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Biomedical subjects

R Karam

Publications and source records attributed to R Karam.

At least 19 recordsLinked to original sources
PubMed2005

Cleft lip/palate and CDH1/E-cadherin mutations in families with hereditary diffuse gastric cancer.

We report the association of CDH1/E-cadherin mutations with cleft lip, with or without cleft palate (CLP), in two families with hereditary diffuse gastric cancer (HDGC). In each family, the CDH1 mutation was a splicing mutation generating aberrant transcripts with an in-frame deletion, removing the extracellular cadherin repeat domains involved in cell-cell adhesion. Such transcripts might encode mutant proteins with trans-dominant negative effects. We found that CDH1 is highly expressed at 4 and 5 weeks in the frontonasal prominence, and at 6 weeks in the lateral and medial nasal prominences of human embryos, and is therefore expressed during the critical stages of lip and palate development. These findings suggest that alteration of the E-cadherin pathway can contribute to human clefting.

Adult↗
PubMed2004

Toxic epidermal necrolysis syndrome--management and case report.

Toxic epidermal necrolysis syndrome [known also as Lyell's syndrome] is a severe drug reaction, characterized by fever. systemic toxicity, extensive skin rash with blisters and exfoliation similar to that of major burns. It carries an average mortality rate of 25%. The data concerning most frequent triggering agents and the differential diagnosis is presented; An overview of the management protocol for these patient in the Burn Center of the Lebanese Hospital is exposed with a case presentation of a young woman who sustained a 95% body surface area [BSA] cutaneous loss after the ingestion of only 2 tablets of amoxycilline documented by the complication and evolution.

Adult↗
PubMed2002

High signals in the uterine cervix on T2-weighted MRI sequences.

The aim of this pictorial review was to illustrate the normal cervix appearance on T2-weighted images, and give a review of common or less common disorders of the uterine cervix that appear as high signal intensity lesions on T2-weighted sequences. Numerous aetiologies dominated by cervical cancer are reviewed and discussed. This gamut is obviously incomplete; however, radiologists who perform MR women's imaging should perform T2-weighted sequences in the sagittal plane regardless of the indication for pelvic MR. Those sequences will diagnose some previously unknown cervical cancers as well as many other unknown cervical or uterine lesions.

Adult↗
PubMed2001

Imaging of membranous dysmenorrhea.

Membranous dysmenorrhea is an unusual clinical entity. It is characterized by the expulsion of huge fragments of endometrium during the menses, favored by hormonal abnormality or drug intake. This report describes a case with clinical, US, and MRI findings before the expulsion. Differential diagnoses are discussed.

Adult↗
PubMed2001

[A case of muscular and canal of nuck involvement by endometriosis].

Endometriosis is defined by the presence of endometrial tissue outside the uterine cavity and having the functional property of menstrual bleeding. We report a case of endometriosis involving the abdominal wall muscles and canal of Nuck in a 28 year old woman. Abdominal wall sonography showed a hypoechoic lesion at the rectus abdominis insertion. T1W and T2W MRI images showed a hemorrhagic high signal intensity lesion in the muscle. MRI also showed a similar lesion in the canal of Nuck.

Abdominal Muscles↗
PubMed1999

Azimilide pharmacokinetics and pharmacodynamics upon multiple oral dosing.

This study assessed steady-state azimilide pharmacokinetics and pharmacodynamics in 119 healthy male and female volunteers. Parallel groups of 18-40-year-old subjects received doses of 35, 100, 150 or 200 mg day(-1) for up to 14 days, with 1, 2 or 3 days of loading. Another group of > 55-year-old subjects received 100 mg day(-1) with a 3-day loading regimen. There was a slight overshoot of steady-state (24%) after loading, but concentrations decreased to steady-state by day 7. Mean peak steady-state azimilide concentrations ranged from 186 to 1030 ng mL(-1) across the 35-200 mg day(-1) dose range, while mean trough steady-state azimilide concentrations ranged from 108 to 549 ng mL(-1). Azimilide pharmacokinetics were proportional to dose, except for renal clearance, and did not differ between 18-40-year-old and > 55-year-old subjects. Pharmacodynamics did not differ across dose groups. The mean maximum effect (Emax) ranged from 24 to 28% change in QTc from baseline. The concentration needed to attain one half Emax ranged from 432 to 542 ng mL(-1) across dose groups. Equilibration was rapid between blood and the biophase, with equilibration half-lives of less than 1 min.

Administration, Oral↗
PubMed1999

[Double hemorrhagic complication of endo-urologic drainage in single kidney].

Hemorrhage is the most worrisome complication of percutaneous renal procedures, and usually occurs early in the postoperative period. The incidence of severe arterial injury is 1 to 2%. We report a patient who had 2 bleeding episodes on a solitary kidney. The first, which occurred early after the procedure, was due to an arteriocaliceal fistula treated by coil embolization. The second bleeding episode occurred two weeks later, and was caused by erosion of a lumbar artery; it was embolized by microparticles. To our knowledge, this is the first report of the imaging findings. In summary, when bleeding occurs after endourologic procedures, renal as well as extrarenal parietal causes should be investigated.

Adult↗
PubMed1999

[Arteriovenous fistula following femoral angioplasty].

