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Biomedical subjects

S Said

Publications and source records attributed to S Said.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Laparoscopic appendectomy. A review of the literature].

Laparoscopic methods are becoming increasingly popular in surgery. In the course of a review concerning laparoscopic appendectomy undertaken up to 31 December 1993 all publications were evaluated by computer-assisted research. Out of a total of 90 publications only 14 deal with the comparison of the laparoscopic versus open appendectomy. Two prospective randomized studies are published. Because of the low number of patients the evaluation of the laparoscopic method is not yet definite.

Adolescent↗
PubMed1994

Blood coagulation, fibrinolytic, and inhibitory proteins in end-stage renal disease: effect of hemodialysis.

Patients with end-stage renal disease (ESRD) are at risk of ischemic cardiovascular complications and vascular thrombosis. These observations prompted the present survey of the blood coagulation, fibrinolytic, and inhibitory proteins in a group of 31 ESRD patients and 32 normal controls. Immunologic and functional assays were used to quantitate plasma antigen concentrations and/or functional activities of factors XII, XI, IX, VIII, VII, X, II, and XIII, von Willebrand factor, fibrinogen, fibronectin, high molecular weight kininogen, D-dimer, antithrombin III, protein C, protein S, plasminogen, tissue-type plasminogen activator, plasminogen activator inhibitor, alpha 2-antiplasmin, alpha 1-antitrypsin, and alpha 2-macroglobulin as well as antiplasmin activity. The coagulant activities of factors XII, IX, X, and II were significantly reduced in ESRD patients despite their normal or increased plasma antigen concentrations. In addition, the ESRD patients showed hyperfibrinogenemia and significant elevations of plasma concentrations of D-dimer, von Willebrand factor, factor VII, and factor XIII antigens. They also exhibited significant reductions of antithrombin III, free protein S, plasminogen, and tissue-type plasminogen activator concentrations. Despite ultrafiltration, plasma factor IX activity and von Willebrand factor and fibrinogen concentrations decreased after hemodialysis with little or slight changes in other measured parameters. The ESRD patients studied here exhibited numerous abnormalities of coagulation, fibrinolytic, and inhibitory proteins at multiple levels. These abnormalities may be involved in the pathogenesis of cardiovascular complications and vascular thrombosis in this population. The precise mechanism(s) and clinical significance of the observed abnormalities are unknown and await further investigation.

Antithrombin III↗
PubMed1994

Adynamic bone disease in patients with uremia.

Adynamic (or aplastic) bone disease is a bone histologic pattern characterized by decreased bone formation rate, low cellularity, and normal or decreased osteoid thickness. It was first described in symptomatic patients undergoing dialysis who were overloaded with aluminum because of contaminated dialysate or chronic ingestion of aluminic phosphate binders; the evidence of the overload was extensive coloration (more than 25%) with aurin tricarboxylic acid, whereas the Perls stain coloration for iron was negative. We have, however, reported these histologic changes in asymptomatic patients with uremia who were never exposed to aluminum, in two patients before end-stage renal failure and in six patients undergoing dialysis. The main step in the prevention of adynamic bone disease is the absolute exclusion of aluminum exposition even by so-called "safe doses" of aluminum phosphate binders because in the long term they are never actually safe. Because idiopathic adynamic bone disease may nevertheless occur, parathyroid hormone suppressive treatment by oral calcium taken with meals as phosphate binders (+/- 1 alpha-hydroxyvitamin D3 derivatives) should be carefully monitored by measurements of plasma concentrations of not only calcium and phosphate but also of intact parathyroid hormone levels. In order to have normal bone formation rate levels, patient intact parathyroid hormone levels should be between one and three times the upper limit of the normal level. Although adynamic bone disease may not be a true bone disease when not due to aluminum, it is a risk factor for increased incidence of hypercalcemia and hyperphosphatemia and therefore for metastatic calcifications. Therefore, when hypercalcemia occurs with hyperphosphatemia and normal intact parathyroid hormone in patients treated with 1 alpha-hydroxyvitamin D3, it is proposed that the latter drug should be discontinued first, whereas oral calcium is increased to correct hyperphosphatemia, and calcium concentration is decreased in the dialysate to prevent hypercalcemia, even though plasma parathyroid hormone may increase up to three times the upper limit of the normal level. In patients previously exposed to aluminum, a deferoxamine test should be performed and a deferoxamine treatment started if the test is positive.

