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Biomedical subjects

M Kassab

Publications and source records attributed to M Kassab.

At least 19 recordsLinked to original sources
PubMed2005

[Twenty nine shoulder reconstructions after resection of the proximal humerus for neoplasm with mean 7-year follow-up].

PURPOSE OF THE STUDY: Techniques available for shoulder reconstruction after resection of a tumor of the proximal humerus include scapulohumeral arthrodesis, humerus prosthesis with or without an allograft, inverted prostheses, and massive allografts. The purpose of this study was to review clinical and radiological outcomes in a series of 29 patients (20 men and 9 women) who underwent resection-reconstruction of the proximal humerus and to establish from these cases a decision making algorithm for therapeutic indications as a function of tumor invasion. MATERIAL AND METHODS: The tumors were 20 chondrosarcomas, five osteosarcomas, two Ewing sarcomas and one malignant hemangiopericytoma. In 17 patients epiphyso-metaphyseal or epiphyso-metaphyso-diaphyseal resection was performed with preservation of the abductor muscles (type S34A or S345A according to the Musculoskeletal Tumor Society classification). For 12 patients epiphyso-metaphyseal or epiphyso-metaphyso-diaphyseal resection was performed without preservation of the abductor muscles (type S34B or S345B). Reconstruction was achieved using a centromedullary cemented nail in one patient, scapulohumeral arthrodesis in three, a massive humerus prosthesis in 15, and composite humerus prosthesis in three and an inverted prosthesis in seven. The functional score of the Musculoskeletal Tumor Society (MSTS) and standard x-rays were used to assess outcome. RESULTS: Mean follow-up was 85 months (range 16-300). The mean MSTS score was 88% for inverted prostheses, 76% for composite prostheses, 72.6% for massive prostheses, 75% for scapulohumeral arthrodeses, 67% for massive prostheses, and 80% for cemented centromendullary nail. Five patients died from their malignant disease and one from another cause. Four patients are alive but with active disease after a mean follow-up of 108 months and 19 patients (65.5%) are alive and free of locoregional recurrence or metastasis after a mean 83.5 months. We had 28 complications. Glenohumeral instability was the most frequent (11 cases). DISCUSSION: Resection of the upper portion of the humerus should be performed to achieve cancerologically satisfactory tumor resection and enable shoulder resection, if possible, with preservation of a viable and functional abductor system. The functional outcome after such reconstruction depends on the type of bony resection, but also on the sacrifice of the rotator cuff and the deltoid muscle. In light of our experience and results in the literature, we advocate, despite the small number of cases for the different reconstructions, the following decision-making algorithm after resection of the proximal humerus without joint invasion: when the resection removes the rotator cuff and the deltoid (or the axillary nerve), there are two options: scapulohumeral arthrodesis or massive humerus prosthesis for patients who do not desire a complex therapy with a long postoperative period; when the resection preserves the rotator cuff and/or the deltoid muscle, reconstruction can be achieved with a composite (inverted or not) prosthesis with suture of the cuff tendons. We prefer the inverted composite prosthesis; if the deltoid muscle can be preserved but not the rotator cuff, the composite inverted prosthesis appears to be the most logical solution, but scapulohumeral arthrodesis can be proposed in selected cases.

Adolescent↗
PubMed2005

[Sequelae of intra-articular calcaneal fractures: patterns and management].

