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Biomedical subjects

M Saab

Publications and source records attributed to M Saab.

At least 19 recordsLinked to original sources
PubMed1997

Twenty-four hour nurse practitioner service in the accident and emergency department.

This paper discusses the introduction of a 24-h nurse practitioner service in a major accident and emergency department and monitors it over a 3-month period. The paper provides a description of the activities of the nurse practitioners and a critical evaluation of their role. It shows that every major accident and emergency department can set up a 24-h nurse practitioner scheme and the organization of such a scheme can be very simple. This is the first article to look at a 24-h service.

Adult↗
PubMed1997

Traumatic radial head dislocation in children--a missed injury.

The purpose of this article is to remind accident and emergency doctors of an easily missed injury-isolated traumatic radial head dislocation in children. We present two such cases. This is a very uncommon injury and the diagnosis was overlooked in both cases. A high index of suspicion is necessary and careful examination of the radiographs is mandatory. The radiographic appearance of this injury is explained.

Child↗
PubMed1997

Widening of the mediastinum following a sternal fracture.

Sternal fractures, once thought of as uncommon, occur with increasing frequency, parallelling the incidence of motor vehicle accidents. A fractured sternum can produce a widening of the mediastinum even in the absence of an aortic injury. The Advanced Trauma Life Support course teaches that a widening of the mediastinum after blunt chest injury is an indication for aortography. In this case report we recommend computerised axial tomography (CT) scan of the chest as the investigation of choice in the non-hypotensive patient who has sustained a fractured sternum after a blunt chest trauma, and who has widening of the mediastinum on the chest X-ray, with no other radiological features suggesting traumatic aortic rupture.

Accidents, Traffic↗
PubMed1996

Warfarin and the apparent minor head injury.

Two cases of patients on warfarin who developed intracranial haematoma after an apparently minor head injury are described. There is a 10-fold increase in the likelihood of developing an intracranial haematoma in these patients. Recommendations are made regarding the management of this type of patient seen in the accident and emergency department.

Aged↗
PubMed1996

Spontaneous splenic rupture: an unusual cause of hypovolaemia.

Splenic rupture in infectious mononucleosis is an extremely rare but often fatal complication. A case presented to the accident and emergency department in ventricular fibrillation seconds after losing signs of any cardiac output. The underlying cause of cardiorespiratory arrest always be sought irrespective of the presenting rhythm.

Adolescent↗
PubMed1995

Factors determining survival in resected N2 lung cancer.

This retrospective study was based on 237 patients with non-small cell lung cancer (NSCLC) and nodal N2 disease. All accessible mediastinal lymph nodes (LN) were removed and classified according to their anatomical location in LN chains. The pulmonary resections performed were: pneumonectomy (n = 187), lobectomy (n = 44) and segmentectomy (n = 4). There was solitary nodal chain involvement by metastasis in 141 cases, two chains in 72 cases and three or more in 24; "skip" metastases were present in 26.6%. N2 disease would have been missed in 45 cases of single chain involvement (31.9%) if routine removal of mediastinal nodes had not been performed. The overall 5-year survival rate was 18.8%. Survival was not influenced by site, size or extension (T) of tumor, tumor histology or the presence of vascular invasion. The prognosis was significantly worsened by the presence of microscopic residual disease (30 cases) and of satellite nodules (23 cases). Survival was significantly improved when metastases involved a single LN chain (26.3 versus 8.3%, P = 0.0003). The location and number of involved nodes in the chain, "skip" metastases and the presence of extracapsular spread of carcinoma did not influence the prognosis. Routine mediastinal LN dissection is necessary to improve survival and for classification of lung cancer. Anatomic description allows better understanding of N2 disease which is not a contraindication to surgery when a gross complete resection can be achieved.

Carcinoma, Non-Small-Cell Lung↗
PubMed1995

[The surgical management of pneumothorax in patients with AIDS].

The occurrence of a pneumothorax occurring as a complication of AIDS is a poor prognostic sign. We have undertaken a review of 26 patients admitted to hospital for a pneumothorax of whom 25 were admitted for therapy: five resolved under simple drainage; twenty required a pleurodesis which was performed on thirteen under video thoracoscopy: these were recurrent pneumothoraces and were bilateral in half the patients; all had failed under simple drainage. The hospital mortality was 30%; the follow-up was unusually long in the majority of cases and only 20% had a simple follow-up. The analysis of this population showed that the results were not tied to the proposed treatment but to the state of the disease and to the pre-existence of pulmonary lesions most often in relation to pneumocystis. Video thoracoscopy enables one to inspect the lung and to resect the diseased area at the origin of the air leak. The technique also enables the pleurodesis to be achieved and a pleural or lung biopsy to be obtained in a relative non-invasive fashion.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Prognostic factors of survival in resected N2 bronchial cancer].

