Biomedical subjects

M Nazzal

Publications and source records attributed to M Nazzal.

14 recordsLinked to original sources

PubMed2001

Stroke rehabilitation: application and analysis of the modified Barthel index in an Arab community.

PURPOSE: The primary aim was to provide experience with a functional evaluation instrument (modified Barthel index MBI) that assures the quality of work and identify its deficiencies, familiarize our staff with the feasibility of its application on our local inpatients and educate our personnel in the field of stroke rehabilitation. The secondary aim was to collect data that are measurable and reproducible, identify specific local factors that adversely affect outcomes and serve as a feedback system to our national organizations. METHODS: In this prospective/retrospective study we evaluated 80 hemiplegic patients with completed stroke, admitted to hospital during the year 1989 1990. They were assessed by a neurologist, physiatrist and physiotherapist on admission and discharge using the MBI. All patients received comprehensive inpatient rehabilitation. The study was interrupted at the beginning of the Gulf crisis. However, the data were revived and retrospectively studied in the year 1994-1995. RESULTS: The MBI proved to be fully acceptable and easily applicable in our community. The rehabilitation staff became rapidly familiarized with its application and the reproduction of its data. The goals of rehabilitation were achieved through the reduction in the number of individuals in the more severe MBI scores and the increase in the number of individuals in the less severe ones. Significant improvements occurred in dressing of the upper and lower body, washing, grooming, care of perineum, transfer chair, toilet and walking on a level of 50 yards (p < or = 0.0005). CONCLUSIONS: We conclude that MBI is simple, convenient, efficient, gives exact and accurate information about daily activities and ambulation and could be used in inpatient follow up sittings, in the Arab and culturally similar Middle East countries.

Activities of Daily Living↗

PubMed1998

Nd Yag laser angioplasty: a safe procedure in peripheral vascular surgery.

BACKGROUND: Thirty-three patients (34 limbs) with peripheral vascular occlusive disease were treated with Nd Yag laser assisted angioplasty over a three-year period (1989-1991). METHODS: Sixteen males and 17 females were included in the study. The mean age of all patients was 70.29 (44-86) years. Twenty-two (66.7%) patients were smokers, 21 (63.6%) had coronary artery disease and 14 (42.4%) had diabetes mellitus. Thirty-three patients (100%) had disabling intermittent claudication, 20 patients (60.6%) had rest pain, 2 patients (6.1%) had ulcers and 10 patients (30.3%) had gangrenous changes. Thirty-nine vessels were treated; 34 (87.2%) superficial femoral arteries, 4 (10.3%) popliteal arteries and 1 external iliac artery. Eleven (28.2%) vessels were totally occluded and the remaining 28 (71.8%) vessels had high grade stenosis of more than 90%. The mean preoperative ABI Index was 0.23+/-12. RESULTS: The preoperative angiogram showed poor out-flow in 24 (70.6%) extremities, 1 patent distal vessel in 7 extremities (20.6%) and at least 2 vessels in 3 extremities (8.8%). The patients were followed up for a period of 9.9 months (20 days-30 months). The procedure could not be done in 2 extremities. All the remaining 32 extremities had patent vessels at the end of the procedure. Fifteen (48.4%) patients stated that they improved but remained symptomatic. Twelve (38.7%) were completely asymptomatic, 3 (9.7%) patients had no change in their symptoms and 2 patients worsened at the end of the follow-up period. The mean postoperative ABI was 0.78. Bleeding from the puncture site requiring closure was the most common complication of the procedure in 6 patients (19.4%). Angioplasty in 5 of these patients was done by the open technique. Other complications included hematoma in 3 (9.7%) patients and one case (3%) of artery perforation. Among those who remained asymptomatic at the end of the follow-up period the mean change in ABI was 0.625+/-0.19, those who improved but remained symptomatic the mean ABI change was 0.43+/-0.25 while those whose symptoms did not change or worsened the mean ABI change was 0.12+/-0.13. The ABI change in the first two groups was significantly higher than the last one (p<0.006 and p<0.001 respectively). There was no significant difference in the outcome of LABA between stenosed and occluded vessels. Smoking was significantly higher in the symptomatic patients (7/20) compared to those who were asymptomatic 5/12, p<0.02. Diabetes mellitus, cardiovascular disease and the preoperative ABI were not significant variables in the outcome of angioplasty. CONCLUSIONS: In conclusion, Nd Yag laser assisted angioplasty is a safe procedure. It could relieve symptoms in 87.1% of cases. Change in the ABI and smoking are predictive of the success of the procedure.

