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Article ; Online: Angiography in patients with pelvic fractures and contrast extravasation on CT following high-energy trauma.

Hammerschlag, Jonathan / Hershkovitz, Yehuda / Ashkenazi, Itamar / Shapira, Zahar / Jeroukhimov, Igor

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

2021 Volume 48, Issue 3, Page(s) 1939–1944

Abstract: Introduction: Pelvic fracture may be accompanied by severe bleeding. Computed tomography (CT) is a gold standard diagnostic tool in stable trauma patients. Contrast extravasation detected on CT of pelvis is a sign of hemorrhage, but its significance is ... ...

Abstract	Introduction: Pelvic fracture may be accompanied by severe bleeding. Computed tomography (CT) is a gold standard diagnostic tool in stable trauma patients. Contrast extravasation detected on CT of pelvis is a sign of hemorrhage, but its significance is not clear. We aimed to evaluate the need for angiography in patients with pelvic fracture and CT revealed contrast extravasation. We tried to identify parameters that might help to choose patients who will benefit from therapeutic angiography. Methods: Electronic medical records of patients with pelvic fracture admitted to Level II Trauma Center during 10 years were retrospectively reviewed. Patients who had contrast extravasation on CT were included. Data base consisted of demographics, injury severity, initial physiologic parameters, laboratory data, results of CT and angiography. Results: Forty out of 396 patients had contrast extravasation detected by CT. Twelve patients underwent angiography and 4 of them benefited from embolization. The sensitivity of contrast extravasation in evaluating the need for embolization was 1.0 (95% CI 0.398, 1.0), positive predictive value was 0.1 (95% CI 0.028, 0.237), and the negative predictive value was 1.0 (95% CI 0.990, 1.0). Conclusion: The role of angiography in stable patients with pelvic fracture and CT identified contrast extravasation remains questionable. Most of these patients are not in need of angioembolization.
MeSH term(s)	Angiography/methods ; Embolization, Therapeutic/methods ; Extravasation of Diagnostic and Therapeutic Materials/diagnostic imaging ; Fractures, Bone/complications ; Hemorrhage/complications ; Hemorrhage/etiology ; Humans ; Pelvic Bones/diagnostic imaging ; Pelvic Bones/injuries ; Retrospective Studies ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2021-03-04
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/s00068-021-01628-w
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Zs.A 1221: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Failure of observation and need for delayed tube thoracostomy in 197 unselected patients with occult pneumothorax: a retrospective study.

Hershkovitz, Yehuda / Ashkenazi, Itamar / Dykman, Daniel / Shapira, Zahar / Jeroukhimov, Igor

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

2021 Volume 48, Issue 2, Page(s) 1513–1518

Abstract: Introduction: Occult pneumothorax (OPTX) is defined as air in the pleural space that was not suspected on plain chest X-ray but detected on CT. Controversy exists in the management of OPTX, especially in patients who require positive pressure ... ...

Abstract	Introduction: Occult pneumothorax (OPTX) is defined as air in the pleural space that was not suspected on plain chest X-ray but detected on CT. Controversy exists in the management of OPTX, especially in patients who require positive pressure ventilation (PPV). In this study, we investigated the need for tube thoracostomy (TT) in blunt trauma patients with OPTX. Materials and methods: This is a retrospective study of blunt trauma patients of all ages with evidence of OPTX, treated in the Shamir Medical Center Trauma Unit between 2008 and 2017. Two groups were defined. Group I consisted of patients requiring PPV. Group II included patients who did not require PPV. We identified the indication for TT insertion (hemothorax, significant pneumothorax, and enlarging pneumothorax). Necessity for delayed TT insertion due to enlarging pneumothorax was analyzed. Results: Overall 512 patients with traumatic pneumothorax were admitted. 197 (38.5%) had OPTX. Motor vehicle accidents and falls from height accounted for most of the injuries, 47.2 and 42.6%, respectively. Fifty-seven patients required PPV. TT was required in 31 (15.7%) patients. No differences were found between the overall rate of TT insertion between the groups (15.7 vs. 21.1%; p = 0.2) and for delayed insertion of a TT due to an enlarging pneumothorax (25.0 vs. 42.1%; p = 0.45). Conclusion: TT is not indicated in every patient with OPTX even in case of mechanical ventilation.
MeSH term(s)	Chest Tubes ; Humans ; Pneumothorax/diagnostic imaging ; Pneumothorax/surgery ; Retrospective Studies ; Thoracic Injuries/diagnostic imaging ; Thoracic Injuries/surgery ; Thoracostomy/methods ; Time-to-Treatment ; Wounds, Nonpenetrating/diagnostic imaging ; Wounds, Nonpenetrating/surgery
Language	English
Publishing date	2021-04-01
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/s00068-021-01653-9
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Zs.A 1221: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Correction to: Failure of observation and need for delayed tube thoracostomy in 197 unselected patients with occult pneumothorax: a retrospective study.

