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R Haddad

Publications and source records attributed to R Haddad.

At least 55 records · Page 3Linked to original sources
PubMed1998

Single-injection gamma probe-guided sentinel lymph node detection in 40 melanomatous lymphadenectomies.

The aim of the study was to evaluate single-injection gamma probe-guided sentinel lymph node (SLN) detection, applied in 40 melanomatous selective sentinel lymphadenectomies (SSLNDs). Thirty-four patients underwent preoperative lymphoscintigraphy, intraoperative SLN identification by a gamma-detecting probe and blue dye, and SLN sampling. The first 11 patients underwent formal lymphadenectomy. The following 23 patients underwent formal lymphadenectomy only when the SLN was involved with tumor. Evaluation included hematoxylin-eosin-stained slide microscopy, monoclonal antibodies to S-100 protein, and the melanoma-associated antigen HMB45. In all patients, single or multiple SLNs were identified by the gamma-detecting probe. However, only 82.5% of these specimens included blue-stained nodes. None of the non-SLN specimens were the exclusive site of metastases. Four patients had metastases in their SLN specimen without non-SLN involvement. We conclude that SSLND can be performed easily and precisely with the exclusive use of the gamma-detecting probe. A single injection is feasible, and decreases operating room contamination and patient discomfort.

Humans↗
PubMed1997

Genomic imprinting and Igf2 influence liver tumorigenesis and loss of heterozygosity in SV40 T antigen transgenic mice.

Maternal-specific loss of heterozygosity (LOH) and allelic imbalances [i.e., partial LOH (pLOH)] observed in SV40 T/t antigen-induced liver tumors suggests that an imprinted gene on chromosome 7 is involved in liver tumorigenesis. Maternal-specific LOH/pLOH may reflect the loss of a maternally expressed tumor suppressor gene or the acquisition of paternally active alleles of a growth promoter. In addition, two oppositely imprinted genes on distal chromosome 7, Igf2 and H19, are re-expressed in most liver tumors from an SV40 T/t antigen transgenic line (M11T-G). Igf2 is a paternally expressed growth promoter, and H19 is a maternally expressed gene that can suppress growth in some tumor cell lines. We studied the role of Igf2 during liver tumorigenesis by creating Igf2 (+/-) M11T-G mice. These mice are essentially null for Igf2 expression because imprinting normally precludes maternal Igf2 expression. M11T-G, Igf2 (+/-) males exhibit a 15-fold reduction in the frequency of large tumors. Igf2 (+/-) tumors do not express maternal Igf2, indicating rigid imprinting control in the liver. LOH/pLOH analysis was performed on the tumors and indicates that acquisition of paternally active Igf2 alleles is a major selective event for M11T-G liver tumorigenesis. This also implies the existence of an imprinted, maternally expressed tumor suppressor gene on chromosome 7 that is unlikely to be H19.

Alleles↗
PubMed1997

[Congenital thumb hypoplasia. Clinical study of twenty patients].

Congenital hypoplasia of the thumb is often seen in association with longitudinal failure of formation of the radius. A clinical study of 20 children, with 26 cases of hypoplasia of the thumb was conducted to evaluate the surgical indications according to the stage of the malformation. The results were evaluated for each patient of the study, with the position of the thumb, its spontaneous movements and its function. In grade II hypoplasia, treatment consisted of reanimation of the hypoplastic thumb by one or more tendinon transfers. In grade IV and V, pollicisation is the treatment of choice. In our experience, the surgical indications raise a problem essentially in grade III hypoplasia of Blauth's classification. In these cases, pollicisation gives the best results. Reanimation of the thumb with tendinon transfers can sometimes be used when parents refuse amputation of the thumb, when the first metacarpal is not excessively hypoplastic, and when the child is old enough to allow early physiotherapy.

Age Factors↗
PubMed1997

Impact of early orchidopexy on testicular growth.

OBJECTIVE: To assess the impact of early orchidopexy on post-operative testicular growth. PATIENTS AND METHODS: One-hundred and ninety boys (age range 1 week to 15 years at the time of initial diagnosis) underwent surgery for the repair of unilateral cryptorchidism, and the relative testicular size was assessed before and after operation. RESULTS: When compared with the size of the uninvolved testis, testicular size increased after surgery in 11.6% of cases and decreased in 2.6%. Testicular growth was more common among children operated when younger than 18 months (P = 0.016) than when older. CONCLUSION: The testicle may grow when orchidopexy is performed in children younger than 18 months.

