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Biomedical subjects

M Nouri

Publications and source records attributed to M Nouri.

At least 19 recordsLinked to original sources
PubMed2001

Endophthalmitis after keratoprosthesis: incidence, bacterial causes, and risk factors.

OBJECTIVES: To determine the rate of endophthalmitis in a group of patients with keratoprostheses and to analyze possible risk factors. METHODS: A total of 108 patient eyes, operated on between 1990 and 2000 with double-plated keratoprostheses, were analyzed with regard to the surface flora, the incidence and cause of bacterial endophthalmitis or sterile vitreitis, the keratoprosthesis design, prophylactic antibiotics, concomitant immunosuppression, and preoperative diagnosis. RESULTS: Surveillance cultures were obtained from 30 uninfected eyes. The flora was similar to that reported in the normal population and did not vary significantly with time. Thirteen cases of bacterial endophthalmitis occurred 2 to 46 months postoperatively in the patient population that had been followed up for 2 months to 17 years (average, 3 years 4 months). The incidence was 39% in 13 patients with Stevens-Johnson syndrome, 19% in 27 patients with ocular cicatricial pemphigoid, and 7% in 28 patients with ocular burns. Only 1 of the other 40 cases (consisting mostly of repeated graft failures in noncicatrizing conditions) developed endophthalmitis; this patient had a filtering bleb. All endophthalmitis pathogens were gram positive: Streptococcus pneumoniae, 23%; other streptococci, 39%; Staphylococcus aureus, 23%; and Staphylococcus epidermidis, 15%. CONCLUSIONS: The most important risk factor for endophthalmitis after these keratoprostheses was found to be preoperative diagnosis. The rate of infection was very high in Stevens-Johnson syndrome and ocular cicatricial pemphigoid, moderate in chemical burns, and low in noncicatrizing corneal disease.

Anti-Bacterial Agents↗
PubMed2001

[Bilateral emphysematous pyelonephritis].

Based on a case report and a review of the literature, the authors describe the features of bilateral emphysematous pyelonephritis. This rare disease with a poor prognosis constitutes a difficult clinical diagnosis. The positive diagnosis is based on urgent computed tomography. The reference treatment is emergency nephrectomy in an intensive care context.

Aged↗
PubMed2001

[Martius' technique in the treatment of complex vesicovaginal fistula].

Sixteen cases of vesicovaginal fistulae (including 14 urethrovaginal fistulae), were treated vaginally using Martius' procedure. The authors describe the technique for the interposition of a labial fat pad, between the bladder and the vagina. The results are good. Thirteen patients have been cured. In one case a second was necessary using Guittes technique. There was two failures.

Adult↗
PubMed2001

Subtotal cystectomy with ileocystoplasty for severe hemorrhagic cystitis after bone marrow transplantation.

In a retrospective analysis of hemorrhagic cystitis subsequent to allogeneic bone marrow transplantation, we focused on patients who underwent subtotal cystectomy with ileocystoplasty because stepwise use of conservative treatments had failed. Severe lasting hemorrhagic cystitis (more than 40 days) led to urinary tract obstruction and sepsis that required subtotal cystectomy in 3 of 1300 bone graft patients. Hematuria did not recur after surgery with a satisfactory functional result (follow-up 10 months to 17 years). Subtotal cystectomy with detubularized ileocystoplasty can be used to control life-threatening hemorrhagic cystitis.

Bone Marrow Transplantation↗
PubMed2001

Retinal capillary hemangioma: a comparison of sporadic cases and cases associated with von Hippel-Lindau disease.

OBJECTIVE: To report observations regarding the onset of tumors in patients with retinal capillary hemangiomas (RCH) and comparing sporadic cases with those associated with von Hippel-Lindau (VHL) disease. DESIGN: Retrospective consecutive case series. PARTICIPANTS: Sixty-eight patients with RCH managed at a tertiary referral center. MAIN OUTCOME MEASURES: The data were analyzed for age at diagnosis of RCH, two-hit mutation model, onset of new tumors, and random (Poisson) distribution. RESULTS: Among 68 patients, we identified 174 RCHs in 86 eyes. Thirty-one patients had VHL disease, and 37 patients were sporadic. The median age at diagnosis in cases with VHL disease was 17.6 years (range, 2.8-46.7 years), and in those without VHL disease it was 36.1 years (range, 7.0-74 years). The age distribution of RCH followed a two-hit mutation model. In eyes with VHL disease, the total number of RCH were distributed randomly as calculated by the Poisson distribution (mean number of tumors = 4). Overall onset of 33 new tumors was documented in 11 eyes (13%) over a median interval of 16 months (range, 3-235 months). All new tumors developed before the age of 47 years. The retinal location of new tumors was similar to the previous tumors with most new tumors located in the superotemporal quadrant (42%) and in the midperipheral retina (58%). Of the 50 patients initially manifesting solitary RCH, only 4 had new tumors develop over a median follow-up duration of 6.4 years (range, 0-33 years). All four cases had VHL disease. CONCLUSIONS: The median age at diagnosis of RCH in patients with VHL disease was almost 18 years less than those without VHL disease. The age distribution of RCH followed the two-hit mutation model. In VHL disease, the number of RCH is determined randomly. Most of the new RCH develop by the age of 47 years. In the absence of VHL disease, it is unlikely for patients with solitary RCH to develop new tumors.

