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Biomedical subjects

A Awada

Publications and source records attributed to A Awada.

At least 73 records · Page 4Linked to original sources
PubMed1996

Transvaginal ultrasound studies of vascular and morphological changes in uteri exposed to diethylstilbestrol in utero.

The aim of this prospective study was to establish complementary data of uteri exposed to diethylstilbestrol (DES) in utero for transvaginal analysis and vascularity changes during the menstrual cycle. A total of 28 women with DES-exposed uteri were compared with 60 non-exposed women. Transvaginal ultrasound and colour Doppler imaging were performed on days 5 and 22 of the menstrual cycle. Uteri were measured on sagittal and transverse scans. Uterine length, width, thickness and uterine cavity length and width were measured. Uterine volume and uterine cavity area were calculated. DES-exposed uterine volume was equal to 31.84 +/- 3.37 cm3. The cavity area of DES-exposed uterus was equal to 35.85 +/- 3.93 cm2. Cervix length of DES-exposed uterus was significantly smaller than that of non-exposed uterus. The uterine artery pulsatility index (PI) of DES-exposed uterus was significantly higher than that of normal uterus. Blood flow remained stable throughout the menstrual cycle. The PI of DES-exposed uterus remained stable during the menstrual cycle, as in non-exposed uterus, and it decreased during the luteal phase. This lack of modification in vascularity of DES-exposed uterus may explain miscarriages and obstetric complications such as intrauterine growth retardation or pre-eclampsia. The data may have implications for the assessment of reproductive status and the design of future studies on disorders of implantation in DES-exposed uterus.

Adult↗
PubMed1996

Leuko-araiosis and stroke: a case-control study.

OBJECTIVE: Association of leuko-araiosis (LA) with certain risk factors has been reported in Western patients. This is a case-control study to determine the risk factors and the type of stroke associated with LA in Saudi patients. DESIGN AND SETTING: 398 consecutive Saudi patients with the diagnosis of stroke admitted over a 6-year period were evaluated for presence or absence of LA on cranial computed tomography. LA and non-LA groups were compared with regards to the presence of certain risk factors such as type of stroke, age, brain atrophy, systemic hypertension and history of cardiac disease or diabetes mellitus. The odds ratio and its 95% confidence interval (CI) were used to estimate the strength of association between the different parameters. RESULTS: The mean age in the LA group was 67.8 +/- 8.5 years as compared to 61.2 +/- 13.2 years in the non-LA group. No patient younger than 40 years had LA on CT. Incidence of LA increased with age. Forty-seven percent of the LA group were over 70 years of age compared to 31% of the non-LA group (OR = 2, CI 1.26-3.15). Generalised atrophy was detected in 40% of patients with LA compared to 20% of non-LA group (OR 2.7, CI 1.65-4.39). Sixty-nine percent of patients in the LA group had lacunar infarct compare to 39% in the non-LA group (OR 3.4, CI 2.15-5.59). The difference was not significant between the two groups in relation to the frequency of cerebral hemorrhage or larger infarcts. Systemic hypertension was also significantly associated with the presence of LA (OR 2.15, CI 1.34-3.43). CONCLUSION: LA is associated mainly with lacunar infarcts, cerebral atrophy, systemic hypertension and advanced age in Saudi patients.

Adult↗
PubMed1996

An ongoing European organization for research and treatment of cancer crossover trial comparing single-agent paclitaxel and doxorubicin as first- and second-line treatment of advanced breast cancer.

The activity of paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) in advanced breast cancer patients who have failed doxorubicin treatment is well established, but the optimal sequence between these two important agents remains to be determined. The European Organization for Research and Treatment of Cancer therefore designed a prospective randomized clinical trial in which patients not exposed to anthracyclines in the adjuvant setting received either first-line paclitaxel, given as a 3-hour infusion at a dose of 200 mg/m2 followed at the time of disease progression by second-line doxorubicin, given as a bolus injection at a dose of 75 mg/m2 or the reverse sequence. The target accrual is 330 patients. Interim results on 207 evaluable patients of 289 randomized are presented.

Adenocarcinoma↗
PubMed1995

Brain magnetic resonance imaging in non-alcoholic cirrhosis.

