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Biomedical subjects

R Safadi

Publications and source records attributed to R Safadi.

At least 73 records · Page 4Linked to original sources
PubMed1996

Gallbladder varices: a case report and review of the literature.

We present an 18 year old woman suffering from cavernous transformation of the portal vein, hypersplenism and bleeding esophageal varices. Color flow Doppler sonography showed gallbladder wall varices. A review of the literature, revealed 76 cases of gallbladder varices. Mostly, these were associated with portal vein occlusion and rarely with hemobilia. The color flow Doppler was the gold standard procedure for the diagnosis, although angiography, computerized tomography and magnetic resonance had also been reported. Surgeons should be aware of this finding since these varices can be a source of major blood loss.

Adolescent↗
PubMed1996

Conservative therapy in an ERCP-induced abdominal abscess.

We describe a 30 year-old man who presented with an abdominal abscess as an unusual complication of endoscopic retrograde cholangiopancreatography with papillotomy. His presenting symptom was recurrent vomiting, while fever, abdominal pain, and leukocytosis were not significant. The abscess was observed with repeated computerized tomographic scans and completely regressed with intravenous antibiotic treatment over a three week period, leading to complete remission.

Abdominal Abscess↗
PubMed1996

A patient with hypoparathyroidism, dysmorphic features and mental retardation.

There have been various reports in the medical literature concerning children with syndromes of congenital hypoparathyroidism, seizures, dysmorphic features and mental retardation. We describe a patient with hypoparathyroidism, mental retardation, micrognathia, deep-set eyes and pes cavus in a 31-year-old man. This combination of abnormalities in an adult is unique.

Adult↗
PubMed1996

Beneficial effect of ribavirin on hepatitis C-associated cryoglobulinemia after liver transplantation.

Mixed cryoglobulinemia is a well-known complication after hepatitis C virus (HCV) infection. We report five cases in which cryoglobulinemia appeared or grossly exacerbated following orthotopic liver transplantation (OLT). Cryoglobulinemia and the associated clinical symptoms resolved or improved in two patients treated with ribavirin after liver transplantation, while plasmapheresis was ineffective in another patient. The mechanism involved in induction of cryoglobulinemia after liver transplantation is unknown. However, the effect of antiviral therapy observed in these patients suggests a correlation between cryoglobulinemia, HCV replication, and possibly hepatocellular disease activity. A larger-scale study is warranted to test the effect of ribavirin on post-OLT HCV-associated cryoglobulinemia.

Adult↗
PubMed1996

Molecular genetics of familial hypercholesterolemia in Israel.

Familial hypercholesterolemia (FH) is an autosomal dominant disease caused by a multitude of low density lipoprotein receptor (LDL-R) mutations. The purpose of the current investigation was to define the spectrum of mutations causing FH in Israel and determine their relative distribution among diverse origin groups. A total of 193 FH families were recruited in Israel, 54 of them through the MED PED (Make Early Diagnosis Prevent Early Death) FH program. Molecular analysis of the LDL-R using single-strand conformation polymorphism (SSCP) or denaturing gradient gel electrophoresis (DGGE) or both has been completed in 95 index cases. This analysis resulted in the identification of 15 LDL receptor mutations, including 7 novel mutations (del 197, C308G, R385W, splice junction mutation of intron 14, del 328, del 502-505, stop 10, del 165), that were present in 49 index cases (52%). The 15 mutations are mapped to three known functional domains of the receptor (7 in the LDL-binding region, 7 in the epidermal growth factor precursor homology region and 1 in the membrane-spanning region). Screening for the identified mutations in the remaining 98 index cases enabled the molecular diagnosis of 31 additional cases. It is therefore concluded that 80 out of 193 index cases (41%) harbor 1 of the 15 mutations described here. Three mutations-del197 (FH-Lithuania), D147H (FH-Sephardic), and stop660 (Lebanese allele)-were found in a total of 66 index cases (34%); these may be regarded as founder mutations in the three respective origin groups. In conclusion, in Israel molecular heterogeneity at the LDL receptor gene locus reflects the ethnic distribution of its origin groups. The results of the present investigation provide valuable diagnostic tools for a subset of the Israeli patients with FH who are at high risk for atherosclerosis and its complications.

