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Biomedical subjects

Fikri M Abu-Zidan

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

At least 19 recordsLinked to original sources
PubMed2007

Necrotizing fasciitis: a challenging diagnosis.

The objective of the study was to evaluate our recent experience in diagnosis and management of necrotizing fasciitis. Records of patients who were diagnosed as having necrotizing fasciitis at Al-Ain Hospital in the period between March 2003 and August 2005 were studied retrospectively with regard to clinical features, risk factors, diagnosis, causative organisms, treatment, and outcome. Eleven patients, eight of whom were men of low socio-economic status, were studied. The median age (range) was 46 (8-65) years. The main risk factor was diabetes mellitus in seven patients (64%). The provisional clinical diagnosis was incorrect in seven patients (64%). Pure beta-hemolytic streptococcus group A or B was the causative organism in five patients (46%). Most of our patients underwent multiple surgical debridements with a median range of two (1-11) operations. Two patients died (overall mortality rate 18%). High clinical suspicion is essential for the diagnosis of necrotizing fasciitis. Accurate early diagnosis, aggressive resuscitation, using proper antibiotics, and extensive surgical debridement are essential for a favorable outcome.

Adolescent↗
PubMed2006

High patient satisfaction after arthroscopic subacromial decompression for shoulder impingement: a prospective study of 50 patients.

BACKGROUND: Arthroscopic subacromial decompression (ASD) for shoulder impingement has gained popularity. We evaluated the result of this common procedure prospectively, from a patient perspective. METHOD: We used the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Visual Analogue Scale (VAS) to evaluate 50 patients with a mean age of 49 (27-72) years. All patients had undergone 6 months of failed nonoperative treatment prior to surgery. Exclusion criteria were total rotator cuff rupture, shoulder instability, clinically verified acromioclavicular joint osteoarthritis, calcifying tendonitis or neurological symptoms. All the decompressions were done by experienced shoulder arthroscopists. RESULTS: A significant improvement in both the median DASH score and the VAS had occurred 6 months after surgery. INTERPRETATION: ASD for impingement in properly selected patients performed by experienced surgeons gives a high degree of patient satisfaction 6 months after surgery.

Activities of Daily Living↗
PubMed2006

Does colostomy prevent infection in open blunt pelvic fractures? A systematic review.

BACKGROUND: Open pelvic fracture is a rare injury. Our aim in this study is to systematically review the literature to define when diverting colostomy is indicated to protect the patient from infection in open blunt pelvic fractures. METHODS: Papers studying open pelvic fractures and the use of colostomy were retrieved through MEDLINE and PUBMED. The papers were critically appraised regarding their methodology and conclusions. Relevant information was combined. RESULTS: The level of evidence for the use of colostomy in open pelvic fractures is very low. All reports are retrospective and no statistical methods have been used to support conclusions drawn. We found no difference in the overall infectious complication rate between the colostomy and noncolostomy groups. There is an assumption that patients with perineal wounds would benefit from colostomy; however, rectal involvement in these injuries was not detailed. CONCLUSION: The role of colostomy in open blunt pelvic fractures is unresolved and randomized multicenter trials are needed.

Colostomy↗
PubMed2006

The effects of early rapid control of multiple bowel perforations after high-energy trauma to the abdomen: implications for damage control surgery.

BACKGROUND: This study evaluates the effects of early rapid control of multiple bowel perforations on cardiovascular and pulmonary function in high-energy traumatic shock compared with conventional small bowel resection anastomosis. METHODS: Fifteen anesthetized pigs, 10 to 12 weeks old, were exposed to a reproducible high-energy trauma and were divided into two groups. In the first group, the resection anastomosis group (RA, n = 8), small-bowel injuries were treated with resection and anastomosis; in the second group, the multiple bowel ligation group (BL, n = 7), small-bowel injuries were treated by resection and ligation. Repeated measurement analysis of variance was used to study the within group change overtime, the between group difference, and the interaction between them. Mean outcome measures were intravascular pressures, cardiac output, vascular resistance, lactic acid, and blood gases. RESULTS: The high-energy injuries caused traumatic shock in both groups with reduced cardiac output (p < 0.001) and lactic acidemia (p < 0.001). The BL group had a trend for higher cardiac output (p = 0.06). The rise in systemic and pulmonary vascular resistance was significantly reduced in the BL group compared with the RA group (p < 0.05). The BL group had a strong trend for higher oxygen extraction ratio (p = 0.06). There was a trend for less oxygen consumption in the BL group (p = 0.07). There was no difference in the lactic acidemia between the two groups. CONCLUSIONS: Early rapid control of multiple bowel perforations after high-energy trauma resulted in less impairment of cardiovascular function than conventional resection anastomosis of the bowel.

