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Biomedical subjects

A Harti

Publications and source records attributed to A Harti.

At least 19 recordsLinked to original sources
PubMed2005

[Complication of tracheal intubation: severe cervical cellulitis].

A 40-year-old man, victim of a traffic accident has been hospitalized for a severe head trauma. His trachea has been intubated under general anaesthesia with an 8.0 mm ID tube (Vygon). The cerebral scan revealed a surgical subdural haematoma. In the postoperative period, the patient was admitted in surgical intensive care, under sedation and mechanically ventilation. At day 12 the patient developed a cervical cellulitis complicated of a septic shock. The cervical scan showed an important dilatation of the trachea in the site of the tube cuff. The surgical exploration discovered a complete destruction of the anterior face of de trachea on several centimetres of height. The patient died 24 hours later by multiple organ failure.

Accidents, Traffic↗
PubMed2004

Diaphragmatic rupture during labor.

Diaphragmatic rupture during labor is uncommon and generally occurs in patients with a history of congenital diaphragmatic hernia or traumatic abdominal or chest injury. We present a case of a 41-year-old woman who presented with abdominal pain, vomiting and hypoventilation four days after a full-term home delivery. Chest radiography suggested the presence of a ruptured diaphragm, and laparotomy revealed a congenital left Bochdalek defect with herniation of the stomach, transverse colon and spleen into the left pleural cavity. Diaphragmatic hernia rupture during labor is a serious but rare complication that requires emergency surgery to prevent visceral perforation and cardio-respiratory failure.

Electrocardiography↗
PubMed2003

[Neostigmine added to bupivacaine in axillary plexus block: which benefit?].

INTRODUCTION: Recent study showed that neostigmine (500 microg) by intra-articular produces postoperative analgesia without adverse effect. The author's goal was to determine whether 500 microg of neostigmine added to bupivacaine in axillary plexus block could prolonged postoperative analgesia without increasing the incidence of side effects. METHODS: Ninety patients scheduled for orthopedic or plastic surgery with axillary plexus block were randomly assigned to one of 3 groups : group 1 (TGr n = 30) received saline solution (1 ml) in the axillary plexus, group 2 (NAGr n = 30) received 500 microg (1 ml) neostigmine in the axillary plexus and group 3.500 microg neostigmine subcutaneously (NSGr n = 30). We evaluated visual analog pain scores (VAS), the consumption of the ketoprofene, nausea and vomiting incidence during the first 24 h. ANOVA, Kruskall Wallis and Fisher tests were used for statistical analysis. A p value of <0.05 was considered significant. RESULTS: The VAS score was lower in NAGr (21 +/- 18) vs NSGr (31 +/- 14) and control group TGr (45 +/- 2) (p < 0.05). The consumption of the ketoprofene is 127 +/- 65 mg in NAGr vs 150 +/- 53 mg in NSGr and 200 +/- 50 mg in group TGr (p = 0.02). Incidence of nausea and vomiting was 3.5% in NAGr vs 6.8% in NSGr and 0% for TGr. CONCLUSION: Neostigmine combined to a mixture of lidocaine and bupivacaine prolongs postoperative analgesia after axillary plexus block.

Adult↗
PubMed2002

[Surgical complications of nephrectomy in living donors].

Renal transplantation from a living donor is now considered the best treatment for chronic renal failure. We reviewed the operative complications in 38 living related donor nephrectomies performed at our institution over the past 14 years. The mean age of our donors was 30 years old with age range between 18 and 58 years old and female predominance (55.2%). These swabs were realized by a posterolateral lumbar lombotomy with resection of the 11 third. The left kidney was removed in 34 donors (90%), surgical complications were noted in 39.4% of the cases: one case of wound of inferior vena cava (2.6%), one case of release of the renal artery clamp (2.6%), four cases of pleural grap (10.5%), one case of pneumothorax (2.6%), one case of pleurisy (2.6%), three cases of urinary infection (7.8%), three cases of parietal infection (7.8%) and one case of patient pain at the level of the wound (2.6%). There were no mortalities. We conclude that the morbidity of living donor nephrectomy is negligible compared with the advantages for the recipient.

Adolescent↗
PubMed2002

[Renal angiomyolipoma complicated by retroperitoneal hematoma].

Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.

Aged↗
PubMed2001

[Extra-adrenal pheochromocytoma discovered peroperatively].

