Biomedical subjects

S Yazbeck

Publications and source records attributed to S Yazbeck.

At least 37 records · Page 2Linked to original sources

PubMed1993

Prolonged pH monitoring is of limited usefulness for gastroesophageal reflux.

OBJECTIVE: To assess the diagnostic value of pH monitoring. DESIGN: A prospective study. SETTING: Pediatric university hospital serving as a secondary and tertiary referral center. PARTICIPANTS: Thirty-eight infants, aged 1 to 12 months, and 26 children, aged 13 months to 18 years, admitted during a 2-year period because of clinically significant gastroesophageal reflux (GER). INTERVENTIONS: Prolonged (20-hour) pH monitoring as well as endoscopy and biopsy of the esophagus were carried out in all patients who, on the basis of clinical data, were classified as having mild, moderate, or severe GER disease. RESULTS: In the infant group, results of prolonged pH monitoring were abnormal in 34 (89.5%). In the older group, results were abnormal in less than half (11 [42.3%]) of the cases. In both groups, pH monitoring data did not correlate with the severity of GER disease or of esophagitis. Severity of GER disease was not predictive of esophagitis. CONCLUSIONS: (1) Endoscopy and biopsy of the esophagus should be the first procedures whenever there are clinical findings of moderate to severe GER disease. (2) Monitoring of pH should be restricted to those patients without a clear-cut history of GER disease.

Adolescent↗

PubMed1993

Childhood primary pulmonary neoplasms.

Nine children (6 boys, 3 girls) were diagnosed with a primary endobronchial or pulmonary parenchymal neoplasm. The average age at diagnosis was 9 years. Presenting complaints included cough (7), fever (5), pulmonary infection (3), respiratory distress (3), weight loss (2), pain (2), and hemoptysis (1). Pulmonary x-rays showed persistent atelectasis, pneumonic infiltrates or mass lesions. A computed tomography scan was performed in 8. Five of six endobronchial tumors were diagnosed with bronchoscopy and biopsy. Treatment consisted of thoracotomy and pulmonary resection in 7 cases and laser resection in 2. The pathologic diagnoses were bronchial carcinoid (3), bronchial mucoepidermoid carcinoma (1), inflammatory pseudotumor (plasma cell granuloma) of the bronchus (2) and of the lung parenchyma (1), fibrosarcoma (1), and rhabdomyosarcoma (1). Postoperative chemotherapy was given only to the patient with pulmonary rhabdomyosarcoma; this child died. One child has developed a local recurrence while 7 children are alive and free of disease at an average of 2.4 years postresection. Pulmonary neoplasms are unusual in the pediatric age group and represent a wide spectrum of pathology. Including the present series, 383 tumors have been described. Seventy-six percent were malignant. Early investigation and surgical intervention are essential in children with persistent pulmonary symptoms or x-ray abnormalities. In most cases, the prognosis is excellent with complete surgical resection; however, malignancies other than bronchial adenoma are associated with significantly mortality.

Bronchial Neoplasms↗

PubMed1993

Anal fistula in infants: etiology, features, management.

Anal fistulas in infants are poorly understood. A high incidence of recurrence has been attributed to a congenital abnormality of the anal crypts. To verify this hypothesis, we reviewed all anal fistulas seen in children less than 2 years of age and treated between 1980 and 1991. All patients were males with a mean age of 9.5 months, and only 3 had other illnesses. Ninety-two percent have had previous anorectal abscesses. The fistulas were single in 31 patients and double in 5. Their origin in the crypts was clearly identified in 14 cases. When anoscopy was routinely performed, deep thick-walled crypts were found in 47% of the cases. In most instances only one crypt was abnormal. The operative management included fistulotomy in 17 patients and fistulectomy in 9. Cryptotomies besides fistula excision were performed in 9 cases, and concurrent abscess drainage in 6. Follow-up was available in 31 patients for a mean length of 20 months. There were 4 complications (11%): one abscess requiring drainage, one wound infection treated conservatively, one granuloma, and one postoperative laryngitis. No recurrences were observed and none of the patients had fistula-related complaints at the last visit. Anal fistulas in infants are observed exclusively in males and are often related to abnormal crypts. Although 92% of fistulas are preceded by a perianal abscess, only 42% of perianal abscesses will result in fistula formation. Anal fistulas can be treated by either fistulotomy or fistulectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗

PubMed1993

The abdominoscrotal hydrocele.

