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Biomedical subjects

S Saab

Publications and source records attributed to S Saab.

At least 37 records · Page 2Linked to original sources
PubMed2000

Endoscopic management of biliary leaks after T-tube removal in liver transplant recipients: nasobiliary drainage versus biliary stenting.

This study presents the long-term sequelae of endoscopic retrograde cholangiopancreatography (ERCP)-managed biliary leakage in patients who underwent orthotopic liver transplantation (OLT) and compares the relative efficacy, safety, and charges of nasobiliary drainage (NBD) versus biliary stenting (BS). We identified all orthotopic liver transplant recipients from January 1, 1993, to December 31, 1997, who had undergone ERCP for biliary leakage. Clinical outcome and charges were calculated on an intention-to-treat basis according to initial endoscopic therapy. Of the 1,166 adult OLTs performed during the study period, 442 patients underwent elective T-tube removal. ERCP was attempted in 69 patients (16%) who developed biliary leakage after T-tube removal. Three patients (5%) in whom initial ERCP was unsuccessful underwent surgery. NBD and BS were used as primary therapy in 45 (68%) and 21 patients (32%), respectively. Three patients initially treated with NBD required reendoscopy or surgery compared with 6 patients initially treated with BS (P <.05). Although not statistically significant, there was a trend toward greater expense in the BS group compared with the NBD group. ERCP is a safe and effective method of managing biliary leakage after T-tube removal in orthotopic liver transplant recipients. However, our results suggest NBD is the preferred method because recurrent leaks were more common in patients treated initially with BS. With prompt use of ERCP, surgery is rarely needed for this complication of OLT.

Bile↗
PubMed2000

Tests for acute and chronic viral hepatitis. Finding your way through the alphabet soup of infection and superinfection.

Because clinical signs are of little or no help for identifying various causes of viral hepatitis, accurate diagnosis can only be achieved with serologic and molecular testing. Knowledge of the strengths and limitations of these tests allows rational use and interpretation of results. The findings have implications for public health surveillance, estimating prognosis, and identifying candidates for treatment.

Diagnosis, Differential↗
PubMed1998

Corticosteroids and systemic lupus erythematosus pancreatitis: a case series.

OBJECTIVE: To determine whether (1) corticosteroids cause pancreatitis in patients with systemic lupus erythematosus (SLE); (2) SLE pancreatitis occurs in the setting of a generalized SLE flare; and (3) corticosteroids can be used to treat SLE pancreatitis. METHODS: A total of 8 patients over a 10 year period with pancreatitis and SLE were identified retrospectively from a hospital database at the University of California San Diego Medical Center. RESULTS: All 8 patients received therapeutic doses of corticosteroids as part of their treatment for SLE and pancreatitis. All patients manifested both clinical and biochemical resolution of their pancreatitis with the administration of corticosteroids. No patient in our study experienced immediate complications related to corticosteroids. Only 2 of the 8 patients manifested active concurrent systemic disease related to the SLE. CONCLUSION: Corticosteroids do not cause pancreatitis in patients with SLE, and they should be administered during episodes of acute pancreatitis if clinically necessary. Pancreatitis does not tend to occur in the setting of a generalized SLE flare.

Acute Disease↗
PubMed1997

The scratch test is unreliable for detecting the liver edge.

To determine the validity and reliability of the scratch test method for estimating the liver span below the right costal margin, we performed a prospective double-blind study using multiple examiners at different levels of training. Twenty-two patients were examined by 11 observers using only the scratch test. Measures of liver edge length below the right costal margin using the scratch test were compared with those by ultrasound. The validity of the scratch test was determined by simple linear regression and the concordance correlation coefficient. There was very poor correlation between the scratch test estimates and ultrasound measurements for all examiners. Measurement reliability, estimated using generalizability theory, for seven observers who examined the same nine patients was 0.68. The reliability of a single examiner was 0.24. The scratch test method for measuring the liver edge span below the right costal margin was neither a valid nor reliable method of physical examination.

Adult↗
PubMed1997

The clinical detection of scleral icterus: observations of multiple examiners.

Sixty-two medical observers at various levels of medical training examined six patients for the presence or absence of scleral icterus in a double-blind survey. At a total serum bilirubin of 42.8 mmol/l (2.5 mg/dl) and 53.0 mmol/l (3.1 mg/dl), 58% (95% confidence interval [CI] 33-80%) and 68% (95% CI 46-85%) of examiners detected the presence of scleral icterus, respectively. Level of training appeared to influence specificity, as 6 of 8 apparent false-positives (total serum bilirubin = 12.0 mmol/l [0.7 mg/dl] and the presence of scleral icterus) were attributable to medical students. Level of training did not appear to influence sensitivity, as 3 of 11 apparent false-negatives (total serum bilirubin = 66.7 mmol/l [3.9 mg/dl] and the absence of detection of scleral icterus) were not attributable to medical students (p = 0.278). Even at the often-quoted estimate of 42.8 mmol/l (2.5 mg/dl) at which at scleral icterus is detected, approximately one-third of medical examiners in our study did not detect scleral icterus.

Adult↗
PubMed1996

Fibrolamellar hepatocellular carcinoma. Case reports and a review of the literature.

Fibrolamellar hepatocellular carcinoma is an uncommon malignancy seen in young adults without underlying liver disease. Physical signs are minimal and laboratory values are noncontributory. Diagnosis is suggested by clinical history, supported by radiographic studies, and confirmed by histologic examination. Individuals with fibrolamellar carcinoma generally have a greater survival than those with hepatocellular carcinoma. Although most patients with fibrolamellar carcinoma undergo curative surgery, two of the three patients we report had inoperable tumors.

Adult↗
PubMed1996

Ascites and the acquired immunodeficiency syndrome. Report of 54 cases.

We identified 54 patients with AIDS and ascites seen over a 4.5-year period at a university hospital. This retrospective study is the largest reported series of patients with AIDS and ascites. Patients with AIDS who are evaluated for ascites should be stratified by the CD4 + cell count and the presence or absence of portal hypertension based upon the serum-ascites albumin gradient and clinical presentation. Awareness of possible surgery-related causes of ascites is crucial, as these patients may not manifest the usual signs and symptoms of peritonitis or abdominal catastrophes seen in immunocompetent hosts. Patients with evidence of portal hypertension due to hepatic cirrhosis and an elevated ascitic neutrophil count should be suspected to be infected with common bacterial pathogens associated with peritonitis unless the CD4 + cell count is below 50 cells/mm3. When the CD4 + cell count declines below this threshold, infections due to Mycobacterium avium complex, cytomegalovirus, and other opportunistic infections should be considered.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Evolving misidentification syndromes and facial recognition deficits.

In this paper, the authors report the case of a 33 year old man with several misidentification delusions involving the self. Evidence suggests that one type of misidentification delusion may evolve into another type. Neuropsychological testing further suggests that misidentification delusions may be associated with subtle abnormalities in facial recognition abilities and with non dominant cerebral compromise.

Adult↗
PubMed1977

True and false aneurysms of the left ventricle following myocardial infarction.

Anterolateral myocardial infarction resulted in the formation of both true and false aneurysms in a 75 year old man in whom severe congestive heart failure subsequently developed as the false aneurysm became progressively larger. Left ventriculography detected and quantified both aneurysms, and demonstrated reasonable function of the remaining volume-overloaded left ventricle. Resection of both aneurysms was accomplished with marked relief of symptoms. The literature on false aneurysm is reviewed, and the dilemma posed by the need to recognize false aneurysms before they become symptomatic or rupture is discussed.

Aged↗