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Biomedical subjects

A Khoury

Publications and source records attributed to A Khoury.

At least 55 records · Page 3Linked to original sources
PubMed1994

Plasma renin activity in chagasic patients with and without congestive heart failure.

Chagasic patients with advanced heart disease have fluid retention-dependent symptoms. Since fluid retention is mostly dependent on the renin-angiotensin-aldosterone system, chagasic patients with congestion related symptoms should have activation of the renin-angiotensin-aldosterone system. The purpose of this investigation was to determine the plasma renin activity baseline values of chagasic patients with and without congestive heart failure. Twenty-eight patients with positive serology for Chagas' disease were studied. Nineteen patients were asymptomatic (functional class I New York Heart Association) and nine were symptomatic (functional classes II-IV). Cardiac catheterization and ventricular cineangiography were performed on 20 patients. The symptomatic patients had significantly higher plasma renin activity levels (4.11 +/- 1.03 ng/ml/h) than the asymptomatic patients (1.08 +/- 0.11 ng/ml/h, P < 0.001) and the normal sedentary controls (1.65 +/- 0.22 ng/ml/h, P < 0.05, mean +/- S.E.). The plasma renin activity baseline values of the asymptomatic and symptomatic patients correlated directly with the baseline heart rate (r = 0.77, P < 0.0001). The symptomatic patients had larger ventricular volumes, moderately depressed ejection fractions and increased left ventricular end-diastolic pressures. The plasma renin activity baseline values also correlated directly with the left ventricular diastolic pressures (r = 0.70, P < 0.0006) and with the left ventricular diastolic (r = 0.66, P < 0.001) and systolic volumes (r = 0.67, P < 0.001). These results indicate that chagasic patients with fluid retention-dependent symptoms and hemodynamic evidence of left ventricular systolic dysfunction have activation of the renin-angiotensin-aldosterone system.

Adult↗
PubMed1994

Cardiac function in fetuses and newborns exposed to low-dose aspirin during pregnancy.

OBJECTIVE: Our purpose was to evaluate cardiac function in fetuses exposed to low-dose aspirin. STUDY DESIGN: To assess its efficacy in preventing preeclampsia, 60 mg/day aspirin or a matching placebo was administered to women in a double-blind fashion during the second and third trimesters. As a part of this study, 146 echo Doppler studies were performed on 63 fetuses from 15 to 40 weeks' gestation. These studies allowed assessment of systolic and diastolic cardiac function. Cardiac function was also assessed in 87 neonates. RESULTS: Throughout gestation ductus arteriosus flow velocity, right ventricular output and diastolic area, and left ventricular output and diastolic area all increased and were similar in both aspirin- and placebo-exposed fetuses. Fetal diastolic flow velocities were also alike in both groups. The two groups had similar gestational ages at delivery (39.2 +/- 2.3 vs 38.7 +/- 2.7 weeks) and birth weights (3174 +/- 575 vs 3105 +/- 579 gm, respectively). Furthermore, there was no difference in fractional shortening, cardiac output, prevalence of tricuspid regurgitation, or patency of the ductus arteriosus at birth between the two groups. CONCLUSION: The circulation of fetuses and newborns is not affected adversely by exposure to low-dose aspirin during gestation.

Aspirin↗
PubMed1994

The value of amniotic fluid interleukin-6 determination in patients with preterm labor and intact membranes in the detection of microbial invasion of the amniotic cavity.

