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Biomedical subjects

A Khoury

Publications and source records attributed to A Khoury.

At least 37 records · Page 2Linked to original sources
PubMed2000

The natural history of neonatal vesicoureteral reflux associated with antenatal hydronephrosis.

PURPOSE: In an attempt to evaluate the natural history of neonatal vesicoureteral reflux, patients with antenatal history of hydronephrosis and documented reflux in the first 30 days of life were analyzed. MATERIALS AND METHODS: Between 1993 and 1998, 260 patients with a history of antenatal hydronephrosis were referred for evaluation. Of these patients 31 were diagnosed with unilateral or bilateral refluxing renal units (54 renal units). Patients were treated with a prospective plan of observational therapy and prophylactic antibiotics, and resolution rate was calculated in patients with adequate followup. Reflux grade was correlated with postnatal ultrasonographic findings, urinary tract infections and differential renal function. Outcome analysis of 34 high grade (III to V) refluxing renal units using the Kaplan-Meier survival curves was undertaken with the end point being complete resolution or improvement. Three patients with vesicostomy and 2 who underwent ureteral reimplantation were excluded from analysis. RESULTS: Reflux was grade I in 5% (33% males), II in 15% (62% males), III in 32% (71% males), IV in 18% (90% males) and V in 30% (100% males) of the patients. Postnatal ultrasound findings correlated poorly with the presence and degree of vesicoureteral reflux. Of 17 patients followed for at least 14 months (average followup 20) there was complete resolution in 60% with grade III, 50% with grade IV and 28% with grade V reflux. Using the Kaplan-Meier estimate there was a 50% chance of improvement (decrease in reflux grade by at least 2 grades) in high grade reflux by age 16 months. Urinary tract infections developed in 8 patients (26%) while on antibiotics. Of 46 renal units in 23 patients evaluated with a renal scan before urinary tract infection, 12 had less than 35% function. CONCLUSIONS: A normal postnatal ultrasound should not be a basis for excluding the use of cystography. Our Kaplan-Meier estimate shows that high grade reflux does improve and may resolve spontaneously. In addition, renal scarring may be seen with high and low grade reflux in the absence of urinary tract infection but high grade reflux is associated with a higher incidence of infection.

Female↗
PubMed2000

Ocular findings in aplastic anemia.

OBJECTIVE: To analyze the ocular findings in aplastic anemia. DESIGN: Eighteen patients with aplastic anemia were examined. RESULTS: Ocular findings included cotton wool spots (38%), nerve fiber layer or preretinal hemorrhages (67%), vitreous hemorrhages (13%), a picture resembling central retinal vein occlusion (13%) and optic disk edema (6%). Preretinal hemorrhages were the presenting sign of aplastic anemia in 2 patients (13%). CONCLUSIONS: A blood profile is needed in patients with unexplained retinal hemorrhages. Patients with aplastic anemia need to avoid ocular massage and Valsalva maneuvers to decrease ocular morbidity.

Adolescent↗
PubMed1999

[Thromboembolism in orthopedic trauma].

Trauma increases risk of thromboembolic complications. Thus, in pelvic fractures and spinal injuries the incidence of deep vein thrombosis (DVT) is about 35-60%. Half occur in the pelvic veins and are the most likely to result in pulmonary embolism. While symptomatic pulmonary embolism occurs in 2-10% of patients, more have silent pulmonary embolism. 0.5-2% of pulmonary embolisms are fatal. In lower extremity trauma the incidence of DVT is about 58%, with 18% of them in the proximal veins. Thromboembolic complications are the prime cause of morbidity and mortality among trauma patients, yet they can be prevented efficiently and cost-effectively. The arsenal of prophylactic agents includes heparin, low molecular weight heparin, and mechanical devices including inferior vena cava filters.

Fractures, Bone↗
PubMed1999

Morphologic study of the glenoid in primary glenohumeral osteoarthritis.

We studied the natural course and the possibility of making a prognostic classification of glenoid morphology in primary glenohumeral osteoarthritis (GHOA). For this purpose, serial computed tomography scans of 113 osteoarthritic shoulders were reviewed. The position of the humeral head with respect to the glenoid seems to be an important predictor of the glenoid morphologic evolution. Three main glenoid types were defined: Type A, Type B, Type C. Type A (59%) was marked by a well-centered humeral head and a balanced distribution of strengths against the surface of the glenoid. The symmetric erosion was explained by the absence of subluxation. In Type B (32%), the posterior subluxation of the humeral head was responsible for the asymmetric load against the glenoid and was implicated in the development of primary GHOA, particularly the exaggerated posterior wear pattern. Type C (9%) was defined by a glenoid retroversion of more than 25 degrees, regardless of erosion; retroversion was primarily of dysplastic origin and explained the early event of osteoarthritis. In primary GHOA, this classification of the glenoid can discriminate retroversion between posterior erosion and dysplasia.

Aged↗
PubMed1999

A low-cost approach to prospective identification of impending high cost outcomes.