Adolescent↗
PubMed1997

Silicone oil removal: results, risks and complications.

PURPOSE: We studied the results and complications of silicone oil removal applying basic criteria for the selection of eyes. METHODS: The criteria for oil removal: 1. Completely attached retina for at least 4 weeks, 2. Absence of tractions and active proliferations, 3. Preoperative vision > 0.01. The oil was removed from 90 of 261 oil filled eyes (removal rate: 34.5%). 83 eyes were included in the further study. FOLLOW-UP: 1.3-62.5 months (mean 15.7). RESULTS: Visual acuity improved (> or = 1 line) in 40 of the 83 eyes (48.2%), remained unchanged in 22 eyes (26.5%) and deteriorated (> or = 1 line) in 21 eyes (25.3%). COMPLICATIONS: reproliferations (42.2%), retinal detachment (20.5%), pressure rises (27.7%), lens opacification (36.7%), severe keratopathy (8.4%). CONCLUSION: Silicone oil removal has a distinct rate of complications, despite preoperative selection of eyes with a better prognosis. Reduction of reproliferations and weighing of risk and benefit could improve the results.

Cataract↗
PubMed1997

Preoperative pulmonary function tests do not predict outcome after coronary artery bypass.

PURPOSE: To evaluate the utility of preoperative pulmonary function tests in predicting postoperative complications and lengths of stay after coronary artery bypass grafting. METHODS: Medical records of 193 consecutive patients who underwent coronary artery bypass grafting from October 1993 to September 1994 were reviewed. Preoperative pulmonary function tests, comorbid conditions, smoking history, postoperative complications, and total days in the intensive care unit, hospital, and on mechanical ventilation were abstracted. Data were analyzed using linear regressions, analyses of variance, and nonpaired Student's t tests. RESULTS: Pulmonary function tests were normal in 56 subjects (29%, group 1), mildly impaired in 72 (37%, group 2), and moderately impaired in 35 (18%, group 3). Thirty patients (16%) had no pulmonary function tests. Group 3 subjects were older (71) compared to groups 1 and 2 (63 and 65, P < 0.05). There was no major difference in comorbid conditions or smoking status among the groups. All patients had atelectasis postoperatively. The most frequent postoperative complications were pleural effusions (43%), pulmonary edema or congestive heart failure (28%), and atrial fibrillation (35%). The repeat surgery rate was 3.6%. The mean length of hospital stay was 10.1 +/- 0.6 days, with 1.5 +/- 0.1 days of mechanical ventilation and 2.8 +/- 0.2 days of intensive care unit stay. Overall, pulmonary function tests had no predictive value for postoperative pulmonary and nonpulmonary complications, nor for durations of mechanical ventilation and intensive care unit stay. There was a trend toward increased length of hospital stay in patients with impaired pulmonary function tests (group 18.6 +/- 0.6, group 2 9.6 +/- 0.8, group 312.7 +/- 2.3 days, P = 0.09) but this was consistent with random variation. CONCLUSIONS: Preoperative pulmonary function tests were not useful in predicting postoperative outcomes in patients undergoing coronary artery bypass grafting.

Aged↗
PubMed1996

A system for obtaining undiluted intraoperative vitreous biopsy samples.

For many analyses of the vitreous, it is essential to obtain undiluted vitreous specimens under sterile conditions intraoperatively. In this new technique, a metal device is integrated into the aspiration system. The device fits on standard laboratory plastic containers with integrated caps. Undiluted vitreous accumulates in the container, which is then removed and sent to the laboratory. With a new container in place, vitrectomy can be continued as usual. This technique is simple, safe, effective, and inexpensive.

Biopsy↗
PubMed1996

Photodynamic therapy of colorectal cancer using a new light source: from in vitro studies to a patient treatment.

PURPOSE: Photodynamic therapy (PDT) is a relatively new alternative modality for palliation of rectal cancer. Current source of light for PDT are laser systems that are expensive and not necessarily needed for PDT. We evaluated a new nonlaser light source for PDT, Versa-Light. METHODS AND RESULTS: In vitro PDT--CT26 murine colon carcinoma cells were incubated with aluminum phthalocyanine (AlPcS4) for 48 hours and subjected to photoradiation using Versa-Light, and viability was assessed. There was a significant decrease in viability of treated cells compared with controls. In vivo PDT--BALB/c mice were injected either subcutaneously or intrarectally with CT26 cancer cells. IP AlPcS4 (2.5 mg/kg) was injected when tumors were visible. After 24 hours, mice were subjected to photoradiation. Massive tumor necrosis in response to PDT was observed. PDT also prolonged survival of treated mice. Patient treatment--A 70-year-old woman with recurrent local rectal carcinoma received intravenous Photofrin II (2 mg/kg). After 48 and 96 hours, she was subjected to direct photoradiation. After the first light session, there was complete macroscopic disappearance of the tumor. Biopsies up to 10 weeks after the treatment showed no cancer cells in the treated area. Sixteen weeks later, a randomized biopsy from previous tumor site showed carcinoma cells. CONCLUSIONS: We believe that Versa-Light, is a good light source for PDT. It was effective in both in vitro and animal studies. It can also be safely used for clinical PDT.