While hydrocele is among the commonest inguinal anomalies in children, less than 20 cases have been reported of its extreme form, the abdominoscrotal hydrocele (ASH). This anomaly consists of a large inguinoscrotal hydrocele which communicates in an hour-glass fashion with a large "intra-abdominal" component. The latter lies deep to the narrow internal inguinal ring, but superficial to the peritoneal cavity proper, which is displaced superiorly and medially. The abdominal component of the ASH thus lies latero- and retroperitoneally, sometimes reaching the lower pole of the kidney. We report five ASH in four children under one year old. All four underwent complete resection of the ASH. If the abdominal portion of the hydrocele can not be delivered through a standard approach, we advocate a properitoneal approach as described for recurrent adult hernias. The external oblique, internal oblique and transversalis muscles are divided horizontally above the level of the internal inguinal ring. The peritoneal cavity is retracted superiorly, separating it from the ASH. By decompressing the scrotal component of the ASH, its abdominal part can be emptied through the narrow communication at the internal ring. In this fashion, the processus vaginalis can be identified and ligated deep to internal ring, and the floor of the inguinal canal is left intact. The pathophysiology of ASH is not clear. A one-way valve effect of the patent processus vaginalis may be one cause of the massive accumulation of peritoneal fluid in the ASH. Complete resection is curative, and the properitoneal approach should be considered.

Humans↗

PubMed1993

Testicular torsion in infants and children: diagnosis with Doppler sonography.

The accuracy of Doppler sonography in the evaluation of testicular torsion was tested in 65 boys (aged 0-18 years) with acute scrotal pain or swelling. All patients underwent pulsed Doppler sonography of both testes, followed by scintigraphy (n = 16) and/or surgery (n = 34) and a close clinical follow-up for 4-8 months (n = 31). Color Doppler sonography was performed in 29 patients. The testicular artery was deemed patent if Doppler shifts from branches within the parenchyma could be found. Surgery revealed 19 cases of testicular torsion, 17 of which were diagnosed with Doppler sonography. There were six technical failures, in which no signals could be found on either side. In four boys, no color signals were obtained in either testis but subsequent examination with a mechanical sector scanner and pulsed Doppler sonography yielded arterial signals. Doppler sonography was successful in 59 of 65 boys (91%) and yielded a sensitivity of 89% and specificity of 100%. Pulsed Doppler sonography with mechanical sector scanners was more sensitive than color Doppler sonography. Intermittent torsion was missed both with Doppler sonography and scintigraphy.

Adolescent↗

PubMed1992

Cholelithiasis in newborns and infants.

Cholelithiasis in infants is rare, and has usually been associated with hemolysis, ileal disease, congenital anomalies of the biliary tree, hyperalimentation, and prolonged fasting. With the increased use of abdominal ultrasonography (US), more cases of cholelithiasis are being discovered. We report our experience with 13 infants diagnosed on abdominal US to have gallstones. There were 9 boys and 4 girls with an average age at diagnosis of 2.6 months (range, 0 to 9 months). Predisposing factors could be identified in only 6 of the 13 patients. Two patients with obstructive jaundice underwent cholecystectomy and common bile duct exploration. One patient with choledocolithiasis and common bile duct dilatation was observed. His stone passed spontaneously, with resolution of symptoms. Ten patients without cholestasis remained asymptomatic, with disappearance of lithiasis in five of them. Neonatal cholelithiasis is more common than previously suspected; it seems to affect males more often than females and is usually not associated with known predisposing factors. It appears to be a temporary, self-limiting phenomenon, and an aggressive approach is not warranted in the asymptomatic infant. Surgical or radiological intervention should be reserved for the symptomatic patients or those with underlying lithogenic disorders.

Cholecystectomy↗

PubMed1992

Anterior perineal approach and three-flap anoplasty for imperforate anus: optimal reconstruction with minimal destruction.