Acidosis, Lactic↗
PubMed2006

Focussed Assessment Sonograph Trauma (FAST) and CT scan in blunt abdominal trauma: surgeon's perspective.

BACKGROUND: Diagnosis of blunt abdominal trauma is a real challenge even for experienced trauma surgeons. Diagnostic tools that help the treating doctor in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma (FAST), Diagnostic peritoneal lavage (DPL) and CT scan. OBJECTIVES: the aim of this communication is to define the recent role of FAST and CT scan of the abdomen in the diagnosis of blunt abdominal trauma. FINDINGS AND CONCLUSIONS: FAST is useful as the initial diagnostic tool for abdominal trauma to detect intraabdominal fluid. With proper training and understanding the limitations of ultrasound, the results of FAST can be optimized. DPL is indicated to diagnose suspected internal abdominal injury when ultrasound machine is not available, there is no trained person to perform FAST, or the results of FAST are equivocal or difficult to interpret in a haemodynamically unstable patient. In contrast, in haemodynamically stable patients the diagnostic modality of choice is CT with intravenous contrast. It is useful to detect free air and intraperitoneal fluid, delineate the extent of solid organ injury, detect retroperitoneal injuries, and help in the decision for conservative treatment. Helical CT is done rapidly which reduces the time the patient stays in the CT scan room. Furthermore, this improves sagittal and coronal reconstruction images which are useful for detecting ruptured diaphragm.

Abdominal Injuries↗
PubMed2006

Motor vehicle collisions with large animals.

Motor vehicle collisions MVC with large animals are a worldwide problem. In this review, we aim to analyze the mechanisms and patterns of human injuries caused by MVC with large animals and various ways to prevent them. Reported studies on large animals that can cause such accidents include the moose, camels, deer, and kangaroos. The moose causes a typical rear-and downward deformity of the roof of the car. The camel falls on the roof of the car causing cervical and head injury to the occupants. Injuries caused by kangaroos and deer are usually mild. Injuries may be caused by direct collision with the animal or hitting another object when trying to avoid it. Alarming signs, underpasses or overpasses for animals, and reflectors that frighten the animals were all used to prevent the collisions. Roo-bars are used in Australia to reduce the car damage when hit by a kangaroo. Fencing has proven useful in United Arab Emirates. The mechanism of injury varies with the size and height of the animal and can be serious. Increased awareness of the effects of collision with large animals and ways to reduce it has to be promoted.

Accidents, Traffic↗
PubMed2005

Actinomycosis of the gallbladder: case report and review of the literature.

Actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphy's sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required.

Actinomycosis↗
PubMed2005

Establishment of a course for Focused Assessment Sonography for Trauma.

OBJECTIVE: Focused Assessment Sonography for Trauma (FAST) is not widely practiced by Trauma Surgeons in the Middle East despite its international acceptance. A FAST course was established by the Trauma Group at the Faculty of Medicine and Health Sciences at United Arab Emirates (UAE) University aiming to introduce doctors who have limited experience of ultrasound to the basics of FAST. This article summarizes the content of the course; the evaluation of the participants and their recommendations. METHODS: An 8 hour FAST course was offered to 18 participants in May 2004 in the Faculty of Medicine and Health Sciences, UAE University, Al-Ain, UAE. Lectures with syllabus material were used to cover the following topics: basic ultrasound physics, knobology and sonographic orientation, the FAST scan, chest and cardiac trauma sonographic evaluation, training and credentialing issues. Each participant received 3 hours of hands-on ultrasound instruction. On completion of the course participants responded anonymously to an evaluation questionnaire. RESULTS: All participants responded to the questionnaire (100% response rate). Delegates found the course well organized, relevant, met their needs and encourages them to use FAST in their own practice. The course objectives were met. Participants suggested that including actual patients and the use of animal models improve the practical sessions. CONCLUSION: Organizing a FAST course is an important step towards recognizing and implementing it in practice. Nevertheless, there is a need for appropriate quality assurance and credentialing guidelines before commencing.

Clinical Competence↗
PubMed2005

Adhesive intestinal obstruction following blunt abdominal trauma.

Advances in diagnosis and management of multiple trauma patients have lead to adopting a conservative approach for most patients with blunt abdominal trauma. Intestinal obstruction is a rare complication for this approach. Herein, we report a 37-year-old male, who did not have an abdominal operation, and who developed adhesive intestinal obstruction 7 weeks following blunt abdominal trauma. We detected no signs of peritonitis or intra-abdominal bleeding clinically or radiologically on admission. We initially treated the intestinal obstruction conservatively, but the obstruction did not resolve. Finally, we performed laparotomy, which showed that the small bowel was matted together by thick fibrous layers of adhesions. We performed adhesiolysis, and the patient was discharged home 3 weeks later. Histopathological findings of the fibrous layer were consistent with repair due to previous trauma and hemorrhage. We review the literature of this rare condition.