Hershkovitz, Yehuda / Ashkenazi, Itamar / Dykman, Daniel / Shapira, Zahar / Jeroukhimov, Igor

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

2021 Volume 48, Issue 2, Page(s) 1519

Language	English
Publishing date	2021-03-29
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-021-01675-3
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Zs.A 1221: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Partial Hepatectomy of a VA-ECMO Patient After Mechanical CPR by LUCAS Device Due to a Catastrophic Liver Laceration: A Case Report.

Grinberg, Reudor / Minha, Saar / Shapira, Zahar / Rapoport, Avigal / Golman, Nina / Hochman, Yuval / Miltau, Danny / Hai, Yaron / Ilgiyaev, Eduard

The American journal of case reports

2023 Volume 24, Page(s) e939771

Abstract: BACKGROUND Many patients experiencing acute coronary syndrome (ACS) present in cardiac arrest. Mechanical chest compressions are a common tool in cardiopulmonary resuscitation (CPR) and have their benefits as well as disadvantages and reported ... ...

Abstract	BACKGROUND Many patients experiencing acute coronary syndrome (ACS) present in cardiac arrest. Mechanical chest compressions are a common tool in cardiopulmonary resuscitation (CPR) and have their benefits as well as disadvantages and reported complications. In recent years, veno-arterial extracorporeal oxygenation membrane (VA-ECMO) has proven to be a promising tool in these circumstances and is now considered part of the treatment algorithm in emergent and refractory cases. The combination of mechanical compressions and the ECMO lead to "new" complicated situations in the patients. We discuss such a patient, who required emergent surgery due to complications from his resuscitation, while under ECMO. CASE REPORT A 56-year-old man, with medical history of cardiovascular risk factors, presented to our facility due to ST segment elevation myocardial infarction. During his catheterization, he went into cardiac arrest and needed cardiopulmonary resuscitation (CPR) using a LUCAS3™ device. Because no rhythm was restored, he was promptly placed on VA-ECMO support with immediate, albeit transient, stabilization. After transportation to our Intensive Care Unit (ICU), he quickly deteriorated again hemodynamically and after imaging workup it was discovered he had a major laceration to his liver and was rushed emergently to the operating room where he underwent partial hepatectomy, while on full anticoagulation due to the ECMO support. CONCLUSIONS Complications from mechanical CPR are common, including liver laceration. Patients who are placed on ECMO following such measures should be carefully evaluated for such complications as they might affect the treatment and prognosis.
MeSH term(s)	Male ; Humans ; Middle Aged ; Cardiopulmonary Resuscitation/adverse effects ; Cardiopulmonary Resuscitation/methods ; Extracorporeal Membrane Oxygenation/methods ; Hepatectomy/adverse effects ; Lacerations/complications ; Heart Arrest/etiology ; Heart Arrest/therapy ; Liver
Language	English
Publishing date	2023-07-24
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.939771
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Article: [A COMPARATIVE STUDY OF THE PATHOLOGICAL CHARACTERISTICS OF RIGHT SIDED VERSUS LEFT SIDED COLON CANCER].