PURPOSE OF THE STUDY: We reviewed retrospectively 24 feet with sequelae of transtalar process fractures of the calcaneum in order to identify the lesion pattern and determine optimal management options, both for acute and sequelar lesions. MATERIAL AND METHODS: There were fourteen men and nine women, mean age 42 years (19-73). Twenty-three had subtalar osteoarthritis, eight had calcaneocuboid osteoarthritis, and fifteen had lateral submalleolar conflicts. There were twelve fibular tendon dislocations or fissurations, three tarsal tunnel syndromes, and two plantar splinters. Prior to treatment, all patients complained of pain. Preoperatively, walking distance was less than 500 m for thirteen patients, 2000-3000 m for four, and greater than 3000 m for five. Mean subtalar joint motion was 30% (0-100%) compared with the healthy side and mean frontal misalignment of the rear foot was 6 degrees valgus. Physical examination, podoscopy and x-rays were obtained in all patients. The Kitaoka score was noted. RESULT: Mean follow-up was 36 months (24-72). Sequelae were treated with a single procedure or with combinations: subtalar arthrodesis (n = 23) including one in association with calcaneocuboid arthrodesis, tension on fibular tendons (n = 7), neurolysis of the posterior tibial nerve (n = 3), resection of plantar splinters (n = 2), resection of the lateral shell (n = 14), and osteotomy (n = 2) to lower the greater tubercle of the calcaneum because of pain when wearing shoes. The mean Kitaoka function score was 31.7/100 (14-79) preoperatively. After treatment, the mean score was 81.7/100 (31-94), giving a 73.2% gain. The outcome was considered good in sixteen feet, fair in six, and poor in two. Mean walking distance was greater than 3000 m for 18 patients. Mean frontal misalignment of the rear foot under loading was 4.5 degrees valgus and the podoscopy demonstrated flat foot in thirteen patients. Three subtalar arthrodesis required revision for nonhealing. DISCUSSION: Initial treatment of a fracture, particularly an articular fracture, of the calcaneum must avoid disabling postoperative pain and shoe wearing problems. These sequelae basically concern: subtalar and calcaneocuboid arthritis, lateral submalleolar conflict, fibular tendon injury, plantar splinters, tarsal tunnel syndrome, loss of height, and misalignment of the rear foot. At the sequelar stage, the physical examination is primordial to confirm the lesion and search for any complication which could develop later postoperatively when walking distance becomes longer. For nine patients with residual pain, four resulted from lesions which were missed at the preoperative physical examination. Arthrodesis of the subtalar joint should be preferred over realignment of the rear foot and can be associated with the treatment of conflicts. This management scheme allows treating during a single operative time all sequelae, thus limiting recovery time. A scan of the ankle and foot with or without opacification of the fibular tendons is needed to confirm the physical examination which, for us, remains the key to successful surgery.

Adult↗
PubMed2003

Ipsilateral fibular transposition in tibial nonunion using Huntington procedure: a 12-year follow-up study.

Eleven patients (10 men and 1 woman) with a mean age of 32 years (range: 16-61 years) and a mean follow-up of 12 years (range: 2-21 years) were studied retrospectively after ipsilateral fibular transposition. The cause of tibial nonunion was a motor vehicle collision (MVC) in eight patients, a fall from a window in one, an adamantinoma in one, and osteomyelitis in one. There was one type I and eight type IIIb open fractures according to the Gustilo classification, and the nonunion was infected in seven patients. Healing of the tibial defect was obtained in eight patients, after a mean interval of 10.5 months. In the patient with the adamantinoma, resection of the tumour left a 22 cm defect in the tibia. Two patients required amputation for acute local infection. Seven of the eight patients in whom tibial union was achieved were able to walk with no aids. The authors conclude that transposition of the ipsilateral fibula is a valuable component of the therapeutic armamentarium and a salvage procedure for patients with multi-operated, infected or uninfected, tibial nonunion.

Adolescent↗
PubMed1996

Aneurysm of the coeliac artery.

A case of coeliac artery aneurysm associated with multiple splanchnic artery aneurysms is reported. This abnormality involved the gastroepiploic and hepatic arteries. The coeliac artery was ligated at laparotomy and the liver revascularized by direct anastomosis of the common hepatic artery to the aorta. Arteriography on the fifth postoperative day showed a satisfactory result. The surgical problems associated with aneurysms of the coeliac artery are reviewed.

Anastomosis, Surgical↗
PubMed1990

[Postoperative vascular infections. A pathognomonic x-ray computed tomographic sign].

The potential gravity of post-operative vascular infection makes early diagnosis essential. We report a case where this diagnosis was made on CT findings alone, in the absence of any other signs of infection. Rapid intervention led to complete cure. Beyond the immediate post-operative period, the presence of gas on the CT scan is rare but pathognomonic in the absence of a cutaneous fistula. The presence of this sign is therefore sufficient to indicate that reintervention is mandatory.

Aged↗
PubMed1990

[Natural and corrected history of obliterative radiation arteritis. Apropos of 14 case reports].

