severity affect immediate outcome in elderly trauma patients

Dvora Kirshenbom / Zila Ben-Zaken / Nehama Albilya / Eva Niyibizi / Miklosh Bala

Journal of Emergencies, Trauma and Shock, Vol 10, Iss 3, Pp 146-

2017 Volume 150

Abstract: Introduction: Trauma in elderly population is frequent and is associated with significant mortality, not only due to age but also due to complicated factors such as the severity of injury, preexisting comorbidity, and incomplete general assessment. Our ... ...

Abstract	Introduction: Trauma in elderly population is frequent and is associated with significant mortality, not only due to age but also due to complicated factors such as the severity of injury, preexisting comorbidity, and incomplete general assessment. Our primary aim was to determine whether age, Injury Severity Score (ISS), and preexisting comorbidities had an adverse effect on the outcome in patients aged 65 years and above following blunt trauma. Methods: We included 1027 patients aged ≥65 years who were admitted to our Level I Trauma Center following blunt trauma. Patients' charts were reviewed for demographics, ISS, mechanism of injury, preexisting comorbidities, Intensive Care Unit and hospital length of stay, complications, and in-hospital mortality. Results: The mean age of injured patients was 78.8 ± 8.3 years (range 65–109). The majority of patients had mild injury severity (ISS 9–14, 66.8%). Multiple comorbidities (≥3) were found in 233 patients (22.7%). Mortality during the hospitalization stay (n = 35, 3.4%) was associated with coronary artery disease, renal failure, dementia, and warfarin use (P < 0.05). Chronic anticoagulation treatment was recorded in 13% of patients. The addition of a single comorbidity increased the odds of wound infection to 1.29 and sepsis to 1.25. Both age and ISS increased the odds of death as −1.08 and −2.47, respectively. Conclusions: Our analysis shows that age alone in elderly trauma population is not a robust measure of outcome, and more valuable predictors such as injury severity, preexisting comorbidities, and medications are accounted for adverse outcome. Trauma care in this population with special considerations should be tailored to meet their specific needs.
Keywords	Blunt trauma ; complications ; geriatric trauma ; injury severity ; mortality ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2017-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Enigma of primary aortoduodenal fistula

Miklosh Bala, Jacob Sosna, Liat Appelbaum, Eran Israeli, Avraham I Rivkind

World Journal of Gastroenterology, Vol 15, Iss 25, Pp 3191-

2009 Volume 3193

Abstract: A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic ... ...

Abstract	A diagnosis of primary aortoenteric fistula is difficult to make despite a high level of clinical suspicion. It should be considered in any elderly patient who presents with upper gastrointestinal bleeding in the context of a known abdominal aortic aneurysm. We present the case of young man with no history of abdominal aortic aneurysm who presented with massive upper gastrointestinal bleeding. Initial misdiagnosis led to a delay in treatment and the patient succumbing to the illness. This case is unique in that the fistula formed as a result of complex atherosclerotic disease of the abdominal aorta, and not from an aneurysm.
Keywords	Aortoduodenal fistula ; Gastrointestinal hemorrhage ; Computed tomography ; Aortography ; Diseases of the digestive system. Gastroenterology ; RC799-869 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Gastroenterology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2009-07-01T00:00:00Z
Publisher	Baishideng Publishing Group Co. Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Delayed Presentations of Blunt Mesenteric and Intestinal Trauma in the Wake of Injury.

Yair, Edden / Miklosh, Bala / Orit, Pappo / Avraham, Rivkind / Gidon, Almogy

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2008 Volume 34, Issue 3, Page(s) 249–254

Abstract: Objective: To analyze the presentation and timing of blunt mesenteric and intestinal trauma requiring surgical intervention.: Methods: The Hadassah-Hebrew University trauma registry was scanned for patients who required surgery following blunt ... ...

Abstract	Objective: To analyze the presentation and timing of blunt mesenteric and intestinal trauma requiring surgical intervention. Methods: The Hadassah-Hebrew University trauma registry was scanned for patients who required surgery following blunt mesenteric and/or bowel trauma. Demographic data, mechanism of injury, time to diagnosis and pathology reports were recorded. A literature search was also performed. Results: The majority of patients were injured in motor vehicle accidents (26/30, 86.7%). Patients were divided into three groups. Seventeen patients diagnosed within 4 h of admission were defined as the immediate group. Indication for surgery was hemodynamic instability and/or peritonitis. The most commonly injured region was the terminal ileum (10/17 patients, 59%). The second group (n = 4) had surgery within 2 weeks of injury (early group). These patients presented initially with hemodynamic instability. The operative findings were consistent with a low-flow state of the terminal ileum and cecum. The third group (n = 9) consisted of patients who were operated later than 2 weeks from the date of injury (late group). These patients presented with prolonged abdominal symptoms, chiefly partial small bowel obstruction. Operative findings were bowel strictures, most commonly of the terminal ileum (7/9 patients, 77.8%). Conclusions: Acceleration-deceleration abdominal injury affects the terminal ileum more commonly. We propose that the ensuing clinical picture depends on the level of energy transmitted: high-energy trauma leads to extensive mesenteric and bowel tears and is diagnosed immediately. Low-energy trauma may lead to chronic ischemia, fibrosis and stricture-formation. The right colon appears to be more vulnerable to lowflow states following blunt trauma.
Language	English
Publishing date	2008-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-007-7045-1
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Article ; Online: A transgenic model for conditional induction and rescue of portal hypertension reveals a role of VEGF-mediated regulation of sinusoidal fenestrations.

