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Biomedical subjects

F Serour

Publications and source records attributed to F Serour.

At least 19 recordsLinked to original sources
PubMed2000

Phenotypic pattern of B cells in the appendix: reduced intensity of CD19 expression.

UNLABELLED: The lymphoid tissue of the appendix is considered as part of the gut-associated lymphoid tissue (GALT). In order to understand better the immunological significance of the appendix we analyzed the cellular composition of normal and inflamed human appendix tissue by flow cytometer with special attention to expression of the CD19 and CD5 markers on B cells. Cellular analysis was also performed on peripheral and appendical vein blood samples as well as on omentum and peritoneal fluid samples. The study population included seventeen patients aged 2-15 yr. (mean age - 11.5 yr.) undergoing appendectomy. Ten children were diagnosed with acute appendicitis while 7 had a normal appendix. RESULTS: Compared to the peripheral blood, the appendix contained a significantly higher percentage of CD19 cells (47.6% of total lymphocytes versus 15%, p<0.0001), and B1 cells (4.98% of total lymphocytes versus 2.42%, p=0.001). In addition, the intensity of CD19-staining was markedly decreased in the appendix (mean - 395.7), and also in the omentum (mean - 398.2) as compared to peripheral lymphocytes (mean - 497.7, p<0.0001 for both comparison). Comparison between the inflamed and the non-inflamed appendices revealed that the inflamed appendix contained a significantly higher proportion of B1 cells (5.64% of total lymphocytes versus 3.53%, p=0.032), and also a higher B1/b cell ratio (0.13 vs. 0.07, p=0.01). CONCLUSIONS: These results indicate that the appendix tissue contains higher number of B1 (and B) cells compared to the peripheral blood and that these cells play a role in the primary immune response to acute infection/inflammation in the appendix. Appendiceal B cell population is unique in term of CD19 intensity expression on their surface.

Adolescent↗
PubMed1999

Alkalinizing local anesthetic does not decrease pain during injection for dorsal penile nerve block.

STUDY OBJECTIVE: To evaluate whether alkalizing local anesthetic with sodium bicarbonate reduces pain related to infiltration of local anesthetic during dorsal penile nerve block for circumcision. DESIGN: Prospective, randomized, double-blind, controlled study. SETTING: E. Wolfson Medical Center, Holon, Israel. PATIENTS: 144 patients aged 15 to 54 years (mean +/- SD = 22.7 +/- 8.8 years), randomized before the block into four groups of 36 patients each. INTERVENTIONS: Group A (control) received a standard solution of 1 mg/kg lidocaine 2% mixed with 0.5 mg/kg bupivacaine 0.5% without epinephrine (pH = 6.3). Patients in Group B, Group C, and Group D received this mixture added with 8.4% sodium bicarbonate for a mean final pH of 6.90, 7.16, and 7.43, respectively. Penile block was performed using a 23-gauge needle by an anesthetist who was blinded to the pH of the solution. MEASUREMENTS AND MAIN RESULTS: Patients were questioned regarding pain suffered during injection of the anesthetic solutions by another physicians who also was blinded to the drug used. Pain was rated by a previously reported subjective pain scale. Mean pain scales were 2.0 +/- 0.17, 2.3 +/- 0.15, 2.2 +/- 0.16, and 1.94 +/- 0.15 for Groups A to D, respectively. The differences between these results were not statistically significant. CONCLUSION: Alkalinizing the acidic local anesthetic solution by sodium bicarbonate does not decrease pain related to infiltration during penile nerve block for circumcision.

Adolescent↗
PubMed1999

Does the size of nasogastric tubes affect gastroesophageal reflux in children?