Aluminum↗
PubMed1994

Minimal invasive surgery in the local treatment of rectal cancer.

At the Surgical Department of the University of Cologne, a system has been developed for transanal endoscopic surgery, which allows all the conventional surgical techniques within the rectal cavity. The clinical and long-term results regarding local excision of broad based adenomas and small (< 4 cm) carcinomas of the rectum were the subject of the study. The main indication was the removal of sessile adenomas. Early rectal carcinomas with favourable histological grading (Grade 1 and 2) and staging (Mason I and II) were also suitable for endorectal therapeutical approach. Infiltrative cancers can be removed endoscopically in one session, but the authors performed local excisions of these cancers only in cases where the patient was unwilling to undergo extensive surgery or due to medical reasons. Nevertheless several Dukes B carcinomas were removed locally. Most of the histological findings of the subsequent radical operations (rectum resection, rectum extirpation) revealed that the carcinoma had already been totally removed. During the period July 1983 to December 1992, the techniques have been employed on 313 patients in 348 cases. Early postoperative complications consisted of intraperitoneal perforations (five cases); rectovaginal fistulae (four cases); haemorrhages (four cases), death due to cardiopulmonary failure (two cases). All the complications occurred within the first three years of the learning phase. The recurrence rate of adenomas amounted to 5%. The technique allows accurate endoscopic microsurgical excision of giant adenomas and early cancers with minimal morbidity and excellent presentation of specimens for complete histological analysis. Open invasive surgery can thus be avoided.

Adenoma↗
PubMed1994

[Preliminary experiences with thoracoscopic operations].

During the period March 3, 1992 to September 30, 1993 36 video-assisted thoracoscopic operations were performed at the Surgical Department of the University of Cologne. In 12 cases wedge resection of peripheral pulmonary nodules were carried out. Two of the patients underwent video-assisted thoracoscopic lobectomy of the left lower lobe due to peripheral primary bronchogenic carcinoma. In 6 cases biopsy of the lung or pleura was undertaken. Further indications were partial pleurectomy and resection of blebs (n = 12). Pleural effusion was drained under thoracoscopic vision twice. No intraoperative complications occurred. Two patients proceeded to thoracotomy after persistence of pneumothorax following thoracoscopic pleurectomy. The postoperative course of the remaining patients was uneventful and was especially characterized by the reduction in pain and disability. In accordance to the experience of other authors we believe that thoracoscopic surgery is a method with a promising future. Further investigations have to evaluate indications, different techniques, and long term results.

Adolescent↗
PubMed1994

[Laparoscopic therapy of nonparasitic liver cysts].

Minimal invasive surgery has become an important part of surgical therapy of non-parasitic cysts of the liver. At the moment there exist only a few but in all cases positive experiences with the laparoscopic unroofing of liver cysts. Until now we treated 3 patients with non-parasitic liver cysts by means of this method. In all cases we had no intra- or postoperative complications and the average hospital stay was 5 days. In agreement with other authors we think that laparoscopic unroofing of non-parasitic liver cysts is a method with promising future. The necessity of an intraoperative cholangiography in case of a bile leak respectively recurrence prophylaxis by means of an omentum major plastic will be decided by further clinical investigation.

Biliary Fistula↗
PubMed1993

Localized bullous scabies. Uncommon presentation of scabies.

