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Biomedical subjects

F M Abu-Zidan

Publications and source records attributed to F M Abu-Zidan.

At least 19 recordsLinked to original sources
PubMed2006

Cumulative sum (CUSUM) analysis in the assessment of trainee competence in fetal biometry measurement.

OBJECTIVE: To determine the value of cumulative sum (CUSUM) analysis in assessing trainee proficiency in fetal biometry measurement. METHODS: Three primary healthcare doctors with no prior ultrasound training were recruited. Each trainee measured the fetal biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) on 100 consecutive pregnant women. The supervisor repeated the measurements. The CUSUM for each set of trainee measurements was calculated at a set failure rate of 10%. The point at which the graph fell below two consecutive boundary lines indicated the number of examinations required to achieve competence. RESULTS: The CUSUM graphs showed that the rate of learning measurement skills varied among the three trainees. The graph for the CUSUM series for BPD and HC measurement for all trainees fell below two consecutive boundary lines and remained there, indicating competence. The CUSUM series for AC measurement for two of the trainees indicated that competence was achieved; however, for the third trainee, while the graph fell below two consecutive boundary lines, indicating competence, it rose again, crossing two consecutive boundary lines. This indicated a loss of competence and the need for further training. FL measurements for the same trainee never fell below two consecutive boundary lines, indicating failure to achieve competence; the other two achieved competence, but failed to maintain it. CONCLUSIONS: CUSUM is a useful tool for identifying points of competence and for quantifying the duration of ultrasound training required for each trainee. It provides an early indication of performance, and highlights difficulties in individual performance.

Abdomen↗
PubMed2006

Primary anterior abdominal wall actinomycosis.

Actinomycosis of the anterior abdominal wall is rare. We report a 50-year-old diabetic man who presented with a left hypochondrial mass of three weeks duration associated with fever. Abdominal computed tomography showed a 2 x 4 cm mass projecting from the internal abdominal wall associated with surrounding inflammation. The mass did not decrease after a week of intravenous antibiotics. Excision of the mass and primary closure of the abdominal wall were performed. The mass involved the deep muscles of anterior abdominal wall. The omentum was adherent to the parietal peritoneum underneath the mass. Microscopical examination of the mass was consistent with actinomycosis. The postoperative period was uneventful and the patient recovered completely. The patient received penicillin for six months.

Abdominal Muscles↗
PubMed2006

Head injuries in warfarinised patients.

INTRODUCTION: The objective of this study was to study the clinical course and outcome of warfarinised patients who were hospitalised because of head trauma. METHODS: 13 patients (ten males and three females; median age 69 years) who presented to the Royal Perth Hospital, Australia and who had suffered a head injury between July 1994 and June 2000 while concurrently taking warfarin, were studied. RESULTS: Confusion was the commonest presenting symptom (four patients). Five patients presented after more than 24 hours of the injury. Eight patients were anticoagulated for thromboembolic disease and five for atrial fibrillation. The patients had a median injury severity score of 25 (range 1-43). The median international normalised ratio was 2.4 (range 1.8-10) on admission and 1.8 (range 1.0-10) on discharge. 11 of the 13 patients had computed tomography of the head. Intracerebral bleeding was the commonest injury (nine patients). The median length of hospital stay was six days (range 3-30). Five patients died (38.5%). CONCLUSION: Warfarinised patients who sustain minor head trauma should be hospitalised for close neurological observation and should have a low threshold for performing computed tomography.

Accidental Falls↗
PubMed2004

Liver metastasis in renal chondrosarcoma.

A 39-year-old woman who had a left radical nephrectomy for a renal chondrosarcoma presented 18 years later with a large epigastric mass and deep jaundice. The patient was very dyspnoeic and had a feeling of continuous pressure on her chest. Computed tomography arterioportography of the abdomen showed that the mass involved both lobes of the liver. Multiple non-anatomical resections of tumour masses were performed, including a mass arising from the falciform ligament, left lateral segment, and segments VII and VIII. The largest resected mass weighed 2.5kg and had a diameter of 15cm. Histopathology of the hepatic metastasis was similar to the original renal chondrosarcoma. The patient was followed up for 24 months postoperatively and had symptomatic relief. Our case demonstrates the slow-growing nature of this tumour and the usefulness of palliative surgery despite large tumour load.

Adult↗
PubMed2002

Effects of prone and supine posture on cardiopulmonary function after experimental chlorine gas lung injury.