BACKGROUND: To evaluate the effects of nasogastric tube insertion and different nasogastric tube sizes on gastroesophageal reflux in children. METHODS: During a prospective randomized study, 29 patients aged 1 month to 4 years (median, 9 months) underwent 24 hours of continuous esophageal pH monitoring to rule out gastroesophageal reflux as the cause of severe pulmonary problems. Each patient was monitored without nasogastric tube for 16 hours (baseline), and thereafter the first nasogastric tube, small (8-Fr) or large (10-Fr or 12-Fr), was placed. Four hours later, the original nasogastric tube was replaced by a new one of large (instead of small) size or of small (instead of large) size. We selected the times of wakefulness in these study periods and compared the number of reflux episodes (NREs), the number of reflux episodes that lasted more than 5 minutes (NRE>5), and the percentage of time with esophageal pH less than 4 (PTP<4). RESULTS: The 12-Fr group in comparison with the 8-Fr group and baseline showed significant difference (P<0.05) in the NRE>5 and PTP<4 parameters. No significant differences were found when comparing 8-Fr versus 10-Fr groups and baseline. In children with (n = 20) and without (n = 9) gastroesophageal reflux, comparison of the various reflux parameters between baseline and the different sizes of nasogastric tubes showed the same results. CONCLUSIONS: Size of the nasogastric tubes is a significant factor in predisposing the child to gastroesophageal reflux. Large nasogastric tubes interfere with the clearance of the refluxed acid from the esophagus.

Child, Preschool↗
PubMed1998

Efficacy of EMLA cream prior to dorsal penile nerve block for circumcision in children.

BACKGROUND: While circumcision may be performed solely with dorsal penile nerve block (DPNB), some painful steps in its use are skin needle penetration and infiltration of the anesthetic product. The objective of this study was to evaluate the efficacy of EMLA cream, prior to DPNB for circumcision in children. METHODS: We conducted a prospective, randomized, double-blinded, placebo-controlled study with 42 children undergoing circumcision with DPNB alone, as an ambulatory procedure. Overall efficacy of EMLA cream (Group A) during needle penetration and infiltration was assessed using a visual analog scale, compared with a placebo cream (Group B). Patients were asked to orally report any pain during skin needle penetration and infiltration of anesthetic, and were graded from 1 to 4 according to intensity of pain, as 1) none, 2) slight, 3) moderate, or 4) severe. The child graded the global discomfort of the entire procedure using the visual analog scale. RESULTS: When assessing needle penetration, none from Group A suffered any pain, whereas all from Group B suffered at least mild pain. Considering infiltration of the anesthetic, all children suffered at least slight-to-moderate pain. Based on the children's visual analog scale scores, EMLA cream has no beneficial effect for penile block. CONCLUSION: Since the dorsal penile nerves are located under the Buck's fascia, topical anesthesia may not reach them and other techniques may be necessary to anesthetize them. We found that although EMLA cream is efficient as a topical anesthesia during needle penetration for DPNB, it has no beneficial effect during infiltration.

Adolescent↗
PubMed1998

Slow injection of local anaesthetic will decrease pain during dorsal penile nerve block.

PURPOSE: To evaluate whether a very slow injection of local anaesthetics during dorsal penile nerve block for circumcision causes less pain than a more rapid injection. METHODS: In a prospective, double-blind, randomized study, 75 patients aged 15 to 53 yr (mean +/- SD = 22 +/- 8.4 yr) were randomized into two groups. A solution of 2% lidocaine, 1 mg.kg-1, and 0.5% bupivacaine, 0.5 mg.kg-1 without epinephrine to a maximum dose of 10 ml was injected using either a very slow rate (injection time 100 to 150 s, Group A) or a faster rate (injection time 40 to 80 s, Group B). Patients were questioned regarding pain by a physician who was blinded to the mode of therapy. Pain was rated as 1) mild (negligible), 2) moderate (non-negligible, but easily endurable), 3) intense (but endurable) and 4) total refusal to continue. RESULTS: A significant pain score difference was found between Groups A and B (median = 1 vs. 2, P = 0.0006) as well as a significant correlation between pain score and the rate of infiltration (rs = -0.394, P < 0.0001). CONCLUSIONS: Slow injection is an important factor in reducing pain during penile block.

Adolescent↗
PubMed1998

Intussusception in children: reduction with repeated, delayed air enema.

