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Biomedical subjects

A Hafez

Publications and source records attributed to A Hafez.

At least 19 recordsLinked to original sources
PubMed1992

Neonatal tetanus in rural Bangladesh: risk factors and toxoid efficacy.

OBJECTIVES: Tetanus continues to be a leading cause of neonatal death in Bangladesh as in other developing countries, yet little is known about risk factors or the efficacy of tetanus toxoid in this setting. METHODS: In May 1990, mothers of 6148 infants born alive between March 15, 1989, and March 14, 1990, in 30 rural unions of Rajshahi Division in Bangladesh were interviewed. Three surviving controls for each neonatal tetanus death were matched for sex, residence, and date of birth. RESULTS: Of 330 neonatal deaths, 112 met the case definition for tetanus. Risk was increased with a history of neonatal tetanus in a previous child, application of coconut oil to the vagina, and use of multiple ties on the umbilical cord. Risk was reduced by the birth attendant washing hands and using a cleaned cord-cutting tool. Risk was not reduced by a maternal history of two doses of tetanus toxoid (TT2), although estimated efficacy of TT2 was 45% (95% confidence interval = 16% to 64%). Subsequent to the survey, a reference laboratory reported to potency in three consecutive lots of tetanus vaccine from the production laboratory in Bangladesh. CONCLUSIONS: These findings identify high-risk mothers, stress the importance of washing hands and cleaning the cord-cutting tool, and demand improved quality control of tetanus vaccine production.

Administration, Intravaginal↗
PubMed1988

Coarctation of the abdominal aorta.

Coarctation of the abdominal aorta constitutes a rare group of vascular abnormalities, including segmental stenoses and extended hypoplasia. Hypertension is the usual solitary clinical finding and contrasts with the diversity of anatomic lesions and surgical techniques used for treatment. It is often difficult to determine whether the lesion is congenital or due to Takayasu's aortitis. Three cases of hypoplasia in adolescents are reported. Treatment consisted of an aortoaortic bypass in all cases. Vein angioplasty of the renal arteries was performed concomitantly in one case of inter- and infrarenal hypoplasia associated with stenosis of the two renal arteries. In one of the two cases of suprarenal hypoplasia, the celiac axis was reimplanted after excision of an associated aneurysm. In all three cases, blood pressure returned to normal values without medical treatment.

Adolescent↗
PubMed1986

Isolated ventricular inversion with situs solitus: successful surgical repair.

A 7-month-old infant with ventricular inversion without transposition of the great arteries in situs solitus, associated with a ventricular septal defect, is reported. When the infant was 13 months of age, successful surgical repair was undertaken by performing an intraatrial transposition of venous return using the Senning procedure and by closing the ventricular septal defect with a patch. The postoperative course was uneventful except for a well-tolerated complete heart block. No systemic valve incompetence appeared during the 53 months of actual follow-up. A complete review of the literature suggests that this is the sixth reported instance of successful repair. Injury of the abnormally located conduction tissue is regarded as the most threatening complication.

Angiocardiography↗
PubMed1985

Current reconstructive management of subglottic stenosis of the larynx with reference to sixty consecutively treated cases.

Sixty patients with subglottic stenosis of acquired and nonneoplastic origin were surgically managed by multiple open procedures. Follow-up ranged from 1 to 10 years. Fifty-seven patients had stable and excellent or good results, 2 of them after further surgery, 1 patient had to live with a retained tracheostomy indefinitely and the remaining 2 patients died. While the whole spectrum of surgical modalities employed in this series may not be recommended with total conviction, the authors express their satisfaction with single resection and end-to-end anastomosis which yields invariably good and rapidly obtainable results (22 cases with complete success). Nevertheless, laryngeal enlargement seems to be essential in the case of upper glottic lesions (19 operations provided 19 successes) while primary resection with moulding plasties may be applicable to complex and extended stenoses (19 operations: 16 successful results and 3 failures). With regard to the choice of operation, the authors emphasize the importance of careful preoperative assessment of the lesions which should assure adequate selection of therapeutic methods according to the degree of associated involvement of the trachea, glottis or supraglottic area. Conservative measures including dilatation, electro-coagulation and laser-beam surgery are considered as palliative only, however, they may be useful either in the course of the patient's preparation or in order to achieve more successful postoperative results.

Adolescent↗
PubMed1985

Anomalous origin of the right pulmonary artery from the ascending aorta: successful surgical repair.

A case of isolated anomalous origin of the right pulmonary artery from the ascending aorta with severe pulmonary hypertension is reported. Surgical repair was achieved by anastomosis of the anomalous vessel to the pulmonary artery trunk using a continuous absorbable suture. Special emphasis is laid on the favorable postoperative evolution of the pulmonary hypertensive disease following the successful repair. The poor natural history of this uncommon congenital defect if untreated makes early corrective surgery imperative.

Adult↗
PubMed1984

[Endotracheal hemorrhage caused by fissuration of the innominate artery during prolonged intubation. Surgical treatment].