Gatot, Inbar / Chikman, Bar / Shapira, Zahar / Zandbank, Judit / Halevy, Ariel

Harefuah

2018 Volume 157, Issue 5, Page(s) 292–295

Abstract: Aims: This study aimed to investigate the pathologic differences between right and left sided colonic cancer.: Background: The incidence of right sided colon cancer during the past several decades is increasing as compared to left sided colon cancer. ...

Abstract	Aims: This study aimed to investigate the pathologic differences between right and left sided colonic cancer. Background: The incidence of right sided colon cancer during the past several decades is increasing as compared to left sided colon cancer. There are cumulative publications describing epidemiological, pathological and genetic differences between right and left sided colon cancer. A few studies have also shown a lower survival rate in patients with right sided colon cancer as compared to patients with left sided colon cancer. Methods: A retrospective study based on the accumulated data on right and left sided colonic cancer. Results: Data on 823 patients was collected; 426 patients (52.8%) had colon cancer located on the right side and in 397 patients (48.2%) it was located on the left side. There were no statistically significant differences between right and left colon cancer regarding sex, lymph node metastases and lymphovascular invasion. However, there was a significantly higher proportion of poorly differentiated adenocarcinomas (19%vs.8.7%; p<.001) and a trend to higher T stage (T3-4:87.7%vs.82.8%; p<.049) in right sided tumors as compared to left sided tumors. The incidence of mucinous tumors and mucinous components was also significantly higher in right sided tumors (7.3%vs.2%; p<.001, 13.1%vs.7%; p<.001). Conclusions: We found histopathological differences between right and left sided colon cancer. Tumors on the right colon were found to be more aggressive, as expressed by poorer differentiation, higher T stage and mucinous tumors. The reasons are unclear, either the existence of two distinct molecular pathways or simply a delay in the diagnosis of right sided colon cancer. Future studies are needed to better understand the true nature of these differences.
MeSH term(s)	Adenocarcinoma/pathology ; Colonic Neoplasms/pathology ; Humans ; Neoplasm Staging ; Retrospective Studies ; Survival Rate
Language	Hebrew
Publishing date	2018-05-26
Publishing country	Israel
Document type	Comparative Study ; Journal Article
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Article: Planned Re-Laparotomy in a Non-Trauma Setting: A Single Center Experience.

Hershkovitz, Yehuda / Ashkenazi, Itamar / Shapira, Zahar / Zmora, Oded / Jeroukhimov, Igor

The Israel Medical Association journal : IMAJ

2018 Volume 20, Issue 5, Page(s) 300–303

Abstract: Background: Damage control laparotomy (DCL) is the widely accepted procedure of choice in management of severely injured trauma patient. It has been implemented in non-trauma-related surgical pathology in the last decade.: Objectives: To evaluate our ...

Abstract	Background: Damage control laparotomy (DCL) is the widely accepted procedure of choice in management of severely injured trauma patient. It has been implemented in non-trauma-related surgical pathology in the last decade. Objectives: To evaluate our experience with planned re-laparotomy (PRL) in non-trauma patients and compare it to other reports. Methods: Charts of all patients admitted to Assaf Harofeh Medical Center who underwent PRL for non-trauma-related abdominal pathology during a 6 year period were reviewed. Data regarding demographics, vital signs, laboratory tests, indications for surgery, length of hospital stay, and mortality were obtained from medical charts. Indications for surgery, risk factors, and mortality were analyzed. Results: The study was comprised of 181 patients. Primary abdominal sepsis (50), postoperative sepsis (49), mesenteric event (32), and intestinal obstruction (28) were the most common indications for PRL. Mortality rate was 48.6%. Factors correlating with increased mortality were advanced age, hypotension, hypothermia, metabolic acidosis, and renal failure. Bowel resection was performed on 122 patients (67%) and primary intestinal anastomosis constructed in 46.7%. Mortality rate was lower in patients who underwent PRL with primary anastomosis compared to patients with postponed bowel anastomosis (33.3% vs. 55.4%, P = 0.018). Conclusions: PRL in abdominal emergencies carries a high mortality rate. Primary anastomosis may be considered in non-trauma-related PRL.
MeSH term(s)	Abdomen/pathology ; Abdomen/surgery ; Abdominal Cavity/pathology ; Abdominal Cavity/surgery ; Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Humans ; Intestinal Diseases/pathology ; Intestinal Diseases/surgery ; Male ; Middle Aged ; Retreatment ; Retrospective Studies ; Sepsis/pathology ; Sepsis/surgery ; Treatment Outcome
Language	English
Publishing date	2018-05-14
Publishing country	Israel
Document type	Journal Article ; Observational Study
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Zs.A 5470: Show issues

