Biomedical subjects
Publications and source records attributed to M Daoud.
A case of ileocecal herniation through the foramen of Winslow is presented. This is an uncommon type of internal hernia and the diagnosis is difficult. From this case, clinical signs, imaging procedures and treatment options are discussed.
Mycetomas are inflammatory pseudotumors of chronic and progressive evolution, of fungal (Eumycetoma), or bacterial (Actinomycetoma) origin. We conducted a retrospective study of patients who have been consulted for mycetoma over a period of 28 years. Thirteen cases of mycetomas were collected during the 28-year period, 10 patients were of rural origin. The lesions were localized on the foot in all instances. There was no male predominance. Histopathological examination confirmed mycetoma in all 13 cases and the determination of the infectious agent in 9 cases: 4 actinomycotic and 5 fungal. Microbiological examination identified the species in 7 cases. Bone involvement was found in 10 cases. Eumycetomas were treated by ketoconazole. The other cases were treated as actinomycetomas by antibiotics. The antibiotic treatment was associated with surgical excision in 4 cases and with amputation in 1 case. Mycetomas are rare in Tunisia, and only observed sporadically, for this reason the diagnosis is usually late, with severe functional, psychological, and socioeconomic consequences.
We report on the case of a 54-year-old woman diagnosed as having culture-negative endocarditis (clinical and histopathologic evidence compatible with a recent episode of endocarditis). The responsibility of Chlamydia pneumoniae in this episode of endocarditis was suggested by a serological study and was then confirmed by the positive results of PCR and in situ hybridization tests with aortic and mitral valves tissues. To our knowledge, this is the first case of endocarditis due to C. pneumoniae confirmed by molecular biology-based techniques.
Long-term results of percutaneous mitral commissurotomy were evaluated in 410 patients with mean age of 31 years (18 to 68 years). 48% of patients had mean thickened leaflets, 35% had calcified valves and 17% had flexible leaflets and subvalvular apparatus. Procedure was performed with a double balloon in 57% and with Inoue's balloon in 43% patients. A good immediate results was obtained in 77% of patients. A good result was defined as a mitral valve area > or = 1.5 cm2 without mitral regurgitation. Clinical follow-up concern 378 patients. The actuarial 5 years rate were 84% in our serie, without surgery or new percutaneous mitral commissurotomy and good functional results (NYHA class I or II) were 71%. Valvular anatomy, immediate results (mitral valve area), history of mitral commissurotomy, old patients, atrial fibrillation can influence strongly the results.
We consider a mixture of two incompatible polymers A and B, confined between two parallel surfaces of the same chemical nature, separated by a distance L. It is assumed that both surfaces strongly adsorb one of the species (A) at high temperature. It is also assumed that a demixing transition occurs at a critical temperature T(c) below the adsorption temperature T(a). The strong adsorption implies that the composition of species A on surfaces is quenched even when the temperature is lowered. The presence of strong density fluctuations near the critical point induces an interaction between the surfaces. We reexamine this attractive force and determine its dependence with the thickness L, when the latter is smaller than the thermal correlation length. We find that, in the vicinity of the critical point, this force decreases with distance as L-4. We show that the corresponding amplitude is a universal number, independent of the value of the composition on surfaces, and we give its exact expression. Finally, we note that the present system may be considered as a typical model enabling one to understand qualitatively and quantitatively the flocculation of colloids embedded in critical binary polymer blends.
We report the case of a 58 years old male affected by a severe relapsing ventricular tachycardia despite a well administered anti arrhythmic therapy. Etiology is an arrhythmogene right ventricular dysplasia. Considering the severity of this arrhythmia we proceed to percutaneous implantation of an automatically implantable defibrillator under local anesthesia. Evolution was favorable with a follow-up of 3 months.
Cardiac hydatosis is a rare condition, and the localization of a hydatid cyst within the interventricular septum is exceptional. A 61-year-old man found to have a hydatid cyst of the interventricular septum is reported. Presenting manifestations were congestive heart failure and signs suggestive of an aortic valvulopathy. Diagnosis was made by Doppler echocardiography and confirmed by magnetic resonance imaging. The cyst was approached surgically by right ventriculotomy. Despite a technically successful intervention without rupture of the cyst or appearance of a conduction delay, the patient died on the 20th postoperative day because of acute respiratory distress syndrome complicating infectious pneumonia.
Vascular complications and arterial hypertension are major risk factors in the evolution of disease connected with coarctation of the aorta. Supra- and sub-stenotic aortic aneurysms are classical findings, whereas a dissecting aneurysm is a rare occurrence. In this study, we report on a case of acute dissection of the ascending aorta complicating a poorly followed-up coarctation of the aorta in a ten-year-old girl. The diagnosis, determined by X-ray of the thorax, was confirmed by echocardiography and magnetic resonance imaging. The first operative stage consisted of treating the aneurysm. After resection of the latter, an impregnated dacron prosthesis was inserted in termino-terminal. The immediate result is satisfactory, and a second operation is planned for the aortic coarctation.