Adult↗

PubMed1997

Laparoscopic appendectomy: a viable alternative approach.

Laparoscopic appendectomy (LA) is relatively a new technique and requires comparison to open appendectomy (OA) to determine the more favorable approach in the surgical management of acute appendicitis. We designed this study to compare the course and postoperative complications between LA and OA. We reviewed the charts of both groups of patients and followed their course in the hospital. Seventy-seven patients who underwent LA with one conversion to the open technique (1.3%) were compared to 84 patients who underwent OA. There was no difference in age and sex distribution. The mean hospital stay was shorter in the LA (32.5+/-10 vs 74.2+/-24 h, p < 0.0001). Parenteral analgesia requirement was higher in the OA group (4.7+/-1.4 vs 2.6+/-2, p < 0.0001). The total cost was higher in the OA group ($11,260+/-4000 vs 7,090+/-3500, p < 0.05). There was no significant difference in the OR time, duration of the procedure, and surgery costs between both groups. Normal appendices removed were similar in both OA and LA groups (23.8 vs 28.9%). There was no difference in the rates of postoperative complications between both groups. We conclude that LA is a viable alternative to OA. It is safe, cost effective, and less invasive than the OA with less pain and shorter hospital stay.

Acute Disease↗

PubMed1996

Spontaneous duodenal perforation in neonates: a case report and review of literature.

Although duodenal perforation in neonates is an extremely rare entity, it should be suspected in any case with signs of viscus perforation. If found in the absence of possible causes, duodenal perforation is considered to be spontaneous. It is believed to be of multifactorial origin. Once found primary closure with or without omental patching is the treatment of choice. In this article we describe one case of spontaneous perforation and analyze the possible causes.

Duodenal Diseases↗

PubMed1995

Tumor necrosis factor-alpha: a marker for peritoneal adhesion formation.

This study investigates the possible correlation between higher levels of tumor necrosis factor-alpha (TNF-alpha) and higher rates of adhesion formation following standard bowel injury. Forty-five Sprague-Dawley rats were divided into three equal groups. Blood was obtained from all rats preoperatively. All rats were subjected to a laparotomy. In group 1 the peritoneal cavity was irrigated with normal saline. In group 2 the cecal serosa was abraded, while rats in group 3 had 2 cm of their small bowel resected. A peritoneal catheter was placed in all rats prior to closure. Blood samples were obtained at 30, 90, and 180 min following injury. Peritoneal exudate (PE) was collected and the catheter removed in 3 hr. Blood samples and peritoneal exudate were processed and levels of TNF-alpha were determined. The severity of adhesions was graded 3 weeks postoperatively using a score of 0 (absent) to III (extensive, dense). Histological evaluation for collagen deposition and fibroblasts was carried out. Rats in group 1 had significantly lower adhesion grades when compared to groups 2 and 3 (grade 0; P < 0.0001). Postoperatively, groups 2 and 3 had higher serum and PE TNF-alpha levels when compared with group 1 (P < 0.01). There was a significant correlation between higher grades of adhesions and higher levels of serum and PE at 30, 90, and 180 min following operation (P < 0.01 and < 0.05, respectively). TNF-alpha, a proinflammatory cytokine, appears to be a good biological marker for postoperative intraabdominal adhesion formation.

Animals↗

PubMed1995

Preoperative administration of antibodies against tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 (IL-1) and their impact on peritoneal adhesion formation.