Analysis of a series of 14 cases of obliterative radiation arteriopathy was carried out in order to study the clinical features, symptomatology and the results of appropriate therapy. This demonstrated that the diagnosis is often missed due to the time interval since radiation and that on the contrary the diagnosis should only be considered in precise circumstances in terms of the delay and localisation superimposed on the irradiated zone with respect of other non-irradiated zones. Diagnosis requires double investigation both in terms of the arterial disease and associated post-radiation lesions and also in terms of the malignant disease, its progression and treatment. Arterial surgery is fraught with difficulty due to sclerosis and other specific problems: skin closure problems, and in the case of a prosthesis, anastomotic breakdown and superinfection. These dangers should not be underestimated even if in the series presented there were no serious postoperative complications. The indication for surgery should therefore be carefully considered: best avoided in asymptomatic forms, dilatation for short lesions and revascularisation for widespread and symptomatic lesions, while choosing the most appropriate revascularisation procedure. Radiation arteritis should be better understood by radiotherapists who should pay attention to preventive measures and advise systematic screening after three years.

Adult↗
PubMed1989

[Lumbar sympathectomy in the aged subject: surgery or phenolization? Prospective study of early results].

Lumbar sympathectomy, which is usually indicated in the arteritic patient in cases of severe ischemia and occlusion of leg arteries when bypass surgery is not feasible, can be performed surgically or by scanner-guided phenolization. Surgical sympathectomy was performed by resection of the 2nd, 3rd, 4th and 5th lumbar ganglia under general anesthesia by a retroperitoneal route. Chemical sympathectomy involved scanner-guided injection of phenol diluted 6.7% into the sympathetic nervous system at L3 and L4 level. This act, performed on outpatients, required no anesthesia. Prospective study of the early results (within one month) obtained with these two techniques in 428 patients indicates that rates of death, amputation and noteworthy complications for those less than 70 yr (table IV, VI and VIII) were respectively 4.7%, 8.5% and 7.4% for surgery, and 2.5%, 5% and 0% for phenolization; for those greater than 70 yr the rates were respectively 12%, 11% and 10% for surgery, and 10%, 9% and 8% for phenolization. It may be concluded that phenolization of the sympathetic nervous system provides the same results as surgical sympathectomy but has the advantage of lower morbidity and shorter hospitalization (24 h vs 10 days). The results of these two techniques in terms of limb conservation are disappointing and markedly poorer than those of distal bypass surgery.

Aged↗
PubMed1989

[Aneurysms of digestive arteries. What are the indications?].

Twelve cases of visceral artery aneurysms have been retrospectively reviewed in order to evaluate the results of the various therapeutic decisions. Aneurysms were located on splenic (n = 5), hepatic (n = 1), celiac (n = 3), superior mesenteric (n = 1), pancreatico-duodenal arteries (n = 1) and superior mesenteric artery branches (n = 2). Among two patients operated on for ruptured aneurysms, one patient who suffered from free intraperitoneal hemorrhage died after the operation. All patients operated on with unruptured aneurysms survived. Among two patients who were not operated on because of the small size of the aneurysms, one died suddenly a few years later from an unknown cause which may have been a rupture, and the second one was lost from the survey. Our results and those in the literature suggest that surgical treatment (or in some cases percutaneous embolization) is indicated in any symptomatic aneurysm and in most asymptomatic aneurysms except in splenic artery aneurysms. The latter should be operated on only when the diameter is more than 2.5 cm or when they are found in pregnant women or in women with child-bearing capacity.

Adult↗
PubMed1988

[Surgery of primary hyperparathyroidism in 1988. Strategies during primary operations, in case of failure and in case of cancer].

In primary hyperparathyroidism, an operation is indicated when the calcemia exceeds 115 mg/l and phosphoremia is low in several successive instances, regardless of the symptoms, even if PTH levels and cervical ultrasonography are normal. In case of calcemia under 110 mg/l, the diagnosis must be confirmed by titration of the nephrogenic cyclic AMP and symptomatic patients must be operated upon as well as asymptomatic patients with a life expectancy exceeding 10 years. In case of acute hypercalcemia, the procedure must be performed as a semi-emergency without waiting for a definite diagnosis, since the course may rapidly be fatal in spite of all medical treatments. Ultrasonography mostly presents the advantage of detecting intrathyroid parathyroids glands. The experience of the surgeon is essential for the mandatory locating of 4 glands, and the choice of the surgical strategy. In front of a secondary indication for failure or recurrence, one must take into consideration what was seen and done during the first procedure, the calcemia levels and clinical, radiological or biological consequences. Finally, in case of cancer (2 p. cent), the best prognosis rests in wide excision of the thyroid compartment and nodes areas, since medical treatments and radiation therapy are ineffective.

