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Biomedical subjects

S Sultan

Publications and source records attributed to S Sultan.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Chylous ascites in cirrhosis. Retrospective study of 20 cases].

Chylous ascites is a rare complication of cirrhosis. We report 20 cirrhotic patients with chylous ascites seen between 1976 and 1989. Hepatocellular carcinoma was associated in 2 cases and, in 5 cases, chylous ascites followed surgery (portosystemic shunt in 4 cases). Chylous ascites was spontaneous in the 13 other cases. Prevalence of chylous ascites was 1.1 p. 100 in the cirrhotic population with ascites observed between 1983 and 1988. Chylous ascites, whether spontaneous or postoperative, was almost always refractory to medical treatment (16 of 18 patients). Treatment by Le Veen shunt was unsuccessful in 4 patients and lead to infection in 2 cases. Four of 6 patients treated by portocaval shunt died during the first postoperative month. Repeated paracentesis should be preferred, but this can be complicated by malnutrition. Seven of 10 alcoholic cirrhotics with spontaneous chylous ascites and 2 of 4 patients with postoperative chylous ascites died during the year following diagnosis. In view of this poor prognosis, hepatic transplantation should be considered early in selected patients.

Adult↗
PubMed1990

[Chylous ascites in adults: etiological, therapeutic and prognostic aspects. Apropos of 35 cases].

Chylous ascites is a rare disease which often poses difficult problems in diagnosis and management. We reported a series of 35 patients with chylous ascites, seen between 1976 and 1989. Diagnosis of chylous ascites was made on: (1) a milky appearance of ascites; (2) an ascitic concentration of triglycerides higher than in serum and higher than 1.5 mmol/l. Incidence was about 1/8 850 admissions. Cancers (mainly lymphomas and abdominal carcinomas), cirrhosis and retroperitoneal surgery accounted for more than 90 p. cent of cases. In all cases of cancer the tumor was extensive, and the prognosis was poor with a one year mortality rate of 80 p. cent. The two postoperative chylous ascites without cirrhosis were cured, after treatment with medium chain triglycerides in one case, and surgical repair in the other case. Chylous ascites in cirrhosis, spontaneous or after porto-systemic shunt, became refractory in 13 of 15 patients, and the one year mortality rate was high (69%).

Adult↗
PubMed1990

Treatment of supersensitivity psychosis with antiepileptic drugs: report of a series of 43 cases.

Supersensitivity psychosis has emerged as a potential side effect of long-term neuroleptic therapy that may be similar to tardive dyskinesia. Schizophrenic patients with supersensitivity psychosis and considered to be drug-resistant were treated with anti-epileptic medication. Forty-three separate trials were conducted on a total of 35 patients. Over half improved on clinical global impression, some of them considerably. We propose that antiepileptic drugs ameliorate supersensitivity psychosis and so-called "drug-resistant" schizophrenic patients by correcting a pharmacological kindling effect in the limbic system which results from chronic neuroleptic therapy.

Adult↗
PubMed1989

Use of prophylactic antibiotic in clean surgical cases--a prospective trial of various regimens.

In a randomised controlled prospective trial, different antibiotic regimens were evaluated as prophylaxis in wound infection following elective surgical procedures. Four hundred and four consecutive cases were divided in four groups. Two groups were allotted two different conventional postoperative antibiotic regimens while the fourth group received short term perioperative antibiotic; group one served as control. A higher frequency of postoperative wound infection was observed in the controls. Results showed reduction in gross infection in only group III where short term perioperative antibiotic was used. Combination of penicillin and streptomycin were not found effective, and low infection rate was observed with Cephamendole used perioperatively.

Anti-Bacterial Agents↗
PubMed1986

Renal bicarbonate handling in low birth weight infants during metabolic acidosis.

We studied the fractional excretion of bicarbonate (FE HCO-3) in 10 low birth weight infants aged 1-6 days during metabolic acidosis (base excess greater than or equal to -5 mEq/l) and during subsequent sodium HCO-3 infusion. The mean birth weight was 1,095 g; the mean gestational age was 29 weeks. The ability to decrease urine pH to less than 5.5 and FE HCO-3 to less than 1% during metabolic acidosis was not limited by low gestational age or birth weight. After HCO-3 therapy, all infants corrected their negative base excess, and plasma HCO-3 increased significantly. All infants with blood pH less than or equal to 7.22 or PaCO2 greater than or equal to 50 mm Hg had minimal or absent FE HCO-3. Infants with elevated PaCO2 and mild or absent acidosis also had complete HCO-3 tubular reabsorption. These results suggest that the HCO-3 tubular reabsorption is adequate during metabolic and/or respiratory acidosis in low birth weight infants.