Twenty-six patients with stable non-alcoholic cirrhosis and normal neurological examination were investigated by brain MRI (inversion recovery sequences) and compared with 16 controls. Brain MRI findings were correlated with the clinical and metabolic status of the patients and analysis of variance and, when necessary, co-variance was performed. Five of the patients (19%) and all 16 controls showed no MRI changes. Twelve patients (46%) showed moderately high signal in the globus pallidus (score 1), and nine (35%) very high signal (score 2). Analysis of variance showed that age was the only significant variable (P = 0.038). Analysis of co-variance after adjustment for age showed that high pallidal signal was correlated only to ammonia level (P = 0.02) but not to any other clinical or biological parameter. We conclude that T1 high intensity pallidal signal is common in non-alcoholic cirrhosis even when neurological examination is normal, but its significance remains unclear.

Adult↗
PubMed1995

Stroke and pregnancy.

OBJECTIVE: To study the controversial relationship between pregnancy and stroke. Old studies and those from developing countries suggest that pregnancy considerably increases the risk of stroke. METHODS: The records of 946 consecutive cases of stroke observed in Saudi patients in 10 years were reviewed. Cases which occurred during pregnancy or during the first 15 days postpartum were included in the study. RESULTS: Twelve patients (1.3%) were pregnant or in postpartum at stroke onset. They constituted 27% of women of childbearing age. Cerebral infarction was diagnosed in nine cases and cerebral hemorrhage in three. Four patients died. CONCLUSION: The risk of stroke is only marginally increased (x 1.5) in pregnant compared with non-pregnant Saudi women. Many factors including peripartum cardiomyopathy, patent foramen ovale, changes in clotting factors, peripartum angiopathy and vasoactive steroid hormones, could be responsible for this increased risk.

Adolescent↗
PubMed1995

Angiographic patterns of carotid ischemic cerebrovascular disease in Saudi Arabia.

The angiographic findings in 100 Saudi patients with carotid ischemic cerebrovascular disease (CVD) (transient ischemic attacks (TIA) or strokes) were retrospectively reviewed. These patients were representative of all patients with similar disorders in the terms of sex, frequency of diabetes mellitus and ischemic heart disease. They were, however, significantly younger, smoked more, had more cervical bruits and less atrial fibrillation. Analysis of the data showed that a significant stenosis (> 70%) of the carotid artery origin was found only in 12% of TIA cases, 4% in the lacunar infarction cases and 6% of the large infarction cases on the symptomatic side and only in one case of TIA in the asymptomatic side. These frequencies were significantly lower than those found in similar studies performed in western countries. This study suggests that stenoses and occlusions of extracranial carotid artery plays a smaller role in the pathogenesis of ischemic CVD in Saudis than in Caucasians. The low consumption of cigarettes among elderly and females may be one of the explanations.

Aged↗
PubMed1995

An EORTC pilot study of filgrastim (recombinant human granulocyte colony stimulating factor) as support to a high dose-intensive epiadriamycin-cyclophosphamide regimen in chemotherapy-naive patients with locally advanced or metastatic breast cancer.

BACKGROUND: In an attempt to increase chemotherapy dose intensity by step-wise reduction of the time interval between treatment cycles, filgrastim was administered to breast cancer patients receiving a three-month combination chemotherapy with epirubicin (E) and cyclophosphamide (C). PATIENTS AND METHODS: Chemotherapy-naïve patients with locally advanced or metastatic breast cancer received fixed doses of E (120 mg/m2) and C 9830 mg/m2) by 15-min i.v. infusion on day 1 of each cycle and filgrastim at a dose of 4 micrograms/kg once daily by SC injection starting 24 hours after chemotherapy. Cohorts of patients were treated in successive schedules, each schedule corresponding to a specified time interval between chemotherapy cycles. The toxicity observed in each schedule was evaluated before patients were accrued to the next schedule, which corresponded to a shorter time interval between chemotherapy cycles. RESULTS: The maximum tolerated schedule was E (120 mg/m2) plus C 9830 mg/m2) given every 14 days with filgrastim support from day 2 until day 13. On this schedule, 5 of 12 patients experienced dose-intensity-limiting toxicities (DLT) during the 3-month study period. Non-hematological DLT occurred in 2/12 patients (mucositis, skin toxicity) while /312 experienced febrile neutropenia requiring i.v. antibiotics. All patients achieved recovery of ANC to >1.5 x 10(9)/l by the time of scheduled retreatment. The combination of filgrastim with this regimen did not seem to add major toxicities. The efficacy was high, with 87% of patients achieving an objective response and a median response duration of 18 months (range: 4-52 months). CONCLUSIONS: Filgrastim permits at 33% increase in 'EC' dose intensification over that of the conventional every-3-week administration. Randomized studies should now be initiated to evaluate the merit, if any, of 'accelerated' chemotherapy in advanced breast cancer.