OBJECTIVES: The overall objective of this study was to define and evaluate patterns of use of medical services in the care of patients with chronic illness that represent circumstances which, if modified, might lead to reduction in risk of acute-level care. METHODS: This was a retrospective observational study. The study population consisted of Kaiser Permanente enrollees at four sites during January 1993 through June 1995, who were 20 to 64 years of age and had two of three chronic diseases (diabetes, circulatory disorders, obstructive pulmonary disorders). Using logistic regression, the effect of primary care visit patterns and therapeutically risky drug combinations on likelihood of hospital admission in a subsequent 3-month period is adjusted for age, gender, and disease state in the prior 12-month period. RESULTS: Enrollees with visits to three or more different primary care physicians were 46% more likely to be admitted than expected (P < 0.01) according to their age, gender, and disease state, and those with therapeutically risky drug combinations were 34% more likely to be admitted (P < 0.01). CONCLUSIONS: The risk adjustment models evaluated in this study defined care processes associated with increased risk of subsequent acute-level services. Those processes may represent nascent acute disease states or suboptimal organization of care delivery. The results of these models can be used to inform changes in organization and delivery of outpatient care that might improve patient outcomes.

Adult↗
PubMed1999

HOLON/CADSE: integrating open software standards and formal methods to generate guideline-based decision support agents.

This paper describes the efforts of a consortium that is trying to develop and validate formal methods and a meta-environment for authoring, checking, and maintaining a large repository of machine executable practice guidelines. The goal is to integrate and extend a number of open software standards so that guidelines in the meta-environment become a resource that any vendor can plug their applications into and run in their proprietary environment provided they conform to the interface standards.

Computer Communication Networks↗
PubMed1998

The use of a selective axillary nerve block for outpatient hand surgery.

UNLABELLED: Although no guidelines concerning discharge criteria after axillary plexus block are available, many institutions consider recovery of motor function as a critical factor. With the midhumeral approach, the four main nerves of the upper extremity can be blocked separately using a peripheral nerve stimulator. The aim of this double-blind study was to block the radial (R) and musculocutaneous (MC) nerves with lidocaine, and the median (M) and ulnar (U) nerves with bupivacaine to recover motor function of the elbow and wrist more rapidly while maintaining long-lasting postoperative analgesia at the operative site. Patients undergoing surgery for Dupuytren's contracture were randomized into two groups in a double-blind fashion: in the control group (n = 17), each of the four nerves was infiltrated with 10 mL of a mixture of 2% lidocaine and 0.5% bupivacaine, whereas in the selective group (n = 17), the R and MC nerves were blocked with 10 mL of 2% lidocaine each and the M and U nerves were blocked with 10 mL of 0.5% bupivacaine each. Recovery of motor block was significantly faster in the selective group (231 +/- 91 vs 466 +/- 154 min). However, time to first sensation of pain was not different between groups (707 +/- 274 vs 706 +/- 291 min). In conclusion, this new approach at the midhumeral level enables the anesthesiologist to selectively administer local anesthetics on different nerves. IMPLICATIONS: In outpatients undergoing surgery for Dupuytren's contracture, a midhumeral block was used with the musculocutaneous and radial nerves blocked by lidocaine and the median and ulnar nerves blocked with bupivacaine. Recovery of motor function and time to discharge were shorter compared with patients who received the mixture on all four nerves.

Ambulatory Surgical Procedures↗
PubMed1998

Cerebral hemodynamic changes induced by simulated tracheal intubation: a possible role in perioperative stroke? Magnetic resonance angiography and flow analysis in 160 cases.

BACKGROUND AND PURPOSE: Perioperative stroke is a rare complication of generalized surgery (1% to 6%). Unexpected difficulties with tracheal intubation (TI), as well as the hyperextended position, may predispose a patient to or play a role in stroke. We sought to identify blood flow changes in carotid and vertebral arterial circulation during simulated TI and develop profile models for stroke risk before possible generalized surgery. METHODS: One hundred sixty consecutive patients with suspected cerebral vascular disease or pending surgery underwent MR angiography with flow analysis. Simulated TI position was maintained for 3 to 4 minutes per acquisition. RESULTS: The cohort consisted of 89 females (56%) and 71 males (44%) with a mean age of 66 years (range, 17 to 89 years). Hypoplastic vertebral arteries with flow less than 50 mL/s were present in 40 patients (25%). Profound alteration in basilar artery flow was noted in this group with increased frequency of microinfarctions on MRI (77% versus 38%). Unsuspected carotid occlusion (n=6) and vertebral artery occlusion (n=2) were associated with significant basilar artery flow changes. Flow reversal was present in five cases. Carotid arterial changes were not significant with simulated TI. No overt ischemic symptoms developed during these maneuvers. CONCLUSIONS: Simulated TI is safe yet induces distinct and potentially detrimental flow abnormalities. Individuals identified with the biological markers of hypoplasia, carotid and vertebral occlusion, severe stenosis, or prior ischemic vascular disease should receive special attention to neck position not only during surgery but also in the postoperative period. Sustained neck hyperextension greater than 12 minutes appears to be a neglected potential hemodynamic factor that may play a pivotal role in the pathogenesis of perioperative stroke.