Abdominal Injuries↗
PubMed2004

Stromal sarcoma of the breast: a case report.

We report a case of a 36-year-old lady who presented with a huge fungating tumour that involved the entire right breast. The tumour was diagnosed histologically as undifferentiated primary stromal tumour of the breast with axillary lymph node metastasis. We review the literature of this rare malignant tumour. Stromal sarcomas of the breast lack epithelial participation, and diagnosis of these tumours can be difficult. Genome-wide expression profiling is currently used to determine the cell of origin of most sarcomas. Surgery offers the best therapeutic option. Adjuvant radiotherapy is not very beneficial, while chemotherapy has, to date, no established role in the management of this disease. The prognosis is dismal for patients with lymph node involvement. The size of the tumour has a lesser bearing on outcome.

Adult↗
PubMed2004

Establishment of a teaching animal model for sonographic diagnosis of trauma.

BACKGROUND: Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intra-abdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. METHODS: Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. RESULTS: The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. CONCLUSION: The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

Abdominal Injuries↗
PubMed2003

Elevated protein carbonyls as plasma markers of oxidative stress in acute pancreatitis.

BACKGROUND: Experimental studies have demonstrated that protein and lipid oxidation is a feature of acute pancreatitis and that antioxidant pretreatment can ameliorate the severity of the disease. Justification for a clinical trial of antioxidant therapy requires stronger evidence for oxidative stress in patients. AIMS: To determine if oxidative stress is evident in patients with acute pancreatitis on admission to hospital, if it increases after admission and if it is related to disease severity. METHODS: Measurement of plasma concentrations of protein carbonyls and malondialdehyde as markers of protein oxidation and lipid peroxidation, respectively, in a consecutive series of 85 patients with acute pancreatitis 0, 2 and 5 days after admission. RESULTS: Patients with acute pancreatitis had significantly increased concentrations of protein carbonyls in plasma on recruitment (median 27 h after the onset of symptoms) that persisted over 5 days. Protein carbonyls were higher in severe compared with mild disease (median 0.099 and 0.043 nmol/mg protein, respectively, p = 0.0016). They were higher at day 0 in patients recruited with more established pancreatitis than in those presenting early. No increases in malondialdehyde were seen. Receiver operator characteristic curve analysis demonstrated that protein carbonyls at day 0 were comparable with C-reactive protein at predicting pancreatitis severity. CONCLUSION: Our demonstration of substantial protein oxidation provides further evidence for oxidative stress in patients with severe pancreatitis. Our results suggest that there could be a window for early antioxidant intervention and that protein carbonyls could be a useful plasma marker of oxidative injury.

Acute Disease↗
PubMed2003

Factors affecting the severity of horse-related injuries.

Horse riding and handling are uniquely dangerous. Knowledge of the risk factors of horse-related injuries is essential to prevent them. We aimed to define the factors that affect the severity of horse-related injuries and the length of hospital stay. A number of 231 patients (136 females and 95 males) with horse-related injuries were studied. A generalized linear model was used to test the effect of age, sex, cause of injury, complexity of the mechanism of injury, year, place of injury and profession of the injured, on the injury severity score (ISS) and the hospital stay. Fall from a horse was the most common cause of injury (67%). Most of the patients were non-professional (153, 66%). Females were significantly younger than males (P<0.001, t-test). Statistical analysis showed that the primary mechanism of injury (F=2.73, P=0.014) and the complexity of this mechanism (F=4.47, P=0.013) significantly affected the duration of hospital stay. None of the studied variables affected the injury severity score. The mechanism of the horse-related injuries and their complexity significantly affected the duration of hospital stay but not the injury severity score.

Abdominal Injuries↗
PubMed2003

A quantitative analysis of medical publications from Arab countries.

OBJECTIVE: To perform geographical analysis of the number of biomedical publications produced in 20 Arab countries over a 15-year period from 1987 to 2001 and to compare publication rates normalized by country population, school enrollment, adult illiteracy, and gross domestic product (GDP). METHODS: This study was carried out at the Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates. A search of the Medline database for publications in which the first author of original articles is affiliated with an institution located in the Arab World was performed. Data collection, extraction, and validation was performed. RESULTS: The Kingdom of Saudi Arabia and Egypt had the highest number of publications together accounting for 58.4% of the Arab World's publications. Kuwait and the United Arab Emirates (UAE) had the highest number when normalizing by population with 6.57/100,000 for Kuwait and 2.62/100,000 for UAE. Normalizing by the GDP indicator, Jordan had the highest number of publications with 11.2 per one billion average yearly GDP followed by Lebanon with 10.3 per one billion average yearly GDP. CONCLUSION: Normalizing publications by different indicators is important as results may vary when using different normalizing indicators or no normalization at all.

Bibliometrics↗