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S Sultan

Publications and source records attributed to S Sultan.

At least 37 records · Page 2Linked to original sources
PubMed2001

Endoluminal stent grafts in the management of infrarenal abdominal aortic aneurysms: a realistic assessment.

OBJECTIVES: transfemoral endoluminal aortic management (TEAM) is technically feasible in the treatment of infrarenal abdominal aortic aneurysms but its advantage over conventional repair is unproved. We report our initial experience, learning curve and technical difficulties encountered during the process of establishing this novel technique in our institute. MATERIAL AND METHODS: over a 3-year period 400 cases of abdominal aortic aneurysms were reviewed; only 58 cases (15%) were suitable for endovascular repair under our TEAM protocol and 36 (9%) were offered endovascular intervention. They were mainly high-risk patients (85% ASA III and IV) with a mean age of 72 years. Thirty-three bifurcated grafts, two straight tube grafts and one aorto mono-iliac graft were deployed. We oversized the graft by 15-20% to the diameter of the aortic neck and both common iliac arteries. RESULTS: two cases (6%-95% CI: 1-19%) had on-table conversion because of ruptured common iliac arteries. Peri-operatively there were two deaths from multi-organ failure. Transient renal failure occurred in two patients and three patients (9%) suffered a non-fatal myocardial infarction. Sixteen percent of patients had a groin wound problem. The mean hospital stay was 7 days. Five minor endoleaks (15%) were identified and sealed at 30 days. One secondary endoleak was identified at 18 months because of a patent juxta-renal lumbar artery. No secondary cuffs or extensions were used. Mean follow-up was 29 months and all grafts remained patent. The technical, clinical, continuous and secondary success rates were 78%, 91%, 89% and 91% respectively with TEAM. CONCLUSION: endovascular training, patient selection and learning curve impose an impact on the final outcome. Until a reliable hard point is reached so that endovascular repair could be exercised in routine practice, the use of TEAM must be questioned in high-risk patients, and should be performed under clinical trial conditions using strict selection criteria.

Aged↗
PubMed2001

Ultrasound guided human thrombin injection. A new modality in the management of femoral artery pseudo-aneurysms.

OBJECTIVES: We report our initial results of a prospective study of duplex ultrasound-guided injection (UGTI ) of thrombin in the management of femoral artery pseudo-aneurysms. We used human thrombin to avoid the increase in the human antibodies directed against fibrinogen, with the use of bovine thrombus, that preclude further utilisation of the bovine fibrin glue during cardio-thoracic surgery. METHODS: From 1999 to 2001, 19 patients, aged 69 (range 52-85) years presented with 21 femoral pseudo-aneurysms were treated. The mean pseudoaneurysm diameter was 30 (15-55) mm. All but two were secondary to cardiac procedures and the common femoral artery was the injured vessel in all instances. Patients were referred within 2-21 days following their iatrogenic injury. RESULTS: Immediate thrombosis of the sac occurred in 19 (90%) of the 21 pseudo-aneurysms. After a second injection, complete occlusion occurred in the remaining two patients. Two patients (CI 95%; 1-19) with three femoral pseudo-aneurysms developed leg pain. Duplex ultrasound follow-up showed two recurrences (9.5% - CI 95%; 1-19) and both were treated by repeat UGTI. There was no conversion to surgical repair. CONCLUSION: This percutaneous minimally invasive technique is safe and effective in the management of iatrogenic pseudo-aneurysms in this high-risk group of patients. Human thrombin has significant advantages over bovine thrombin.

Aged↗
PubMed2001

How type 1 diabetic patients with good or poor glycemic control cope with diabetes-related stress.

OBJECTIVE: To determine the link between glycemic control and the strategies adopted by patients in coping with diabetes-related stress. MATERIAL AND METHODS: In a cross-sectional study of 122 type 1 diabetic patients, glycemic control was evaluated on the basis of the last mean annual HbA(1c) level, and a comparison was made of two groups of patients, i.e., those with "good control" (HbA(1c)<7.5%) and "poor control" (HbA(1c) > 8.5%). Sociodemographic were collected for all patients by the referring physician. The nature of the diabetes-related stress and the coping strategies adopted by patients were determined by analyzing validated self-assessment questionnaires. RESULTS: Comparison showed that there was no significant difference between the two groups in terms of the patients' age, level of education, age at onset, duration of the diabetes, or the nature of diabetes-related stress factors. In contrast, the difference between the groups was significant in that patients in the "well controlled" group carried out more home blood glucose tests (p<0.02), had fewer complications (p<0.003), and made greater use of so-called "task oriented" strategies (p=0.023), regardless of the existence of any complications. CONCLUSIONS: Even though the nature of the diabetes-related stress appears to be the same for the two groups, type 1 diabetic patients with good glycemic control manage their condition differently (more frequent home blood glucose tests) and use coping strategies that place greater emphasis on problem solving.

Adaptation, Psychological↗
PubMed2001

[Anal condyloma: its management is still difficult].