Female↗
PubMed1988

Adventitial cystic disease of the popliteal artery: treatment by cyst removal.

Controversy still exists concerning the optimal treatment for adventitial cystic disease of the popliteal artery: complete removal of the cyst without arterectomy or arteriectomy with venous replacement. In the two cases presented here, it was possible to completely excise the cyst and to preserve a solid arterial wall despite the magnitude of lesions documented on preoperative angiograms. Good functional and anatomic outcome has been maintained for 5 and 9 years, respectively. According to the available literature on pathologic data, complete cyst excision without arterial reconstruction is often feasible. Our results, as well as those published by others, suggest that short- and long-term outcome is better after complete cyst removal without than that with arterial reconstruction. As most patients are generally young adults, cystic excision should be preferred to venous bypass whenever feasible and whenever the remaining arterial wall seems to be healthy and solid.

Adult↗
PubMed1987

[Diagnosis and localization of primary hyperparathyroidism].

The diagnostic value of pre-operative laboratory tests and current imaging methods was evaluated in a series of 65 patients operated upon for primary hyperparathyroidism. Among laboratory tests, nephrogenous cyclic AMP and PTH serum levels had sensitivities of 100% and 71.7% respectively. Total urinary cyclic AMP and bone biopsy were much less reliable. Imaging procedures were mainly real-time ultrasonography and thallium-technetium substraction scintigraphy with sensitivities of 50.8% and 46.7% and specificities of 86.3 and 76.3% respectively. Failure of cervical exploration occurred in only one case and was attributed to an incorrect diagnosis (1.5%). Thus the selective use of these preoperative investigations may be envisaged in the following cases: hypercalcemic crises, highly probable PHP, uncertain PHP and in secondary surgical exploration.

Adult↗
PubMed1987

[Accidents caused by arteritis after fracture or tibial osteotomy].

In five cases of fracture or osteotomy of the tibia complicated by delayed union, non-union or infection, a latent chronic vascular insufficiency was belatedly discovered, often after failure of local treatment. It was responsible for the complication, since, in all the cases, the restoration of arterial patency resulted in healing. A study of the arterial circulation should be made, especially in smokers, when there is delay in union.

Aged↗
PubMed1986

[Femoro-popliteal endarterectomy using a pneumatic oscillator].

In patients with severe ischaemia from femoro-popliteal thrombosis, but without suitable vein for bypass, a synthetic or bioprosthesis is usually installed. This is a costly method giving statistically mediocre results. An alternative method is femoro-popliteal endarterectomy performed with rings that are made to oscillate by a pneumatic motor. The procedure requires 3 arteriotomies: one at each end and one in-between to insert rings of a different caliber. Arteriography is mandatory at the end of the operation. This type of endarterectomy is feasible only when blood flow is adequate upstreams, when the femoro-popliteal axis is not calcified and when at least one artery of the leg remains patent. The method is less expensive, and its early results apparently better than those of prostheses extending beyond the knee.

Endarterectomy↗
PubMed1985

Pelvimetry by digital radiography.

We studied the ability of digital radiographs generated on a computed tomography scanner to replace conventional pelvimetry. Two digital radiographs were usually sufficient to measure the maternal pelvis. The antero-posterior (AP) digital radiograph allowed measurement of the transverse diameter of the pelvic inlet, the interspinous distance and the intertuberous diameter. These three distances were corrected for magnification after reference to the lateral digital radiograph. The lateral radiograph gives the AP diameter of the pelvic inlet and the low sagittal diameter. Dosimetry studies demonstrated that maternal skin doses and fetal gonad doses were very low. Pelvimetry using digital radiography is a simple procedure which offers the advantage of low radiation exposure to both fetus and mother and a high accuracy of measurement.

Female↗