This study investigates the effects of preoperative intravenous administration of antibodies against TNF-alpha and IL-1 on peritoneal adhesion formation. Fifty-six Sprague-Dawley rats (350-400 gm) were used in this study. Eight rats were used to empirically determine the amount of anti TNF-alpha and anti IL-1 needed for complete in vivo neutralization. This amount was used for preoperative treatment of selected groups. Forty-eight rats were divided into four equal groups (n = 12). All rats underwent a midline laparotomy. Ten cm square of cecal serosa was abraded, the peritoneal cavity was irrigated with normal saline, and the incision was closed in layers. Cultures were obtained intraoperatively and rats with positive cultures were excluded. Rats in Group 1 were not treated (control), while rats in Groups 2, 3, and 4 were treated with anti TNF-alpha, anti IL-1, and a combination of anti TNF-alpha and IL-1 respectively. All rats were killed at 3 weeks, and peritoneal adhesions were graded using a scale of 0 (none) to 3 (extensive, dense). Rats treated with anti IL-1 (Group 3) and those treated with a combination of anti TNF-alpha and anti IL-1 (Group 4) had significantly fewer adhesions when compared with Group 1 (control) (P < 0.01 and < 0.005, respectively). Least adhesion formation was associated with Group 4 rats. In conclusion, selective immunosuppression, at a molecular level, appears to have a significant impact on rates of postoperative peritoneal adhesion formation.

Animals↗

PubMed1995

Cryptococcal meningitis and confusional psychosis. A case report and literature review.

A previously healthy and immuno-competent 22-year-old man presented in confusional psychosis. Cryptococcal meningitis was later found to be the underlying cause as proven by culturing Cryptococcus neoformans serotype A from the cerebrospinal fluid. Combined antifungal therapy with amphotericin B and 5-fluorocytosine resulted in sustained improvement of all mental and physical functions. Cryptococcosis has rarely been reported from the Middle East. This represents the second case from Kuwait.

Adult↗

PubMed1994

Hemodynamic sequelae of combined arteriovenous injury in an experimental canine hindlimb model: venous ligation vs. repair.

The hemodynamic effects of combined venoarterial injury and stasis were studied in the hindlimbs of 10 dogs. Femoral arterial blood flow and pressure, peripheral venous pressure, and peripheral resistance were measured after the restoration of blood flow following venoarterial injury and a 4-hour period of occlusion for up to 72 hours. In one limb of each animal both the artery and vein were repaired, whereas only the artery was repaired in the other limb and the vein was ligated. Arterial blood flow was similar in both groups but was significantly diminished from baseline for the first 30 minutes after restoration of blood flow, but then it became significantly reduced in the limbs with venous ligation when compared with values in those with venous repair. By 72 hours the flow on both sides returned to control values. Peripheral venous hypertension and edema occurred in all 10 limbs with venous ligation and persisted for the 72-hour experimental period. In the 10 limbs with venous repair, edema occurred in four and venous hypertension in none. The peripheral resistance was elevated on both sides; this elevation persisted for 75 minutes and then dropped to control values. None of the repaired arteries and only one repaired vein thrombosed during the experiment. Combined venous and arterial occlusion for 4 hours reduced both the amount of arterial flow and its subsequent rate of increase compared with changes seen after release of an acute venous occlusion. The rate of increase was enhanced by repair of the affected venous segment compared with simple venous ligation.

Animals↗

PubMed1994

Laparoscopic cholecystectomy: analysis of the complications at a community hospital.

With the worldwide acceptance of laparoscopic cholecystectomy (LC) as the treatment of choice for symptomatic gallbladder disease, great concern has grown over the spectrum of complications associated with this new procedure. The nature, causes, frequency, as well as ways to avoid these complications have been the subject of many articles and studies. Although it is established that the frequency of the major complications decreases with increased experience, there will still be new surgeons performing the procedure with limited experience in the early stages of their surgical practice. Therefore, continuous efforts should be exerted to bring to a minimum the number of serious morbidities, especially common bile duct injuries. Review of each institution's experience and sharing it with other medical centers may be a valuable approach to achieve this important goal. In this report, we will analyze the spectrum of complications we encountered during our experience with LC as well as some recommendations to avoid some of the serious morbidities related to this procedure.

Adolescent↗

PubMed1991

Forskolin impregnation of small calibre PTFE grafts lowers early platelet graft sequestration and improves patency in a sheep model.

Synthetic vascular grafts have a thrombogenic surface which plays a role in graft failure. Systemic pharmacologic interventions have been used to lower platelet sequestration onto the graft surface but are associated with side effects. In this communication we describe the results of a new therapeutic principle of applying forskolin, a powerful cyclic adenosine monophosphate stimulator (cAMP) to the inner surface of PTFE vascular grafts. The grafts were evaluated with Indium-III-oxine labelled platelets and by graft patency on 3 consecutive days after implantation at 1 month and 3 months. Forskolin significantly lowered early platelet sequestration onto the treated graft surface when compared with controls. Graft potency at 1 and 3 months was also significantly higher in the forskolin treated grafts.