Acidosis↗
PubMed1980

Psychopathological assessment of child-abusing, neglecting, and normal mothers.

The authors attempted to differentiate groups of abusing, neglecting, and normal mothers on the basis of clinically familiar dimensions of psychopathology. Using the Current and Past Psychopathology Scales (CAPPS), two psychiatrists conducted standardized interviews and blindly assessed 60 subjects. Although the current section of the CAPPS failed to discern more psychopathology in the maltreating parents, a multiple discriminant analysis of 18 past summary scales significantly distinguished the three groups and correctly reclassified 63.3 per cent of the mothers. The neglect group obtained high ratings on the Neurotic Childhood scale, whereas abusers showed greater disturbance on Disorganized and Anger-Excitability.

Child↗
PubMed1980

Nursing audit.

Explore the source record for details and available documents.

Aged↗
PubMedDate not supplied

Prospective randomized trial of a metallic intravascular stent in hemodialysis graft maintenance.

PURPOSE: To evaluate percutaneous transluminal angioplasty (PTA) alone versus PTA and flexible self-expanding stent placement for the management of hemodialysis access graft stenoses. MATERIALS AND METHODS: Thirty-seven grafts in 34 patients were evaluated for abnormal intradialytic parameters (n = 27) or occlusion (n = 10). Angiography identified stenoses (mean, 69%; range, 50%-95%) at or within 3 cm of the vein-graft junction (70%) or in the peripheral outflow vein (30%) that had recurred within a 6-month period after previous PTA. They were randomized to PTA alone (n = 20) or PTA with Wallstent (n = 17). Additional lesions were treated by PTA alone, and a mean of 1.4 (range, 1-3) lesions were treated per patient. Significant differences existed in the mean number of previous accesses (1.8 and 0.8 in the PTA and stent groups, respectively) and in the mean number of previous interventions in the current access (1.8 and 2.9, respectively). End points were subsequent radiologic or surgical intervention, transplantation, and death. RESULTS: Technical success was 100% (mean residual stenosis, 12%; range, 0%-30%). The primary patency of 128 days and secondary patency of 431 days were similar for both groups. Secondary patency required a mean of 1.8 and 1.6 additional interventions for the PTA and stent groups, respectively. The adjunctive stent placement increased the cost of the procedure by 90%. CONCLUSION: Despite significant added costs, there was no advantage to stent placement for recurrent peripheral hemodialysis graft stenoses that were already adequately dilated with balloon angioplasty.

Adult↗
PubMedDate not supplied

Atraumatic acute upper limb ischemia: a series of 64 patients in a Middle East tertiary vascular center and literature review.

This paper documents the various causes of upper limb ischemia in a series of 64 Egyptian patients presenting to a tertiary referral center over a 4-year period and offers a diagnostic dissertation and review of the pertinent literature. Atraumatic upper limb ischemia is an uncommon entity. It has a broad etiology with diverse management pathways. Nineteen patients presented with severe and immediate limb-threatening ischemia. These patients underwent immediate surgical exploration: an embolus was diagnosed in 15 and thrombosis in 4. Twenty-eight patients presented with ischemia of lesser severity, allowing preoperative angiography. Of these 28 patients, 6 had an embolus, 14 had thrombosis, 4 had thoracic outlet syndrome, the remainder had miscellaneous causes. Fifteen patients had upper limb ischemia secondary to arteritis, and 2 patients with dissection of the ascending thoracic aorta presented with upper limb ischemia. Forty-seven patients underwent a surgical procedure, with a morbidity rate of 21% and mortality rate of 19%. Patients presenting with upper limb ischemia tend to have significant co-existing disease. Management of upper limb ischemia requires preoperative and/or peroperative angiography with careful application of vascular surgical expertise.

Acute Disease↗
PubMedDate not supplied

Low dose intraarterial thrombolysis with tissue plasminogen activator: does it deliver as promised?