OBJECTIVES: Our purpose was to (1) determine the value of amniotic fluid interleukin-6 determination in the detection of microbial invasion of the amniotic cavity and (2) compare interleukin-6 to other rapid tests in the evaluation of preterm labor. STUDY DESIGN: Amniotic fluid interleukin-6 was determined quantitatively by enzyme-linked immunosorbent assay in 91 amniotic fluid specimens obtained by amniocentesis in 89 patients with preterm labor. Amniotic fluid cultures for aerobes, anaerobes, and mycoplasma species were performed. Receiver-operator characteristic curve analysis, logistic regression analysis, and Cox's proportional-hazards model were used to explore the relationship between several explanatory and outcome variables. Diagnostic index values of interleukin-6, glucose level, Gram stain, leukocyte esterase, and limulus amebocyte lysate assay for prediction of a positive amniotic fluid culture, preterm delivery, clinical infection, and neonatal sepsis were calculated. RESULTS: The prevalence of positive amniotic fluid cultures was 13% (12/89). The median interleukin-6 concentration in patients with positive cultures was 241.8 ng/ml, in contrast to 0.291 ng/ml in patients with negative cultures (p. < 0.005). Sensitivity and specificity of an interleukin-6 level > or = 6.17 ng/ml was 75% and 79%, in contrast to that of glucose, < or = 12 mg/dl (83% and 86%) for a positive amniotic fluid culture and sensitivity (p = 0.26, z test). All patients with an interleukin-6 level > 6.17 ng/ml were delivered preterm, in contrast to 85.2% of patients with a glucose level < or = 12 mg/dl. When all rapid tests and clinical parameters were considered simultaneously in the logistic model, only interleukin-6 maintained a significant relationship to preterm birth (odds ratio 35, p = 0.003). Cox's proportional analysis demonstrated a strong relationship between interleukin-6 and the amniocentesis-to-delivery interval after clinical variables were controlled for (hazard ratio 3.01, p < 0.00001). CONCLUSION: Amniotic fluid interleukin-6 determination may be a useful adjunct to our armamentarium of rapid tests to exclude infection and predict delivery in patients with preterm labor and intact membranes.

Amniocentesis↗
PubMed1994

Peritoneal dialysis in the prune belly syndrome.

OBJECTIVES: To describe our experience with chronic ambulatory peritoneal dialysis in children with the prune belly syndrome (PBS). DESIGN: From our peritoneal dialysis (PD) program we were able to review the medical records of 6 boys with PBS. Data were collected on potential complications such as infections, hernias, growth, and problems encountered with PD catheter insertion. RESULTS: The ages of the 6 boys ranged from 10 months-17 years. The dialysis duration was from 9-22 months, with a total of 76 patient-months on PD. There was one death, possibly as a complication of an exit-site infection. Five received a renal transplant, and 4 have functioning grafts. Peritonitis occurred once in every 10.8 patient-months, and exit-site or tunnel infection was diagnosed every 7.6 patient-months. Four patients required PD catheter replacement because of tunnel infection in 2, persistent exit-site infection in 1, and fluid leakage in 1. Of a total of nine catheters, three were inserted using a laparoscopic technique. There were no leaks in these three; however, there was one exit-site infection. Two patients had inguinal hernias that required surgery. CONCLUSION: Deficiency of abdominal musculature in PBS poses potential problems for the use of PD, in particular, catheter anchorage, exit-site healing, and leakage. In our patients the most serious complications were infections of the exit site or catheter tunnel. Our experience suggests that a laparoscopic technique may provide improved catheter placement. PD offers a potentially successful form of dialysis for patients with PBS.

Abdominal Muscles↗
PubMed1991

[Intravenous anesthesia for cesarean section. Comparison of propanidid and methohexital].

Propanidid and methohexital were compared retrospectively to assess the possible neonatal depression following general anesthesia for caesarean section: both have rapid onset and short duration of action and their transplacental passages are similar. Anesthesia was induced with equivalent doses of the two agents in 90 women (45 in each group). For each anesthetic agent, three subgroups were defined according to the indications, depending on emergency criteria and fetal state. There was no significant statistical difference (Student test) regarding clinical and biochemical criteria except for the fetal arterial pH which was more acidic in the propanidid group. In both groups, Apgar scores, arterial and venous pH were significantly more altered when caesarean section was performed for acute fetal depression.

Adult↗
PubMed1990

The effect of mode of delivery on the perinatal outcome in fetuses with abdominal wall defects.

