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Biomedical subjects

F Serour

Publications and source records attributed to F Serour.

At least 37 records · Page 2Linked to original sources
PubMed1996

Acute appendicitis following abdominal trauma.

Acute appendicitis (AA) is generally considered to be a consequence of lumenal obstruction and inflammation of the appendix. At the beginning of the 20th century, trauma was considered to be one of the possible causes of AA but this relationship has not been examined much since then. Our experience with three cases of AA following blunt abdominal trauma led to an extensive review of the world literature on the subject. We believe that abdominal trauma might be causative of AA. The potential for this hazardous and easily missed diagnostic entity should be appreciated in cases of blunt abdominal trauma both for sound clinical decision making and for its potential medical and legal implications.

Abdominal Injuries↗
PubMed1996

Dorsal penile nerve block in children undergoing circumcision in a day-care surgery.

PURPOSE: Circumcision is performed under general anaesthesia (GA) with dorsal penile nerve block (DPNB) as an analgesic technique for postoperative pain. The purpose of this study was to compare DPNB as the sole anaesthetic procedure vs GA and DPNB for circumcision in children as an outpatient procedure. METHODS: In a six-month prospective study, 250 boys aged 6 to 17 yr (mean age 11.5 +/- 3.5 yr) were randomized into two groups. Group A (n = 122) received DPNB only prior to circumcision, and Group B (n = 128) received GA + DPNB. The groups were compared for complications of the block, effectiveness of anaesthesia, operating room time, postoperative time and ease of recovery. RESULTS: There were no major operative complications in the two groups. Minor block complications, including oedema and haematoma, occurred in 16 (13.1%) boys in Group A and 27 (21.10%) boys in Group B (NS). At surgery, 3 (2.6%) from Group A received additional GA and 1 (0.8%) received additional local anaesthesia. They represent a DPNB failure rate of 3.3%. Mean operating room time was 11 +/- 2.5 min in Group A and 19 +/- 3.5 min in Group B, and post-anaesthesia care unit (PACU) time was 51 +/- 10 min in Group A and 101 +/- 14.5 min in Group B (P < 0.001). Nausea and vomiting in the PACU were noted in one patient in Group A and in 15 in Group B (P < 0.05). Only patients in Group B required additional analgesia and tranquilizers in the PACU (0 versus 20; P < 0.05). CONCLUSIONS: These data confirm that DPNB has advantages over GA + DPNB for paediatric circumcision in day-care surgery.

Adolescent↗
PubMed1996

Subcuticular skin closure as a standard approach to emergency appendectomy in children: prospective clinical trial.

We evaluated the morbidity associated with primary closure by interrupted subcuticular absorbable sutures following emergency appendectomy. In a prospective clinical trial over a 12-month period, 216 children who underwent emergency appendectomy had skin closure using subcuticular interrupted absorbable polyglactin 4-0 sutures. Preoperative prophylactic antibiotics consisting of metronidazole alone or in combination with gentamicin were used in patients with suspected phlegmonous appendicitis; a combination of metronidazole, gentamicin, and ampicillin was used when perforation of the appendix was suspected. Postoperatively, in patients with phlegmonous appendicitis metronidazole was given for 24 hours, whereas in those with peritonitis the triple antibiotics were continued for 7 to 10 days. All patients were assessed for complications resulting from the technique of wound closure. No intraabdominal abscesses or serious complications were recorded. The overall incidence of wound infection was 1.8%. Among children with a perforated appendix the rate of superficial wound infection was 5.7%. There was no difference in the rate of wound infection between patients who received metronidazole alone or metronidazole plus gentamicin preoperatively. All the patients and their families were satisfied with the cosmetic results and with the fact that removal of skin sutures was unnecessary. We conclude that the use of prophylactic antibiotics permits standard skin closure by interrupted absorbable subcuticular suture.

Adolescent↗
PubMed1996

Air enema for reduction of intussusception in children: risk of bacteremia.