Dalit May / Valentin Djonov / Gideon Zamir / Miklosh Bala / Rifaat Safadi / Miriam Sklair-Levy / Eli Keshet

PLoS ONE, Vol 6, Iss 7, p e

2011 Volume 21478

Abstract: Portal hypertension (PH) is a common complication and a leading cause of death in patients with chronic liver diseases. PH is underlined by structural and functional derangement of liver sinusoid vessels and its fenestrated endothelium. Because in most ... ...

Abstract	Portal hypertension (PH) is a common complication and a leading cause of death in patients with chronic liver diseases. PH is underlined by structural and functional derangement of liver sinusoid vessels and its fenestrated endothelium. Because in most clinical settings PH is accompanied by parenchymal injury, it has been difficult to determine the precise role of microvascular perturbations in causing PH. Reasoning that Vascular Endothelial Growth Factor (VEGF) is required to maintain functional integrity of the hepatic microcirculation, we developed a transgenic mouse system for a liver-specific-, reversible VEGF inhibition. The system is based on conditional induction and de-induction of a VEGF decoy receptor that sequesters VEGF and preclude signaling. VEGF blockade results in sinusoidal endothelial cells (SECs) fenestrations closure and in accumulation and transformation of the normally quiescent hepatic stellate cells, i.e. provoking the two processes underlying sinusoidal capillarization. Importantly, sinusoidal capillarization was sufficient to cause PH and its typical sequela, ascites, splenomegaly and venous collateralization without inflicting parenchymal damage or fibrosis. Remarkably, these dramatic phenotypes were fully reversed within few days from lifting-off VEGF blockade and resultant re-opening of SECs' fenestrations. This study not only uncovered an indispensible role for VEGF in maintaining structure and function of mature SECs, but also highlights the vasculo-centric nature of PH pathogenesis. Unprecedented ability to rescue PH and its secondary manifestations via manipulating a single vascular factor may also be harnessed for examining the potential utility of de-capillarization treatment modalities.
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2011-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A pandemic recap

Federico Coccolini / Enrico Cicuttin / Camilla Cremonini / Dario Tartaglia / Bruno Viaggi / Akira Kuriyama / Edoardo Picetti / Chad Ball / Fikri Abu-Zidan / Marco Ceresoli / Bruno Turri / Sumita Jain / Carlo Palombo / Xavier Guirao / Gabriel Rodrigues / Mahir Gachabayov / Fernando Machado / Lostoridis Eftychios / Souha S. Kanj /

Isidoro Di Carlo / Salomone Di Saverio / Vladimir Khokha / Andrew Kirkpatrick / Damien Massalou / Francesco Forfori / Francesco Corradi / Samir Delibegovic / Gustavo M. Machain Vega / Massimo Fantoni / Demetrios Demetriades / Garima Kapoor / Yoram Kluger / Shamshul Ansari / Ron Maier / Ari Leppaniemi / Timothy Hardcastle / Andras Vereczkei / Evika Karamagioli / Emmanouil Pikoulis / Mauro Pistello / Boris E. Sakakushev / Pradeep H. Navsaria / Rita Galeiras / Ali I. Yahya / Aleksei V. Osipov / Evgeni Dimitrov / Krstina Doklestić / Michele Pisano / Paolo Malacarne / Paolo Carcoforo / Maria Grazia Sibilla / Igor A. Kryvoruchko / Luigi Bonavina / Jae Il Kim / Vishal G. Shelat / Jacek Czepiel / Emilio Maseda / Sanjay Marwah / Mircea Chirica / Giandomenico Biancofiore / Mauro Podda / Lorenzo Cobianchi / Luca Ansaloni / Paola Fugazzola / Charalampos Seretis / Carlos Augusto Gomez / Fabio Tumietto / Manu Malbrain / Martin Reichert / Goran Augustin / Bruno Amato / Alessandro Puzziello / Andreas Hecker / Angelo Gemignani / Arda Isik / Alessandro Cucchetti / Mirco Nacoti / Doron Kopelman / Cristian Mesina / Wagih Ghannam / Offir Ben-Ishay / Sameer Dhingra / Raul Coimbra / Ernest E. Moore / Yunfeng Cui / Martha A. Quiodettis / Miklosh Bala / Mario Testini / Jose Diaz / Massimo Girardis / Walter L. Biffl / Matthias Hecker / Ibrahima Sall / Ugo Boggi / Gabriele Materazzi / Lorenzo Ghiadoni / Junichi Matsumoto / Wietse P. Zuidema / Rao Ivatury / Mushira A. Enani / Andrey Litvin / Majdi N. Al-Hasan / Zaza Demetrashvili / Oussama Baraket / Carlos A. Ordoñez / Ionut Negoi / Ronald Kiguba / Ziad A. Memish / Mutasim M. Elmangory / Matti Tolonen / Korey Das / Julival Ribeiro / Donal B. O’Connor / Boun Kim Tan / Harry Van Goor / Suman Baral / Belinda De Simone / Davide Corbella / Pietro Brambillasca / Michelangelo Scaglione / Fulvio Basolo / Nicola De’Angelis / Cino Bendinelli / Dieter Weber / Leonardo Pagani / Cinzia Monti / Gianluca Baiocchi / Massimo Chiarugi / Fausto Catena / Massimo Sartelli

World Journal of Emergency Surgery, Vol 16, Iss 1, Pp 1-

lessons we have learned

2021 Volume 8

Abstract: Abstract On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white ...

Abstract	Abstract On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.
Keywords	Pandemia ; International ; Thoughts ; Reflection ; Ethics ; Biology ; Surgery ; RD1-811 ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
Subject code	360
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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