A theoretical model of copolymers made of N blocks is studied at the air-water interface. Each block is made of a sequence A of ZA hydrophobic and of a sequence B of ZB hydrophilic monomers. The A and B sequences cannot cross the interface. The conformation of an adsorbed polymer is determined as a random walk of N elements whose size is the Flory radius of a single sequence. The structure of the interfacial layer is determined as a function of alpha = ZA/ZB and of the surface concentration using scaling law arguments. Only three different regions are found in the phase diagram to describe the change of surface regime as a function of the total surface concentration. The energy of flower-like micelles of polymers is calculated and compared with the energy of adsorbed macromolecules in order to determine the surface concentration at saturation. The surface pressure is also calculated as a function of the surface concentration in the three different regions of the phase diagram. It is found that these surface pressure isotherms are not affected by the solvent quality except when the properties of the interfacial layer are dominated by a purely two-dimensional behavior (semidiluted regime of the whole polymer or of the A sequences on the air side of the interface). Finally the properties of this model are compared with experimental data obtained with protein adsorbed layers and encouraging agreement is found although proteins are much more complicated polymers than this crude model. Copyright 1999 Academic Press.
BACKGROUND: There is ample evidence that the incidence of operative cholangiography has declined since the introduction of laparoscopic cholecystectomy. It has been suggested that one of the reasons for this decline is the technical difficulty of cystic duct catheterization. A method of cholangiography which does not require such catheterization has been developed by others. This paper examines the ease and effectiveness of operative cholangiography performed by direct puncture of the gall-bladder. METHODS: A retrospective study was made of the records of 380 consecutive patients who underwent attempted laparoscopic cholecystectomy. After exclusion of patients in whom laparoscopic cholecystectomy was abandoned in favour of open cholecystectomy and those patients in whom operative cholangiography was not attempted, the records of 325 patients were available to the study. The operation notes of each patient were studied to determine whether, in the operator's opinion, a successful cholangiogram had been obtained. RESULTS: There were 290 patients in whom cholangiography was attempted using direct gall-bladder puncture (cholecystocholangiography (CCC)). There were 35 patients in whom cholangiography was attempted via cystic duct cannulation (CDC). Cholecystocholangiography was successful in 86% of those cases in which it was attempted. Cystic duct cannulation was successful in 83% of those cases in which it was attempted. CONCLUSION: Cholecystocholangiography is a valid alternative to cystic duct catheterization in its ability to achieve intra-operative cholangiography in the setting of laparoscopic cholecystectomy.
We consider theoretically the possibility of solid state NMR experiments with frozen linear polymer chains at interfaces. Three different cases are studied, namely, when the macromolecules are grafted on the surface, when they are adsorbed, and when they are very strongly adsorbed from a melt that is subsequently washed by a good solvent. The latter case is somewhat intermediate between the two former ones. For each case, we consider the relaxation when paramagnetic centers are located on the surface. We show that the shape of the relaxation curves depends critically on the monomer concentration profile, and exhibits characteristic power-law variations.
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The authors report two cases of coronary-right ventricular fistulas diagnosed in a 7-month-old infant and a 9-year-old girl. The discovery of the heart disease was incidental in both cases, following detection of a low continuous murmur. Doppler ultrasonography established the diagnosis, which was confirmed by haemodynamic studies and coronary angiography. The left anterior descending artery was involved in both cases and the recipient cavity was the right ventricle. The first patient was cured by early operation with distal ligation of the artery. In the second patient, the natural course was complicated by aneurysmal dilatation of the coronary artery. The authors recall the value of colour Doppler ultrasound in the noninvasive diagnosis, especially of the recipient cavity by colour Doppler and the need to rapidly treat coronary fistulas to prevent the development of complications reported after an average age of 20 years.
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OBJECTIVE: To determine the carriage rate of Streptococcus agalactiae in a group of pregnant women and evaluate its role in a neonatal infections. DESIGN: Prospective study between December 1992 and May 1993. SETTING: University hospital. PARTICIPANTS: 166 patients aged 17 to 41 years (m = 28 yrs) with a gestational age of 32 to 42 wks (m = 39.99 +/- 1.73) were admitted to the delivery suite. All patients had a vaginal swab on admission before any lavage. RESULTS: The recovery rate of Streptococcus agalactiae (group B) was found to be 7.8% (13/166) in our population. Twelve of the thirteen newborn to colonized mothers (92%) were term newborn as compared to 141 of 153 (92.1%) newborn to non-colonized mothers (p = 0.72). Three of thirteen (23%) colonized mothers had premature rupture of membranes and 23% (3/13) had prolonged labor > 12 h as compared to of 38 (25.1%) and 8 (5.1%) non-colonized mothers (respectively p = 0.58; NS; p = 0.035). No intra-partum fever was reported. All neonates born to colonized mothers had a birth weight > 2,800 g, an average Apgar score of 8.6 while neonates of non-colonized women had a weight > 2,800 g in 89.4% of cases and an average Apgar of 8.8 (p = 0.9). Two (15.4%) newborn infants born to colonized mothers had an early neonatal infection: one had a pneumonia and had a favorable outcome, the other one developed sepsis and meningitis and died on day 3. CONCLUSION: Despite the low rate of Streptococcus agalactiae (group B) colonization (found in our population), regular identification of the organism is recommended because of the high risk of neonatal infection with a high mortality. Further studies on a larger group are needed to confirm such an approach.
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