Arabs↗
PubMed1996

Manometric responses of human duodenum during infusion of HCl, hyperosmolar saline, bile and oleic acid.

Duodenal motor activity is incompletely understood. The purpose of this study was to define the contractile patterns of the duodenum that occur in response to rate controlled injection of various solutions. In nine healthy volunteers we placed a six channel perfused catheter, and recorded pressure activity in the antrum, pylorus and duodenum. Volumes of 10 and 20 mL of 0.9% NaCl, 100 mM HCl (pH 1), 5% NaCl (1711 mOsm/kg), human bile and iso-osmolar sodium oleate were randomly injected into the duodenum at 20 ml/min, starting 15 min after phase III migratory motor complex (MMC). A 20 mL bolus of each solution caused more activity (P < 0.05) than a 10 mL bolus, but the motor pattern was similar. The control, 0.9% NaCl, produced occasional pressure waves, whereas bile and sodium oleate induced more (P < 0.05) activity which consisted of low amplitude, isolated or clusters (2-4 cycle/min) of non-propagating pressure waves that occurred at random sites. In three subjects, oleate produced isolated pyloric phasic contractions. In contrast, HCl and 5% NaCl induced high amplitude pressure waves that were seen either at a single channel or at multiple channels, occurring simultaneously. The motility index was also greater (P < 0.05) than that induced by other solutions. Additionally, within 2 min of infusion, a phase III MMC like pattern was observed in five of the nine subjects who received HCl and three of the nine who received 5% NaCl. A non-nutrient iso-osmolar solution induced occasional motor activity. HCl and hyperosmolar solutions induced more frequent and large amplitude, segmental contractions whereas lipid and bile induced fewer and smaller amplitude contractions. The volume, the pH, the osmolar and the nutrient make up of the infusate may each influence the duodenal motor responses.

Adolescent↗
PubMed1996

Mononeuritis multiplex: a rare complication of acute hepatitis A.

A 28-year-old man suffered from acute severe hepatitis A virus infection, documented by serologic diagnosis. During the clinical and enzymatic recovery phase, mononeuritis multiplex that involved the left ulnar and right lateral cutaneous nerves developed. It presented by sensorimotor disturbances in left arm and right thigh. Mononeuritis multiplex has been frequently described in patients with chronic hepatitis B, either isolated or associated with periarteritis nodosa. However, it has not been reported in association with hepatitis A infection.

Adult↗
PubMed1996

Metformin-induced lactic acidosis associated with acute renal failure.

A 69-year-old diabetic woman with diffuse atherosclerosis presented with acute renal failure due to contrast nephropathy and severe metformin-induced lactic acidosis. There was a discrepancy between the patient's elevated serum creatinine level, indicative of severe renal insufficiency, and her very low blood urea nitrogen content. It is postulated that the patient's extremely severe acidosis interfered with her hepatic urea generation, contributing to this unusual biochemical abnormality.

Acidosis, Lactic↗
PubMed1996

Merkel cell tumor in a woman with chronic lymphocytic leukemia.

We describe a 69-year-old woman with basal cell carcinoma, and chronic lymphocytic leukemia who developed Merkel cell tumor. This latter malignancy first appeared as enlarged lymph nodes in the axilla and elbow regions and responded initially to radiotherapy. Later, the patient developed obstructive jaundice which was due to pancreatic metastases of the Merkel cell tumor, documented by post-mortem examination. To our knowledge, this is the first description of a Merkel cell tumor causing obstructive jaundice, in a patient with chronic lymphocytic leukemia.

Aged↗
PubMed1996

Glomerulonephritis associated with acute hepatitis B.