PURPOSE: To evaluate the incidence of bacteremia in children undergoing air enema for the diagnosis and reduction of intussusception. MATERIALS AND METHODS: Twenty-seven children who underwent air enema for the diagnosis and treatment of intussusception were evaluated to identify the incidence of transient bacteremia and fever associated with the procedure. Blood cultures were obtained prior to the manipulation (point 0), immediately after completion of the procedure (point 1), and 2 hours later (point 2). RESULTS: The results of six of 81 sets of blood cultures were positive for bacterial pathogens. Three of them that were obtained at point 0 and two at point 1 grew common skin contaminants. A sixth blood culture drawn at point 1 was positive for Staphylococcus aureus. No patient had more than one positive blood culture result, and all recovered without antimicrobial therapy. Five patients had temperature elevations to > or = 38 degrees C following the enema. Only one of the patients was febrile at admission, and none had positive blood culture results. CONCLUSION: The risk of bacteremia from enteric pathogens following air enema for reduction of intussusception in children appears to be low.

Air↗
PubMed1996

Appendiceal colic in children: a true clinical entity?

BACKGROUND: Unexplained recurrent abdominal pain is a frequent problem in the pediatric population. An organic cause is found in 10 percent of children. Recurrent abdominal pain is responsible for multiple hospital admissions and patient evaluations. In some children, partial luminal obstruction of the appendix without inflammation may be the cause of this pain, and is defined as "appendiceal colic." STUDY DESIGN: During a period of five years, we performed a prospective study among children admitted for right lower quadrant abdominal pain. Children operated on for suspected acute appendicitis were eliminated from the study. Among the remaining patients, those with recurrent pain were evaluated for appendiceal colic. Medical histories were obtained, and the patients underwent physical examinations, routine laboratory studies, stool cultures, abdominal roentgenograms, and sonography scans (including the pelvic region in girls). Precise radiologic evaluation of the appendix was performed by barium swallow in 22 children or by barium enema in four. The diagnosis of appendiceal colic was made if the following three criteria were met: a history of longer than one month with three or more recurrent attacks of right lower quadrant abdominal pain; localized tenderness in the right lower abdomen without signs of peritoneal irritation or inflammation; or radiologic findings at barium examination consisting of irregular filling of the appendix, nonfilling or partial filling of the appendix after 24 hours, or nonemptying of the appendix after 72 hours. Children thus diagnosed underwent elective appendectomy, which was performed only after an additional episode of abdominal pain. RESULTS: Twenty-six children (average age 11.4 years) were treated by appendectomy and of these, 23 (88.5 percent) experienced pain relief in the immediate postoperative period. The remaining three children had pain relief within four months after appendectomy. CONCLUSIONS: Appendiceal colic may be a true clinical entity. Children suffering from appendiceal colic may benefit from elective appendectomy.

Adolescent↗
PubMed1995

Circumcision in children with penile block alone.

Surgical procedures in children are usually performed with the patient under general anesthesia. For circumcision and additional dorsal penile nerve block is used for postoperative analgesia. We retrospectively evaluated dorsal penile nerve block as the only analgesic technique for the relief of intraoperative pain in children undergoing circumcision. For 6 months dorsal penile nerve block was performed in 454 children 3 to 11 years old (mean 8.15 +/- 2.08 years) as the sole preoperative anesthesia. All boys were considered to have had good preoperative analgesia. No major complications were reported. Block related hematoma was noted in 12 patients (2.6%) and mild local edema occurred in 83 (18.3%). There was no excessive bleeding and hemostasis was easily achieved. The overall average operating time was 7.2 +/- 2.6 minutes (range 6 to 25). General anesthesia was added in 13 patients, representing a dorsal penile nerve block failure rate of 2.9%. Four boys suffered from erratic pain, while no objective cause of failure was recorded in the remaining 9. Average patient age was 5.8 +/- 2.2 years (range 3 to 10) in the 13 boys and 8.2 +/- 2 years (range 3 to 11) in the remaining 441 patients (p < 0.001). Failure was more frequent in children 3 to 5 years old (15.5%) than in those older than 6 years (1.5%, p < 0.05). Average operating time was 20.7 +/- 2.8 minutes (range 15 to 25) in the 13 children and 6.8 +/- 1.1 minutes (range 6 to 15) in the remaining 441 (p < 0.001). During the recovery period, only children from the general anesthesia group suffered from nausea and vomiting (9), and pain, agitation and fear (6 boys 3 to 6 years old). Average recovery room time was 38.7 +/- 7.4 minutes (range 30 to 60) in children with dorsal penile nerve block alone and 95 +/- 9.8 minutes (range 85 to 120) in those with additional general anesthesia (p < 0.001). We conclude that dorsal penile nerve block alone provides good intraoperative analgesia for circumcision in children, particularly those older than 6 years.