A previously unreported form of localized bullous scabies mimicking bullous pemphigoid is described. The patient presented with a localized, severely pruritic erythematous plaque with a cutaneous eruption consisting of several papules and a single tense bulla on an erythematous base. The histologic findings consisted of a subepidermal inflammatory bullous dermatosis with lymphocytes, neutrophils, and many eosinophils, and the results of direct immunofluorescence were negative. Correlation of the clinical course with the histologic and immunofluorescence findings were necessary to establish the diagnosis of infestation by Sarcoptes scabiei.

Aged↗
PubMed1993

Correlations between morphological changes in platelet aggregates and underlying endothelial damage in cerebral microcirculation of mice.

BACKGROUND AND PURPOSE: The aim of this study was to test the hypothesis that, once formed, platelet aggregates may injure underlying cerebrovascular endothelium. Such injury could make the same site selectively attractive to the next wave of passing emboli or activated platelets. This vicious circle could account for repetitive, stereotypic symptoms in transient ischemic attacks. METHODS: In pial arterioles, minor endothelial injury was produced by a laser/dye technique. After various periods of platelet aggregation at the damaged site, the vessels were fixed in situ for electron microscopic study. The degree of platelet activation (rounded and/or degranulated forms) was evaluated by counting these forms in the electron photomicrographs. These counts were related to the degree of endothelial damage ascertained in the micrographs. Other statistical relations were also examined. RESULTS: Endothelial damage progressed in parallel with the duration of platelet aggregation and the degree of platelet degranulation at the site. Correlations were number of activated platelets versus degree of damage, r = .43, P < .03; duration of aggregation versus damage, r = .52, P < .01; and number of degranulated platelets versus the degree of endothelial damage, r = .83, P < .001. If an aggregate embolized, endothelial damage did not appear to progress. No correlation existed between the duration of exposure to the laser and the degree of injury. CONCLUSIONS: The parallel between changes in platelets and endothelial damage could represent either an effect of endothelium on platelets or an effect of platelets on endothelium. Although the former alternative cannot be totally ruled out, the observations seem to fit best the hypothesis that progressive endothelial damage can result from increasing activation and degranulation of overlying platelets.

Animals↗
PubMed1993

Combined treatment of large and calcified gallstones by ESWL and laparoscopic cholecystectomy.

In order to facilitate laparoscopic cholecystectomy in the presence of large gallbladder stones seven patients underwent ESWL before operation. In six cases (83%) a fragmentation to less than or equal to 1 cm could be achieved by application of 1,605 to 2,900 (mean 2,266) shock waves with the spark-gap lithotripter Philips-Dornier MFL 5000. In these cases intraoperative stone destruction or an increase of the puncture incision size could be avoided, thus proving the efficacy of this combined treatment approach. Laparoscopic inspection was performed 2 to 48 hours after ESWL. Including two additional cases operated because of unsuccessful ESWL, hematomas of the liver and adjacent organs were observed in six of nine patients (67%). This high rate of subclinical tissue lesions warrants caution if repeated ESWL sessions are scheduled at short-term intervals.

Cholecystectomy, Laparoscopic↗
PubMed1993

[Laparoscopic hernia surgery].

While classical inguinal hernia repair has recently been brought up for discussions among surgeons, at present various modified techniques are being reintroduced in general surgery. Surgical hernia repair techniques which partly are known since several decades are being carried out laparoscopically since 1989. Between August 1992 and June 1993, the authors performed 52 laparoscopic inguinal hernia repairs using the preperitoneal placement of nonresorbable mesh. There were no intraoperative complications. Merely one patient had an abdominal wall hematoma at the site of a trocar which resolved spontaneously. All patients have been followed up for 3-13 months. To date, all postoperative check ups revealed no recurrences, testicular atrophy or paresthesia. Even though little can yet be said regarding long-term results especially about recurrences, laparoscopic preperitoneal hernia repair seems to be a promising surgical procedure concerning early postoperative results.

Adult↗
PubMed1993

Technique and clinical results of endorectal surgery.