BACKGROUND: Chlorine gas may induce severe acute lung injury. Improvement of pulmonary gas exchange in patients and animals with acute lung injury nursed in the prone position was observed in recent years. The purpose of this study was to evaluate the effects of prone and supine positions on pulmonary and cardiovascular functions following experimental chlorine gas lung injury. METHODS: Twenty anesthetized and mechanically ventilated pigs were exposed to chlorine gas (400 p.p.m. in air) for 20 min in the supine position, then assigned randomly to ventilation in the supine or prone positions (n=10 in each group). Hemodynamics, gas exchange, lung mechanics and oxygen transport were evaluated for 5 h. RESULTS: All animals showed severe pulmonary dysfunction immediately after chlorine gassing with a threefold increase in pulmonary vascular resistance index, a drop in arterial oxygenation (12.3+/-1.3 kPa to 5.4+/-0.7 kPa) and a fall in lung-thorax compliance (22+/-1 ml cmH2O-1 to 8+/-2 ml cmH2O-1). Venous admixture (Qs/Qt) improved in animals in the prone position while there was no change in the supine position (prone 32+/-11% vs. supine 42+/-9% at 5 h,P<0.05). Lung-thorax compliance improved significantly with time in the prone group only (P<0.01). Oxygen delivery increased significantly in prone animals compared with animals nursed in the supine posture (P<0.001). CONCLUSION: Immediate prone positioning after chlorine gas injury not only inhibited deterioration of gas exchange but was also associated with improved pulmonary function and oxygen transport.

Administration, Inhalation↗
PubMed2002

Instructional skills of surgical tutors.

AIM OF STUDY: This study was aimed at evaluating the pattern of instructional skills of surgical tutors in a university hospital and the effect of feedback on this pattern. METHOD: Students who followed three clinical rotations at the Department of Surgery, Mubarak Al-Kabeer Teaching Hospital, Kuwait, responded anonymously to a structured questionnaire on the instructional skills of their tutors immediately after the rotation was completed. The questionnaire included six statements related to teacher-centred instructional skills and six statements related to student-centred instructional skills. The students indicated their perception on a five-point rating scale (very poor, poor, fair, good and very good). A summary of students' opinions was made available to the teachers soon after each rotation. RESULTS: The percentage of good/very good categories was significantly higher in the teacher-centred skills compared with the student-centred skills (median (range), 87.05% (85.9-91.7) compared with 79.6% (76.6-80.6), (p = 0.004, Mann Whitney U test). This difference was significant in the first two rotations (p < 0.005) but not in the third rotation (p=0.59). CONCLUSIONS: This study shows that behaviours of teachers which dealt directly with the learner's role in learning received lower emphasis than the teacher-centred activities and that feedback may modify this behaviour.

Adult↗
PubMed2001

Students' evaluation of surgical seminars in a teaching hospital.

AIM: To evaluate the surgical seminars given for medical students at Auckland University and factors affecting them, so as to define areas for improvement. METHODS: A confidential questionnaire was completed by fourth-year medical students for each surgical seminar they attended during an academic year. The seminars were repeated four times during the year. The questionnaire consisted of five statements relating to whether the seminar was stimulating, problem- oriented, patient-centred, evidence-based and interactive. The students rated each statement on a 7-point scale. RESULTS: 556 questionnaires evaluating 28 clinical teachers were collected. A generalized linear model showed that the clinical teachers (F=4.16, P = 0.0001), the attachment (F=4.39, P=0.005) and the interaction between the seniority and institute (F=6.38, P=0.019) had a significant effect on the rating of the seminars. University consultants and hospital registrars had the highest overall least-squares mean, followed by hospital consultants, while university lecturers had the lowest overall least-squares mean (5.56, 5.4, 5.18, and 4.36, respectively). Ratings for problem-oriented approach improved over the studied period, while ratings of evidence-based and patient-centred approaches remained lower. University consultants and hospital registrars had the best patient-centred approach compared with hospital consultants and university lecturers (least-squares means 5.52, 5.4, 5.01, 4.18, respectively). Hospital registrars showed the best interactive ability ratings (least-squares mean 5.51) while university lecturers had the least stimulating seminars (least-squares mean 4.46). CONCLUSIONS: Surgical seminars which were introduced to cover surgical topics had acceptable ratings in each of the teaching domains, although there is a need for improvement in the patient-centred and evidence-based approaches.

Clinical Competence↗
PubMed2001

Plasma amylin concentration is related to the severity of intestinal ischemic injury in rats.

