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Biomedical subjects

N Khouri

Publications and source records attributed to N Khouri.

At least 19 recordsLinked to original sources
PubMed2006

Multiple lumbar plexus neurotizations of the ninth, tenth, and eleventh intercostal nerves.

The topographic anatomy of the lower intercostal nerves is less known than the upper ones except for the twelfth intercostal nerve. It is possible to use the lower intercostal nerves to carry out a neurotization of the lumbar roots. We studied the anatomy of the ninth, tenth, and eleventh intercostal nerves in order to specify the data of descriptive and topographic anatomy allowing to carry out their harvesting under good conditions. Ninth, tenth, and eleventh intercostal nerves of 50 cadavers were dissected. The proximal part of the nerve in the posterior intercostal space was exposed through a posterior approach. The lateral intercostal space was exposed through a lateral approach, under the latissimus dorsi, which made it possible to harvest the intercostals nerve. The proximal course of the nerve in posterior intercostals space was the same in all the cases. The nerve moves obliquely towards the outside to reach the lower border of the rib. The exit of posterior intercostal space is a fibrous strait that marks the entry of a channel between two muscular layers. We describe an aponevrotic channel in which the nerve and the vessels are, immediately at the lower border of the cranial rib. The mean total length of intercostal nerve harvested by our technique was 17.96 cm for the ninth intercostal nerve, 17.14 cm for the tenth intercostal nerve, and 15.94 cm for the eleventh intercostal nerve. The bifurcation of the intercostal nerve in a deep branch and the ramus cutaneus lateralis was found in the majority of the cases, from 9.5 to 21 cm of the emergence of the intercostal nerve in posterior intercostal space. This anatomical study of the ninth, tenth, and eleventh intercostal nerves in posterior intercostal space and lateral intercostal space appears to us to allow the realization of a reliable surgical harvesting.

Cadaver↗
PubMed2004

Anatomical study of the paraspinal approach to the lumbar spine.

The original description of the paraspinal posterior approach to the lumbar spine was for spinal fusion, especially regarding lumbosacral spondylolisthesis treatment. In spite of the technical details described by Wiltse, exact location of the area where the sacrospinalis muscle has to be split remains somewhat unclear. The goal of this study was to provide topographic landmarks to facilitate this surgical approach. Thirty cadavers were dissected in order to precisely describe the anatomy of the trans-muscular paraspinal approach. The level of the natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle was noted and measurements were done between this level and the midline at the level of the spinous process of L4. A natural cleavage plane between the multifidus and the longissimus part of the sacrospinalis muscle was present in all cases. There was a fibrous separation between the two muscular parts in 55 out of 60 cases. The mean distance between the level of the cleavage plane and the midline was 4 cm (2.4-5.5 cm). In all cases, small arteries and veins were present, precisely at the level of the cleavage plane. We found it possible to easily localize the anatomical cleavage plane between the multifidus part and the longissimus part of the sacrospinalis muscle. First the superficial muscular fascia is opened near the midline, exposing the posterior aspect of the sacrospinalis muscle. Then, the location of the muscular cleft can be found by identifying the perforating vessels leaving the anatomical inter-muscular space.

Female↗
PubMed2003

[Intraspinal rib penetration in four patients in neurofibromatosis vertebral deformities].

We describe the clinical and radiological features observed in four patients with neurofibromatosis-related scoliosis or kyphoscoliosis who developed rib penetration into the intervertebral foraminae. Rib penetration should be searched for on standard and elective x-rays in patients with moderate curvatures. The diagnosis can be confirmed by computed tomography or magnetic resonance imaging of the spine. In case of major deviation, x-rays must be carefully examined, with an accurate search for spinal cord compression to avoid missing the diagnosis. Surgical treatment must consist in ablation of the posterior ends of the dislocated ribs associated with anterior and posterior fusion. It should be performed early to avoid the development of spinal cord compression.

Adolescent↗
PubMed2000

[Stretching the triceps surae muscle after 40 degrees C warming in patients with cerebral palsy].