At the Surgical Department of the University of Cologne, a new system has been developed for transanal endoscopic surgery that allows all the conventional surgical techniques within the entire rectal cavity. The method has been in clinical use since 1983. The main indication is the removal of sessile adenomas. Early rectal carcinomas with favorable histologic grading (grades 1 and 2) and staging (Mason I and II) are also suitable for the method. Advanced cancers can also be removed endoscopically in one session, but we perform local excisions of advanced cancers only in cases in which the patient is unwilling to undergo extensive surgery. During the period from July 1983 to December 1990, this method has been employed on 233 patients in 251 cases. The intraoperative and postoperative course of 236 (94%) operations out of 251 was free from any complications. Early postoperative complications consisted of intraperitoneal perforations (five cases), rectovaginal fistulas (four cases), hemorrhages (four cases), and death as a result of cardiopulmonary failure (two cases). The recurrence rate of adenomas is 4.9%. Endorectal surgery allows endoscopic local transanal excision of large adenomas and early cancers with minimal morbidity and excellent presentation of specimens for complete histologic analysis.

Adenoma↗
PubMed1992

[Transanal endoscopic microsurgery: technique and clinical results].

A new system has been developed for transanal endoscopic microsurgery (TEM), which allows all the conventional surgical techniques within the rectal cavity. The main indication is the removal of sessile adenomas. "Early rectal carcinomas" are also suitable for local excision. We perform local excision of advanced cancer only in cases where a contraindication exists to perform radical surgery or when the patients is unwilling to undergo demolitive surgery. The system has been employed at our Surgical Department on 206 patients in 223 cases. In 192 cases (87.7%) only one local excision was carried out due to sufficient excision as confirmed by histology (including patients with early "low risk" cancer). the postoperative course of 208 cases (93.3%) was free from any complications. The recurrence rate of adenomas amounted to 5.2%. This technique is particularly applicable for elderly, high risk patients and those with broad based adenomas so that anterior resection, abdominoperineal resection or other invasive operations can be avoided.

Adenoma↗
PubMed1992

Spectrum of renal involvement in familial Mediterranean fever.

Kidney biopsies were performed on fifteen patients with a long-standing history of familial Mediterranean fever (FMF) and evidence of renal involvement. On light microscopy, seven patients were found to have amyloidosis, six mesangial proliferative glomerulonephritis (MsPGN) and two patients rapid progressive glomerulonephritis (RPGN). Immunofluorescent studies of the six biopsies with MsPGN were positive for mesangial IgA deposits (IgA nephropathy) in three patients and IgM mesangial deposits in three (IgM nephropathy). We conclude that in patients with FMF and renal involvement, non-amyloid renal lesions (IgA nephropathy, IgM nephropathy and RPGN) should be considered in the differential diagnosis in addition to amyloidosis.

Adolescent↗
PubMed1992

[Minimally invasive surgery of the rectum].

Low precision of transanal techniques, their limited area of application and high rate of complications of extensive surgical techniques led to the development of an endoscopic surgical system. Its main indication is the removal of broad based adenomas and early rectal cancers. Further indications are palliative excisions of advanced cancers. From July 1983 till December 1990 the endoscopic system has been employed on 233 patients. The total sum of operations raised to 251 cases due to recurrences and new tumour formations. The overall crude 5 year survival with merely local removal of rectal cancer was 67% for early rectal carcinoma patients and 75% for patients with pT2 carcinomas. Early postoperative complications consisted of 5 intraperitoneal perforations, 4 recto-vaginal fistulas and 4 haemorrhages (complication rate 5.2%). There were 2 postoperative deaths due to cardiopulmonary failure (clinical lethality 0.8%). The overall recurrence rate of adenomas was 4.9%. In accordance with the selection criterias of other authors, our selection criteria for curative local excisions of rectal cancers enclose tumour diameter less than 4 cm, pT1 carcinomas, low grade malignancy and tumour free margins of locally excised specimen.