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Article ; Online: Frequency of intra-abdominal organ injury is higher in patients with concomitant stab wounds to other anatomical areas.

Jeroukhimov, Igor / Wiser, Itay / Hershkovitz, Yehuda / Shapira, Zahar / Peleg, Kobi / Alfici, Ricardo / Givon, Adi / Kessel, Boris

BMC emergency medicine

2018 Volume 18, Issue 1, Page(s) 18

Abstract: Background: Management of stable patients with abdominal stab wound remains controversial, particularly for those with no clear indications for explorative laparotomy. We evaluated the risk of intra-abdominal injury in stab wound victims concomitantly ... ...

Abstract	Background: Management of stable patients with abdominal stab wound remains controversial, particularly for those with no clear indications for explorative laparotomy. We evaluated the risk of intra-abdominal injury in stab wound victims concomitantly stabbed in other anatomical body areas. Methods: We performed a retrospective cohort study of patients with abdominal stab wounds recorded in the Israeli National Trauma Registry from January 1st, 1997, to December 31st, 2013. Patients with an isolated abdominal stab wound were compared to those with concomitant stab wounds to other anatomical areas. Intra-abdominal organ injury was defined by imaging or surgery findings. Multivariate analysis using a logistic regression model was conducted to assess independent risk for intra-abdominal organ injury. Results: The study included 3964 patients. After controlling for age, gender and hypotension on arrival, patients with multi-regional stab wounds had an increased risk of intra-abdominal injury (OR = 1.3, CI 95% 1.1-1.6, p < 0.001). These patients also had a higher rate of injury to the solid organs than patients with an isolated abdominal stab wound. Conclusions: Patients with multi-regional stab wounds have an increased risk of intra-abdominal injury. Worldwide accepted "clinical follow up" protocol may not be appropriate in management of patients with multi-regional stab wounds.
MeSH term(s)	Abdominal Injuries/epidemiology ; Abdominal Injuries/surgery ; Adult ; Female ; Humans ; Israel/epidemiology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Trauma Severity Indices ; Wounds, Stab/epidemiology ; Wounds, Stab/surgery
Language	English
Publishing date	2018-06-27
Publishing country	England
Document type	Journal Article
ISSN	1471-227X
ISSN (online)	1471-227X
DOI	10.1186/s12873-018-0167-4
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Article: Diagnostic Use of Endoscopic Retrograde Cholangiopancreatectography for Pancreatic Duct Injury in Trauma Patients.

Jeroukhimov, Igor / Zoarets, Itay / Wiser, Itay / Shapira, Zahar / Abramovich, Dov / Nesterenko, Vladimir / Halevy, Ariel

The Israel Medical Association journal : IMAJ

2015 Volume 17, Issue 7, Page(s) 401–404

Abstract: Background: Trauma patients diagnosed with pancreatic duct injury (PDI) have a high complication rate and prolonged hospital stay. The role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of PDI remains unclear. During the last ...

