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Biomedical subjects

H Farid

Publications and source records attributed to H Farid.

5 recordsLinked to original sources
PubMed1995

Methods to decrease the morbidity of abdominoperineal resection.

Recent reports stress that abdominoperineal resections (APR) are associated with many complications, including hemorrhage, long hospitalization, and delayed closure of an open perineal wound. Thirty-five patients underwent an abdominoperineal resection for cancer at Kaiser Permanente Medical Center, Los Angeles, from January 1989 to December 1993. All patients, except two, had their perineal wound closed after closure of the peritoneum and insertion of closed system suction catheters. Ninety-one per cent of patients achieved successful primary healing. Three patients (8.5%) suffered perineal wound dehiscence. Overall morbidity was 55 per cent, with urinary retention being the most common, occurring in 23 per cent of patients. This was managed successfully by early in-and-out self catheterization. There was no incidence of urinary tract infections. There were no operative deaths. Length of stay averaged 8.6 days, with a median of 7 days. Five patients had previous radiation therapy. Of those, two (40%) had perineal wound dehiscence, compared to only one of 33 (3.3%) patients without previous radiation. APRs can be done with minimal mortality, although with an increased morbidity in irradiated patients. Primary closure and drainage of the perineal wound significantly lowers the complication rate, as does early Foley removal and self in-and-out catheterization.

Adenocarcinoma↗
PubMed1994

Hepatic resections: changing mortality and morbidity.

Hepatic resections have been associated with high mortality and morbidity; therefore, this procedure was not used frequently. With increasing safety, acceptance of the procedure grew. A review of recent series still reveals a strikingly high incidence of complications. However, in a review of the last 100 hepatic resections performed at Kaiser Permanente Medical Center, Los Angeles, the average blood loss was 1351 mL, (range 90-10,000 mL) with a median of 900 mL. Blood transfusion requirements averaged 1.5 units, with 50 per cent of patients requiring no transfusion, and 80 per cent of patients requiring two units or less. Cirrhosis, present in 15 per cent of our patients, was associated with increased blood loss and morbidity. The use of the Cavitron Ultrasonic Aspirator (CUSA) and the liver clamp have had a major impact on reducing intraoperative blood loss and transfusion requirement. Operative time was significantly reduced from previous reports, to an average of 221 minutes (90 to 410 minutes). Hospital stay averaged 7 days, with a median of 6 days. Both the mortality rate of 2 per cent and the morbidity rate of 22 per cent represent significant improvements. Utilizing modern techniques, hepatic resections can be done with acceptable mortality and mortality, and may lead to its increased application.

Adolescent↗
PubMed1994

Gastrointestinal complications associated with cardiopulmonary bypass procedures.

Gastrointestinal complications after cardiopulmonary bypass (CPB) procedures are rare, but when they do occur, they carry a significant incidence of morbidity and mortality. Over a 5-year period spanning 1988-1992, 4923 CPB procedures were performed and 64 patients were identified who suffered a GI complication, giving an incidence of 1.3 per cent. The most frequent complications were GI bleeding (40%) and pancreatitis (34%). Other complications included acute cholecystitis (11%), perforated duodenal ulcer (8%), ischemic bowel (5%), and diverticulitis (2%). Complications occurred most frequently in patients undergoing procedures with longer pump and cross-clamp times, such as valvular and combination (CABG/valve) procedures. Redo procedures and the use of an intra-aortic balloon pump increased the risk of developing a GI complication 2.5 and 12 times, respectively. Patients were treated aggressively both medically and surgically, but suffered a higher mortality (16%) as compared to those not suffering a GI complication (3%). We conclude that GI complications after CPB procedures are infrequent but lethal. Clinical features are often subtle, and a high index of suspicion is needed for early diagnosis and aggressive treatment.

Adolescent↗