We present our surgical procedure for the control of tracheal haemorrhages due to fissuration of the innominate artery in patients with prolonged tracheal intubation or tracheostomy. Temporary haemostasis and protection of the airways against flooding are ensured by downward advancement of the tube, overinflation of the cuffs and digital pressure if required. The fistula is then located and surgical haemostasis is obtained by resection of the innominate artery away from the infected area. The arterial stumps are covered up for protection against secondary infection. Re-establishment of blood flow is not systematic. Cervicosternotomy is regarded as the incision of choice. No complication was encountered in patients treated by this method.

Brachiocephalic Trunk↗
PubMed1984

Late cataclysmic hemorrhage from the innominate artery after tracheostomy.

We report on 12 patients sustaining late cataclysmic hemorrhage as a complication of tracheostomy or endotracheal intubation, resulting from erosion of the innominate artery. Four long-term survivors are reported. A number of surgical techniques was used and up-to-date management is briefly described. Our technique mainly consists of transecting and suturing the innominate artery without prior debridement. Innominate artery blood flow was not reestablished in all patients, thereby avoiding local wound infection and recurrence of hemorrhage. Initial temporary control of bleeding was achieved either by hyperinflation of the cuff of the tracheostomy tube, or finger compression of the innominate artery against the sternal notch. Definite surgical repair of this lesion and reestablishment of innominate artery flow is carried out through complete sternotomy in combination with right cervical extension which is considered the incision of choice by the authors. To prevent this unusual and lethal complication, tracheostomy should not be used without proper indication and technical errors of its performance, such as placing it lower than the level of third tracheal ring, must be avoided.

Adolescent↗
PubMed1983

Perirenal space implantation of permanent cardiac pacemakers in infants and small children.

Permanent pacemakers were implanted in 40 children aged one day to 17 years. A new technique, necessitating thoracotomy and lumbotomy, is described briefly. Indications were surgical block in 22 (55%) and congenital block in 18 (45%) patients. Five of 40 (12.5%) died. Reoperation was required 4 times: for electrode problems (3), and wound problem (one). No late infection or wire fractures were noted. The time paced ranged from 7 days to 37 months. All of these patients received lithium units.

Adolescent↗
PubMed1983

Pulmonary arterial embolus by an unusual wandering bullet.

We report on a wandering bullet embolus to the left pulmonary artery after it had first passed from the right ventricular to the right renal vein via the inferior vena cava. Its presence in the left pulmonary artery was confirmed by pulmonary angiography. Hemorrhage due to the right ventricular wound was controlled by a median sternotomy and the bullet was extracted by left lateral thoracotomy. Intravascular migratory bullets continue to be a surgical curiosity. Clinical diagnosis may present a difficult aspect in emergency practice and angiography is mandatory. The removal of foreign bodies is recommended by the majority of authors.

Adult↗
PubMed1983

[Use of PTFE (Gore-Tex) in pulmonary systemic anastomoses. Apropos of 50 cases].

Between 1977 and 1981 palliative anastomosis procedures between the subclavian and pulmonary arteries using a PTFE (Gore-Tex) prosthesis for anatomical reasons (short subclavian artery or trajectory incompatible with a Blalock-Taussig anastomosis) were carried out in 50 patients from 1 day to 24 years of age with cyanotic congenital heart disease. Two groups of patients were identified: ten patients in which the PTFE prosthesis was used as an "extension" to the subclavian artery, and 40 patients in which the PTFE was interposed between the respected subclavian and pulmonary arteries. There were three deaths (6 p. 100) at 1,7 and 15 days after surgery (mean mortality 5,7 and 12,3 p. 100). There were no major complications in the survivors. Two prostheses became occluded, one of which was reanastomosed to the ascending aorta. The follow-up ranges from 6 months to 5,5 years. The angiographic investigations performed before complete repair demonstrated the patency and good function of these anastomoses.

Adolescent↗
PubMed1983

[Pacemakers in infants and young children. Comparative study of pleural and lumbar modes of implantation].

The authors report their experience of 62 implantations of pacemakers in babies and small children by two different methods. The pleural cavity was chosen as the site of implantation in 22 patients aged 8 months to 10 years, weighing 4,2 to 26 kg, with a maximum follow-up period of 7 years. Reoperation was required in 11 cases: 6 replacements of mercury batteries, 5 electrode dysfunctions, 1 electrical leak syndrome and 1 septic complication. In the other 40 patients aged 24 hours to 17 years, weighing 2,2 to 37 kg, with a maximum follow-up period of 5 years, the pacemaker was implanted in the lumbar region. Reoperation was required in 4 cases; 1 pacemaker replacement for infection and 3 electrode faults with pacemaker replacement. It is 5 years since the authors abandoned the pleural cavity in favour of the lumbar area as the site of implantation in babies and small children. Programmable pacemakers with lithium power sources are preferred for their many well known advantages. The use of the pulse generators and the progressive improvement in the electromechanical properties of the pacing electrodes which have become more and more reliable, have made reoperation a rare occurrence. In addition, replacement of implanted material only requires a small lobotomy in the great majority of cases. Recurrent thoracotomies, difficult for the surgeon and dangerous to the patient, are thereby avoided.

Adolescent↗