Despite progress in the treatment of imperforate anus, anal stenosis, rectal prolapse, and other late complications may still arise. In 1987, we described the three-flap anoplasty for the treatment of rectal prolapse following pull-through operations. Since 1986, we have performed 14 three-flap anoplasties in combination with an anterior perineal rectal pull-through for primary treatment of imperforate anus. The mean age at definitive repair was 4.4 months (range, 0 to 14 months). Eleven of the 14 primary pull-through procedures could be performed through a perineal approach only. There were no deaths. At a mean follow-up of 24.2 months, none of the patients has developed prolapse, and only one has had a temporary stenosis. Three children are already fully continent, and soiling is absent in 12. All have a good sphincter tone. Although it is too early to evaluate long-term results, it appears that the three-flap anoplasty prevents mucosal prolapse through the interposition of a skin-lined anal canal. Moreover, a combination of this technique with the anterior perineal approach provides an excellent exposure with minimal dissection of the perineal and pelvic musculature and allows for easy and safe pull-through of the rectal pouch, making an abdominal counterincision unnecessary in most cases. It reproduces at the same time a normal anatomy while taking advantage of all existing structures.

Anal Canal↗

PubMed1992

Changes in the presentation of intussusception.

Intussusception is most often diagnosed in well-nourished 7- to 10-month-old infants, but may be overlooked in older children. From 1985 to 1991, we treated 118 boys and 62 girls ranging in age from 2 months to 15 years (average, 22.6 months). Thirty-seven percent were older than 2 years, significantly more than in earlier experience at this institution. Overall, children with intussusception had a less than average weight (P < .05). The majority of intussusceptions in all age groups were idiopathic. Seventy-three percent of the patients were treated successfully by barium enema. The presence of air-fluid levels on the plain radiograph decreased the success rate of barium enema reduction from 81% to 49%. Barium enema reduction should nevertheless be attempted regardless of the age of the patient or the duration of symptoms, and routine surgical exploration is never recommended.

Adolescent↗

PubMed1991

Mesenteric cysts in children.

Mesenteric cysts are rare intraabdominal lesions of childhood that may vary in presentation from an asymptomatic mass to an acute abdomen. From 1970 to 1990, 15 children were diagnosed and treated for mesenteric cysts at Ste Justine Hospital in Montreal. The ages ranged from birth to 18 years (average age, 6 years). There were 9 boys and 6 girls. Ten patients required emergency surgery and five underwent elective surgery. The main presenting symptom was abdominal pain. Ten patients had preoperative ultrasounds that were diagnostic for a cystic mass in all patients. The second most frequent preoperative diagnosis was appendicitis. The cysts were located in the small bowel mesentery in 5 cases, the base of the mesentery with retroperitoneal extension in 4 cases, the transverse mesocolon in 4 cases, and the gastrocolic ligament in 2 cases. Operative procedures performed included complete cyst excision (9 patients), complete excision with intestinal resection (5 patients), and drainage of the cyst (1 patient). The only recurrence in this series occurred after drainage. One other patient had recurrence of a mesenteric cyst following resection performed elsewhere. Mesenteric cysts are rare in children, are usually symptomatic, and are most commonly misdiagnosed as acute appendicitis. Accurate preoperative diagnosis is possible with current ultrasonographic imaging techniques. Complete cyst resection is the procedure of choice and results in an excellent outcome.

Abdominal Pain↗

PubMed1991

Benign liver tumors in children: a 25-year experience.

