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F H al-Kawas

Publications and source records attributed to F H al-Kawas.

At least 19 recordsLinked to original sources
PubMed1997

A new system for defining endoscopic complications emphasizing the measure of importance.

BACKGROUND: Currently, there are no satisfactory systems for defining, classifying, and/or scoring endoscopic complications, although it would be important for quality assurance, comparative studies, and outcomes research. Recently the term "negative outcomes" was proposed rather than "complications," and an approach that incorporates "measures of importance" was added to compare negative outcomes. METHODS: A system was developed that defines, classifies, and grades negative outcomes with a scoring system based on measures of importance. Information was recorded on a Morbidity and Mortality (M & M) form, which was used at a monthly quality assurance (M & M) conference. Several measures of importance related to the immediate negative outcome (O) were quantified (effect of the complication on completion of the endoscopy, change in level of care, change in number of hospital days, necessity for new invasive procedures). The disability (D), defined as a residual or chronic negative outcome caused by the complication, was characterized and scored. Death (D) was also characterized, the value varying with circumstances. As a quantitative measure, an overall ODD score was used. RESULTS: One hundred twenty-three negative outcomes were retrospectively classified using the new M & M form and the ODD score was applied for 117 complications. Complications were ranked according to the ODD score. CONCLUSION: A system for defining, classifying, and grading negative outcomes of endoscopic procedures is proposed with a quantitative scoring system that emphasizes measures of importance. The ODD score looks at the immediate negative outcome and also the separate long-term issues of disability and death.

Documentation↗
PubMed1996

Flumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy.

BACKGROUND: Flumazenil is a competitive benzodiazepine antagonist that acts to reverse their sedative and hypnotic effects. It is indicated in the management of benzodiazepine overdose, but its role in the routine reversal of endoscopic conscious sedation has not been defined. METHODS: Patients undergoing diagnostic upper endoscopy who received sedation with either diazepam or midazolam alone were given flumazenil 0.2 mg incrementally immediately following the procedure until awake. They were then asked to repeat three psychomotor tests measuring cognitive and motor skills, with their baseline scores compared with postprocedure scores over a 3-hour period. RESULTS: Full psychomotor function was restored to baseline values within 30 minutes after flumazenil in 79% of patients, with no differences in the reversal of psychomotor skill impairment observed between diazepam and midazolam sedation. There was no evidence of rebound sedation seen for up to 3 hours. No significant anterograde amnesia was evident in 78% of individuals. CONCLUSIONS: These results demonstrate that flumazenil's effects on reversing psychomotor impairment are similar when midazolam or diazepam are used for conscious sedation. However, the potential usefulness of routine flumazenil reversal of conscious sedation will require further evaluation of specific psychomotor performance skills (such as driving a car) before we lift the admonition against leaving the endoscopic suite unattended, driving a vehicle, or operating complicated machinery for several hours.

Adult↗
PubMed1996

Rare causes of occult small intestinal bleeding, including aortoenteric fistulas, small bowel tumors, and small bowel ulcers.

The most common cause for gastrointestinal bleeding of small bowel origin is angiodysplasia, followed by tumors of the small intestine, and various other causes, including small bowel ulcers and aortienteric fistulas. With the advent of improved diagnostic tests, including push and sonde enteroscopy, timely endoscopic diagnosis of these rare small bowel lesions has become possible, enabling the clinician to make better therapeutic decisions. This article focuses on the rare small bowel sources of intermittent and chronic gastrointestinal blood loss.

Endoscopy, Gastrointestinal↗
PubMed1995

Endoscopic ultrasound for staging esophageal cancer, with or without dilation, is clinically important and safe.