PURPOSE OF THE STUDY: Equinus in patients with cerebral palsy results from at least two factors: excessive contracture of the triceps surae and muscle retraction. Tendon surgery and progressive lengthening techniques using plaster walking boots can provide variable improvement in retraction. We compared the effect of this technique when applied with or without prior 40 degrees C warming in the same patients. We also assessed the efficacy of this treatment method in terms or degree of retraction, patient age, puberty maturity, and sex. MATERIALS AND METHODS: This series included 70 muscles in 52 patients with cerebral palsy aged 2 years 11 months to 21 years (mean 8 years 3 months). Common features in these patients were: - equinus mainly explained by triceps retraction, - no history of prior surgery on the triceps tendon, - knee flexion less than 15 degrees in the upright position, - easily reduced lateral deformation of the foot, - absence of mediotarsal dislocation, - triceps stretching could be achieved without triggering unacceptably intense contracture. The retraction of the triceps surae was measured from the maximal passive dorsal flexion angle of the foot, before and after applying each stretching boot. The difference between these measurements gave the gain obtained with the plaster boot. Protocol R- (stretching with plaster boot) consisted in a series of slow stretchings for 10 minutes before making the boot which was worn 7 days. Recurrent retraction in these same patients warranted another treatment within a delay of 3 to 17 months (mean delay 8.7 months). The same treatment then followed protocol R+ where the stretching was preceded by immersion of the segment in a 40 degrees C water bath for 10 minutes. RESULTS: Mean gain obtained with protocol R+ (warming) was 6.8 degrees knee extended and 7.1 degrees knee flexed. These differences were highly significant in both cases (p <0.0001). We had no failures with protocol R+ while with protocol R- (stretching without warming) the gain was nil or less than 5 degrees for 29 muscles knee extended and for 32 muscles, knee flexed. The gain was not related to age, sex or puberty maturity. It was not related to the angle of dorsal flexion of the foot prior to stretching. DISCUSSION: Our findings demonstrate that when the conditions allowing prolonged stretching of the triceps surae are present, prior warming at 40 degrees C for 10 minutes leads to an improvement in muscle lengthening in all patients, even in those for whom prior treatment had been unsuccessful without warming. This observation would indicate that the mechanisms allowing greater lengthening are present in all patients with cerebral palsy but that they cannot be triggered due to abnormal muscle viscosity related to distal vasomotor disorders frequently observed in this condition. Further research is needed to detail this point.

Adolescent↗
PubMed1994

Extensibility of hip adductors in children with cerebral palsy.

The passive extension of relaxed hip adductor muscles was measured in 20 normal children and 10 children (aged nine to 13 years) with cerebral palsy (CP) by a method that could distinguish between shortening of the muscle body and tendon. No muscle-body contracture occurred in the children with CP during treatment (physiotherapy plus moderate stretching on an apparatus for six hours a day); only the tendons were short. However, four children showed signs of muscle-body contracture after interrupting treatment for six to eight weeks. It is possible that muscle-body contracture can be prevented by non-surgical methods, although tendon shortening can, at present, only be treated surgically.

Cerebral Palsy↗
PubMed1994

[Is surgery of the hip adductor muscles justified in children with cerebral palsy?].

INTRODUCTION: Restricted passive hip abduction in children with cerebral palsy (CP) may be caused by uninhibited resting contractions and/or retractions, i.e., shortened muscle body or tendons. Pathological short tendons require surgical intervention, but lack of muscle body elasticity responds to physiotherapy or a postural splinting. Clinical examination can distinguish between short tendons and short muscle body. The thigh is slowly and passively extended while palpating the tendon. Tension is detected in the tendon when the leg is at angle Ao. The elastic tension of the muscle body then increases until no further movement is possible, at angle Amax. The difference Amax-Ao is an index of the structural length of the muscle body. If this difference is reduced during passive straightening there is shortening of the muscle body; if it is displaced it indicates shortening of the tendon. The value Ao indicates the muscular or tendon origin of the retraction for a given passive limitation (Amax). This study defines the physiological values of Ao and the relative precisions of chemical and instrumental measurements. MATERIALS AND METHODS: A total of 30 children aged 9-11 years, 10 CP patients (7 girls and 3 boys, mean age 10.3 years) and 20 controls (11 girls and 9 boys, mean age 10.5 years) were studied. All the CP children had lower limb spasticity and adopted an adduction posture. None had undergone hip muscle surgery. Ao and Amax were measured clinically with a goniometer and EMG to monitor muscle silence, and experimentally using a deformable parallelogram and force transducers. RESULTS: The minimum physiological value of Ao was 8 degrees with the knee flexed and 0 degree with the knee extended. Smaller values of this angle indicated tendon retraction. The difference between Ao and Amax in the controls and CP children was < or = 10 degrees; the reproducibilities of the clinical measurement of Ao and Amax were very similar. DISCUSSION: Clinical examination provides an acceptably accurate method of distinguishing between tendon and muscle body retraction of adductor muscles in CP children. The conditions required for successful measurement are: careful examination with strict positional reference and sufficiently relaxed pelvic muscles. A hip extension angle Ao of less than 8 degrees with the knee flexed or 0 degree with the knee straight indicates tendon retraction requiring tendon surgery, otherwise, the retraction involves only the muscle body. This reduced elasticity can be overcome by prolonged extension (at least 6 hours/24). Effective muscle extension may be hindered by non-suppressed adductor contractions. This must be overcome prior to physiotherapy by surgery of the ramus ant. n. obturatorii. CONCLUSION: Clinical measurement of Ao of adductor muscles is a reliable way of distinguishing between tendon retractions requiring surgery and muscle body retractions resulting from staying too long in a position with the muscle shortened. This muscle body shortening can be due to lack of physiotherapy or a stretching apparatus treatment, pathological contractions, or compensation for disorders of the controlateral limb.