The most common benign liver tumors are hemangiomas and hamartomas, both of mesenchymal origin. Mortality for patients with these tumors has traditionally been substantial despite benign histology. Between 1965 and 1989, 22 patients were treated for a benign liver tumor. This represents 42% of all primary neoplasms of the liver observed during this period. Incidental findings of liver tumors at autopsy were excluded from this series. There were 9 boys and 13 girls with a mean age at presentation of 2.3 years (range, birth to 14 years). Sixteen had hemangiomas and presented earlier in life (mean age, 4.4 months). In this subgroup, high-output cardiac failure was present in 58% of the newborns. Seven hemangiomas were resected, four were observed, three were treated with digitalis, diuretics, and steroids, and one received epsilon-aminocaproic acid. Nonhemangiomatous tumors included four hamartomas, one focal nodular hyperplasia, and one nodular transformation. All six were resected. There was one death early in the series. At a mean follow-up of 38 months, 21 of the 22 patients are cured or asymptomatic. In the past, mortality rates of close to 90% have prompted many investigators to advocate resection of every symptomatic hemangioma. With the availability of more sophisticated imaging techniques and refinements in the treatment of cardiac failure, surgery can be used more selectively. Hepatic resections, once considered heroic, can now be performed with minimal morbidity and virtually no mortality. The 96% survival in this series of benign liver tumors contrasts with high mortality rates reported in the literature and illustrates the spectacular improvements that have been made in the diagnosis and management of these once ill-reputed tumors.

Adolescent↗

PubMed1990

Surgical complications of the hemolytic-uremic syndrome.

Hemolytic-uremic syndrome (HUS) of childhood is a triad of acute hemolytic anemia, thrombocytopenia, and acute renal failure associated with a gastrointestinal prodrome. From 1977 to 1988, 134 patients with HUS were admitted to this institution. All patients presented with abdominal pain and diarrhea, which was virtually always bloody. Seventy-eight patients (60%) required dialysis. Five patients died (4%). One patient died as a result of colon perforation, the other four patients died of other nonsurgical complications of HUS. Three patients underwent exploratory laparotomy. One patient had a hemoperitoneum from mesenteric and transmural bleeding of the entire intraabdominal colon. Another patient had undergone surgery elsewhere for presumed intussusception with pancolitis found at exploration. Fourteen days postoperatively, he had a spontaneous perforation of the transverse colon. The third patient presented with pancolitis and perforation of the transverse colon. Despite surgical intervention he died on the sixth postoperative day. One other patient was treated conservatively for pancreatitis, which developed 3 weeks after her presentation with HUS. Complications requiring surgical intervention in HUS are rare, potentially lethal, and usually involve the colon.

Child, Preschool↗

PubMed1990

Complications associated with surgical treatment of congenital intrinsic duodenal obstruction.

Although survival rates for infants undergoing surgical treatment for congenital intrinsic duodenal obstruction are high, long-term follow-up suggests a high complication rate related to surgical therapy. We reviewed 33 neonates who underwent surgery for congenital intrinsic duodenal obstruction during the past 10 years. There were 20 girls and 13 boys; the mean gestational age was 36 weeks, and mean birthweight was 2,485 g. Bilious vomiting and intestinal obstruction were the most frequent presenting symptoms. Hydramnios was present in 75% of cases and 21% had associated Down's syndrome. Findings at laparotomy included duodenal atresia (14), annular pancreas (11), and duodenal diaphragm (8). The most frequent surgical procedure was side-to-side duodenoduodenostomy (DD), followed by duodenojejunostomy and resection of web with Heineke-Mikulicz type duodenoplasty. Bowel transit was reestablished at a mean of 13.1 days (range, 6 to 45 days). Seventy-percent of patients developed postoperative complications, the most frequent being megaduodenum with blind loop syndrome or bile reflux gastritis (22%), cholestatic jaundice (17%), gastroesophageal reflux (17%), delayed transit (8%), and bowel obstruction (8%). Six patients (18%) required secondary surgical procedures for postoperative complications (ie, megaduodenum, nonfunctioning anastomosis, missed intrinsic stenosis). Two patients died (6%). Stagnation and functional obstruction in the proximal duodenum is the main factor influencing the morbidity rate among these patients. Consideration should be given to the tapering duodenoplasty and diamond-shaped anastomosis in order to help reduce problems associated with megaduodenum and help restore earlier bowel transit.

Abnormalities, Multiple↗

PubMed1990

Ultrashort Hirschsprung's disease: myth or reality.

