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Biomedical subjects

M Jabbour

Publications and source records attributed to M Jabbour.

8 recordsLinked to original sources
PubMed2000

Necrotizing fasciitis in children in eastern Ontario: a case-control study.

BACKGROUND: Early recognition and treatment are important factors that can help improve survival following necrotizing fasciitis. However, early recognition is complicated by the difficulty in distinguishing the infection from other, less serious soft-tissue infections such as cellulitis. We reviewed the charts of children presenting with necrotizing fasciitis at a tertiary care pediatric hospital in Ontario to document potential increases in the frequency of cases and to identify clinical and laboratory features that could help distinguish between necrotizing fasciitis and cellulitis. METHODS: Necrotizing fasciitis was defined as a soft-tissue infection characterized by necrosis of subcutaneous tissue and confirmed at surgery or on pathological examination. A retrospective chart review was conducted to identify cases of necrotizing fasciitis that occurred between June 1, 1983, and May 31, 1999. The characteristics of the identified cases, their clinical manifestations and the laboratory features at presentation were compared with those of matched controls admitted to the hospital with cellulitis. RESULTS: In total, 8 cases of necrotizing fasciitis were identified during the study period. There were no cases from 1983 to 1987, 1 from 1988 to 1991, 1 from 1992 to 1995, and 6 cases from 1996 to 1999. Compared with the children who had cellulitis, those who had necrotizing fasciitis were more likely to present with a generalized erythematous rash (odds ratio [OR] 11.0; 95% confidence interval [CI] 1.5-81.6) and a toxic appearance (OR 23.0; 95% CI 2.0-262.5). They were also more likely than the children with cellulitis to have a history of fever (8/8 v. 10/24, p = 0.004), a higher temperature (mean 38.7 degrees C v. 37.8 degrees C, p = 0.006), a higher respiratory rate (mean 31.5 v. 25.4 breaths/min, p = 0.02) and a lower platelet count on presentation (mean 194.0 v. 299.3 x 10(9)/L, p = 0.03). INTERPRETATION: On presentation, factors that may help distinguish necrotizing fasciitis from cellulitis include a generalized erythematous rash, toxic appearance, fever and low platelet count.

Adolescent↗
PubMed1998

Treatment of staghorn calculi by percutaneous nephrolithotomy and SWL: the Hotel Dieu de France experience.

To evaluate the combined approach of percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (SWL) in the treatment of staghorn calculi, we carried out a retrospective review of 101 patients. The stone surface area ranged from 654 to 3042 mm2 (1535 mm2 on average). During PCNL, a single access tract was used in 22 patients, a double tract in 65 patients, and a triple tract in 14 patients. A double-J stent was placed percutaneously in 62 patients. Extracorporeal lithotripsy was scheduled at the patient's convenience on an outpatient basis approximately 2 weeks after PCNL. The mean hospital stay was 4.4 days. The combined approach showed a stone-free rate of 67% on the initial evaluation, an insignificant residual fragment rate of 26%, and a residual stone rate of 7%. With a follow-up of 52 months on average, the global stone growth rate was 17%, being 4.4% only among the stone-free group and 27% among the group with insignificant residual fragments. The global transfusion rate was 10%. Percutaneous stone debulking combined with SWL on an outpatient basis is an efficient, minimally invasive treatment for staghorn renal calculi. Reducing the number of access tracts, using the flexible nephroscope liberally, and placing a double-J stent frequently after PCNL increases the stone-free rate while reducing the morbidity and hospital stay.

Adult↗
PubMed1997

Management of posttraumatic posterior urethral disruption.

We reviewed our experience with 17 cases of posterior urethral disruption due to traumatic pelvic injuries. In all cases, a suprapubic cystostomy was performed at first. For blunt injuries, urethroplasty was delayed for 6 months in average. For most of the penetrating injuries (3/4), we performed immediate debridement and primary repair. Resulting bulbous or membranous strictures less than 3 cm long were treated with one-stage perineal excision-reanastomosis urethroplasty. Membranous strictures longer than 3 cm were managed with a combined transpubic-perineal repair, while bulbous defects longer than 3 cm were treated with a scrotal pedicled island flap. The overall restricture rate was 25%. Those having had initial repeated urethrotomies displayed a 100% restenosis rate. Incontinence rate was 12.5% Erectile dysfunction occurring in 42% of our patients is a sequela of the pelvic injury and was found to be directly related postoperatively to its presence at the time of surgery.