Aged↗
PubMed1996

[Contamination of intraocular fluid in pars plana vitrectomy].

UNLABELLED: Endophthalmitis after pars plana vitrectomy is rare, with an incidence of 0.05-0.14%. The aim of this study was to evaluate the microbiological situation during pars plana vitrectomy and to ascertain what organisms and how many enter the eye during the operation. PATIENTS AND METHODS: Twenty-five consecutive subjects undergoing primary pars plana vitrectomy were included in the study. Patients were excluded if they had evidence of local or systemic infections or had undergone antibiotic therapy within 3 weeks before surgery. A standard three-port pars plana vitrectomy was performed on each patient. Preoperative smears of the conjunctiva and intraoperative aspirates of the vitreous were taken immediately after sclerotomy, and aspirates of the intraocular fluid at the conclusion of operation. RESULTS: We obtained preoperative smears from the conjunctival sac of all patients, and found that 19 patients (76%) had positive cultures, with coagulase-negative staphylococci as the most commonly isolated organisms, (n = 14; 56%). Vitreous--aspirated immediately after sclerotomy--was sterile in 68% (n = 17). In 32% (n = 8) contamination occurred, the microorganisms isolated being coagulase-negative staphylococci (20%) and Staphylococcus aureus (12%). Five of the samples (20%) of intraocular fluid from the vitreous cavity--aspirated before wound closure--were contaminated, coagulase-negative staphylococci (8%) and Staphylococcus aureus (12%) again being found in culture. In no case did postoperative endophthalmitis develop. CONCLUSIONS: This study demonstrates that bacteria enter the eye during pars plana vitrectomy and that there is a change in the contaminating bacterial species during operation. Even if bacteria remain in the eye after pars plana vitrectomy, postoperative endopthalamitis does not necessarily develop.

Aged↗
PubMed1996

Endometriosis in abdominal scars: a diagnostic pitfall.

Endometriosis is ectopic endometrial tissue that responds to hormonal stimulation and is found in 8 to 15 per cent of all menstruating women. Endometrioma in a surgical scar is rare and appears in 0.1 per cent of women who have undergone cesarean section; 25 per cent of these women have concomitant pelvic endometriosis. Endometrioma in a scar can present as a painful swelling on the scar that worsens during cough and effort, with the patient's complaints resembling those of a postoperative hernia occurring in a scar. It can also mimic other lesions of the abdominal wall, such as hematomas, granulomas, abscesses, and tumors. Four cases of endometriomas in a cesarean section scar are described. Two were diagnosed preoperatively as postoperative ventral hernias, and the other two presented with an abdominal wall mass causing pain and discomfort. All patients underwent surgery, and the error of their preoperative diagnosis was revealed by histology, which confirmed endometrioma. We contend that endometrioma in scarring is a diagnostic pitfall that should be considered in the differential diagnosis of postoperative ventral hernias and various abdominal wall masses.

Abdominal Muscles↗
PubMed1995

[Median clefts of the hand. Classification and therapeutic indications apropos of 29 cases].