BACKGROUND: Previous work has demonstrated that intestinal ischemia increases plasma amylin concentration. This study examined the relationship between the degree of intestinal ischemia injury and plasma amylin in an experimental rat model. METHODS: Wistar rats were divided into a control group (n = 6); a sham-operated group (n = 9); and 3 intestinal ischemia-reperfusion groups (n = 8 in each), which underwent clamping of the superior mesenteric artery for either 15, 30, or 45 minutes followed by 15 minutes of reperfusion. Samples were then collected for intestinal histology and measurement of amylin, insulin, and glucose. RESULTS: There was a positive correlation between the histologic score of the intestinal injury and the measured plasma amylin concentration (R = 0.48, P =.007). The median plasma concentration of amylin was 62 pmol/L (range, 42-97 pmol/L) in the 30-minute intestinal ischemia group and 58 pmol/L (42-86 pmol/L) in the 45-minute intestinal ischemia group. Both these groups were increased compared with the sham-operated group (29 pmol/L; range, 22-57 pmol/L; P <.001 and P <.005, respectively) and the control group (28 pmol/L; range, 26-42 pmol/L; P <.001 and P <.0005, respectively). The median plasma concentration of insulin in the 30-minute intestinal ischemia group was 4230 pmol/L (range, 1360-5770 pmol/L), which was increased compared with both the control group (950 pmol/L; range, 550-1510 pmol/L; P <.005) and the sham-operated group (720 pmol/L; range, 280-4180 pmol/L; P<.005). There were no differences between any of the other groups either for glucose, insulin, or amylin. CONCLUSIONS: Plasma amylin concentration is related to the severity of intestinal ischemic injury.

Amyloid↗
PubMed2001

The surgical morbidity and mortality meeting as an educational tool.

PURPOSE: This study aimed at evaluating the educational value of the morbidity mortality meeting and benefits obtained from it so as to implement changes that can improve it. METHODS: Surgeons (n = 13) at a university hospital responded anonymously to a questionnaire which was structured to monitor the educational activity of the morbidity mortality meeting. They indicated their perceptions on a five-point scale (very poor, poor, fair, good and very good). Depending on the results of the first questionnaire, these changes were made: 1) Standardisation of the notice of the Meeting 2) Organization of the meeting 3) Review of the literature on the specific problems encountered. The participants were not aware of the results of the first questionnaire. Nine weeks later, the same questionnaire was repeated (n=12). Mann-Whitney test was used to compare the ratings of the two questionnaires. RESULTS: The attributes which showed significant improvement between the first and second questionnaires were a) organization (p = 0.004; (median (range) 3 (2-5) compared with 5 (3-5)) b) knowledge is up-to-date (p < 0.005; (median (range) 3 (2-4) compared with 4 (3-5)), c) discussion related to the problem (0.01; (median (range) 3 (1-4) compared with 4 (3-5)) and d) notice of the meeting (p < 0.026; (median (range) 3 (2-4) compared with 4 (2-5)). CONCLUSIONS: This study showed that specific actions can improve the educational quality of the morbidity mortality meeting.

General Surgery↗
PubMed2000

Severity of acute pancreatitis: a multivariate analysis of oxidative stress markers and modified Glasgow criteria.

BACKGROUND: It is unknown whether measurement of markers of oxidative stress can improve the prediction of severity of acute pancreatitis. METHODS: Consecutive patients admitted with a diagnosis of acute pancreatitis were divided into mild (n = 62) and severe (n = 23) groups based on the Atlanta classification. Plasma oxidative stress markers were measured within 24 h of admission and included ascorbic acid (endogenous antioxidant), protein carbonyl (a marker of protein oxidation), thiobarbituric acid reactive substances (a marker of lipid peroxidation) and myeloperoxidase (a neutrophil enzyme that produces oxidants). Canonical correlation analysis was used to describe the relationship between these markers and the modified Glasgow criteria. Canonical variate analysis was used to define the best variables that could discriminate mild and severe pancreatitis. RESULTS: There was a significant correlation between markers of oxidative stress and the modified Glasgow criteria (first canonical correlation 0.69, P < 0.0001, Wilk's lambda test). Blood urea, serum albumin and white cell count were the best variables that discriminated mild and severe acute pancreatitis, and all were better than the oxidative stress markers. CONCLUSION: The markers of oxidative stress were highly correlated with the severity of pancreatitis. They are unlikely to be better than the modified Glasgow criteria in predicting it.

Acute Disease↗
PubMed2000

Caerulein-induced pancreatitis in Wistar rats.

We describe a refined model of intravenous caerulein-induced pancreatitis by using osmotic infusion pumps in the conscious unrestrained Wistar rat. The volume of caerulein required for the 6-h infusion is loaded into PE-55 catheter tubing attached to an Alzet (Alza Corporation, Palo Alto, CA) implantable osmotic pump that has been primed with saline. The technique has reliably induced mild edematous pancreatitis, which we verified histologically. Our refined model has the advantages of unrestrained animals, reduced animal handling and acclimation, and decreased cost.

Animals↗