In this study, an uncommon case has been reported of an ectopic pheochromocytoma without the presence of any clinical symptoms. The radiological investigations showed a right retroperitoneal tumor without any kidney involvement. The diagnosis was established by biopsy and subsequent histological findings. In the course of surgery as the large tumor mass was being removed, tachycardia was observed which caused the resection to be performed as rapidly as possible. Once the tumor had been removed, bradycardia occurred, followed by cardiac arrest: although the latter was stabilized after cardiac massage, the patient died one hour after the operative field had been closed. In addition to this case report, the diagnosis, therapeutic strategy and prognosis regarding an ectopically located pheochromocytoma have been discussed.

Biopsy↗
PubMed2001

[Pheochromocytoma discovered in the preoperative period: analysis of 3 cases].

Phaeochromocytoma is a rare tumour that may be discovered incidentally during a surgical operation that can sometimes cause fatal arrhythmias. The authors report 3 cases of phaeochromocytoma presenting in the form of hypertensive crisis and serious arrhythmias following manipulation of the tumour with a fatal outcome in 2 cases. These cases illustrate the severity and complexity of the problems encountered and the importance of preoperative detection of phaeochromocytomas, particularly at the pre-anaesthetic visit.

Adrenal Gland Neoplasms↗
PubMed1999

[Peritonitis caused by spontaneous rupture of pyonephrosis in pregnancy. Report of a case].

Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.

Female↗
PubMed1998

[Local digital anesthesia using lidocaine with or without bicarbonate. A comparative randomized study].

PURPOSE OF THE STUDY: Local anesthesia with lidocaine is widely used in surgery of the extremities, particularly for fingers. Injection causes pain. In order to minimize this discomfort, addition of bicarbonate has been used by many authors. Results were however contradictory in relation with the difference of approaches. Our study is based on a randomized comparative series with and without lidocaine alcalinization. MATERIAL AND METHODS: Sixty patients presenting multidigital trauma concerning at least two fingers. For each patient, one finger was anesthetized by lidocaine 2 per cent alone and one by lidocaine 2 per cent plus bicarbonate 8.4 per cent respectively in proportion of 4/5 and 1/5. We compared the intensity of pain during injection by a scale ranging from 0 to 10. RESULTS: Significant difference was found between both groups (p < 0.001), alcalinization appearing to decrease discomfort during injection. DISCUSSION: Mechanism of pain decrease by alcalinization is unclear. It appears that intracellular passage of non ionic form of lidocaine is facilitated by alcalinization. This allows the decrease of latence of lidocaine and relieve pain more rapidly by pain receptors blockade. CONCLUSION: Diminution of pain during anesthetic injection has major advantage in out-patient surgery of extremities, in ligamentar testing of digital articulations and in steroid injection.

Adult↗
PubMed1998

[Postpartum cerebral thrombophlebitis. A case secondary to acquired antithrombin III deficiency].

The cerebral thrombophlebitis is a rare complication of the pregnancy and the postpartum. We report a case of a 21 year-woman presenting a post-partum cerebral thrombophlebitis, secondary to an acquired deficiency of antithrombin III. The clinical symptoms of cerebral thrombophlebitis can be misleading. The angiography and the magnetic resonance imaging permit the diagnosis. The treatment is relied on anticoagulating heparin therapy. This treatment will be adapted in case of coagulation's factors deficiency that must be searched in any thromboembolic accident having an unusual localization.

Adult↗
PubMed1998

[Critical analysis of hemostasis disorders in the course of eclampsia. Report of 106 cases].

OBJECTIVE: Study of hemostatic disorders during eclampsia, their risk factors, maternal complications and associated mortality. METHODS: Retrospective study concerning 106 cases of severe eclampsia treated in intensive care between September 1992 and December 96. Patients with or without hemostatic disorders were compared for laboratory findings, maternal complications and mortality. RESULTS: Forty patients had hemostasis disorders as follows: isolated thrombopenia in 19 cases, disseminated intravascular coagulation (DIC) in 5 cases, Hellp syndrome associated to DIC in 7 cases and Hellp syndrome in 9 cases. Hemostasis disorders were associated to maternal advanced age, but not with gestational age or blood pressure in admission or time of convulsions. Complications and mortality associated with hemostasis disorders were more frequent compared to patients without hemostasis disorders. Among the 17 deaths of our series, 10 had hemostasis disorders. CONCLUSION: Hemostasis disorders were prognosis factors in eclampsia requiring systematic laboratory tests at admission and immediate delivery.