Based on a series of 29 patients with median clefts of the hand (29 hands), the authors define the place of this malformation, its various clinical features and the therapeutic indications. The series consists of 13 boys and 7 girls, 9 bilateral cases and 11 unilateral cases. Involvement of the feet was observed in 9 cases. Several children also presented other malformations. 16 children were operated (22 hands). Two types of technique were used: simple closure of the cleft (Barsky's operation) and transposition of the index finger according to the Snow-Littler or Miura-Komada techniques. All operated patients were reviewed with a follow-up of more than one year and the results were assessed in terms of three criteria: overall use of the hand, thumb-index finger pinch grip, aesthetic appearance. The authors propose a new classification of median clefts of the hand based on examination of this series of 20 children: simple clefts with more or less complete absence of the middle finger, complex clefts with syndactyly (especially I and II), transverse bone polydactyly, extensive clefts with severe aplasia of the radial segment of the hand. Clinical and radiological examination confirm the experimental studies by Ogino. Barsky's operation gives satisfactory results in simple forms with parallel fingers. Translocation of the index finger to the base of the 3rd metacarpal is necessary in the presence of divergent fingers and syndactyly. Median clefts of the hand are very distinct from median aplasia, which is always unilateral, with no familial nature and no involvement of the feet and which can be classified together with brachysyndactyly. Each case must be studied before deciding treatment, as functional adaptation is always remarkable. The least favourable surgical results are observed in forms with abnormal position of the index finger (malrotation syndactyly). Lastly, the Snow-Littler operation is not devoid of complications.

Child↗
PubMed1995

[Surgical treatment of camptodactyly].

Almost all anatomical structures of the hand have been held responsible for non-traumatic, non-paralytic flexion deformity of the proximal interphalangeal joint. Together with Millesi and Flatt, we define camptodactyly as a disorder of flexor-extensor equilibrium in the PIP. This definition determined our therapeutic approach. 59 patients with one or several fingers affected by camptodactyly were followed between 1975 and 1989. In 3 cases, the anomaly was associated with another malformation of the hand and 56 cases, it was isolated. 11 children did not receive any active treatment, but were followed and manipulated. 17 (27 fingers) were treated by static or dynamic splints. 31 (43 fingers) were operated according to the following technique: total anterior tenoarthrolysis leading to recession of the flexor apparatus and lengthening of the skin on the palmar surface of the first phalanx by a rotation flap. This operation was preceded and followed by application of a dynamic extension splint onto the operated finger. Of the 20 fingers treated by manipulations and reviewed, 11 had improved, 7 were stable and 2 had deteriorated. Of the 24 fingers treated by splints and reviewed, 14 had improved, 5 were stable and 5 had deteriorated. Of the 30 fingers operated and reviewed, 30 had improved, 7 were stable and 2 had deteriorated. Although recent anatomical studies tend to indicate that anomalies of the lumbrical muscles are frequent in operated camptodactyly, these studies do not take into account the numerous anomalies of these muscles observed in the general population. The therapeutic conclusion resulting from these studies are also unconvincing. The technique which we propose cannot be applied to every case. The milder forms only require orthopaedic treatment. C camptodactyly in adolescents or adults with joint blocking are only slightly improved by surgery and only require corrective osteotomy. In all other cases, especially in young children, anterior tenoarthrolysis of the finger with cutaneous elongation allows reduction or correction of the deformity.

Adolescent↗
PubMed1995

[Surgical treatment of duplication of the thumb. Apropos of 106 cases].

The surgical treatment of thumb duplication remains difficult, the sequelae usually observed are aesthetic (ungual dystrophy, hypoplastic pulp, clinodactyly) or functional (joint stiffness or instability). In order to clarify our therapeutic approach, we classify duplications into two types: proximal duplications (Wassel stage IV, V and VI) and distal duplications (Wassel stage I, II and III). Our experience is based on 106 cases operated over the last 15 years (1977). Our indications and operative techniques have progressed since 1988, in particular, we no longer perform Bilhaut-Cloquet operation, and prefer to perform the first operation before the age of one year. Resection of the hypoplastic supernumerary thumb. Preservation of the pulp skin to reconstitute the paronychium and pulp of the remaining thumb. Resection of supplementary joint facets. Meticulous repair of the capsulo-ligamentus apparatus by means of a capsulo-periosteal flap taken from the "sacrificed" thumb. Tendinous reequilibration and reinsertion of thenar muscles. We do not perform systematic subcapital osteotomy. When necessary, this procedure is performed during a complementary operation at the age of 2 to 3 years. Since the introduction of these technical modifications, our functional and aesthetic results have improved. Temporary overcorrection of the pulp is necessary. Parents must be advised that this deliberately hypertrophic appearance becomes normal with growth.

Dermatologic Surgical Procedures↗
PubMed1995

Successful delayed repair of a complete transection of the right mainstem bronchus in a five-year-old girl: case report.

Bronchial transection of a main bronchus is usually recognized and repaired immediately after injury. Delayed repair is uncommon, especially in pediatric patients. We report a case of delayed repair of a transected right mainstem bronchus in a 5-year-old girl, 3 years after the initial injury. The transected lung re-expanded immediately and showed continued growth 3 years later.

Bronchi↗