The term ultrashort Hirschsprung's disease has been used to define a spectrum of conditions with clinical presentation similar to Hirschsprung's disease but with presence of ganglion cells on rectal biopsy. In contrast to Hirschsprung's disease, there is no transition zone on barium enema. However, as in classical Hirschsprung's disease, there is no reflex internal sphincter relaxation on rectal manometry. We reviewed the presentation of five patients with chronic constipation who fulfilled the criteria for ultrashort Hirschsprung's disease. After positive anorectal manometry, despite the presence of ganglion cells on suction rectal biopsy, internal sphincter myomectomy was performed in four patients. Resolution of symptoms was noted in all operated patients. Normal ganglion cells were present throughout the entire length of all myomectomy specimens. There is controversy in the literature concerning the diagnosis of ultrashort Hirschsprung's disease. Most of the confusion concerns whether a short segment of aganglionosis proximal to the dentate line is permissible for the diagnosis of ultrashort Hirschsprung's disease and to what extent such aganglionosis is physiological. Perhaps it would be more accurate to define this entity by the presence of ganglion cells on rectal biopsy as well as the failure of the internal sphincter to relax on rectal manometry and to describe it as anorectal achalasia in severely constipated patients.

Adolescent↗

PubMed1990

Malrotation presenting beyond the neonatal period.

The diagnosis of malrotation is easily made in the neonatal period, but is often delayed in older patients. Among 82 patients treated for malrotation in this institution, 45 patients presented with symptoms related to their malrotation, seven were diagnosed at exploration for concomitant intrinsic duodenal obstruction, and 30 patients had malrotations discovered as incidental findings at laparotomy or autopsy. Among the 45 symptomatic patients, 25 (56%) underwent surgery in the first month of life, whereas 20 patients (44%) underwent surgery at an older age. In this last group, the mean age at surgery was 51.5 months (range, 2 months to 16 years), the mean age of onset of symptoms was 2 years (range, 0 to 15 years) and the mean delay in diagnosis was 1.7 years. Although bilious vomiting was the presenting symptom among all patients undergoing surgery in the neonatal period, clinical features of older patients included intestinal obstruction (7), chronic abdominal pain (4), malabsorption/diarrhea (3), peritonitis/septic shock (2), solid food intolerance (1), common bile duct obstruction (1), abdominal distention (1), and delayed transit postappendectomy (1). The frequency of midgut volvulus was equal among both groups. Unusual forms of malrotation were more frequent in patients undergoing surgery beyond the neonatal period. In this group there was evidence of chronic venous and lymphatic obstruction with one case of superior mesenteric vein thrombosis and two cases of intestinal gangrene. A Ladd's procedure was performed in all cases and the most frequent postoperative complication was adhesive intestinal obstruction. There were no deaths. Awareness of the unusual presentation in patients who present beyond the neonatal period may help reduce delays in diagnosis and surgical treatment. We believe that laparotomy is indicated in all patients with malrotation, even if they are asymptomatic.

Abnormalities, Multiple↗

PubMed1990

Multiple small bowel perforations in leukemia secondary to Epstein-Barr virus lymphoma with survival: a case report.

This is the case report of a 4-year-old white boy who was diagnosed as having acute lymphoblastic leukemia (ALL) in November 1985. While in remission and on maintenance chemotherapy, he developed a primary Epstein-Barr virus (EBV) respiratory infection in October 1986. On October 27, 1986 a plain abdominal radiograph taken for abdominal distention showed free air. At celiotomy, multiple nodules were noted to stud the small bowel. Central necrosis of these nodules with perforations were present in the distal small bowel. Resections and end-to-end anastomoses were performed. Three days later the patient again had a similar acute abdominal episode. At reexploration, similar lesions in the liver, kidney, duodenum, proximal jejunum, and colon were found. Liver biopsy as well as intestinal resections and end-to-end anastomoses were performed, along with a loop ileostomy. Polymorphic B-cell lymphoma positive for EBV was found in the specimens. After cessation of chemotherapy and institution of abdominal radiotherapy, the hepatic and renal lesions were seen to resolve on computed tomography scan. The patient's course was complicated by the development of cervical and mediastinal abscesses that were drained, and E coli sepsis accompanied by chronic diarrhea requiring intravenous hyperalimentation. By January 1988, he appeared to be recovering. His ileostomy was closed in March 1988. Despite cessation of chemotherapy since October 1986, the patient is now well and in complete remission.

Child, Preschool↗

PubMed1990

[Transient fever associated with a reduction of intestinal invagination].

