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Biomedical subjects

J Saada

Publications and source records attributed to J Saada.

11 recordsLinked to original sources
PubMed2005

Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction.

BACKGROUND: We prospectively compared laparoscopic gastrojejunostomy with duodenal stenting as a means of palliating malignant gastric outflow obstruction. METHODS: A total of 27 patients with malignant gastric outflow obstruction were randomized to either laparoscopic gastrojejunostomy (LGJ) or duodenal stenting (DS) over a 3-year period. RESULTS: Thirteen patients underwent successful LGJ and 10 had successful DS. Eight patients had complications after LGJ, but none had complications after DS. Patients who underwent LGJ had a significant increase in visual analog pain score at day 1 (p = 0.05), and also had a longer hospital stay compared to those who underwent DS (11.4 vs. 5.2 days, p = 0.02). After DS, patients experienced an improvement in physical health at 1 month as measured using the Short Form-36 (SF-36) questionnaire (p < 0.01). There was no change following LGJ. CONCLUSION: Duodenal stenting is a safe means of palliating malignant gastric outflow obstruction. It offers significant advantages for patients compared with minimal-access surgery.

Aged↗
PubMed1997

Small hepatocellular carcinomas in cirrhotic explant livers: identification by macroscopic examination and lipiodol localization.

Small hepatocellular carcinomas (HCCs) in cirrhotic livers are difficult to detect. This study aimed to assess if small HCCs can be better identified using specific macroscopic sampling criteria and Lipiodol (iodized oil) localization on radiographs, and to evaluate thereby their incidence and morphology. Prospective cirrhotic recipients of orthotopic liver transplantation (OLT) were administered hepatic arterial Lipiodol at angiography. Posttransplantation, the explant livers were sliced and inspected as per routine for unusual nodules. If unusual nodules were found or HCC clinically suspected, the slices underwent soft-tissue radiography. Tissue samples were then taken as per protocol from all nodules with diameter > or =1 cm/unusual appearance/exophytic bulge, and from foci of radiographic Lipiodol uptake or high soft-tissue density. One hundred three lesions were assessed and classified histologically as HCC (n = 55) or regenerative nodule (n = 39) or borderline (n = 9). Sampling according to predetermined macroscopic criteria proved an effective method for identifying small HCCs: 44 cancers were detected, most <5 mm in diameter, additional to those picked up on routine assessment. Green nodules were more likely to be HCC (P < .0001). The cancers were all multifocal, and had characteristic histological features of HCC except for 12 unusual fibrotic cancers in livers with alcoholic cirrhosis. Lipiodolization alone identified one additional HCC. Lipiodol retention on x-ray is fairly specific for HCC (83%), and can even identify lesions 2 mm in diameter. But its sensitivity is poor (45%), and its routine use to identify HCCs in explant livers is not recommended.

Carcinoma, Hepatocellular↗
PubMed1997

Detection of small hepatocellular carcinomas in cirrhotic livers using iodised oil computed tomography.

BACKGROUND: The detection of hepatocellular cancers (HCC) is a major role of preoperative imaging in patients with end stage liver disease being considered for orthotopic liver transplantation (OLT). AIMS: To assess the sensitivity of iodised oil computed tomography (IOCT). PATIENTS AND METHODS: A prospective evaluation in 50 consecutive patients undergoing OLT included ultrasound scan, contrast enhanced CT, angiography (with intra-arterial injection of iodised oil), and a second CT (IOCT) 10 days later. Following transplantation the explant liver was serially sectioned for pathological evaluation. Soft tissue radiographs of the liver slices were used to match histological lesions with CT findings. RESULTS: Eleven patients were excluded due to protocol violations. Of the remaining 39, histological evaluation revealed no cancers in 33 explant livers, in keeping with negative preoperative imaging. Six explant livers contained 55 HCCs, 84% of which were less than 1 cm in diameter. Pretransplant IOCT detected 3/6 patients with cancer (50%) but only 7% of cancerous lesions. Ultrasound, contrast CT, and angiography each detected 2/6 patients with cancer and 4% of cancerous lesions. CONCLUSION: IOCT is an insensitive method for the detection of small HCCs in livers with advanced cirrhosis but in this study was slightly superior to ultrasound, CT, and angiography.