Adult↗
PubMed1995

Cerebral venous thrombosis in adults. A study of 40 cases from Saudi Arabia.

BACKGROUND AND PURPOSE: We undertook this study to determine the frequency, clinical patterns, and etiologies of cerebral venous thrombosis in a Middle Eastern country. METHODS: Records of all adults patients admitted with an angiographically documented diagnosis of cerebral venous thrombosis from 1985 through 1994 in two major hospitals of Riyadh, Saudi Arabia, were reviewed. RESULTS: Forty patients (20 men, 20 women) aged 16 to 40 years were identified. Hospital frequency was 7 per 100,000 patients, and the relative frequency against arterial strokes was 1:62.5. Nineteen cases (47%) had a clinical picture of pseudotumor cerebri. Behçet's disease was the cause in 10 cases (25%). Other causes included antiphospholipid antibodies in 4, protein S deficiency in 3, intracranial tumors in 3, systemic lupus erythematosus in 3, infections in 3, antithrombin III deficiency in 2, postpartum in 1, and oral contraceptives in 1. CONCLUSIONS: Cerebral venous thrombosis in adults is not uncommon in Saudi Arabia. Behçet's disease is the single most common etiology. Infection is no longer an important cause, whereas "new" coagulation disorders are common. Patients with a pseudotumor cerebri syndrome should undergo angiography or brain MRI before being labeled idiopathic.

Adolescent↗
PubMed1995

Comparative study of three amniotic fluid markers in premature rupture of membranes: fetal fibronectin, alpha-fetoprotein, diamino-oxydase.

BACKGROUND: To study the comparative diagnostic value in premature rupture of membranes (PRM) of three amniotic components: fetal fibronectin (fFN), alphafetoprotein (AFP), diamino-oxydase (DAO). METHODS: 131 pregnant women took part in our prospective study. Three samples were obtained successively for each patient in a random order. Two clinical situations were studied: group A of 68 women with clinical certain PRM and group B of 63 women with a highly unlikely PRM. RESULTS: fFN is the best marker for diagnosis of PRM (sensitivity of 94% and specificity of 97%). AFP and DAO are complementary: the NPV is greater for AFP (87% against 84%) whereas the PPV is greater for DAO (95% against 86%). CONCLUSION: Apart from its value in predicting premature labor, vaginal fFN represents a diagnostic test of PRM with good specificity and sensitivity.

Amine Oxidase (Copper-Containing)↗
PubMed1995

[Uncommon reflex automatisms after brain death].

Two cases of unusual complex movements observed in brain dead patients are described. Rapid and sustained flexion of the neck induced slow abduction of the arms with flexion of the elbows, wrists and fingers over 5 to 10 seconds. These movements have been rarely described and although they have similar clinical patterns, they are pathophysiologically different from the Lazarus sign which is observed few minutes after respiratory support cessation. While Lazarus sign is supposed to be due to an agonal discharge of anoxic spinal neurons, the movements described in this article result probably from complex reflexes generated in a disinhibited spinal cord. It is however surprising that they have never been described in patients with high cervical spinal injuries.

Adult↗
PubMed1994

Obstetrical prognosis of the septate uterus: a plea for treatment of the septum.