This study was based on 206 patients with non small cell lung cancer and N2 nodal disease submitted to curative surgery: pneumonectomy 163, lobectomy 39 and segmentectomy 4. All accessible mediastinal lymph nodes were removed and classified according to their anatomical location in lymph node chains; "skip" metastases were present in 24.8% of cases. N2 disease would have been missed in 20% of cases if routine removal of mediastinal nodes had not been performed. There was solitary nodal chain involvement by metastasis in 126 cases (61.2%). Overall 5-year survival was 18.3% +/- 3. Survival was not influenced by site, size or extension (T) of tumor, adjuvant radiotherapy, tumor histology or presence of vascular invasion. The prognosis was significantly worsened by the presence of microscopic residual disease (22 cases) and of satellite nodules (18 cases). Survival was significantly improved when metastases involved a single node chain (25% versus 8.5%). The location and number of involved nodes in the chain, "skip" metastasis and presence of extracapsular spread of carcinoma did not influence prognosis. Routine mediastinal lymph node dissection is necessary to improve survival and for classification of lung cancer. Anatomical description allows better understanding of N2 disease which is not a contraindication to surgery when a complete gross resection can be achieved.

Adult↗
PubMed1993

[Extrapulmonary intrathoracic pneumocystosis. Apropos of 4 cases in HIV positive patients].

The authors report 4 cases of intrathoracic extrapulmonary pneumocystosis; 3 of them involved the pleura and 1 the mediastinal lymph nodes. As in other rare but apparently increasingly frequent cases, everything seemed to incriminate the use of prophylactic Pentamidine aerosols, but only a prospective study of systemic versus aerosol prophylaxis can confirm this suspicion.

AIDS-Related Opportunistic Infections↗
PubMed1993

[The lymphatic drainage of the esophagus].

The study was carried on 65 cadavers: 50 adults and 15 newborns. The esophagus was injected at the level to the neck 16 times, in the thorax at the superior level 18 times, middle level 30 times and inferior level 21 times. The lymphatic pathways were named short when joining the nodes at the same level, half long when joining the nodes of the neighbouring level, long when joining third level, and very long. At the level of the neck were injected 24 lymph nodes chains: in 12.5% of the cases the pathways were long, joining the nodes of the arch of the Azygos vein. At the superior thorax level were injected 27 chains: half of the pathways were half-long: 7.5% long (-joining the pharynx once and the cardia once). At the middle thorax level were injected 37 chains: 27% were long and very long. At the inferior thoracic level were injected 21 chains: The pathways were half long in half cases and very long in 15% of the cases joining the cervical nodes. These results compare with experience in oncology and justify the need for total esophagectomies and nodes resection of all levels in surgical treatment of carcinomas of the esophagus.

Adult↗
PubMed1993

[Chylomediastinum after mediastinoscopy. Apropos of a case].

A mediastinal chylous effusion occurred in a young woman after a mediastinoscopy. This effusion healed rapidly with medical treatment. An understanding of the anatomy of these intra-thoracic/lymphatic channels explains that intra-thoracic chylous effusions may occur in case of incontinence of the lymphatic vessels which connect the tracheo-bronchial nodes to the thoracic duct in the mediastinum. This is very important following the surgical excision of a node because incontinent lymphatic vessels are directly sectioned. When the lymph nodes are biopsied in an enclosed cavity such as the mediastinum, the quantity of lymphoid tissue acts as an obstacle to reflux of the lymph which is thus less significant and more easily controlled.

Adolescent↗
PubMed1993

[Excision of mediastinal nodes using video-thoracoscopy].

A man of seventy-one years with gross respiratory failure was suspected of having a cancer of the right upper lobe with metastases to the right pretracheal and intertracheobronchial nodes. A diagnostic mediastinoscopy did not achieve a diagnosis, and a right sub-bronchial node biopsy was performed, using videothoracoscopy and this revealed the presence of tuberculosis without any further delay.

Aged↗
PubMed1992

[Surgery for cancer with mediastinal lymph node invasiveness (N2)].

Resection is indicated in about 20% of N2 cases. When it is complete a 5-year survival rate may be expected. It represents for these patients a chance of cure and therefore must be considered in all cases of N2, either immediately or after an adjuvant treatment. Its results can be improved by strict selection of the patients and by an efficient chemotherapy.

Chemotherapy, Adjuvant↗