BACKGROUND: To fully evaluate patients with esophageal cancer by endoscopic ultrasonography (EUS), the transducer must pass through the entire tumor to the cardia to scan the celiac axis. Dilation may be necessary. Published information suggests that dilation with EUS carries a sizeable risk. METHODS: In order to assess the complication rate associated with dilation prior to EUS in patients with esophageal cancer and the clinical significance of dilation for complete EUS staging, we reviewed the records of all patients who had undergone EUS for esophageal cancer. RESULTS: Sixty-three patients underwent EUS staging of esophageal cancer. Thirty-nine (62%) had lesions through which the EUS scope was passable (Group I). Ten (16%) patients (Group II) had lesions through which an EUS scope (diameter 13 mm) was unable to pass even after dilation. Fourteen patients (22%) had lesions that were dilated to allow passage of the EUS scope (Group III). All patients in Groups II and III had confirmation of EUS staging by CT and/or surgery. In Group II, five patients had tumors defined as T4 (50%) and five as T3 (50%). In Group III, nine (64%) had T4 tumors, four (29%) had T3, and one (7.7%) had T2. No complications were encountered in any group. CONCLUSION: EUS, either alone or after dilation, is a safe procedure and the complete EUS examination with celiac node visualization adds prognostically significant information.

Adult↗
PubMed1995

Acute pancreatitis: diagnosis and management.

Acute pancreatitis is a clinical syndrome characterized by midepigastric pain, nausea and vomiting. Numerous etiologies have been linked with this entity, principally alcoholism and biliary disease. Once the clinical suspicion of pancreatitis is confirmed, supportive therapy with intravenous hydration and close observation is effective in the vast majority of patients. Lack of improvement may indicate the need to search for a local complication such as pseudocyst or abscess. Fine-needle aspiration of suspected infected collections should be performed under computed tomographic guidance. Surgical intervention may be required if infection is confirmed. Evidence of the systemic complications of pancreatitis mandates intensive care monitoring.

Acute Disease↗
PubMed1992

Yield of upper endoscopy in the evaluation of asymptomatic patients with Hemoccult-positive stool after a negative colonoscopy.

The yield of upper endoscopy in asymptomatic patients with positive fecal occult blood test (FOBT) and a negative colonoscopy was evaluated prospectively in 70 consecutive patients. Significant pathology was diagnosed in 19 patients (27%), eight patients with ulcers, five with arteriovenous malformations, three with esophageal or gastric varices, two with multiple erosions, and two with biopsy-proven Barrett's esophagus. Thirteen patients had iron deficiency anemia and demonstrated a 38% prevalence of significant pathology. Fifteen patients on nonsteroidal anti-inflammatory agents had a 30% prevalence of significant pathology. No statistically significant difference was noted between subgroups. In conclusion, asymptomatic patients without a colonic source to explain a positive FOBT often have significant lesions, on upper endoscopy. Iron deficiency anemia did not have an impact on pathology. Because treatment and follow-up plans were altered in many of the cases in which significant pathology was demonstrated, we conclude that upper endoscopy should be seriously considered for all asymptomatic patients with occult gastrointestinal bleeding and a negative colonoscopic examination.

Adult↗
PubMed1991

Dieulafoy's lesion. Diagnosis and management.

A review of 177 cases of upper gastrointestinal hemorrhage due to Dieulafoy's lesion is reported. Dieulafoy's lesion is frequently responsible for severe and recurrent upper gastrointestinal hemorrhage. The lesion was predominantly found in the proximal stomach. Repeat endoscopies were needed in 33% of the patients in order to make the correct diagnosis. When preoperative diagnosis and localization were made, surgery was an effective therapeutic modality. Therapeutic endoscopy was successful in achieving permanent hemostasis in 85% of the reported cases. Re-treatment was needed in an additional 10% and surgical therapy in 5% of the cases. Therapeutic endoscopy should be considered initially in all patients. Surgical intervention and angiography with embolization may be effective options if endoscopic therapy is unsuccessful.

Gastrointestinal Hemorrhage↗
PubMed1991

PEG ileus. A new cause of small bowel obstruction.

A case of small bowel obstruction due to a lodged percutaneous endoscopic gastrostomy tube inner bumper is described. Most probably inner bumper lodgement in the terminal ileum is related to its size. Laparotomy was required to remove the bumper and relieve the obstruction. We suggest that all percutaneous endoscopic gastrostomy bumpers be retrieved endoscopically when the PEG tube is removed or replaced unless a collapsible inner bumper is used.

Aged↗