Anal condylomas result from papillomavirus infection, the most common sexually transmitted disease. The principal risk is the development of cancer of the anal canal. The risk of contamination is high, even after a single sexual contact. No specific antiviral treatment is available and no consensus has been reached on the appropriate treatment of anal condylomas. Despite the development of various methods (interferon, imiquimod), electrocoagulation remains the treatment of choice. Finally, regular follow-up and treatment of the partner(s) are essential.

Anus Diseases↗
PubMed1999

Outcome of the first 100 femoropopliteal angioplasties performed in the operating theatre.

OBJECTIVES: To examine the factors influencing outcome and restenosis in an initial series of 100 infrainguinal angioplasties. DESIGN: Prospective study of angioplasties of the superficial femoral and popliteal arteries performed over a 42-month period. MATERIALS AND METHODS: One hundred consecutive angioplasties in 96 patients performed in the operating theatre between January 1993 and June 1996 were followed prospectively with clinical, ABI, and duplex assessment. Forty-four procedures were for disabling claudication and 56 for critical ischaemia. Stents were deployed in 30 limbs. RESULTS: Angioplasty was successful in 84 of 100 limbs. Cumulative patency of the entire group at 3, 6, 12 and 18 months was 78%, 60%, 53%, and 49% respectively, while excluding initial failures, gave patencies of 95%, 69%, 63%, and 58%, respectively. Claudicants with a 1-year patency of 64% did significantly better than patients with critical ischaemia (44% p < 0.05). Angioplasties performed during the initial 21 months had a 1-year patency of 42%, while those performed in the final 21 months had a 74% patency (p = N.S.). The patency for stented arteries was 66% vs. 49% for angioplasty alone (p = N.S.). The 2-year limb salvage rate was 91% in patents with critical ischaemia. Forty-six per cent of restenoses were asymptomatic. CONCLUSIONS: The results suggest that while angioplasty is useful in treating infrainguinal arterial disease, there is a learning curve, resulting in a high restenosis rate for occlusive and multilevel disease, while concomitant placement of stents may be beneficial.

Aged↗
PubMed1999

Fifteen-year experience of transperitoneal management of inflammatory abdominal aortic aneurysms.

OBJECTIVES: to assess the long-term outcome of patients with inflammatory abdominal aortic aneurysms. MATERIALS AND METHODS: over a fifteen-year period 598 cases of abdominal aortic aneurysm were treated and, of these, 32 cases (5.3%) were inflammatory in nature. The diagnosis was made on preoperative (CT) computed tomography in fifteen cases. Twenty-six patients were symptomatic on presentation and ten cases were repaired on an emergency basis. Only six were repaired electively. The transabdominal transaortic approach without dissection on the nearby adherent structures was used routinely. RESULTS: there was one postoperative death from a respiratory arrest leading to a thirty-day mortality of 3.1%. Early graft thrombosis occurred in three cases (9.3%) and all underwent successful thrombectomy. Colonic ischaemia was encountered in one patient who later developed an aortoenteric fistula. Two patients suffered a non-fatal myocardial infarction postoperatively leading to an overall morbidity of 18.7%. CONCLUSIONS: patients with inflammatory aortic aneurysms fare worse than patients with aortic aneurysms in general. Preoperative suspicion assists in planning surgery. We believe that the transperitoneal approach with an anterolateral aortotomy and minimal dissection of adherent structures offers excellent results in dealing with this difficult group of patients.

Aged↗
PubMed1999

Aorto-left renal vein fistula: is there a place for endovascular management?

PURPOSE: To describe the endovascular treatment of an aorto-left renal vein fistula. METHODS AND RESULTS: A 77-year-old man with multiple comorbidities presented with low back pain, hematuria, cyanosis, and a pulsatile abdominal mass. Imaging confirmed a 7-cm abdominal aortic aneurysm with a contained rupture into the left renal vein. Owing to the patient's high surgical risk, a Talent Endoluminal Stent-Graft was implanted to satisfactorily exclude the aneurysm. Hemodynamic stability and normal renal function were restored; however, continued perfusion of the sac prompted an attempt to percutaneously repair the renal vein defect. This effort failed, so open laparotomy was necessary. CONCLUSIONS: Although total endovascular management was not successful in this case, the initial use of a minimally invasive approach allowed the patient's clinical status to improve and lower the risk of subsequent surgery.

Aged↗
PubMed1999

Myositis overlap syndromes.

Myositis-overlap syndromes are characterized by a heterogeneous group of clinical syndromes of which many are closely linked with specific autoantibodies. Clinical and laboratory-based research into this fascinating group of syndromes have given us clues in elucidating the role of immunogenetic, environmental influences on the etiopathogenesis of autoimmune disease. Patients positive for anti-snU1 RNP antibody often present with a constellation of "autoimmune-related" clinical features, often not fulfilling the diagnostic criteria for a single disease entity. Controversy remains as to whether this represents a single disease entity, namely mixed connective tissue disease, or an undifferentiated autoimmune rheumatic/overlap syndrome. Anti-PM-Scl antibodies are linked with myositis-scleroderma overlap and generally tend to follow a benign course, often responding well to minimal immunosuppression. More recently the number of anti-tRNA synthetase antibody-associated overlap syndromes has expanded; antibodies to the autoantigen histidyl-tRNA synthetase (Jo1) being the commonest and best characterized. Patients with these antibodies often have severe interstitial lung disease and the poorest prognosis, often necessitating aggressive immunosuppressive therapy.