Adolescent↗
PubMed2001

Keratoprosthesis: preoperative prognostic categories.

PURPOSE: Recent advances aimed at preventing and treating complications after keratoprosthesis surgery have improved prognosis, but it has been suspected that various preoperative diagnoses may carry substantially different postoperative outcomes. This article attempts to clarify the ranking of prognostic categories for patients undergoing keratoprosthesis surgery. METHODS: A retrospective review of the outcome in a recent series of 63 patient eyes operated at the Massachusetts Eye and Ear Infirmary between 1990 and 1997 and followed up for a minimum of 21 months. Anatomic retention of the device and the loss of vision caused by complications were recorded. The patients were divided into four categories according to preoperative cause. RESULTS: Anatomically, one keratoprosthesis extruded spontaneously. Another 10 were permanently removed because of complications. Of the 63 eyes, 10 never achieved a visual acuity of at least 20/200 vision because of preexisting retinal or optic nerve damage. The remaining 53 had a visual acuity of 20/200 to 20/20 as follows: Stevens-Johnson syndrome (n = 7), after 2 years: 33%, after 5 years: 0%; chemical burn (n = 17), after 2 years: 64%, after 5 years: 25%; ocular cicatricial pemphigoid (n = 20), after 2 years: 72%, after 5 years: 43%; graft failure in noncicatrizing conditions (dystrophies, degenerations, or bacterial or viral infections) when a repeat graft was expected to have a poor prognosis (n = 19), after 2 years: 83%, after 5 years: 68%. The difference in outcome between the Stevens-Johnson syndrome outcome group and the graft failure group or the ocular cicatricial pemphigoid group was statistically significant. In the group of 53 eyes, visual acuity was restored to 20/200 to 20/20 for a cumulative total of 138 years. CONCLUSION: Outcome of the keratoprosthesis surgery varied markedly with preoperative diagnosis. Most favorable was graft failures in non-cicatrizing conditions, whereas Stevens-Johnson syndrome was the worst. Ocular cicatricial pemphigoid and chemical burns occupied a middle ground. The difference between the groups seemed to correlate with the degree of past preoperative inflammation.

Adult↗
PubMed2001

[Obstetrical vesico-vaginal fistula. Report of 114 cases].

OBJECTIVE: Obstetric vesico-vaginal fistulas are frequent in North Africa. The objective of this paper is to analyse the epidemiologic and therapeutic factors, basing our study on 114 cases of vesico-vaginal fistulas. METHODS: From February 1989 to December 1998, 114 patients with a mean age of 33 years (range: 17 to 76 years) were admitted to the department of urology for urogenital fistulas, classified as a function of the site of the fistula into 3 types, according to Benchekroun's classification: type I: urethrovaginal fistula (39.96%); type II: cervicovaginal fistula (11.40%); type III: vesicovaginal fistula (52.63%). Investigation of each patient comprised complete physical examination with laboratory and radiological assessment. Treatment was only performed after a minimal period of 3 months. RESULTS: The majority of fistulas occurred in young multiparous women living in rural zones, predominantly due to an obstetric aetiology (87%). 183 reconstructive operations were performed in 114 patients, i.e. 1.73 operations per patient. Cure was obtained in 87 patients (76.3%) with 37% for type I, 92% for type II and 100% for type III. Twelve intermediate results (fistulas were closed, with persistent stress incontinence or frequency) and 16 failures (persistence of a residual fistula or need for urinary diversion) all concerned type I fistulas. CONCLUSION: It appears that VVFs represent a public health problem in North Africa and that their surgical treatment is still technically difficult.

Adolescent↗
PubMed2001

[Urethral diverticulosis in women. Analysis of 15 cases].