Carcinoma, Hepatocellular↗
PubMed1997

Real time validation of paediatric biochemical reports using the Valab-Biochem system.

Validation of biochemical reports must be fast and clinically accurate to be of assistance to clinicians. Considerable skill is required to analyse the consistency of different data in the report and to consider influences on the data. When performed throughout the day, such analysis is time-consuming and uncertain. We therefore decided to use a computer-assisted validation system, Valab-Biochem. Its decisions result from a decision tree based primarily on the intrinsic consistency of the data, validation ranges and patients' sex, age and hospital ward. Three hundred randomly chosen reports were simultaneously submitted to Valab-Biochem and to five biologists in order to analyse the computer's findings. The sensitivity of Valab-Biochem was 80% compared to biologists' consensus decision, which was taken as the gold standard. The specificity was 78%. This system provided autonomous assessment of the reports and could be used as an initial screen to assist biologists and focus attention on potentially inconsistent reports.

Artificial Intelligence↗
PubMed1994

[Refractory hypoxemia caused by transient opening of the foramen ovale after pneumonectomy].

A patient with bronchogenic cancer underwent right pneumonectomy. Surgical and infectious criteria were normal during the postoperative period when immediate postoperative severe hypoxeamia occurred. Pure oxygen only incompletely corrected the situation. Transoesophageal echocardiography with injection of microbulles for contrast imaging demonstrated a right-left shunt due to an open foramen ovale. Reopening the foramen ovale is rare but well documented complication of pneumonectomy. The pathogenics is still debated since hyperpressure in the right atria usually is not present. Echocardiography with contrast test is the best means of making the diagnosis.

Aged↗
PubMed1991

[Late post-pneumonectomy hematogenous pyothorax. Apropos of 3 cases].

The authors describe three cases of patients who had previously undergone a pneumonectomy (two for cancer, one for bronchiectasis) with a favourable postoperative course, who subsequently developed pyothorax in the thoracic cavity. The bacteria isolated where in the first patient, Pasteurella Multocida; in the second, Campylobacter foetus foetus; in the third, a variety of anaerobic organisms. The characteristic of the organisms allow us to exclude the possibility that these cases of pyothorax were due to a contamination during the operation, in favour of transient bacteraemia with contamination of the fluid of the thoracic cavity. In a patient who has undergone pneumonectomy (as in patients with a joint or valve prosthesis) it is important to avoid (or to treat early) any infections which could give rise to bacteraemia, especially dental infections.

Adult↗
PubMed1987

[Benign mediastinal hemangiomas].

Haemangiomas represent a very rare form of primary mediastinal tumour. Their benign character, though rare, should not allow one to forget that their excision is correct, though sometimes tricky on account of their special anatomic situation. Two new observations are reported here as evidence of this difficulty. The prognosis, save for a few exceptional cases of local recurrence as in one of the cases sighted here is always good.

Adult↗
PubMed1980

Fazadinium pharmacokinetics in patients with liver disease.

Serum concentrations of fazadinium were measured in eight patients with cirrhosis and eight patients with total biliary obstruction who underwent abdominal surgery. A biexponential decay of the concentration was observed after a single i.v. injection of fazadinium. A two-compartment open model was used in the pharmacokinetic analysis of the data. The pharmacokinetic parameters were compared with those obtained in 11 normal patients. A 90% increase in both the distribution half-life (T 1/2 alpha), from 10 to 19 min, and in the elimination half-life (T 1/2 beta), from 82 min to 153 min, was observed in patients with cirrhosis. These changes are the consequence of an increase (60%) in the total apparent volume of distribution (V). In contrast, the plasma clearance (Cl) was not modified. Total biliary obstruction was associated with very little change in the pharmacokinetics of fazadinium, T 1/2 beta being slightly prolonged to 103 min. No significant decrease in plasma clearance was observed in patients with cholestasis. These results suggest that biliary excretion of fazadinium does not represent an important supplementary pathway to renal excretion. The relatively rapid decrease of the blood concentration of fazadinium compared with other non-depolarizing relaxants is probably related to another extrarenal pathway of elimination which has not yet been identified.

Abdomen↗