Adolescent↗
PubMed1997

[False aneurysm of the knee after arthroscopy].

Pseudoaneurysm of the inferomedial genicular artery is a rare complication of arthroscopy. We report one case after arthroscopy ans medialisation of the anterior tibial tuberosity. Exploration and excision were performed.

Aged↗
PubMed1997

[Cardiac failure caused by renal arteriovenous fistula fifty years after nephrectomy. A new case and review of the literature].

Arterio-venous fistulae are rare after nephrectomy. They are the cause of congestive cardiac failure. This case report has two particularities: an exceptionally long interval, 50 years after nephrectomy, and a severe hypertension due to stenosis of the contra-lateral renal artery. Surgical treatment of these fistulae is essential and gives excellent results with rapid regression of the signs of cardiac failure. Percutaneous embolization is an alternative in patients with a high surgical risk. All previously reported cases are reviewed (n = 72) with their aetiological, clinical and therapeutic features.

Aortography↗
PubMed1996

Differential characterization of human coronary collateral blood flow velocity.

The functional importance and protective nature of the coronary collateral circulation has been well established. There are few data, however, regarding the phasic nature and absolute velocities of collateral flow in patients. The aim of this study was to characterize and quantify ipsilateral coronary collateral blood flow velocity in patients during coronary angioplasty. Coronary collateral flow velocity was measured in 49 patients during coronary angioplasty. Angiographic collateral filling was categorized by the Rentrop grading scale (0 to 3) and by anatomic pathway (epicardial, intramyocardial, or unknown [acutely recruited]). Collateral blood flow velocity was measured with a Doppler-tipped guide wire placed distal to the balloon occlusion in the collateralized vessel. Collateral flow velocity was characterized as predominantly systolic or diastolic, and phasic flow patterns were defined as biphasic (both systolic and diastolic), monophasic (only systolic or diastolic), or bidirectional (antegrade and retrograde velocity). Twenty-three (47%) patients had biphasic flow; 17 (35%) patients had monophasic flow; and 9 (18%) patients had bidirectional flow. Thirty-six (73%) of 49 patients had predominantly systolic flow signals. Epicardial collateral pathways had the highest total flow velocity integral, at 15.0 +/- 7.0 (vs intramyocardial [8.4 +/- 5.7] and acutely recruitable [5.4 +/- 2.1]; p < 0.05). There were no differences in flow velocity integrals among the Rentrop angiographic grades of collateral filling. These data establish three patterns of coronary collateral blood flow and demonstrate that the majority of collateral flow in the ipsllateral receiving vessel occurs during systole. The measurement of coronary collateral flow velocity provides a unique means to study the effects of pharmacologic or mechanical interventions on human collateral blood flow.

Adult↗
PubMed1996

Coronary physiology of percutaneous rotational atherectomy.

Integration of coronary blood flow velocity measurements into interventional procedures has enhanced our understanding of coronary flow dynamics. The coronary physiology of rotational atherectomy, with and without adjunctive coronary angioplasty, has not been well-defined. This review describes the coronary physiology induced by rotational atherectomy. Serial coronary blood flow and translesional hemodynamics, measured following rotational atherectomy and again after adjunctive balloon angioplasty, indicate that coronary blood flow and flow reserve may not be normalized despite significant angiographic improvements after rotational atherectomy alone and after adjunctive balloon angioplasty.

Aged↗
PubMed1995

Critical neck position as an independent risk factor for posterior circulation stroke. A magnetic resonance angiographic analysis.

The purpose of this study was to compare the effects of critical neck angulation (rotation and hyperextension) on vertebral artery perfusion in symptomatic and control populations and to determine whether this represents a risk factor for ischemic stroke. In a cross-sectional study, 64 symptomatic individuals with well-documented brainstem ischemic events (average age, 70.9 yr) and 37 control subjects (average age, 66.3 yr) were evaluated using a dynamic magnetic resonance angiography technique designed to mimic activities of daily living. Abnormalities of perfusion at the atlantoaxial and atlantooccipital junction and distal vertebral artery were recorded and scored independently by two neuroradiologists. Volume flow analysis was also recorded at the basilar artery, and distal and proximal vertebral arteries. Symptomatic subjects displayed a consistent pattern (56.4%) of contralateral hypoperfusion at the atlantoaxial and atlantooccipital junction and distal segments (grades 3 and 4) (p < 0.001). Unsuspected hypoplasia was noted in 13% of the symptomatic subjects with a right-sided preponderance (88%), suggesting developmental susceptibility. Occlusion was noted in all subjects with contralateral neck rotation. Postpositional ischemia was present (68%) and correlated with female gender (p < 0.001), severity of stenosis (p < 0.001), vascular risk factors (p < 0.001), and microinfarction on magnetic resonance images (p < 0.05). Flow analysis showed low basilar artery perfusion (< 25 ml/min) in 63.6%, and unsuspected steal with neck motion in 4 subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