Biomedical subjects
Publications and source records attributed to M Haddad.
Aortocaval fistula is a rare phenomenon which has both acute and chronic clinical presentations. Its diagnosis and treatment are difficult and it presents a surgical challenge of the first degree, requiring intensive perioperative care. A patient with an aortocaval fistula is described. It was found during emergency operation for a ruptured abdominal aortic aneurysm.
Explore the source record for details and available documents.
A 10-year-old boy presenting with recurrent successive events of peripheral arterial occlusion in both legs, more prominent on the left side, was diagnosed as having acute promyelocytic leukemia. Histological examination of the occluding material showed that it was composed of leukemic blast cells. The boy underwent five operations. Each time the arterial flow was reestablished by removing cylindrical hollow white material obstructing the lumen. However, after the last operation, irreversible ischemia developed, necessitating an above-knee amputation. There was no evidence of disseminated intravascular coagulation. Three months later a right lumbar sympathectomy was performed for relief of causalgic-ischemic pains, with successful results. Preoperative angiography demonstrated irregular narrowing of the right iliac arteries and tibioperoneal trunk stenosis.
We report a clinico-pathological case of neurosarcoidosis characterized by chronic meningitis, intracranial hypertension, bilateral optic atrophy, arthritis and enlargement of liver and lung hilar nodes. Synovial and supraclavicular node biopsies showed multiple non caseating nodules without tubercle bacilli, Candida albicans and Cryptococcus neoformans. Post-mortem examination showed a severe meningeal lymphoplasmocytic infiltration with numerous non-caseating nodules, several giant cells and presence of Candida albicans. There were also a periventricular infiltration of similar cells and numerous cerebral and cerebellar infarctions. We think that the Candida albicans meningitis was a consequence of the immunodepression of sarcoidosis and of corticosteroid therapy.
A TI-59 programmable calculator program is presented for calculating either risk probability, sample size or confidence level (given 2 of the 3 variables) in cases in which an event of concern did not occur, or as expressed mathematically, had zero numerators. Its main usefulness is as a tool for interpreting previously published data containing no adverse event of concern while contemplating medical alternatives. These conditions are not infrequent in rare medical events--either diseases or complications. However, applicability of the program extends beyond these confines, exemplified in experimental planning for considering expected sample size or in calculating certainty in terms of confidence level.
Eight patients were treated for ischemic venous thrombosis of the extremities. The patients were evaluated retrospectively concerning their history, clinical signs and symptoms, management and follow-up. Neoplastic disease and immobility were the major etiological factors. Once diagnosed, an urgent combined medical and surgical approach proved to be successful in all patients as far as restoration of blood flow to the limb was concerned.
The problem of long waiting list of patients for varicose vein surgery may be eased by bilateral operation when both limbs are involved and not in two separate operations as is the practice in many surgical centers. We found that patients undergoing unilateral high ligation and stripping did not differ from patients who had bilateral limb operation in terms of complications, morbidity and length of hospitalization. Most of our patients were released after one day of hospitalization. Therefore, we recommend bilateral operation when there is an indication, rather than two unilateral operations.
Flexion of the shoulder, abduction, and external rotation in 90 degrees abduction are impaired after operations for breast cancer. We compared postoperative range of motion in 27 patients who underwent modified radical mastectomy and 21 patients who underwent quadrantectomy with axillary dissection and radiation therapy. The patients in the quadrantectomy group demonstrated a significantly higher range of flexion on postoperative day 1 and the day of suture removal. After 3 months, all patients had regained their preoperative range of flexion, with no difference between the groups. The better compliance of the quadrantectomy group to physical therapy may indicate that they suffer less pain and require a briefer or less intensive course of physical therapy.
Unusual presentations of aortoiliac aneurysms may be the reason for a delay in diagnosis of potentially life-threatening conditions. Five such unusual clinical pictures are presented and discussed. The aneurysms were falsely diagnosed as malignant disease, renal colic, sciatic syndrome, intra-abdominal bleeding of unknown origin, and psoas muscle abscess. The medical staff was misled by the atypical complaints, signs and symptoms, which resulted in a dangerous delay in diagnosis. The use of currently available ultrasonography and CAT scans, which enables early diagnosis, depends on the alertness of clinicians when they confront an atypical clinical picture that may be the first clue of a noninnocent aneurysm of the aortoiliac complex. Early surgical intervention before dissection, rupture or fistulization occur ensures a positive outcome and avoids emergency procedures with their attendant high operative mortality and postoperative morbidity.
