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Biomedical subjects

M Abdelkader

Publications and source records attributed to M Abdelkader.

8 recordsLinked to original sources

Endoscopic control of the sphenopalatine artery for epistaxis: long-term results.

The aim of this study was to prospectively evaluate post-operative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east Scotland hospitals. Main outcome measures were recurrence of epistaxis in the immediate post-operative period and at long-term follow up (minimum nine months). Forty-three patients (30 men and 13 women) underwent 45 procedures; two patients underwent bilateral ligation. Two patients suffered recurrence as in-patients. Two patients experienced subsequent epistaxis requiring medical treatment. Two further patients suffered minor late epistaxis not requiring treatment. Success in preventing significant recurrence was 93 per cent. All recurrences requiring intervention occurred within one month of surgery. None of the patients in this series reported nasal complications. We found sphenopalatine artery ligation to be an effective means of achieving long-term control of posterior epistaxis.

Adult↗

Continence after radical prostatectomy with bladder neck preservation.

PURPOSE: Bladder neck preservation during radical prostatectomy has been advocated for improving urinary continence. We evaluate bladder neck preservation looking at continence rates, surgical cancer control and bladder neck contracture. MATERIALS AND METHODS: A total of 40 patients underwent retropubic radical prostatectomy for clinically localized carcinoma of the prostate. The prostatic urethra was dissected in continuity with the bladder away from the lumen of the prostate, which allows for a true urethra-to-urethra anastomosis. RESULTS: Continence was noted immediately in 26 patients, within 2 weeks in 9 and within 6 weeks in 3. Only 2 patients required pads 3 months postoperatively. Microscopic positive surgical margins were noted in 2 of 40 patients. In 1 patient the urethral margins were not involved with carcinoma. In the other patient the urethra was not the sole positive margin and microscopic positive margins were noted elsewhere. Early results of cancer control were good. CONCLUSIONS: Early follow-up of this technique of radical retropubic prostatectomy suggest that preservation of the continence mechanism at the level of the bladder neck and prostatic urethra results in significantly improved postoperative urinary continence without adversely affecting cancer control.

Aged↗

Prospective evaluation of the value of direct referral hearing aid clinic in management of young patients with bilateral hearing loss.

The purpose of this study was to evaluate the value and effectiveness of a direct referral hearing aid clinic (DRHAC) in providing appropriate hearing aids to young patients aged 18-60 years while at the same time identifying patients with significant ear disease who need an otologist's opinion. The patients were referred to a tertiary referral hearing assessment clinic. A total of 137 patients (18-60 years) met the criteria to be included in the study to be assessed in the clinic by both an audiometrician and an otologist. The main outcome measures were hearing evaluation and audiometrician's management. Of them, 114 patients attended the research clinic (83%), 23 patients (17%) did not attend the clinic and 57 patients (51%) did not need any treatment or further investigation as their hearing was normal or near normal. Thirty patients (27%) were given hearing aids. Twenty-five patients (22%) failed the audiometrician assessment and were referred to the otologist. Only 13 (18%) of the 25 patients referred for an otological opinion actually required further investigations, medical or surgical treatment. DRHAC is as viable a system in the younger as in the elderly population.

Acoustic Impedance Tests↗

Early discharge following nasal pack removal: is it feasible?

A prospective study of 50 consecutive patients admitted for nasal packing for epistaxis reveals that only 20% re-bled after removal of packs and that 96% of those recurrences occurred during the first 4 h after pack removal. No patients required repacking or blood transfusion. The need for a 24-h observation period following nasal pack removal therefore appears not to be required, and the implementation of an early discharge policy for patients treated for epistaxis by nasal packing is therefore potentially feasible, and would result in significant cost savings.

Adolescent↗

Aggressive fibromatosis of the head and neck (desmoid tumours).

Desmoid tumours are histologically benign fibrous neoplasms arising from the musculoaponeurotic structures throughout the body. They are characterized as infiltrative, usually well-differentiated firm overgrowth of fibrous tissue and are locally aggressive. An aggressive clinical behaviour with tendency for recurrence makes the treatment of these relatively rare fibrous tumours difficult. Local recurrence rates are reported as high as 70 per cent of cases, the recurrence of desmoid fibromatosis in the head and neck is difficult to ascertain because of the different classification schemes used by different authors. A review of cases of desmoid tumours of the head and neck presented in the last 10 years is reported in this paper. Complete surgical excision of desmoid tumours is considered to be the only effective method of cure by most authorities.

Adult↗

The effect of a nurses' industrial action on psychiatric hospital admissions.

The socio-demographic and clinical characteristics of patients admitted to a large psychiatric hospital during a six month period of industrial action by nurses are described and compared with those from a similar period in the previous year. During the industrial action, the nursing staff agreed only to accept "emergency cases" for admission. The way that medical and social work practices were affected by the restricted conditions are discussed. The admission threshold was raised across all diagnostic categories, although the level of violence and social isolation was markedly less than expected. Chronic patients with a duration of illness of ten years or more were least likely to be admitted during the action. It is probable that some patients were admitted under a compulsory order to facilitate access to in-patient treatment.

Attitude of Health Personnel↗

[Non-dystonic torticollis. A report of a case secondary to retropharyngeal abscess].

INTRODUCTION: There are many causes of acquired non-dystonic torticollis: cervical bony anomalies, nasopharyngeal infections, tumours of the spinal cord, and posterior fossa, ocular, vestibular and gastrointestinal disorders. In children, non-dystonic is commoner than dystonic torticollis, except for in adverse reactions to drugs. Palatopharyngeal lesions due to a rigid object being impacted in the mouth (pencil-injury) are common in childhood. Many are not dangerous and require no specific treatment, although there is a risk of perforation of the pharyngeal wall and of a retropharyngeal abscess. CLINICAL CASE: We report the case of a 9 year old boy who was seen in the Emergency Department complaining of fever present for four days and progressive cervical rigidity for the past two days which did not improve with myorelaxant drugs. A lateral X-ray of the spine showed prevertebral air and on the oesophagogram a fistula tract was seen. On further questioning the boy admitted that a stick he had had in his mouth had caused damage the day before his fever started. CT showed the extent of the abscess. After a week of treatment with antibiotics and corticosteroids the clinical features disappeared, and on CT after two weeks it was seen that the abscess had resolved. CONCLUSIONS: We suggest that a lateral radiograph of the neck should be done in cases of acquired torticollis, even though there is no suspicious clinical history. Early diagnosis and treatment of retropharyngeal abscesses is essential to prevent extension to adjacent structures, and atlanto-axoid subluxation secondary to the oedema and tension of the ligaments caused by the abscess (Grisel's syndrome).

Anti-Bacterial Agents↗