Anesthesia, General↗
PubMed1994

General peritonitis induced by rectal examination: an unusual complication of primary psoas abscess.

Primary psoas abscess is a relatively rare disease with highest incidence in children and adolescents. It usually presents with fever, abdominal pain and limp. Limping tends to incriminate musculoskeletal problems below the pelvis, but movement of the hip involves the psoas muscle which is mostly retroperitoneal and intimately related to pelvic and intraperitoneal organs. Although the current tendency is to use abdominal sonography, rectal examination is still a valuable step in clinical examination, and may help to assess a pelvic mass or abscess. The following case report describes the elusive nature of psoas abscess and a rare occurrence of abscess rupture and peritonitis, immediately after rectal examination.

Child, Preschool↗
PubMed1994

Postappendectomy intra-abdominal abscess: a therapeutic approach.

Four hundred and sixty two children were operated on between January 1989 and June 1993 for acute appendicitis; 10 developed an intra-abdominal abscess. Intra-abdominal abscesses were accompanied by fever above 38 degrees C (nine out of 10 patients) and leucocytosis (mean leucocyte count 20.3 x 10(9)/l) and were detected sonographically four to 14 days after operation. Management included intravenous administration of antibiotics effective against both aerobes and anaerobes, and follow up with serial sonographic studies. Eight patients responded favourably to antibiotic treatment without any drainage procedure, with gradual shrinkage and collapse of abscesses. Two patients, in whom enlargement of collection was demonstrated on serial sonographic examination, eventually underwent percutaneous drainage under sonographic control. These results suggest that some paediatric patients with an intra-abdominal abscess after appendicectomy and who are followed up closely by sonography may be managed successfully with appropriate antibiotics alone.

Abdomen↗
PubMed1994

Optimal regional anesthesia for circumcision.

Dorsal penile nerve block (DPNB) is a useful procedure for analgesia in circumcision. It has minor complications and a reported failure rate of from 4% to 6.7%. To evaluate the intraoperative value of additional anesthesia of the perineal nerves--a branch of the pudendal nerve--during circumcision, we conducted a prospective randomized double-blind study on 250 adults. The postoperative period was not studied. The subpubic space technique of DPNB was used. Patients received DPNB (Group I) or DPNB with an additional ventral injection (Group II) for perineal nerve analgesia. Seventeen patients (13.6%) from Group I suffered pain. Of these, nine (7.2%) had discomfort and mild pain but no supplemental analgesia was needed. In the remaining eight patients, however, it was necessary to add local analgesia. This represents a total failure rate of 6.4%. On the other hand, only six patients (4%) in Group II had a mild diffused discomfort with no need for additional local anesthesia (P < 0.01). The average operating time was 12.4 +/- 2.7 min (range 9-22 min) in Group I and 10.7 +/- 1.6 min (range 8-15 min) in Group II (P < 0.001). We think that perineal nerves play an important part in innervation of the penis and must be anesthetized during the penile block.

Adult↗
PubMed1993

Familial thyroglossal duct cyst.

Thyroglossal duct cysts are common congenital abnormalities or developmental field defects, usually detected in early childhood. Despite their frequent occurrence, familial patterns are rare. We report on two new families with thyroglossal duct cysts. In the first family three siblings were involved, while in the second one, father and son were affected. This trait may be autosomal recessive or possibly multifactorial, as the first family would indicate, and also autosomal dominant, as the second family would suggest.

Adult↗
PubMed1993

False-positive ultrasonography in agenesis of the gallbladder: a pitfall in the laparoscopic cholecystectomy approach.

We report a case of agenesis of the gallbladder in a 15-year-old girl incorrectly diagnosed as cholelithiasis on preoperative sonography and suspected at laparoscopic surgery. The diagnosis of agenesis was confirmed at open surgery with intraoperative sonography, intraoperative cholangiography, and postoperative radioisotope scan. Difficulties in preoperative diagnosis and the management during laparoscopic and open surgery are discussed.