Accidents, Traffic↗
PubMed1996

Life support courses: are they effective?

STUDY OBJECTIVE: To determine the effectiveness of life support courses for health care providers on the basis of one of three outcomes: (1) patient mortality and morbidity, (2) retention of knowledge or skills, and (3) change in practice behavior. METHODS: English-language articles from 1975 to 1992 were identified through MEDLINE and ERIC searches, bibliographies of articles, and current abstracts. Studies were considered relevant if they included a study population of life support providers, an intervention of any of the identified life support courses, and assessment of at least one of the three listed outcomes. Relevant studies were selected and validity scores were assigned to them by agreement of two independent reviewers, using a structured form to assess validity. Data on setting, methods, participants, intervention, and outcomes were then abstracted and verified. RESULTS: Seventeen of 67 identified studies pertaining to life support courses met the inclusion criteria. (1) All three mortality and morbidity studies indicated a positive impact, with an overall odds ratio of.28 (95% confidence interval [Cl], .22 to .37). (2) No net increase in scores was found in 5 of 8 studies of retention of knowledge and in 8 of 9 studies of skills retention. Two of three studies reporting refresher activities yielded positive effects on knowledge retention. Outcomes were not significantly different between groups taught with modular or didactic techniques. (3) Studies assessing behavioral outcome were methodologically weak. CONCLUSION: Among providers, retention of knowledge and skills acquired by participation in support courses is poor. However, refresher activities increase knowledge retention. Modular courses are as good as lectures for learning course material. There is evidence that use of the Advanced Trauma Life Support course has decreased mortality and morbidity. Further studies of patient outcome and provider behaviors are warranted.

Clinical Competence↗
PubMed1995

[Spontaneous splenic rupture due to heparin. Report of a case and review of the literature].

We describe in this report a case of spontaneous rupture of the spleen in a 68-year-old man on heparin therapy for cerebrovascular disease. This spontaneous splenic rupture is a rare complication of anticoagulant or thrombolytic therapy. Twenty cases were reported in the world medical literature. Only one case was due to heparin. The clinical presentation, which includes mainly abdominal and left shoulder pain with shock, could mimic cardiac diseases and delay or even mask the diagnosis. The mechanism of the rupture is still unknown. It is possible that altered hemostatic mechanisms may aggravate unrecognized micro trauma to provoke a rupture of the spleen. Once the rupture is suspected, the diagnosis can be confirmed with CT scan, or ultrasound. The treatment will be mainly reversal of anticoagulation and splenectomy.

Aged↗
PubMed1985

[Oral and cutaneous lesions in Crohn's disease. A case report].

Cutaneous and buccal manifestations of Crohn's disease are common. They are diagnostically helpful either by their specificity or from a biopsy which whilst access is easy offers less satisfactory results with buccal lesions. Stomatological clinical aspects are varied, most commonly of aphthoid or vesicular stomatitis type (as in the case reported here).

Adult↗
PubMed1985

[Idiopathic bilateral salivary megacanals. Apropos 16 cases].

Investigation in 16 patients attending the stomatology outpatients clinic over the last 18 years has enabled definition of a particular radioclinical entity that has been named "idiopathic bilateral salivary megacanal". This generally parotid affection occurs in patients between 50 and 60 years, the onset usually being by an episode of sialodochitis. In addition to these inflammatory attacks there is the persistence of a bilateral "salivary ejaculation" from the ostia of the principal glands, sometimes after manual expression of a mucoid plug. Sialography shows dilatation of canals, the appearance being very suggestive for Stensen's duct, which becomes sinuous, enrolled and segmented. Dilatation is bilateral and affects the total length of the duct. The problem arises as to whether etiopathogenicity is from parietal canalar dysplasia or a constitutional anomaly of the nerve plexus comparable with that described in congenital megacolon. The latter hypothesis is plausible but requires confirmation from histopathology. The always benign course of the disease justifies conservative therapy only: oral antibiotics and canal massage several times a day, with a neostomy only when absolutely necessary.

Aged↗