We describe a case of arteriovenous fistula developing at the site of balloon dilatation immediately after percutaneous transluminal angioplasty of the superficial femoral artery. This occurred during an otherwise uncomplicated angioplasty. The fistula was treated by inflating a slightly larger balloon with a good clinical result as confirmed by color Doppler ultrasound. This uncommon complication of angioplasty is not widely recognized.

Angioplasty, Balloon↗
PubMed1998

The azimilide post-infarct survival evaluation (ALIVE) trial.

The AzimiLide post-Infarct surVival Evaluation (ALIVE) trial is a new clinical trial using an innovative design to examine the potential of azimilide, a novel type of antiarrhythmic, for improving survival in post myocardial infarction (MI) patients at high risk of sudden cardiac death. Azimilide is the first of a unique class of antiarrhythmic drugs that blocks both slow and rapid components of the delayed rectifier potassium currents in human myocardium. Preclinical studies have shown the drug to be effective in reducing cardiac tachyarrhythmias, even under ischemic conditions. Currently, azimilide is in Phase III trials for the treatment of supraventricular arrhythmias. The ALIVE study design is based on lessons learned from the Cardiac Arrhythmia Suppression Trials (CAST), the Survival With Oral d-Sotalol (SWORD) trial, and the European Myocardial Infarction Amiodarone Trial (EMIAT) and identifies recent post-MI patients at high risk of sudden cardiac death. The hypothesis underlying this trial is that azimilide will improve survival in this patient population. The ALIVE trial is designed as a double-blind, placebo-controlled, multinational trial that will overcome the shortcomings of previous antiarrhythmic trials by using left ventricular ejection fraction and heart rate variability as predictors to target a post-MI patient population at high risk of sudden death. The major inclusion criteria for the study are adult patients of either gender with a left ventricular ejection fraction of 15-35% who have had a recent MI (within 6-21 days). Additional stratification will be based on patients with heart rate variability < or = 20 U (heart rate variability index). Exclusion criteria include factors that may predispose a patient to nonarrhythmia-induced death or to low risk of sudden cardiac death caused by arrhythmia. Sample size is based on the assumption that the all-cause mortality rate (the primary endpoint) for 1 year in placebo patients at high risk for sudden cardiac death (heart rate variability < or = 20 U) is 15% and that azimilide will decrease all-cause mortality by at least 45% in these patients. The trial consists of 3 groups-patients receiving 75 mg azimilide orally each day, patients receiving 100 mg azimilide orally each day, and patients receiving placebo. No dose adjustments for age, gender, renal or hepatic failure, or concomitant use of warfarin or digoxin are thought necessary with azimilide. Enrollment for the trial is expected to continue for 24 months, and treatment is scheduled to be administered for a 1-year follow-up period.

Adult↗
PubMed1998

Azimilide dihydrochloride, a novel antiarrhythmic agent.

Azimilide, a novel class III antiarrhythmic agent, blocks both the slowly activating (IKs) and rapidly activating (IKr) components of the delayed rectifier potassium current, which distinguishes it from conventional potassium channel blockers such as sotalol and dofetilide, which block only IKr. Azimilide is being developed to prolong the time to recurrence of atrial fibrillation, atrial flutter, and paroxysmal supraventricular tachycardia in patients with and without structural heart disease. Azimilide is also being studied for its role in prevention of sudden cardiac death in high-risk patients after myocardial infarction (MI). Preclinical and clinical studies indicate that azimilide prolongs cardiac refractory period in a dose-dependent manner, as manifested by increases in action potential duration, QTc interval, and effective refractory period. Azimilide does not affect PR or QRS interval and minimally affects hemodynamic properties such as blood pressure and heart rate. Its in vivo effects appear to be rate-independent and are maintained under ischemic or hypoxic conditions, properties of potential clinical significance. Azimilide has shown excellent efficacy (>85%) in suppressing supraventricular arrhythmias in a variety of dog models. It also suppressed complex ventricular arrhythmias in infarcted dogs and, in a sudden death cardiac model, decreased mortality. Azimilide pharmacokinetics are very predictable. The drug is completely absorbed, and the extent of absorption is not affected by food. It can be administered once daily. Clinical data suggest that dose adjustments of azimilide are not required for age, gender, hepatic or renal function, or concomitant use of digoxin or warfarin. Azimilide has a good safety profile in open-label safety studies in >800 supraventricular arrhythmia patients, most with structural heart disease. The incidence of serious adverse events, including torsade de pointes, is low. The rate of patient withdrawal from long-term studies is also encouragingly low. Unlike amiodarone, azimilide has shown no evidence of pulmonary or ocular toxicity. Azimilide is expected to provide a unique new therapy for the prevention of supraventricular arrhythmias and sudden cardiac death when Phase III clinical trials are complete and safety and efficacy are confirmed.

Animals↗
PubMed1996

Severe neck burns and laryngeal mask airway for frequent general anesthetics.

Securing the airways in a patient suffering severe neck burns or its sequalae may present a challenge to the most experienced anesthesiologist. We investigate the utility of the Laryngeal Mask Airway (LMA) in this situation. We report on success, failure of complications of LMA insertion at the induction of general anesthesia in 23 patients of a Major Burns Unit and compare our results to our records of patients intubated endotracheally in the Unit. 14 out of 15 patients with neck burns had a LMA inserted with no difficulty or complications, while difficult endotracheal intubations in patients with neck burns were more frequent with statistical significance compared to patients with intact necks. LMA insertion seems to ignore the difficulties met with endotracheal intubation in this context.

Anesthesia, General↗