Adolescent↗
PubMed1992

[Paralysis of the radial nerve and supracondylar fractures of the humerus in children. A study of a series of 11 cases].

Eleven radial nerve paralyses, associated with supracondylar fractures of the humerus in children, are reported: 2 incomplete motor, 5 complete motor, 2 complete motor and partial sensory and 2 complete motor and total sensory. The palsy was noticed before any treatment in 8 cases. In the 3 other cases, the palsy was secondary to difficult and repetitive closed reduction manoeuvers. The fractures were all of the extension type, grade III in 2 cases and IV in 9 cases. The displacement of the distal fragment was posterior and medial in 8 cases. Initial treatment of the fracture was conservative in 5 cases with 2 failures and surgical in 6 cases. Nerve function recovery always followed the same sequence: extensor muscles of the wrist, then extensor muscles of the fingers and at last, extensor muscles of the thumb. Time required for full recovery varied from 4 to 6 months. Open reduction and nerve control did not seem to be better than closed reduction with regard to the required time for neurological recovery and its quality. The indications depend on the extension of the paralysis. If radial palsy is incomplete, the first therapeutic step is closed reduction, followed by surgical reduction if not possible. A primary surgical approach is proposed in cases of complete sensory and motor paralysis because of the operative findings of contusion and incarceration of the nerve which may be aggravated by blind manoeuvers.

Child↗
PubMed1991

Synthesis, stereochemical analysis, and neuromuscular blocking activity of oximino ether derivatives of progesterone.

This study consists of the synthesis, separation, and stereochemical analysis of oximino ethers, followed by a preliminary pharmacological evaluation for neuromuscular blockade. Synthesis of the compounds began with the double oximation of progesterone, which yielded EE and ZE dioximes as major products. Both stereoisomers were separated and purified by chromatography followed by crystallization. The diether of each dioxime was prepared by O-alkylation with 2-dimethylaminoethyl chloride hydrochloride, using a mixture of potassium tert-butoxide and sodium hydride as base. The diethers were separated from the monoethers by vacuum chromatography. Configurational assignments of all compounds were based on 1HNMR and 13CNMR spectroscopy. Quaternization with methyl bromide yielded the salts which were purified via fractional crystallization. A preliminary pharmacological evaluation was conducted by using mice on a treadmill apparatus. Structure-activity relationships are discussed on the basis of similarities to succinylcholine.

Alkylation↗
PubMed1991

[Experimental study of material properties of calcium salicylate cement with and without polymeric additives].