Abstract	Background: Trauma patients diagnosed with pancreatic duct injury (PDI) have a high complication rate and prolonged hospital stay. The role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of PDI remains unclear. During the last decade, our trauma unit incorporated ERCP into the management protocol for suspected PDI cases. Objectives: To determine whether ERCP is a sensitive tool to detect PDI. Methods: This retrospective trauma patient series study assessed the diagnostic yield of ERCP in trauma cases with suspected PDI on computed tomography (CT) or intraoperatively. Between 1 January 2004 and 31 December 2011, 13 patients admitted to our medical center underwent ERCP for suspected PDI. Patient demographics, mechanism of injury, Injury Severity Score (ISS), time from injury to ERCP, and ERCP-related complications were documented and assessed. Results: Of the 13 patients included in the analysis, 8 stable patients with suspected PDI on CT had no leak from the main pancreatic duct on ERCP. Two of them underwent surgery for suspected pancreatic transection. ERCP confirmed a main pancreatic duct leak in three patients. Two patients underwent ERCP for suspected PDI after "damage control" surgery. No leak from the pancreatic ducts was diagnosed. No pancreas-related complications or ERCP-related complications were observed. Conclusions: ERCP is a sensitive and relatively safe tool for the diagnosis of PDI, and its use might prevent unnecessary surgical interventions in selected trauma cases.
MeSH term(s)	Adolescent ; Adult ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde/methods ; Female ; Humans ; Injury Severity Score ; Male ; Pancreatic Ducts/injuries ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/methods ; Wounds and Injuries/diagnosis ; Wounds and Injuries/pathology ; Young Adult
Language	English
Publishing date	2015-07
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article: Elevated white blood cell count, decreased hematocrit and presence of macrohematuria correlate with abdominal organ injury in pediatric blunt trauma patients: a retrospective study.

Hershkovitz, Yehuda / Naveh, Sergei / Kessel, Boris / Shapira, Zahar / Halevy, Ariel / Jeroukhimov, Igor

World journal of emergency surgery : WJES

2015 Volume 10, Page(s) 41

Abstract: Introduction: Computerized tomography (CT) has become an important diagnostic modality in trauma patients. Pediatric patients are particularly susceptible to ionized radiation making liberal CT use in this age group unacceptable. We aimed to identify ... ...

Abstract	Introduction: Computerized tomography (CT) has become an important diagnostic modality in trauma patients. Pediatric patients are particularly susceptible to ionized radiation making liberal CT use in this age group unacceptable. We aimed to identify parameters that might predict abnormal findings on abdominal CT leading to patient management changes. Methods: Data on blunt trauma patients up to 15 years of age admitted to Assaf Harofeh Medical Center from January 2007 to October 2014 was retrospectively collected. All patients with abdominal CT scan as part of initial assessment were included. Medical and surgical data were extracted from the medial charts. Patients were divided into two groups. Group I: patients whose management was changed solely based on abdominal CT findings and Group II: patients with normal abdominal CT. The groups were compared by all the data parameters. Results: Overall, 182 patients were included in the study. The groups were comparable by age and mechanism of injury. Management changes based on CT findings were found in 68 (37.4 %) patients. White blood cell count >14000, abnormally low hematocrit level and macrohematuria were associated with a diagnosis of intra-abdominal injury requiring patient management changes (p < 0.05). Group I patients had longer LOS. Fifteen patients (22 %) required active intervention based solely on CT findings. Physical examination, arterial blood gases and initial radiology examinations results did not correlate with abdominal CT findings. Conclusions: Elevated WBC, decreased hematocrit and presence of macrohematuria strongly correlate with abdominal CT findings and lead to changes in patient management.
Language	English
Publishing date	2015
Publishing country	England
Document type	Journal Article
ISSN	1749-7922
ISSN	1749-7922
DOI	10.1186/s13017-015-0034-5
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Article: When Should Abdominal Computed Tomography Be Considered in Patients with Lower Rib Fractures?

Jeroukhimov, Igor / Hershkovitz, Yehuda / Wiser, Itay / Kessel, Boris / Ayyad, Mohammed / Gatot, Inbar / Shapira, Zahar / Jeoravlev, Svetlana / Halevy, Ariel / Lavy, Ron

The Journal of emergency medicine

2017 Volume 52, Issue 5, Page(s) 609–614

Abstract: Background: Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra- ...

Abstract	Background: Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%-40%. Objective: The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures. Methods: Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI. Results: Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1-16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1-13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2-4.8; p = 0.016) as independent risk factors for the presence of IAI. Conclusions: Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission.
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	605559-x
ISSN	0736-4679
ISSN	0736-4679
DOI	10.1016/j.jemermed.2016.11.007
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