Acute hepatitis B virus (HBV) infection has very rarely been associated with glomerulonephritis. We describe a case of post-infections glomerulonephritis associated with acute HBV infection. The kidney disease resolved concomitantly with the hepatitis, and the patient recovered from acute HBV infection.

Acute Disease↗
PubMed1995

Beneficial effect of digoxin-specific Fab antibody fragments in oleander intoxication.

A 24-year-old man presented to the emergency department with nausea, vomiting, abdominal pain, and an acute confusional state of 6 hours' duration. Ten hours before admission, he had ingested a mixture of orange juice and six ground leaves, later identified as Nerium oleander (common pink oleander) leaves. His blood pressure was 100/80 mm Hg, and his pulse rate was irregular at 40/min. He was disoriented and his speech was dysarthric. Twelve-lead electrocardiography revealed a complete atrioventricular block, with a nodal escape rhythm of 40/min and diffuse ST depression. The presumptive diagnosis of acute oleander intoxication was confirmed by the detection of digoxin (1.0 nmol/L [0.8 ng/mL]) on radioimmunoassay. Despite intensive therapy, the patient's hemodynamic condition deteriorated. His blood pressure decreased to 70/40 mm Hg; he became oliguric and nonresponsive to external stimuli; and his potassium concentration rose to 6.8 mmol/L. Eighteen hours after admission, an empiric 480-mg dose of digoxin-specific Fab antibody fragments was administered intravenously over 30 minutes. Within minutes of the initiation of immunotherapy, the patient woke up; his blood pressure rose to 90/50 mm Hg; and he regained a sinus rhythm of 68/min with a prolonged PR interval. His potassium concentration decreased to 5.1 mmol/L within 15 minutes and normalized within 1 hour of therapy initiation. One day later, the 1 degree atrioventricular block disappeared, but the ST depression persisted for an additional 6 days. The value of digoxin-specific Fab antibody fragments in the treatment of plant glycoside and, in particular, oleander intoxication is discussed.

Adult↗
PubMed1995

Talc granuloma of the uterus.

A 40-year-old woman presented with acute obstructive lung disease. She was treated with steroids and achieved a good response. However, she had two previous pelvic operations with histological findings of uterine serosal caseating granulomas presenting in the latter operation. Antituberculosis (TB) prophylaxis was suggested due to the suspicion of TB reactivation under steroid management. Investigation for TB infection or exposure was negative while revision of the histological slides disclosed talc granulomas. Although talc granuloma is reported in starch powder gloves which should not contain talc, it is still very uncommon.

Adult↗
PubMed1994

Pulmonary embolism as the presenting feature of hepatocellular carcinoma.

Primary hepatocellular carcinoma can be revealed by recurrent pulmonary embolism as observed in this case of a 63-year-old woman initially hospitalized for abdominal pain and shortness of breath. The clinical diagnosis was confirmed by laboratory findings, a ventilation perfusion scan and pulmonary angiography which demonstrated peripheral basal artery cut-off and slow filling with delayed washout. The patient was treated with heparin then with nicoumarol and responded well. One month after discharge the patient again complained of shortness of breath and was readmitted. Anticoagulation was adequate as evidenced by a prothrombin time of 1.39 INR and the physical examination and laboratory tests again suggested pulmonary emboli, confirmed by a ventilation perfusion scan. Computed tomography of the chest and abdomen revealed multiple hypodense masses filling half of the liver volume and needle biopsy led to the diagnosis of hepatocellular carcinoma. Hypercoagulability in malignancy is well-known although cases of migratory thrombophlebitis are extremely rare. Pulmonary embolism has not been described as a presenting feature of hepatocellular carcinoma. In this case, there was no evidence of hepatic dysfunction and the pulmonary embolism occurred despite adequate anticoagulation. Clinicians should include occult carcinoma among the possible causes of recurrent pulmonary embolism and when searching for malignancy can include hepatocellular carcinoma among the causes of hypercoagulation.

Carcinoma, Hepatocellular↗