In this study a new calcium-salicylate cement with an additional polymerized filler material (Alkaliner) was compared with a commonly used calcium-salicylate cement without polymerized filler material (Dycal) regarding the microstructure, the EDX elemental analysis, the hydroxid ion release, the compressive strength and the film thickness. The tests showed the following results: 1. Alkaliner and Dycal are almost identical in relation to their micro-morphology and elementary composition (EDX-analysis). 2. In the titration test, Dycal and Alkaliner show no significant differences (p = 0.05) in the hydroxid ion release. 3. Having stored the specimens in synthetic saliva for 2 days, the compressive strength of 25 MPa is noted for both of the materials. Having stored the specimens for 150 days, the compressive strength of Alkaliner (8.3 MPa) is significantly (p = 0.05) higher than that of Dycal (3.8 MPa). 4. The film thickness was measured by placing the materials between dry glass-plates. Dycal measures an average of 19.8 micrometers and Alkaliner of 30 micrometers. Under these experimental conditions the measured difference is statistically significant (p = 0.05). Placing the materials between damp glass-plates, the film thicknesses increase to an average of 56.5 micrometers (Dycal) and of 50 micrometers (Alkaliner) respectively. This difference however, is statistically not significant (p = 0.05).

Calcium↗
PubMed1989

[Triplane fractures of the tibia. Apropos of 25 cases and general review].

The authors report their experience with a series of 25 distal tibial triplane fractures: 13 two-fragment lateral triplane fractures, 10 three-fragment lateral triplane fractures and 2 medial triplane fractures. These cases were mostly adolescents near the end of the growth spurt period. Tomography or CT scanning allowed a better delineation of the anatomic type of the fracture and of the displacements. Treatment modalities, surgical versus conservative are presented. Therapeutic indications depended on the anatomic configuration of the fracture; closed methods were most often applied to the two-fragment lateral triplane fractures, surgical treatment for most of the three-fragment lateral triplane fractures and for the medial triplane fractures. Results were usually good after an intermediate term follow-up. Joint incongruity secondary to insufficient reduction was a more severe sequela than growth disturbances.

Adolescent↗
PubMed1984

The role of computed tomography of the chest in the management of small-cell lung cancer.

Despite the wide application of computed tomography (CT) in the diagnosis and management of lung cancer, the role of this diagnostic modality in the management of small-cell lung cancer (SCC) has not yet been defined. We therefore compared information gained from routine chest radiography (CXR) and CT scans performed on 32 patients with SCC who were treated on an intensive chemotherapy-radiotherapy protocol. Seventy-nine pairs of CXRs and CT scans were retrospectively reviewed. We found that although CT delineates a greater extent of intrathoracic disease in each of nine anatomic areas evaluated than does CXR, agreement between CT and CXR was significant for all areas except the pericardium. Pericardial thickening was seen only on CT scan and is more frequent in SCC patients than has previously been appreciated, but both its etiology and prognostic significance are unclear at this time. CT also allowed interpretation of disease status in cases where radiation-induced fibrosis made interpretation of the CXR impossible. We do not recommend routine use of chest CT at time of diagnosis of SCC, but we recommend that its use be reserved for evaluation of new symptoms or suspected relapse, or when radiation fibrosis on CXR is severe.

Carcinoma, Small Cell↗
PubMed1984

Transbronchial needle aspiration of peripheral pulmonary nodules.

To determine the role of transbronchial needle aspiration (TBNA) in the diagnosis of peripheral pulmonary lesions, TBNA was performed in 20 patients who had unexplained nodules (15) or masses (five) and no endobronchial abnormality. The TBNA cytopathology was positive for malignancy in 11 patients, and provided the only diagnostic specimen in seven. The TBNA yield was significantly higher than that of forceps biopsy or bronchial brushing, either alone or in combination (p less than 0.05). The procedure was complicated by pneumothorax in one patient. Transbronchial needle aspiration is diagnostically useful and safe for evaluation of the peripheral pulmonary nodule.

Biopsy, Needle↗
PubMed1982

[Triple juxtacotyloid osteotomy].

The authors have developed a technique of triple innominate osteotomy derived from that describe by Steele. The three osteotomy divisions are made very close to the acetabulum. With this technique the acetabulum can more easily be re-orientated and the pubis and ischium are left intact with their muscle attachments.

Adolescent↗
PubMed1982

[The nerve of the posterior muscle of the leg].

The nerve of the musculus tibialis posterior was dissected to prepare its elective neuroclasia in a girl with cerebral palsy. Numerous variations relative to the other branches in the neighbourhood were proved, but one may conclude that the origin of this branch from the nervus tibialis at the level of the arcus tendineus musculi solei, as the apparent termination on the muscle's surface are the most proximal of the branches for the deep muscles of the leg. The surgical approach prohibits a complete dissection and it was only the electrical stimulation which identified the nerve with certainty.

Adult↗