A descriptive study of 125 infants with abdominal wall defects was undertaken to determine the effect of mode of delivery on outcome. Fifty-six infants had gastroschisis and 69 had omphalocele. Overall, there were no differences between the omphalocele and the gastroschisis groups in either cesarean section rate (22% vs 26%) or prematurity rate (26% vs 30%). However, the omphalocele group had a significantly higher infant death rate (22% vs 7%, p less than 0.001), a significantly higher incidence of associated major congenital anomalies (29% vs 5%, p less than 0.001), and a higher incidence of long-term infant morbidity (14.5% vs 8.9%). Within either group there was no significant difference between vaginal and cesarean delivery regarding either infant mortality, acute or long-term infant outcome, or frequency of associated major anomalies. We conclude that vaginal delivery of infants with abdominal wall defects does not adversely affect infant outcome.

Abdominal Muscles↗
PubMed1990

Duplicate bladder exstrophy: a new variant of clinical and embryological significance.

A case of duplicate exstrophy of a nature not previously encountered is reported, which we believe has important clinical and embryological implications. The patient presented with what appeared to be classical exstrophy. The inability to identify the ureteral orifices at operation led to the discovery of a previously unrecognized subjacent bladder of normal size and configuration except for a patulous bladder neck and associated epispadias. On excision of the duplicate bladder plate a coloniform projection was discovered that was lined with colonic mucosa. The surgical and potential embryological significance of this rare entity is described.

Bladder Exstrophy↗
PubMed1990

Doppler sonographic demonstration of the progressive spontaneous thrombosis of pseudoaneurysms.

In three patients with diagnosed pseudoaneurysms, surgical intervention was delayed because of the patients' clinical condition. In successive follow-up examinations in one patient, development of a new lobe to the previously single-lobed pseudoaneurysm was noted with progressive centripetal thrombus formation in each lobe leading to the eventual complete thrombosis of the pseudoaneurysm without surgical intervention. The sequence of steps leading to the complete thrombosis of the pseudoaneurysm as seen by color Doppler and pulsed Doppler examination is described. In two other patients with a single-lobed and a multilobed pseudoaneurysm, respectively, follow-up examinations without surgical management revealed complete thrombosis of the pseudoaneurysms. Whereas traditional teaching holds that pseudoaneurysms require surgical repair, this short series of cases suggests that, when progressive centripetal thrombus formation is observed, the pseudoaneurysms can go on to complete thrombosis. Follow-up for up to 4 months reveals no sonographic evidence of rebleeding or other evidence of weakness in the arterial wall at the site of the previous pseudoaneurysms.

Adult↗
PubMed1990

D-dimer and thrombin-antithrombin III complex levels uncorrelated with phlebographic findings in 11 total knee replacement patients.

D-dimer and thrombin-antithrombin III complex (TAT) were assayed in 11 patients at various times pre- and post-operatively in order to determine the possible value of these parameters in screening for thromboembolic complications. Phlebography revealed distal thrombosis in 6 of the 11 patients. The D-dimer level, already elevated before surgery, increased at day 1 and remained high at days 5 and 10. Two methods were used for the assays and showed strongly correlated results. The TAT level increased at day 1 and then progressively returned toward basal values. No difference was observed at any time between patients with or without thrombosis. The results in surgical patients undergoing knee replacement suggest that neither D-dimer nor TAT assays are valid screening procedures for post-operative DVT. Nevertheless, in view of the small number of patient studied, further work is required to confirm these results.

Adult↗
PubMed1989

The hypoechoic band: a normal finding on testicular sonography.

High-resolution sonograms were obtained in 119 patients in whom intrascrotal disease was suspected on the basis of history and physical findings. In 20 of these patients, a total of 22 conspicuous hypoechoic intratesticular bands (18 unilateral and four bilateral) were seen in the middle third of the testicle on scans obtained axially or slightly oblique to conventional axial scans. The bands were up to 3 mm wide and 3 cm long. The bands were on the side with suspected disease in six patients. Of these, three patients had a small epididymal cyst, one had a mild hydrocele, and two had no other sonographic finding. The remaining 16 bands were on the side opposite that with clinically suspected disease and were seen in otherwise normal testes. Follow-up examination in 11 of the 20 patients with the band showed no change. In four of eight patients examined with pulsed Doppler sonography, a normal low-resistance waveform was seen that was characteristic of intratesticular arteries (with gradual descent after peak systole and relatively high diastolic flow). In three of these patients, color Doppler imaging corroborated the presence of arterial flow, which did not fill the entire width of the band, thus suggesting an additional venous component of lower velocity in the band. Identification of flow in only half the cases may have been caused by the limitations in sensitivity of the equipment. We conclude that the hypoechoic bands noted on gray-scale testicular sonography are caused by a normal variant of intratesticular vessels, artery and vein, and that they are of no clinical significance.

