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Biomedical subjects

T Saleh

Publications and source records attributed to T Saleh.

7 recordsLinked to original sources
PubMed2004

The management of patients with morbid obesity in the anaesthetic assessment clinic.

One hundred and two patients with body mass indices of 37 kg x m(-2) or greater were interviewed in an outpatient assessment clinic over an 18-month period. All had been listed for elective surgery under general anaesthesia. All patients were given an explanation of the problems of morbid obesity in relation to anaesthesia. Three options were then offered to the patients: 1) to proceed with general anaesthesia as planned; 2) to undergo the planned procedure under some form of regional anaesthesia, or 3) to postpone surgery and attempt to lose significant amounts of weight. At this initial consultation, 24 patients chose option 1, 21 patients chose option 2, and 52 patients chose option 3. Four patients decided not to have the planned surgery. One patient decided to have his surgery performed at another hospital under general anaesthesia. Of the 52 patients who opted to lose weight, only eight succeeded in reducing their body mass index (BMI) by 3 or more during the period of the study. Of these eight, only four had reduced their BMI to below 35. In this study, an explanation of the problems of obesity in relation to anaesthesia, in advance of the date of surgery, had a significant effect on the type of anaesthesia chosen by most morbidly obese patients that were interviewed. Unfortunately, of those who decided to try and lose weight, only the occasional patient achieved significant weight loss. Although a laudable and advocated aim, optimization of patients with regard to their weight proved impractical in our study.

Adult↗
PubMed1995

[Esophageal dilatation in pediatrics: study of 33 patients].

BACKGROUND: Esophageal dilatation is usually regarded as an effective therapy in a majority of esophageal stenosis in childhood. However, the limited number of pediatric data does not allow definite conclusions on indications and complications of such a procedure. PATIENTS AND METHODS: The files of 33 children whose esophageal stenosis had been treated by dilatation by the same operator between 1983 and 1992 were retrospectively reviewed. The structure mechanisms were: group 1: repair of esophageal atresia (n = 9), group 2: caustic esophagitis (n = 6), group 3: peptic esophagitis (n = 12), group 4: unclassified structures (congenital esophageal stenosis, achalasia) (n = 6). The dilatations were performed under general anesthesia, and the dilatator guide was introduced under endoscopic control. Two methods were used: Savary esophageal bougies and balloon dilatation. A thoracic X-ray was systematically performed after each dilatation. RESULTS: One hundred and fourteen dilatations (3.5 dilatations/child) were performed (range: 1-32 dilatations). Twenty-five of the 33 children (76%) were dramatically improved after mechanical dilatation. Esophageal dilatation was unsuccessful in the eight other patients, seven of them requiring a surgical repair. Complications occurred in 3.4% of the dilatations: one esophageal perforation, one pneumomediastinum and two cardiac arrests (one of vagal origin and 1 after accidental extubation). All patients survived. Efficacy, duration of dilatation and complication rates were not similar in the four groups. CONCLUSIONS: Esophageal dilatation should be considered as a simple and effective procedure when strict security rules are respected by a trained operator.

Adolescent↗
PubMed1992

Lateral hypothalamic area neurotransmission and neuromodulation of the specific cardiac effects of insular cortex stimulation.

Microstimulation of the rat posterior insular cortex in phase with the ECG R wave elicits pure cardiac effects unaccompanied by changes in blood pressure or respiration. This technique has successfully demonstrated cardiac chronotropic organisation and arrhythmogenesis within the insula. Pathways exist linking the insular cortex with the lateral hypothalamic area (LHA). Similarly, the LHA has previously been shown to mediate the sympathetic and blood pressure effects of insular cortex stimulation. Therefore it was anticipated that the tachycardia elicited by insular phasic microstimulation would be responsive to LHA manipulations. Insular tachycardia sites in 28 chloralose-anesthetised male Wistar rats were phasically stimulated once with each cardiac cycle using 500 microA for 1 min before and after microinfusions (390 nl) into the LHA. The insular tachycardia response was abolished by LHA microinfusions of the synaptic blocker cobaltous chloride (4 mM). LHA microinjection of kynurenic acid (250 mM) attenuated insular tachycardia by 95%. Microinjection of naloxone (30 mM) similarly attenuated the tachycardia by 95%. Met-enkephalin (3.5 mM) was without effect on this response whereas Leu-enkephalin (3.5 mM) and neuropeptide Y (0.01 mM) (NPY) doubled the magnitude of the tachycardia. Dynorphin (0.12 mM), a specific kappa opioid receptor agonist, augmented the response to stimulation of insular tachycardia sites 8-fold. Consequently, it is suggested that the LHA contains an obligatory synapse mediating insular tachycardia and that glutamate is the likely neurotransmitter at this site. Neuromodulation of insular tachycardia may be effected by opiate kappa and NPY receptors, a finding of considerable clinical relevance.

Animals↗
PubMed1984

Urography and cystoscopy in bladder mucosal abnormality.

A prospective study was carried out on 60 patients. The diagnostic usefulness of intravenous urography (IVU) compared with that of cystoscopy in assessing the state of the bladder mucosa was evaluated. Collectively, radiology was as good as cystoscopy in suggesting the final diagnosis of the location and severity of a mucosal lesion. The after-micturition film (AMF) from IVU was the single most informative film which produced correct results in 59 of 60 patients. The full bladder film was the least useful examination and in 45 cases suggested an incorrect or misleading diagnosis.

Adolescent↗