Adolescent↗
PubMed1992

Primary neoplasms of the small bowel.

Primary neoplasms of the small bowel are unusual and constitute 1-5% of all gastrointestinal tract neoplasms. Preoperative diagnostic difficulties, frequent dissemination at the time of the diagnosis, and poor prognosis are characteristic of this pathology. During a period of 26 years we treated 61 patients with tumors of the small bowel, 44 malignant and 18 benign (1 patient had both). The most common symptoms were abdominal pain (62%), weight loss (41%), and gastro-intestinal bleeding (31%). More than half of the patients were treated as emergencies and among the remaining, the most useful diagnostic test was the small intestinal barium study. Seventeen patients were operated on for intestinal obstruction, 6 of them due to intussusception of the tumor, while 8 other patients presented with perforation and 7 with massive gastrointestinal bleeding. Leiomyoma was the most frequent benign lesion. Among malignancies lymphoma was encountered in 38.6%, followed by adenocarcinoma (29.6%) and leiomyosarcoma (22.8%). Lymphoma was predominant among Sephardic Jews. Curative procedures were attempted in all but one of the benign cases and in 21 of the malignant cases. At the time of surgery metastases were present in 23 patients. The postoperative mortality was high (20% and 14% in the benign and malignant groups, respectively) most probably due to the high incidence of emergency surgery in a high risk population. The prognosis of the malignant tumors was poor with a 5-year survival of 18%. Their disappointing course seems to be related to late diagnosis because of nonspecific symptoms and difficulty in bringing the tumor to the fore. Hopefully, a greater awareness will lead to an earlier diagnosis and improve the prognosis.

Adolescent↗
PubMed1992

Secretory breast cancer in childhood and adolescence: report of a case and review of the literature.

A 17-year-old boy underwent a wide partial mastectomy with axillary dissection for secretory breast cancer, followed by low grade irradiation (30 Gy). There were no axillary lymph node metastases. Hormone receptor assay of the tumor was positive for progesterone and negative for estrogen. There was no local recurrence or sign of dissemination after nearly 5 years. Literature search revealed 21 cases of secretory breast cancer in childhood and adolescence; in only 2 cases was the hormonal status studied. We report an additional case and review the literature.

Adolescent↗
PubMed1992

Penetration of ciprofloxacin into human peritoneal tissue following a single oral dose of 750 milligrams.

The penetration of ciprofloxacin into the peritoneal tissue was studied in 10 patients after a single oral dose of 750 mg given 5.6 hours (mean) before elective laparotomy. The mean tissue level was 0.29 micrograms/ml (range, 0.082 to 0.96 micrograms/ml) while the mean concomitant serum level was 1.3 micrograms/g (range, 0.52 to 2.57 micrograms/g). The achieved concentrations are above the minimum inhibitory concentrations (MICs) of ciprofloxacin for most gram-negative bacteria commonly involved in intra-abdominal infections.

Abdomen↗
PubMed1991

Penetration of ofloxacin into human lung tissue following a single oral dose of 200 milligrams.

The penetration of ofloxacin into lung tissue was studied in 10 patients subjected to pulmonary surgery. Samples of blood and lung tissue were obtained 3 to 8 h (mean, 5 h) after oral administration of 200 mg. The mean level in tissue was 2.17 +/- 0.5 micrograms/g, while the mean level in serum was 0.85 +/- 0.23 micrograms/ml. The mean lung tissue/serum concentration ratio was 2.55 +/- 0.30. The achievable levels of ofloxacin in lung tissue are above the MICs for most pulmonary pathogens.

Administration, Oral↗
PubMed1990

Penetration of aminoglycosides into human peritoneal tissue.

Each of 30 patients underwent elective laparotomy following administration of a single intravenous dose of amikacin, netilmicin or tobramycin. Therapeutic concentrations of amikacin were achieved in peritoneal tissue in 10/10 patients. Only 13/20 samples from patients receiving the other two antibiotics showed antibacterial activity. Our data suggest that the penetrability of tobramycin (53%) and amikacin (39%) into the uninflamed peritoneal tissue is superior to that of netilmicin (16%).

Amikacin↗