Intussusception is a common cause of small bowel obstruction in infancy and early childhood. As in other forms of intestinal obstruction, there is stagnation of enteral content and edema of the bowel wall, theoretically facilitating translocation of bacteria. Since 1987, 85 cases of intussusception have been at this institution, of which 24 underwent laparotomy. Twenty (83%) developed a fever of more than 38.0 degrees at a mean of 11 hours postoperatively, lasting for less than 24 hours. Of the 61 cases that were treated by barium enema (a success rate of 72%), a similar fever peak was recorded in 26 (43%). All but who patients were afebrile on admission, and all were afebrile upon discharge. Hospital stay was 1.8 days for non-operated patients two remained afebrile and 2.9 days for those who developed a transient fever (p less than 0.05). We postulate that this temporary rise in temperature following manipulation of intussuscepted bowel is caused by a transient bacteremia or endotoxinemia due to bacterial translocation through the intestinal wall, similar to the process that has been described in other forms of intestinal obstruction. Awareness of this phenomenon could avoid needless fever workups, thereby reducing costs and hospital stay. The concept of bacterial translocation casts a doubt on the infectious theory of idiopathic intussusception, since the presence of infected mesenteric lymph nodes could follow, rather than proceed the intussusception.

Adolescent↗

PubMed1989

Adnexal torsion in children.

Adnexal torsion is rare in children and is usually reported as small series or case reports. We reviewed a series of 19 consecutive cases of children aged 3 to 19 years (mean, 9.6 years) who were treated in our institution between 1977 and 1988. Thirteen patients presented with torsion of a previously normal adnexa, while six presented with torsion of a diseased adnexa. The right adnexa was involved in 84% of cases. Detorsion with recovery of vascularization of the adnexa was possible in only four cases. All patients presented with lower abdominal pain, and onset was sudden in 78% of cases with an average of 5.2 days between the first symptom and hospital admission and a mean delay of 30.2 hours between consultation and surgical intervention. A previous history of abdominal pain was present in nine cases. Nausea or vomiting were present in 84% of cases. An abdominal mass was palpable in 42% of the patients and was associated with a delay in surgical intervention. Ultrasound confirmed the presence of a mass in 94% of cases. The preoperative diagnosis was accurate in 37% of cases, and the most common inaccurate diagnosis was appendicitis or appendiceal abcess. Our series confirms the predominance of right-sided lesions as reported in the literature. It is not clear whether this is an anatomic phenomenon or whether the suspicion of appendicitis leads to the more frequent diagnosis of right-sided lesions, whereas many left-sided adnexal torsions are being missed. We therefore advocate pelvic ultrasound in female patients who present with left lower quadrant pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adnexal Diseases↗

PubMed1989

Major perineal trauma in children.

Between 1976 and 1987, 22 children aged 3 to 17 years (mean age, 9.5 years) were admitted to our institution with major perineal trauma. There were 14 urethral ruptures and 9 rectal lesions. The lesions were multiple and combined: vaginal and urethral or vaginal and rectal injuries were found in 10 females, while only 1 of 12 males had both urethral and rectal lesions. In most instances, perineal physical signs did not reflect the severity of the lesion. Among the patients with urethral lesions, there was no sex or age predominance; complete rupture occurred in four females and eight males. The insertion of a urethral catheter was of no diagnostic help. Retrograde urethrogram demonstrated a lesion in seven of eight cases. The intravenous pyelogram (IVP) showed evidence of extravasation in two of the eight cases, and in four instances there were indirect rupture signs. A suprapubic cystostomy was performed in 12 of the 14 urethral injuries. A primary repair with urethral stenting was carried out twice without bladder drainage. Immediate repair was performed in eight cases and delayed in five others. Within this last group, two patients were cured without sequelae by stenting without suture, while the three others who underwent only cystostomy necessitated multiple reconstructive operations with poor results. It is of interest that the four treatment failures occurred in the youngest patients (4 to 7 years of age). The rectal lesions were related to impalement in seven of nine patients. Rectoscopy allowed localization of perforations but did not permit identification of sphincter injuries when the mucosa was intact. Primary repair was possible in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