OBJECTIVE: To evaluate the aetiopathogenic, diagnostic and therapeutic aspects of urethral diverticula in women. MATERIAL AND METHODS: Over a 10-year period (January 1990 to December 1999), 15 patients with a mean age of 36 years (range: 25 to 46 years) with urethral diverticulum were included in this study. The mean parity was 2 with a history of long and difficult delivery in 6 cases. All patients presented lower urinary tract symptoms with a clinical diverticulum on gynaecological examination (14 cases) or on retrograde and voiding cystourethrography (14 cases) or intravenous urography (one case). Diverticulectomy was performed via a transvaginal approach in the dorsal position. RESULTS: There were no postoperative complications. All patients were reviewed with a mean follow-up of 3 years. The urinary symptoms had completely disappeared in 14 cases. One patient was reoperated for recurrent diverticulum. CONCLUSION: Young women with recurrent voiding disorders must be examined for the presence of urethral diverticulum that can be confirmed by cystourethrography. Transvaginal diverticulectomy in the lithotomy position is the operation which ensures the best results.

Adult↗
PubMed2001

[Metastasis to trocar site after lymphadenectomy with retroperitoneal laparoscopy].

The authors report a case of trocar site metastasis, one year after laparoscopic retroperitoneal lymphadenectomy. This is the seventh published case of trocar site metastasis in laparoscopic urological surgery. The lymph node resection procedure and the histological type of the tumour appear to be risk factors for the development of wall metastases.

Carcinoma, Squamous Cell↗
PubMed2001

[Hypospadias in adults].

INTRODUCTION: In order to evaluate the long-term results and complications, the authors reviewed the files of 14 adult patients operated for the first time for hypospadias. MATERIAL AND METHODS: This study was based on retrospective analysis of the files of 15 adults between the ages of 17 and 36 years operated for hypospadias between 1989 and 1999. The findings of the first visit concerned the site of the urethral meatus, the presence and severity of chordee and the primary and secondary sexual characteristics. Urine culture was performed in all patients. RESULTS: The follow-up was 12 months to 8 years. Six of the 15 patients were treated by urethroplasty alone and 9 patients underwent urethroplasty with correction of chordee. 40% of patients (3 cases of anterior hypospadias, 2 cases of midpenile hypospadias and 1 vulviform hypospadias) obtained a good long-term result. In the case of complications (fistula, stenosis or distal necrosis of the tube), a single reoperation allowed good results to be achieved in 80% of the series. CONCLUSION: The results of treatment of hypospadias in adult patients differ from those obtained in children despite the use of similar surgical techniques.

Adolescent↗
PubMed2000

[Surgical treatment of stress urinary incontinence in women].

UNLABELLED: INDICATION FOR SURGERY: Exercise-induced urinary incontinence is responsible for more than 75% of all cases of urinary incontinence in women. Surgery can provide excellent cure if the initial indication is established properly. SURGICAL PROCEDURES: The aim is to correct the mechanical alterations leading to urine leakage: sphincter anomalies and cervico-urethral hypermobility. Colpo-suspension using the indirect Burch procedure and the direct Goebell-Stoeckel procedure are indicated for physically active patients. For sphincter failure, an artificial sphincter with a fixed bladder neck is indicated. Simplified transvaginal colpo-suspension is indicated for elderly women. TENSION FREE VAGINAL TAPE: The recently developed, this new technique appears extremely promising for the treatment of urethral hypermobility.

Adult↗
PubMed2000

[Radial neuropathy after peripheral venous puncture].

We report a case of left radial neuropathy from a venipuncture, in a 59-year-old woman. She had a history of amputation of the four last fingers of the right hand, when she was 27-year-old. One year before, she had a difficult venipuncture of the left radial vein, for a preanaesthetic assessment for cataract surgery. The puncture elicited an excruciating pain, associated with hypoaesthesia in the area of the radial nerve, at forearm and the wrist. Conventional therapeutic means had only a minor efficiency. The concept of nervous system sensitizing is discussed. Prevention is essential.

Female↗
PubMed2000

[Is an authorization for care necessary for the incapacitated adult?].

We report the case of a 30-year-old mentally disabled patient who presented for diagnostic colonoscopy. This patient raised the problem of authorization for such a procedure and the related anaesthetic. The French law of 1968 on the protection of severely incapacitated persons does not clearly solve the problem of the consent for procedures with a therapeutic finality. The distinction relies usually on the extent of the planned act, for asking for an agreement of the guardian, judge of guardianship or the family board. In such cases the problem of the practice of an anaesthetic remains unsolved. For scheduled procedures it is recommended to obtain the written consent of the guardian before any medical act.

Adult↗