PURPOSE: To evaluate the efficacy of pneumatic reduction of intussusception with an emphasis on repeated, delayed trials. MATERIALS AND METHODS: Seventy-one patients with intussusception were treated with air enemas. Before 1993, one trial of air reduction was performed; since 1993, up to three trials of air reduction were performed. The patients were categorized according to the duration of signs and symptoms: less than 12 hours (group A), 12-24 hours (group B), and longer than 24 hours (group C). RESULTS: The success rate for air reduction was 83% overall (59 of 71 patients), 89% in group A (25 of 28 patients), 83% in group B (20 of 24 patients), and 74% in group C (14 of 19 patients). The success rate was 70% (19 of 27 patients) before 1993 and 91% (40 of 44 patients) since 1993 (P < .05). When patients in whom air reduction was successful were compared with patients in whom it was unsuccessful, there was a statistically significant difference in radiographic signs of intestinal obstruction and duration of signs and symptoms but no important difference in age or rectal bleeding. There were no episodes of complications. CONCLUSION: Repeated, delayed pneumatic reduction of intussusception improves the outcome.

Case-Control Studies↗
PubMed1997

Comparative periurethral bacteriology of uncircumcised and circumcised males.

BACKGROUND: It has been established that lack of circumcision increases the risk of urinary tract infection in infants. During the first six months, the presence of foreskin is associated with a greater quantity and a higher concentration of uropathogens in the periurethral area. Very little is known about this association in older males. OBJECTIVE: To compare the periurethral bacteriology of uncircumcised healthy males of more than one year of age. METHODS: The periurethral area of 125 uncircumcised and 46 circumcised healthy males (mean age, 26.5 and 28.3 years, respectively) was swabbed and cultured for facultative and anaerobic bacteria, genital mycoplasmas and Chlamydia trachomatis. RESULTS: Facultative Gram positive cocci predominated in both groups (62% and 80%, respectively). Pure culture of facultative Gram negative rods was more common in uncircumcised males (17% v 4% in circumcised males, p = 0.01). Streptococci, strict anaerobes and genital mycoplasmas were found almost exclusively in uncircumcised males of more than 15 years of age. No case of C trachomatis was identified. CONCLUSIONS: The higher prevalence of potential uropathogens in the subpreputial space is in accordance with a previous finding of increased risk of urinary tract infection in uncircumcised young men. Our results also support the role of the prepuce as a reservoir for sexually transmitted organisms.

Adult↗
PubMed1996

Acute appendicitis following abdominal trauma.

Acute appendicitis (AA) is generally considered to be a consequence of lumenal obstruction and inflammation of the appendix. At the beginning of the 20th century, trauma was considered to be one of the possible causes of AA but this relationship has not been examined much since then. Our experience with three cases of AA following blunt abdominal trauma led to an extensive review of the world literature on the subject. We believe that abdominal trauma might be causative of AA. The potential for this hazardous and easily missed diagnostic entity should be appreciated in cases of blunt abdominal trauma both for sound clinical decision making and for its potential medical and legal implications.

Abdominal Injuries↗
PubMed1996

Dorsal penile nerve block in children undergoing circumcision in a day-care surgery.

PURPOSE: Circumcision is performed under general anaesthesia (GA) with dorsal penile nerve block (DPNB) as an analgesic technique for postoperative pain. The purpose of this study was to compare DPNB as the sole anaesthetic procedure vs GA and DPNB for circumcision in children as an outpatient procedure. METHODS: In a six-month prospective study, 250 boys aged 6 to 17 yr (mean age 11.5 +/- 3.5 yr) were randomized into two groups. Group A (n = 122) received DPNB only prior to circumcision, and Group B (n = 128) received GA + DPNB. The groups were compared for complications of the block, effectiveness of anaesthesia, operating room time, postoperative time and ease of recovery. RESULTS: There were no major operative complications in the two groups. Minor block complications, including oedema and haematoma, occurred in 16 (13.1%) boys in Group A and 27 (21.10%) boys in Group B (NS). At surgery, 3 (2.6%) from Group A received additional GA and 1 (0.8%) received additional local anaesthesia. They represent a DPNB failure rate of 3.3%. Mean operating room time was 11 +/- 2.5 min in Group A and 19 +/- 3.5 min in Group B, and post-anaesthesia care unit (PACU) time was 51 +/- 10 min in Group A and 101 +/- 14.5 min in Group B (P < 0.001). Nausea and vomiting in the PACU were noted in one patient in Group A and in 15 in Group B (P < 0.05). Only patients in Group B required additional analgesia and tranquilizers in the PACU (0 versus 20; P < 0.05). CONCLUSIONS: These data confirm that DPNB has advantages over GA + DPNB for paediatric circumcision in day-care surgery.