OBJECTIVE: To evaluate the obstetrical and perinatal implications of the septate uterus and assess the improvements of the prognosis after treatment of the septum. INVESTIGATION: This retrospective investigation was carried out in a single centre on 78 patients with septate uterus who had previously been correctly classified. A total of 203 pregnancies were observed. All complications occurring during the first, second and third trimesters and the neonatal outcome were logged. Furthermore, 25 patients in this sample underwent surgery which enabled reassessment of the obstetric and neonatal outcome. RESULTS: Prior to surgery, during the 203 pregnancies, the fetal loss rate during the first two trimesters was 47%, prematurity 17% and 89 children were alive, i.e. an overall perinatal mortality rate of 16.8% when pregnancy exceeded 24 weeks. After surgical treatment of the septum, the proportion of pregnancies proceeding subsequent to 24 weeks and infant survival changed, respectively, from 13.3% to 90% and from 4.4% to 87.5%. CONCLUSION: The obstetric and neonatal prognosis of septate uteruses is extremely unfavourable. This is radically transformed by treating the septum.

Female↗
PubMed1994

Stroke in children: a study of 21 cases from Saudi Arabia.

Twenty-one cases of stroke were observed in children aged between 4 months and 15 years attending two large hospitals in Saudi Arabia over a 10-year period. The number constitutes two per cent of all cases of stroke managed in these hospitals during that period. Eleven cases were associated with cerebral arterial infarction, nine with cerebral haemorrhage and one with venous infarction. The main aetiological factors were attributable to embolism of cardiac origin, infections, coagulation disorders, haemoglobinopathies and arteriovenous malformations. Although stroke in children is regarded as rare, its relative frequency in Saudi society is probably higher than in western societies.

Adolescent↗
PubMed1994

Phase I and pharmacokinetic studies of topotecan administered as a 72 or 120 h continuous infusion.

Topotecan (SK&F 104864-A, NSC 609699) is a water-soluble, semi-synthetic analog of camptothecin which is an inhibitor of topoisomerase I. Since topoisomerase I is cell specific for S phase, we undertook a phase I study to determine the maximum tolerated dose and toxicities of continuous infusion (CI) topotecan. This phase I trial first explored a 5 day CI every 21 day schedule. Doses of topotecan included 0.17, 0.34 and 0.68 mg/m2/day. Fourteen patients [median age 60; median performance status (PS) of 1] with refractory malignancies received 59 courses of drug. Hematologic toxicities occurred only at the highest dose level; NCI grade 3-4 granulocytopenia and thrombocytopenia occurred in 4/8 and 3/8 patients, respectively. The protocol was amended to a 3 day infusion in an effort to ameliorate toxicity and obtain greater dose intensity (DI). Doses of 0.68, 0.85, 1.05, 1.3 and 1.6 mg/m2/day were evaluated. Thirty-two patients (median age 60; median PS of 1) received a total of 115 courses. The major toxicity seen was hematologic with 9/32 and 5/32 patients demonstrating grade 3-4 granulocytopenia and thrombocytopenia, respectively. Non-hematologic toxicities were mild (grade 1-2) in the two schedules and included nausea, vomiting, fatigue and alopecia. At the maximum tolerated dose (MTD) on the 5 day schedule, patients received 0.87 mg/m2/week, whereas they received 1.08 mg/m2/week at the MTD on the 3 day schedule (24% increase in relative dose intensity). A steady-state plasma lactone concentration of 5.5 mg/ml of topotecan was achieved at the phase II recommended dose of 1.6 ng/m2/day as a 3 day continuous infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Stroke in Saudi Arabian young adults: a study of 120 cases.