Autoimmune Diseases↗
PubMed1998

Popliteal aneurysms: a 10-year experience.

BACKGROUND: Popliteal aneurysms account for 70% of peripheral arterial aneurysms and, if untreated, pose a serious threat to the affected limb. Debate continues about the best form of treatment especially for asymptomatic lesions. METHOD: We reviewed the computer records and charts of patients seen at this department with a diagnosis of popliteal aneurysm over the last 10 years. Patients who had not been seen within the last year were followed-up through their G.P. RESULTS: Twenty-four patients (M 23/F 1) presented with 40 popliteal aneurysms. The mean age was 63.5 +/- 9 years. Symptoms were present in 23 of the affected limbs while 17 were asymptomatic. Thirty were treated surgically and 10 followed with regular ultrasound. The mean diameter of the repaired aneurysms was 3.3 +/- 1 cm. Aneurysms < 2 cm were more likely to be asymptomatic. No limbs were lost in patients undergoing elective repair of popliteal aneurysms. The secondary patency and limb salvage rates at 3 years were 84% and 96% respectively. Conservative management of asymptomatic lesions < 2 cm was not complicated by the development of symptoms. CONCLUSIONS: Elective repair of popliteal aneurysms by exclusion and bypass is a safe, effective and durable technique. Small asymptomatic lesions can be safely managed with close follow-up.

Aneurysm↗
PubMed1996

Potentiation of fluoxetine by aminoglutethimide, an adrenal steroid suppressant, in obsessive-compulsive disorder resistant to SSRIs: a case report.

1. The role of serotonin in the aetiology of obsessive compulsive disorder (OCD) has been established through considerable indirect evidence (Landry and Chouinard, 1990). The strongest evidence comes from the fact that drugs known to be serotonin-selective reuptake inhibitors (SSRIs) have been found to be useful in the pharmacotherapy of OCD (Landry and Chouinard, 1990). 2. The authors investigated a new treatment approach by adding an adrenal steroid suppressant to a SSRI, fluoxetine, in the case of a severe obsessive-compulsive patient who was drug-resistant to clomipramine and SSRIs. 3. We found that the combination of aminoglutethimide 250 mg qid and fluoxetine 40 mg die significantly improved the patient's condition. Moreover, during a four and a half year period, each time we tried to decrease either fluoxetine or the steroid suppressant, the patient started to relapse, suggesting that the adrenal steroid suppressant had a potentiating effect on the SSRI.

Aminoglutethimide↗
PubMed1996

Evaluation of ureteropelvic junction obstruction (UPJO) by diuretic renography.

Of 52 cases with 56 affected renal units having symptoms and signs suggestive of Ureteropelvic Junction Obstruction (UPJO) evaluated by conventional (F + 15) diuretic renography where frusemide is given 15 minutes post-injection of radiopharmaceutical m99TC.DTPA.F + 15, twelve (21%) showed a good clearance (group A), 16 (28%) showed partial (group B) and 28 (50%) a poor clearance pattern (group C) indicating a definite obstruction. A high flow (F-15) diuretic renography where frusemide is given 15 minutes prior to the radiopharmaceutical m99TC.DTPA, was done in 23 cases with 27 affected renal units. Eleven renal units showed a good clearance (group A). Of these, 7 (64%) showed a persistent good clearance, 3 (27%) converted to poor clearance and 1 (9%) to partial clearance pattern. Of 8 renal units in group B, 5 (63%) converted to poor clearance and two (25%) to good clearance on F-15 and one remained unchanged. All renal units which presented as poor clearance (group C) on conventional (F + 15) diuretic renography remained unchanged on high flow (F-15) diuretic renography. In majority of cases conventional (F + 15) renography gave a reliable assessment of the upper tract drainage, however, since equivocal group was resolved by the F-15 and the intermittent obstruction group was definitely diagnosed, high flow (F-15) diuretic renography was more conclusive in assessment as compared to F + 15.

Adult↗
PubMed1991

Treatment of Alzheimer's disease: hopes and reality.

The relative failure of symptomatic therapeutic trials for Alzheimer's disease using non-selective cholinergic agonists brings about the need for longitudinal studies with parallel designs aimed at disease stabilization, using trophic substances or amyloid suppressors.

Alzheimer Disease↗
PubMed1990

Antiepileptic drugs in the treatment of neuroleptic-induced supersensitivity psychosis.

1. Supersensitivity psychosis (SSP) has emerged as a potential side-effect of long term neuroleptic therapy similar to tardive dyskinesia. 2. Five schizophrenic patients with SSP and considered to be drug-resistant were treated with antiepileptic drugs. All 5 improved initially, and in three the improvement was maintained at follow-up. 3. The proposed mechanism of action of the antiepileptic drugs is through correcting a pharmacological kindling effect in the limbic system which results from chronic neuroleptic therapy.

Adult↗