Adolescent↗
PubMed1996

Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial.

We evaluated the morbidity associated with primary closure by interrupted subcuticular absorbable sutures following emergency appendectomy. In a prospective clinical trial over a 12-month period, 216 children who underwent emergency appendectomy had skin closure using subcuticular interrupted absorbable polyglactin 4-0 sutures. Preoperative prophylactic antibiotics consisting of metronidazole alone or in combination with gentamicin were used in patients with suspected phlegmonous appendicitis; a combination of metronidazole, gentamicin, and ampicillin was used when perforation of the appendix was suspected. Postoperatively, in patients with phlegmonous appendicitis metronidazole was given for 24 hours, whereas in those with peritonitis the triple antibiotics were continued for 7 to 10 days. All patients were assessed for complications resulting from the technique of wound closure. No intraabdominal abscesses or serious complications were recorded. The overall incidence of wound infection was 1.8%. Among children with a perforated appendix the rate of superficial wound infection was 5.7%. There was no difference in the rate of wound infection between patients who received metronidazole alone or metronidazole plus gentamicin preoperatively. All the patients and their families were satisfied with the cosmetic results and with the fact that removal of skin sutures was unnecessary. We conclude that the use of prophylactic antibiotics permits standard skin closure by interrupted absorbable subcuticular suture.

Adolescent↗
PubMed1996

Air enema for reduction of intussusception in children: risk of bacteremia.

PURPOSE: To evaluate the incidence of bacteremia in children undergoing air enema for the diagnosis and reduction of intussusception. MATERIALS AND METHODS: Twenty-seven children who underwent air enema for the diagnosis and treatment of intussusception were evaluated to identify the incidence of transient bacteremia and fever associated with the procedure. Blood cultures were obtained prior to the manipulation (point 0), immediately after completion of the procedure (point 1), and 2 hours later (point 2). RESULTS: The results of six of 81 sets of blood cultures were positive for bacterial pathogens. Three of them that were obtained at point 0 and two at point 1 grew common skin contaminants. A sixth blood culture drawn at point 1 was positive for Staphylococcus aureus. No patient had more than one positive blood culture result, and all recovered without antimicrobial therapy. Five patients had temperature elevations to > or = 38 degrees C following the enema. Only one of the patients was febrile at admission, and none had positive blood culture results. CONCLUSION: The risk of bacteremia from enteric pathogens following air enema for reduction of intussusception in children appears to be low.

Air↗
PubMed1996

Appendiceal colic in children: a true clinical entity?

BACKGROUND: Unexplained recurrent abdominal pain is a frequent problem in the pediatric population. An organic cause is found in 10 percent of children. Recurrent abdominal pain is responsible for multiple hospital admissions and patient evaluations. In some children, partial luminal obstruction of the appendix without inflammation may be the cause of this pain, and is defined as "appendiceal colic." STUDY DESIGN: During a period of five years, we performed a prospective study among children admitted for right lower quadrant abdominal pain. Children operated on for suspected acute appendicitis were eliminated from the study. Among the remaining patients, those with recurrent pain were evaluated for appendiceal colic. Medical histories were obtained, and the patients underwent physical examinations, routine laboratory studies, stool cultures, abdominal roentgenograms, and sonography scans (including the pelvic region in girls). Precise radiologic evaluation of the appendix was performed by barium swallow in 22 children or by barium enema in four. The diagnosis of appendiceal colic was made if the following three criteria were met: a history of longer than one month with three or more recurrent attacks of right lower quadrant abdominal pain; localized tenderness in the right lower abdomen without signs of peritoneal irritation or inflammation; or radiologic findings at barium examination consisting of irregular filling of the appendix, nonfilling or partial filling of the appendix after 24 hours, or nonemptying of the appendix after 72 hours. Children thus diagnosed underwent elective appendectomy, which was performed only after an additional episode of abdominal pain. RESULTS: Twenty-six children (average age 11.4 years) were treated by appendectomy and of these, 23 (88.5 percent) experienced pain relief in the immediate postoperative period. The remaining three children had pain relief within four months after appendectomy. CONCLUSIONS: Appendiceal colic may be a true clinical entity. Children suffering from appendiceal colic may benefit from elective appendectomy.