Humans↗
PubMed1988

Sonography of autonomous follicular ovarian cysts in precocious pseudopuberty.

Isolated follicular cysts of the ovary without elevated gonadotropin levels can occur as the primary source of early pubertal changes in young girls. To date, cyst excision or oophorectomy have been the treatments of choice. We studied three girls aged 5 to 8 7/12 years who presented with sexual precocity and revealed autonomous functioning ovarian cysts (2.2 to 5.5 cm). Clinical signs subsided following resection of the cyst in one case and after regression of the cyst documented by ultrasonography in the other two cases. On the basis of these three cases, we believe ultrasonography can be valuable in the workup of sexual precocity caused by primary ovarian cysts. Given that the spontaneous resolution of such cysts is possible, close clinical follow-up of unequivocally benign-appearing large ovarian cysts in young girls with pubertal changes deserves consideration.

Child↗
PubMed1987

Myositis ossificans progressiva and pregnancy.

Myositis ossificans progressiva is a rare inherited ossifying condition of the striated muscle tissue. In the English language literature there is no reported association of this disease with an advanced state of pregnancy, nor is there any well-documented scientific data about the effect of pregnancy on this disease or of this disease on pregnancy. This report is about a patient with myositis ossificans progressiva carrying to 30 weeks' gestation and successfully delivering a viable female infant. The antenatal care and management problems of this case are discussed.

Adult↗
PubMed1986

Experimental hypertension in pregnant sheep. III. Central hemodynamic alterations in the one-kidney model.

Experimental renal hypertension, with use of the one-kidney, one-clip model, was produced in nine pregnant ewes who were then studied during the last one third of gestation. The animals were chronically instrumented for the recording of arterial pressure, heart rate, and cardiac output; blood volume was determined weekly. The studies were carried out in four phases; a control period of 2 weeks, a surgery period of 1 week, a constriction or hypertensive period, and a postpartum period of 2 weeks. We detected no significant changes in heart rate or cardiac output during any phase of the study. The arterial pressure significantly increased during the constriction and postpartum phases (p less than 0.05). Blood volume remained relatively stable during the three pregnancy phases but significantly decreased in the postpartum phase (p less than 0.05). Systemic vascular resistance followed a pattern similar to that of the arterial pressure.

Animals↗
PubMed1986

Heat flux and oxygen consumption of the pregnant uterus.

Heat flux (conductive and convective heat) and oxygen consumption of the pregnant uterus and its content were measured simultaneously in the same group of pregnant ewes during the acute postoperative period, during a chronic resting period, and during alpha- and beta-adrenergic-receptor stimulation with norepinephrine and ritodrine. Results indicated four conclusions. First, an excellent correlation existed between heat flux and oxygen consumption in the acute and chronic resting condition as well as during increasing uteroplacental vascular resistance and decreasing blood flow produced by norepinephrine infusion; the correlation was not as good during ritodrine infusion. Second, during rest, about 85% of heat generated by the pregnant uterus is eliminated through the uteroplacental circulation while the remaining heat diffuses through the myometrium. Third, during decreasing uteroplacental blood flow and elevated resistance, the pregnant uterus is able to maintain a normal thermostasis by widening the temperature difference in the blood entering and leaving the uterus and by increasing the myometrial heat exchange; oxygen consumption also is maintained at normal level through increase in oxygen extraction. Fourth, with the exception of uteroplacental circulation, the circulatory, metabolic, and thermal conditions of the pregnant ewe are not different after 5 hours from 5 to 7 days after the surgical procedure.

Animals↗