Adult↗
PubMed1992

Pressure ulcer, fibronectin, and related proteins in spinal cord injured patients.

Pressure ulcer is a common occurrence in spinal cord injured (SCI) patients and can lead to serious complications. With proper management, some patients exhibit satisfactory healing whereas others show slow or nonhealing ulcers. Fibronectin has been shown to accumulate in wound, opsonize macroaggregate debris for phagocytosis, promote revascularization, and facilitate fibroblast migration and proliferation. We explored the relationship of plasma fibronectin with healing potential in 21 SCI men with pressure ulcer. They received standard wound care and were observed for eight weeks. Ten otherwise healthy SCI men without pressure ulcer (SCI-controls) and 32 able-bodied normal individuals (normal controls) were also studied. Plasma fibronectin and related proteins, ie, fibrinogen, plasminogen, alpha 2-antiplasmin and Factor XIII, were measured. Ten of 21 SCI patients with pressure ulcer showed rapid healing within four weeks and had significantly higher fibronectin levels as compared with the 11 patients with poor healing ulcers, SCI controls, and normal controls. Factor XIII and alpha 2-antiplasmin were mildly reduced and fibrinogen values were significantly increased in all SCI groups. Plasminogen concentrations were comparable in all groups studied. It thus appears that plasma fibronectin rises in patients with fast healing ulcers but fails to do so in those with poor healing ulcers and as such may be predictive of the course of pressure ulcers.

Adult↗
PubMed1991

Endothelial mediated enhancement of noradrenaline induced vasoconstriction in normal and varicose veins.

The role of the endothelium to influence smooth muscle contraction in normal and varicose veins was investigated in vitro using saphenous vein preparations obtained at vascular surgery. Paired control and endothelium-denuded rings were tested simultaneously and contracted with noradrenaline (10(-9)-10(-4) M). Identical experiments were also performed on sheep femoral veins and arteries. Noradrenaline induced maximal tension was 30% lower in varicose compared to normal veins. In normal veins removal of endothelium significantly reduced the maximal response to noradrenaline by 40% whereas in varicose veins no significant reduction could be seen. In the sheep femoral vein removal of the endothelium also resulted in decrease of noradrenaline-induced contraction. It can be concluded that in the human saphenous vein the endothelium has a contraction facilitating effect in response to stimulation with noradrenaline. In varicose veins the endothelial-mediated enhancement of noradrenaline-induced vasoconstriction is reduced probably because of endothelial damage. This observation may be of importance in the pathogenesis of varicose veins.

Adult↗
PubMed1991

Insufficiency of local approach regarding treatment of early gastric cancer.

Out of 1041 patients who underwent surgery for gastric cancer between 1968 and 1987, 120 patients suffered from early gastric cancer (11.5%). Until 1976, early gastric cancer was treated along the lines of surgical treatment of benign ulcer disease, i.e. by partial 2/3-gastric resection without lymphadenectomy, even though malignancy had been confirmed preoperatively in all cases. Since 1979 oncological criterias (subtotal or total gastrectomy with lymphadenectomy) have gained importance in treating early gastric carcinoma. In the case of mucosal carcinoma, the extent of surgical intervention does not have any influence on the 10-year survival rate. In treating submucosal carcinoma 10-year survival rates of 72.9 (+/- 7.2%) can only be achieved by performing total gastrectomy and lymphadenectomy whereas the 10-year survival rate after performing partial 2/3-gastric resection alone (p = 0.01) is only 17.6 (+/- 9.2%). Since mucosal and submucosal carcinoma cannot accurately be differentiated preoperatively, surgical intervention must be carried out in an oncological sense. The fact that 2/3 partial gastric resection does not generally ensure adequate therapy implies that local procedures are even less sufficient. Even in cases of mucosal infiltration only, local procedures such as laser therapy and local excision of the tumour cannot be considered being a curative approach, since hereby the probability of lymph node metastases (4%) is not taken into account.

Gastrectomy↗