Adolescent↗
PubMed1995

Circumcision in children with penile block alone.

Surgical procedures in children are usually performed with the patient under general anesthesia. For circumcision and additional dorsal penile nerve block is used for postoperative analgesia. We retrospectively evaluated dorsal penile nerve block as the only analgesic technique for the relief of intraoperative pain in children undergoing circumcision. For 6 months dorsal penile nerve block was performed in 454 children 3 to 11 years old (mean 8.15 +/- 2.08 years) as the sole preoperative anesthesia. All boys were considered to have had good preoperative analgesia. No major complications were reported. Block related hematoma was noted in 12 patients (2.6%) and mild local edema occurred in 83 (18.3%). There was no excessive bleeding and hemostasis was easily achieved. The overall average operating time was 7.2 +/- 2.6 minutes (range 6 to 25). General anesthesia was added in 13 patients, representing a dorsal penile nerve block failure rate of 2.9%. Four boys suffered from erratic pain, while no objective cause of failure was recorded in the remaining 9. Average patient age was 5.8 +/- 2.2 years (range 3 to 10) in the 13 boys and 8.2 +/- 2 years (range 3 to 11) in the remaining 441 patients (p < 0.001). Failure was more frequent in children 3 to 5 years old (15.5%) than in those older than 6 years (1.5%, p < 0.05). Average operating time was 20.7 +/- 2.8 minutes (range 15 to 25) in the 13 children and 6.8 +/- 1.1 minutes (range 6 to 15) in the remaining 441 (p < 0.001). During the recovery period, only children from the general anesthesia group suffered from nausea and vomiting (9), and pain, agitation and fear (6 boys 3 to 6 years old). Average recovery room time was 38.7 +/- 7.4 minutes (range 30 to 60) in children with dorsal penile nerve block alone and 95 +/- 9.8 minutes (range 85 to 120) in those with additional general anesthesia (p < 0.001). We conclude that dorsal penile nerve block alone provides good intraoperative analgesia for circumcision in children, particularly those older than 6 years.

Anesthesia, General↗
PubMed1994

General peritonitis induced by rectal examination: an unusual complication of primary psoas abscess.

Primary psoas abscess is a relatively rare disease with highest incidence in children and adolescents. It usually presents with fever, abdominal pain and limp. Limping tends to incriminate musculoskeletal problems below the pelvis, but movement of the hip involves the psoas muscle which is mostly retroperitoneal and intimately related to pelvic and intraperitoneal organs. Although the current tendency is to use abdominal sonography, rectal examination is still a valuable step in clinical examination, and may help to assess a pelvic mass or abscess. The following case report describes the elusive nature of psoas abscess and a rare occurrence of abscess rupture and peritonitis, immediately after rectal examination.

Child, Preschool↗
PubMed1994

Postappendectomy intra-abdominal abscess: a therapeutic approach.

Four hundred and sixty two children were operated on between January 1989 and June 1993 for acute appendicitis; 10 developed an intra-abdominal abscess. Intra-abdominal abscesses were accompanied by fever above 38 degrees C (nine out of 10 patients) and leucocytosis (mean leucocyte count 20.3 x 10(9)/l) and were detected sonographically four to 14 days after operation. Management included intravenous administration of antibiotics effective against both aerobes and anaerobes, and follow up with serial sonographic studies. Eight patients responded favourably to antibiotic treatment without any drainage procedure, with gradual shrinkage and collapse of abscesses. Two patients, in whom enlargement of collection was demonstrated on serial sonographic examination, eventually underwent percutaneous drainage under sonographic control. These results suggest that some paediatric patients with an intra-abdominal abscess after appendicectomy and who are followed up closely by sonography may be managed successfully with appropriate antibiotics alone.

Abdomen↗