Animals↗

PubMed1991

Direct platelet effect of low molecular weight dextran in small calibre PTFE grafts.

The thrombogenicity of synthetic vascular grafts is a major factor in occlusion of grafts when they are used to bypass small calibre arteries. In this paper, the effect of low molecular weight dextran (LMWD, Dextran-40) on graft surface-platelet interaction was studied using Indium-III-oxine labelled platelets. It was found that LMWD significantly reduced platelet deposition onto graft surfaces (P less than 0.001). Dextran had a direct antiplatelet effect independent of plasma volume expansion as dextran-soaked grafts significantly reduced platelet deposition when compared to systemic dextran administration (P less than 0.001). We therefore conclude that LMWD has a direct antiplatelet effect which is beneficial in reducing platelet deposition on synthetic PTFE grafts which may improve the early patency of such grafts.

Animals↗

PubMed1991

Effect of Ridogrel, a thromboxane receptor blocker and synthesis inhibitor on plasma and red blood cell flow in an arterial skin flap in sheep.

This study evaluates the effect of the new combined thromboxane synthesis inhibitor and receptor blocker, ridogrel, on the circulation of arterial skin flaps in sheep. Sixteen flaps, 8 controls and 8 treated with 5 mg/kg ridogrel, were investigated using 111Indium chloride labelled plasma and 99mTc labelled red blood cells (RBCs). Dynamic imaging was performed after a bolus injection using a GE 400 AT gamma camera. For each flap quantitative analysis of plasma and RBC flow was based on time activity curves obtained from 12 regions of interest. Analysis of flow data was made immediately after flap elevation and three hours later. Both plasma and RBC flows declined after 3 hours. Treatment with ridogrel significantly prevented deterioration of perfusion by increasing plasma and RBC flow mostly in the distal, ischaemic regions of the flap where stasis was evident in the control flaps.

Animals↗

PubMed1990

Thrombogenicity and long-term patency in autologous vein, polytetrafluoroethylene (PTFE) and silk grafts in a sheep model: evaluated through the use of indium-III-labeled platelets.

Vascular conduits have different thrombogenicity and since platelet sequestration onto a graft surface is a contributing factor for subsequent graft occlusion, this constitutes an important feature. Most studies on thrombogenicity have been done as short-term experiments. In the present communication we have evaluated graft thrombogenicity for autologous vein, polytetrafluoroethylene (PTFE), and pure chinese silk grafts, immediately after graft implantation, 1, and 2 months thereafter, using Indium-111-labelled platelets, evaluated platelet consumption, and studied patency up to 4 months after graft implantation in a sheep model. The least thrombogenic graft material was found to be the autologous vein, followed by the silk graft and the PTFE graft. Already 1 month after graft implantation healing of the grafts seems to have occurred, resulting in a minimal detectable platelet sequestration. Platelet consumption by the graft can be seen as a decrease in platelet count in the peripheral blood. Four months after graft implantation the autologous vein grafts showed a patency rate of 71%, the silk grafts 55%, and the PTFE grafts 38%. The pure silk prosthesis revealed though at harvest of the grafts, a high incidence of aneurysmal graft dilatation.

Animals↗

PubMed1990

Impregnation of polytetrafluoethylene (PTFE) vascular grafts with C-14-forskolin, a new concept in surface treatment of grafts.

Ten prosthetic polytetrafluoroethylene grafts (50 mm length, i.d. 4 mm) were surface treated with a 0.01% C-14-forskolin solution prior to interposition in the femoral arteries of 5 Australian sheep. The following parameters were monitored: femoral artery blood flow, platelet aggregation, C-14 blood and graft activity measured at intervals up to 120 minutes after declamping (DC). There was only a slightly decreased platelet aggregation in arterial blood samples 30 min. after DC and no changes in blood flow. After an initial peak C-14-forskolin graft activity declined rapidly during the first 30 minutes, thereafter only very slowly. C-14-forskolin blood activity also showed an initial peak and thereafter a fairly steady level 20-120 minutes after DC. These results are discussed in relation to previously very encouraging results in improving graft patency using an identical protocol of graft treatment with forskolin.

Animals↗