The widespread use of intraarterial thrombolytic therapy has been based on perceived benefits over operative treatment and the downgrading of the magnitude of subsequent surgery. Thirty-three patients who had thrombolysis for peripheral artery occlusion were retrospectively analyzed at St. James's Hospital from 1991 to 1997. One patient received streptokinase unsuccessfully. Five other patient's records were inadequate for analysis. Twenty-seven patient's notes were analyzed for risk, duration of occlusion, duration of treatment, dosage of tissue plasminogen activator (tPA) and conduits thrombolysed. There were 15 males and 12 females. The mean age was 62 years (range, 20-87). Fourteen were current or reformed smokers. Five were diabetic. Indications for treatment included acute graft occlusion (n=13), embolus (n=6), and primary and secondary arterial thrombosis (n=8). Duration of occlusion was less than 24 hours in seven, 1 to 7 days in ten, and more than 7 days in ten patients. Twelve (44.44%) patients had complete clot lysis, four (14.81%) had partial clearance, and 11 (40.74%) remained occluded. Eight (29.63%) had serious complications including one death. Eighteen (66.66%) patients needed further surgical intervention to maintain graft patency. Data were analyzed using the chi-square and pooled t test. No significant difference was observed in results from thrombolysis from different conduits, gender, etiology, or smoking history. Increased duration of tPA administration was associated with an increased risk of failure. Administration of total dosages greater than 60 mg was associated with a higher risk of failure. Diabetics had a poor outcome (p=0.0520). Only 44 % of patients successfully underwent lysis. A primary surgical option may be a more sensible course than lysis, given that the vast majority of patients ended up having surgery anyway.

Adult↗
PubMedDate not supplied

Survival of ruptured abdominal aortic aneurysms in the west of Ireland: do prognostic indicators of outcome exist?

Ruptured abdominal aortic aneurysm (RAAA) is a demanding vascular surgical problem and the cause of significant morbidity and mortality. The aim of this study was to identify prognostic factors that influence outcome. Over 6 years, 42 ruptured abdominal aortic aneurysms were operated on with a mean diameter of 7.2 cm. RAAA was defined as free intraperitoneal rupture. Data were collected retrospectively from hospital medical records. The male: female ratio was 8:1 and the mean age was 74 years (range 55-89). Fifteen were in hypovolemic shock and 27 patients were clinically stable. The perioperative mortality rate for the 15 shocked patients was 60% (9 patients) and the 1-year cumulative survival rate was 33%. The perioperative mortality rate for the 27 clinically stable patients was 40% (11 patients) and the 1-year cumulative survival rate was 56%. Survival curves were constructed for these groups to compare male versus female, age >/= 70 versus age < 70, shocked versus stable, and preoperative hemoglobin (Hb) </= 10 vs > 10. No patient with preoperative cardiac arrest survived more than 24 hours. With VassarStats, the confidence interval for age, gender, hemodynamic status, and preoperative Hb were calculated. The standard weighted mean analysis by ANOVA gave a p value of < 0.001. The overall 30-day mortality rate was 47% (20 of 42) and the 1-year mortality rate was 52% (22 of 42). Male patients over 70 years with RAAA in hypovolemic shock with low Hb have a higher 30-day mortality rate and few survive more than 1 year. The study suggests that each of these 4 parameters separately was not a strong prognostic indicator. Collectively, however, they strongly influence the prognosis of patients with RAAA. These findings strengthen the case for selective treatment for RAAA.

Age Factors↗
PubMedDate not supplied

Management of open tibial fractures at Ayub Teaching Hospital, Abbottabad.

BACKGROUND: Open fractures of tibia are usually caused by high-energy injury. Management of such injuries requires care of contaminated soft tissue injury involving skin, muscles and neurovascular structures. Treatment of fracture, which is badly comminuted and potentially contaminated, is always a problem. While limb salvage is the initial aim, medium and long-term problems with soft tissue cover, infection and union are all too common and result in serious disability. METHODS: 32 open grade-III tibial fractures were treated with AO (Arbeitsgemeinschaft fur Osteosynthesefragen) tubular external fixator. The management and outcome were reviewed and tabulated. RESULTS: One out of 32 required primary amputation due to delayed vascular repair. The remainder received standardized wound care consisting of surgical debridement and delayed closure of wound. Once the soft tissue envelope healed and fracture was sticky external frame was removed and patella tendon bearing cast applied. In selected cases internal fixation was done (n = 8, in 5 intramedullay nailing and in 3 plating). Nineteen cases were treated in PTB cast and 4 cases in external fixation till union. Deep infection rate was 13% and pin tract infection 10%. In 31 cases union was achieved in 32 weeks (24 weeks to 62 weeks).

Adult↗
PubMedDate not supplied

Interlocked nailing of comminuted fractures shaft of femur.

BACKGROUND: Comminuted fracture shaft of femur are difficult to treat. Internal fixation with ordinary nail does not hold the fracture fragments while osteosynthesis with plates and screws does not always produce stable fixation and involves an increased risk of infection. METHODS: Thirty six comminuted fractures shaft of femur were treated with closed interlocked nailing. There were twenty closed and sixteen open fractures. RESULTS: Thirty six fractures united without additional surgical intervention. Average time to union was 34 weeks (range 26 to 64 weeks). In five patients secondary bone grafting was done. CONCLUSION: Closed Interlocked nailing is the treatment of choice for most comminuted fracture shaft of femur.

Adolescent↗