Biomedical subjects

H Hashish

Publications and source records attributed to H Hashish.

4 recordsLinked to original sources

PubMed2003

Needlescopic appendectomy.

BACKGROUND: In this paper, we compare our experience with the techniques of needlescopic appendectomy (NA) (2-mm instruments) for the treatment of acute appendicitis with the more conventional approach of a laparoscopic appendectomy (LA). METHODS: We did a retrospective review of patients who underwent NA for the diagnosis of acute appendicitis between August 1996 and January 2002. Variables including operative time, blood loss, postoperative time to discharge, intra- and postoperative complications were analyzed and compared to data from control patients who had undergone an LA for acute appendicitis. RESULTS: The NA group had a longer average operating time (54.5 +/- l3 vs. 42.5 +/- 12.6 min, p = 0.0001) and a longer postoperative hospital stay (2.1 +/- 1.4 vs. 1.3 +/- 1.1 days, p = 0.01). Blood loss was similar for the two groups. CONCLUSIONS: With the exception of superior cosmesis, NA appears to have little advantage over the better-established LA; moreover, it has some disadvantages. A clearer benefit of this procedure over LA, as well as improvements in instrumentation, needs to be shown before it can be widely accepted.

Adolescent↗

PubMed2002

Cranio-cervical decompression for Chiari type I-malformation, adding extreme lateral foramen magnum opening and expansile duroplasty with arachnoid preservation. Technique and long-term functional results in 44 consecutive adult cases -- comparison with literature data.

BACKGROUND: Posterior cranio-cervical decompression by opening at least foramen magnum and C1-lamina usually with corresponding dural and arachnoid opening, is the procedure most currently used for treating Chiari I malformation (alone or in association with syringomyelia). To optimize decompressive effects together with reducing risks, a procedure was developed which consists of a sub-occipital craniectomy and a C1 (or C1/C2) laminectomy, plus an extreme lateral Foramen Magnum opening, a "Y" shaped dural incision with preservation of the arachnoid membrane, and an expansile duroplasty employing autogenous periosteum. The purpose of the article is:1. to report the long-term functional results in a consecutive series of 44 adult patients affected by symptomatic Chiari Malformation type I (CM) using the procedure described.2. and to compare this technical modality with the other modalities reported in the literature. METHOD: This series includes 44 patients harboring CM type I and operated on between 1990 and 2000. 15 patients had CM with syringomyelia (34%) and 29 CM alone (66%). Functional status was evaluated by using the Karnofsky disability scale. Before surgery 37 patients (84.1%) were independent (of whom 13 had syringomyelia) and 7 patients (15.9%) were dependent - i.e., they required assistance - (of whom 2 had syringomyelia). Outcomes were analized with follow-up ranging from 1 to 10 years (4 years on average). FINDINGS: There was no operative mortality, and surgery did not provoke any neurological aggravation. After surgery all the patients were independent. For the patients with CM only, the averaged Karnofsky score was 90 at latest follow up, versus 76 before surgery. For the patients with syringomyelia, the averaged latest Karnofsky score was 89 after surgery, versus 74 before. INTERPRETATION: The presented technique was compared with the other surgical modalities reported in the literature. This comparative study shows that cranio-cervical decompression with extreme lateral resection of the posterior rim of Foramen Magnum out to the level of the occipital condyles on either side, associated with an enlargement duroplasty with preservation of the arachnoid membrane, achieved the best results with minimal complications and side-effects.

Activities of Daily Living↗

PubMed1999

[Chronic hydrocephalus in an adult due to congenital membranous occlusion of the apertura mediana ventriculi quartii (foramen of Magendie). Report of two cases and review of the literature].

Congenital membranous obstruction of the apertura mediana ventriculi quartii (foramen of Magendie) is a rare entity, as only 8 adult cases are mentioned in all medical literature. We report here the cases of 2 patients (35 and 68 year-old) with chronic hydrocephalus due to congenital membranous obstruction of the foramen of Magendie. Both these two patients presented with headaches, nausea, and impairment of gait and memory. CT and MRI examination showed a communicating hydrocephalus, with particular enlargement of the fourth ventricle. Both patients were operated on for microsurgical exploration of the outlet of the fourth ventricle, which demonstrated membranous obstruction of the foramen of Magendie. Microsurgical perforation of the foramen of Magendie was performed, and a ventriculo-cisternal shunt was left in place. The two patients were cured, with a follow-up of 7 years in one case, and 5 years in the other case. Despite its rare occurrence, congenital imperforation or membranous obstruction of the foramen of Magendie must be considered as a possible etiology of chronic hydrocephalus in adult, especially in case of non proportioned enlargement of the fourth ventricle, associated to signs of increased intra-cranial pressure. According to us, the best surgical procedure consists in a microsurgical exploration of the foramen of Magendie associated to a ventriculo-cisternal shunting (from the fourth ventricle to the cisterna magna). Such a procedure can be considered as curative, and has more advantages than a simple ventriculo-peritoneal shunting.

Adult↗

PubMed1993

Epitopes for natural antibodies of human immunodeficiency virus (HIV)-negative (normal) and HIV-positive sera are coincident with two key functional sequences of HIV Tat protein.

We have previously shown that IgM antibodies that react with human immunodeficiency virus (HIV) Tat, a regulatory protein essential for viral replication, are present in sera of all normal, HIV-negative individuals and deficient in sera of HIV-positive individuals at progressively greater frequency as diagnosis of AIDS nears. That IgM was designated as a set of natural antibodies, a repertoire of the normal humoral immune system believed to provide early defense against infectious invaders. In the prior study, by means of a series of synthetic peptides representing the amino acid sequence of HIV-1 Tat, one epitope for the IgM natural antibodies was defined within the cysteine-rich domain, shown in cell transfection studies to participate in Tat function. In this study we have defined another epitope, within the basic domain, with which the natural antibodies react. The specific sequence and amino acid residues required for that epitope are coincident with those required for the role of Tat in viral replication. The IgM antibodies reactive with the two epitopes of Tat make up two distinct sets, which, together, account for the total Tat reactivity of both HIV-negative and HIV-positive sera. The striking coincidence of the two epitopes with the two functional sequences of Tat suggests a potential role of those natural antibodies in control of HIV pathogenesis. By inference from the extensive evidence for the presence of extracellular Tat in cultures of HIV-infected cells, Tat may be expected to be present in the circulating plasma of infected people. We propose, therefore, that the Tat-reactive natural antibodies, documented in these studies to be present in the circulating plasma in the pre-AIDS stages of HIV infection, may inhibit cell entry of plasma-borne Tat and thereby curtail HIV propagation. Thus, those natural antibodies may be a host factor for delay in HIV pathogenetic progression.

Amino Acid Sequence↗