One hundred and twenty cases of stroke occurring in Saudi Arabian subjects aged 15 to 45 years are reviewed. These constituted 12.7% of a group of 946 stroke patients. Males outnumbered females (76/44). The frequency of intracranial hemorrhage, including subarachnoid hemorrhage, was slightly lower than cerebral infarction (41.5 vs 58.5%). The causes of large cerebral infarction were as follows: atherosclerosis 17 (28%), cardiac embolism 12 (19.5%), uncommon and uncertain causes 21 (34.5%). Some unusual causes were encountered such as dissecting arterial aneurysm due to popular healing manoeuvres or to traditional dance, retrograde embolism from a thoracic outlet syndrome or embolism from a fibroelastoma of the mitral valve chorda. Lacunar cerebral infarction was diagnosed in nine cases. Hypertension (25.5%) and arteriovenous malformations (20.5%) were the main causes of cerebral hemorrhage; all subarachnoid hemorrhages except one were due to berry aneurysms. The cause was undetermined in 16% of cerebral infarction and 26% of intracranial hemorrhage. The high frequency of stroke in young Saudi Arabian adults is probably a reflection of the demographic structure of the predominantly young Saudi society. The observed causes were relatively similar to those in industrial societies. Contrary to other developing countries infectious disease no longer seems to be an important cause of stroke. Drug abuse, which is becoming an important cause in Western societies, was encountered in only two of our cases.

Adult↗
PubMed1994

Hematological values and their assessment as risk factor in Saudi patients with stroke.

The retrospective analysis of hematological data on 500 consecutive Saudi patients (342;158F) (mean age 63 +/- 17 yrs) with stroke whose composition was: large infarctions 260 (52%); lacunar infarctions 121 (24.2%), intracerebral hemorrhage 107 (21.2%) and subarachnoid hemorrhage 12 (2.4%), showed that RBC (5.2 +/- 1.9 x 10(12)/L), Hb (143 +/- 21 g/l) and Hct (0.43 +/- 0.07 1/1) values were significantly higher (P < 0.001) in patients with large infarctions as compared to other types of strokes. In both male and female groups of patients, the most likely stroke prone age was 61 to 70 years and interestingly the levels of above three parameters increased or dropped after a certain age. The highest values were in the 61-70 yr age group with men being higher than women (P < 0.001). The overall mortality rate was about 20%, but it was higher in the group of patients with large infarction (63/260; 24.3%). Of these 13 were below the age of 60 years and the remaining 50 aged > 60 included 28 patients (20M;8F) who had Hb > 140 g/l suggesting that Hb > 150 g/L or Hct > 0.44 in men and > 140 g/l or Hct > 0.42 in women is probably a risk factor for having cerebral infarctions and increased mortality. Since this study is neither a cohort nor prospective and was not performed in the acute phase, it was difficult to ascertain if relative polycythemia was a primary event for stroke or was secondary to dehydration in which Saudi hot weather may be a contributory factor.

Adult↗
PubMed1994

Phase I study of docetaxel administered as a 1-hour intravenous infusion on a weekly basis.

PURPOSE: This phase I study of Taxotere (RP 56976, NSC 628503; docetaxel, Rhône-Poulenc Rorer, Antony, France) was undertaken to determine the maximum-tolerated dose (MTD), toxic effects, and basic pharmacokinetics of a day-1 and -8 schedule of this novel semisynthetic product related to Taxol (paclitaxel; Bristol-Myers Squibb, Wallingford, CT). PATIENTS AND METHODS: Thirty-two eligible patients with refractory solid malignancies have been treated with a 1-hour infusion of Taxotere on a day-1 and -8 schedule every 3 weeks as long as patients maintained a polymorphonucleotide count > or = 1,500/microL and a platelet count > or = 100,000/microL. Dose levels tested have ranged between 20 and 110 mg/m2 per course. RESULTS: Considering 128 assessable courses, the main toxicities have been neutropenia (which was dose-limiting), asthenia, alopecia, hypersensitivity reactions, skin toxicity, and edema. No significant cardiac or platelet toxicity has been observed. Seven patients have had aggravation of preexisting paresthesias or new onset of sensory symptoms during Taxotere treatment. The MTD at this schedule appears to be 110 mg/m2 per course, with six of 10 patients at this level experiencing severe toxicity. Five partial remissions have been observed in four heavily pretreated patients with breast cancer and in one patient with adenocarcinoma of unknown origin. Two patients with ovarian cancer have had meaningful decreases in CA125 levels. CONCLUSION: Like Taxol, this novel chemotherapeutic agent appears to possess promising activity in patients with refractory breast and ovarian neoplasms, with tolerable toxicities. Using this schedule, 100 mg/m2 per course is the recommended dose for future phase II trials.

Adult↗