Explore the source record for details and available documents.
The case of a 54-year-old man with a large right retroperitoneal liposarcoma presenting with bilateral leg lymphedema, is reported. Total excision of the tumor resulted in marked reduction of the edema in both legs persisting for four years. Follow-up lymphographies demonstrated lymphatic drainage dysfunction on both sides; nevertheless, the edema did not recur. Based on these findings, a non-compressive hypothesis concerning the evolution of lymphedema in this case is postulated.
The authors describe their experience with two patients who presented with clinical extremes of popliteal entrapment syndrome. One patient presented with acute ischemia and the second patient presented with a chronic Buergerian-like syndrome. The common denominator for both of them was embolic phenomena originating at the site of entrapment. Discussion is centered on pathogenesis of the embolic phenomenon, prevalence of distal arterial degradation and its clinical manifestation. The clue for differentiation from true Buerger disease is the angiographic pattern demonstrating apparently healthy distal arterial segments, confirmed by mandatory arterial biopsy. It is emphasized that in cases having acute embolic presentation the primary pathology should be treated concomitantly to revascularization.
Primary aorto-enteric fistulae are rare. Preoperative diagnosis is important but is difficult and cannot usually be confirmed by upper gastrointestinal series, aortography and endoscopy. Computed tomography demonstrating an abdominal aortic aneurysm with air bubbles in its wall and "soft tissue" mass posteriorly should raise the possibility of penetration of the aneurysm into the lumen of the bowel and related consequences (hematoma, sepsis, infected operating field).
Complex renal artery lesions which formerly would have been treated by nephrectomy may now be reconstructed by extracorporeal surgery and autotransplantation. Our experience in 15 patients (17 operations) with renal artery lesions extending into its branches or confined to them is described. Two patients underwent separate operations on both sides. The indications for surgery were severe renovascular hypertension (10 cases), renal artery aneurysm, (5 cases) and deteriorating renal function (2 cases). Overall clinical results after a mean follow up of 3 years were considered excellent in 13 procedures (11 patients). Improvement in 2 patients and failure in the other 2, who ultimately underwent nephrectomy. Discussion is focussed on results, vascular indications, (namely aneurysm, stenosis, dissecting aneurysm and trauma) and surgical techniques. Preservation of functioning renal tissue should be the ultimate goal of renovascular surgery where the ex vivo technique, when indicated, will achieve favorable results in most patients.
Two brothers presented to us with a progressive myoclonic syndrome with slight cerebellar symptoms. Neurological examination disclosed moderate cerebellar signs and pale optic discs; asymmetric, asynchronous and arrhythmic myoclonus, an arrthesthesic deficit and no muscular weakness. EEG background activity was moderately slow with no irritative discharges. CT was normal in both cases. Intermittent photic stimulation increased the frequency of the myoclonic jerks, which became bilateral and synchronous, progressing to a generalized tonic-clonic seizure. EPs and MRI in one case were normal. Anticonvulsant drugs were ineffective. The diagnosis of mitochondrial encephalomyopathy was based on the finding, in muscle specimens, of thickened basement membranes with myofibrillary degeneration and increased number of mitochondria peripherally distributed and with a dense granular matrix and some vacuoles. The clinical and EEG data suggest a subcortical origin for this type of myoclonic syndrome.
Chylocolporrhea or chylous vaginal discharge is a rare manifestation of the primary chylous reflux syndrome. We describe its occurrence in a young child successfully treated by ligation of retroperitoneal, groin, and vaginal megalymphatics.
Patients over 70 years of age suffering from varicose veins or complications of venous insufficiency formed 6.7 per cent of the population treated in our phlebologic clinic in 10 years. This group of patients is unable to perform intensive walking exercises and fails to use high-pressure elastic stockings; thus, most of the so-called "conservative armamentarium" is nonapplicable. This challenged us to find alternative or modified ways of treatment for this high-risk-for-surgery group. An isolated Trendelenburg procedure under local anesthesia, with sclerotherapy and/or transfixion sutures as an outpatient procedure, was used. In the case of stasis ulceration, patients were treated with sequential intermittent pneumatic compression including local hyperbaric oxygen and teaching the use of elastic support as an inhospital procedure. Both methods proved successful, thereby offering a more acceptable solution to one of the chronic problems of the older age group.