Adult↗
PubMed1997

[Tetraplegia following cervical stab wound].

We report two cases of tetraplegia caused by cervical stab wounds. In the first one, in a 34-year-old patient, the injury caused an immediate tetraplegia from cervical spine section and had a rapid lethal outcome. The second case occurred in a 30-year-old woman, who experienced a progressive tetraplegia associated with a Brown-Séquard syndrome from an oedema of the bulbo-spinal junction. Three months later, the motor recovery was satisfactory, however a thermo-algesic hemi-anaesthesia still persisted after the 6th month.

Adult↗
PubMed1996

[Subcapsular hematoma of the liver. Six cases and review of the literature].

Defined as a blood collection under the Glisson capsule, the subcapsular haematoma of liver is a rare complication of pre-eclampsia. We observed 6 cases of subcapsular haematoma of the liver in the Gynaecology-Obstetrics ward of the Ibnou Rochd University Hospital in Casablanca, Morocco. Age range was 18 to 39 years. Five of the patients were multiparous. All except one had at least one sign of pre-eclampsia. The diagnosis was made post-partum in 5 cases and was only confirmed intra-operatively in 6 cases. The treatment was tamponing-drainage of the peritoneal cavity in 3 cases, ligature of the hepatic artery in 2, and in one case with rupture of the liver, no therapy could be performed. There were 3 maternal deaths and 2 foetal deaths. These results were compared with those in the literature to determine the epidemiologic, diagnostic, therapeutic and prognostic characteristics of the subcapsular haematoma of the liver. The prognosis is poor and requires early diagnosis and treatment. Effective prevention of this severe complication should be based on correct screening and care for pregnant patients with hypertension.

Adolescent↗
PubMed1995

[Neurologic manifestations of fat embolism].

Neurologic manifestations are usual and variable during post-traumatic fat embolism. The pathogenesis of these lesions continues to be a source of considerable controversy. Thirteen cases of post-traumatic fat embolism with neurologic signs were treated in a surgical intensive care unit. All patients had impaired consciousness. Focal neurologic disorders were reported in 5 cases [hemiplegia (2), tetraplegia (2), aphasia (1)]. The aspects on brain CT scan seemed to be related to ischemic lesions (1 case), appeared normal in ten cases, or revealed post-traumatic hemorrhagic lesions (2 cases). The outcome at 2-4 weeks was spontaneously good, with complete resolution, without neurologic sequellae, in 11/13 patients. Two deaths were related to brain trauma severity (one case) and nosocomial pneumonia (one case).

Adult↗
PubMed1994

[Thrombosis of the right atrium disclosed by severe pulmonary embolism].

The case of a thrombosis of the right auricle, revealed by severe pulmonary embolism in a 56-year-old patient without significant medical history is reported. He was admitted to the ICU with a haemorrhagic cerebrovascular accident. The course was characterized by the occurrence of a venous thrombosis of the right lower limb confirmed by phlebography. The treatment with a platelet antiaggregating agent was effective and the patient left hospital two weeks later. He was re-admitted after 2 months with a clinical picture of massive embolism including polypnea, tachycardia and haemoptysis. The diagnosis was confirmed by pulmonary angiography (Miller index > 65%) and echocardiography showed a floating thrombus in the right auricle with dilated right cavities. The phlebocavography displayed an extensive thrombosis in the left lower limb up to femoral, iliac and cava inferior veins. The patient was treated with heparin (500 IU.kg-1.d-1) and later with antivitamine K. The course was favourable. This is a rare case of extensive thrombosis, completely regressive with a treatment including only heparin.

Brain Ischemia↗
PubMed1994

[Tetraplegia in fat embolism].

This is a report of two cases of tetraplegia complicating fat embolism after fracture of long bones. In the first case, a 26 year-old male sustained fractures of femur and tibia. One day after admission, the patient became comatose (Glasgow coma score = 6) with dyspnaea and petechiae present on the anterior chest wall. In second case, a 22 year-old man with a fracture of tibia and humerus, suffered two days after admission from similar signs of fat embolism (dyspnaea, Glasgow score coma = 6, petechiae). A tetraplegia occurred after 7 days in the first patient and 6 days in the second. No lesions were visible on brain CT scan. Magnetic resonance imaging showed relative high-intensity areas on T2 weighted views. The outcome at three weeks was favourable, without neurologic sequelae.

Adult↗