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Biomedical subjects

S Yazbeck

Publications and source records attributed to S Yazbeck.

At least 55 records · Page 3Linked to original sources
PubMed1987

Multiple-flap anoplasty in the treatment of rectal prolapse after pull-through operations for imperforate anus.

Rectal prolapse is a frequent complication after pull-through operations for high imperforate anus. Mucosal prolapse causes soiling, occasional bleeding, and pain. Simple resection of the redundant mucosa is unsatisfactory and leads to frequent recurrences or strictures. In 1982, Millard and Rowe reported a technique designed to correct rectal prolapse using two perineal flaps, thus providing a skin-lined anal canal. We have operated on two patients using the same technique. A three-flap anoplasty was used in nine other patients. With an average follow-up of 13 months, none of out patients presented recurrence of the prolapse or a significant stenosis. This procedure is safe and physiologically sound. The skin-lined anal canal provides some sensation where it is lacking. The functional and esthetic results are gratifying and we are now using the three-flap anoplasty as a primary procedure in the correction of high imperforate anus.

Adolescent↗
PubMed1987

Gastroschisis: a 15-year experience.

Between January 1, 1971 and December 31, 1985, 59 cases of gastroschisis were treated at Hôpital Sainte-Justine in Montreal. In the period before 1978, 6 of 19 patients (31.6%) were closed primarily at the time of surgery and 13 of 19 patients (68.4%) had silon pouch closure. After 1978, 33 of 40 patients (82.5%) had primary closure and 7 of 40 (17.5%) had a silon pouch. Our overall mortality rate was 13.6%. The complication rate for the primary closure group was 25.6% with a 12.8% (5/39) mortality rate, interestingly, in the higher birth weight group. Those closed with a silon pouch had a 75% complication rate, mostly infectious, with 15% mortality. Neither low birth weight nor gestational age influenced mortality. A significant difference in the length of hospital stay was observed. This was 33.6 days for the primary closures and 56 days for the silon pouch closures. Our series demonstrates a definite favorable trend in the results of treatment of this malformation. The most important factor affecting these results is a change in surgical approach. Primary abdominal wall closure, being usually possible, should always be attempted. We also note an association between high birth weight and death due to bowel dysmotility.

Abdominal Muscles↗
PubMed1987

Reoperation by anterior perineal approach for missed puborectalis.

Poor postoperative continence in patients operated for high imperforate anus may result from an inadequate bowel pull-through behind the puborectal muscle. Between 1979 and 1983, we used the anterior perineal approach for reoperations in five such cases (3 males, 2 females). In all of them, preoperative continence was socially unacceptable. Each time it was possible to identify a partially or totally missed puborectal muscle. Although some complications occurred postoperatively, all patients acquired a socially acceptable level of continence with a mean follow-up of 4.5 years. Preoperative and postoperative rectal manometries are presented. The anterior perineal approach not only provides adequate exposure of the urethra and puborectal muscle, but also has the advantage of operating through an area that has not been previously dissected.

Adolescent↗
PubMed1987

Relevance of constipation to enuresis, urinary tract infection and reflux. A review.

Little attention has been afforded the relevance of constipation to urinary symptoms. Problems of definition and measurement have contributed to this problem. A review of the literature suggests that rectal dilatation may influence the function of the urinary tract leading to urinary tract infection and enuresis. Our studies indicate that constipation may, by causing uninhibited bladder contractions, cause urinary tract infection, enuresis and vesicoureteral reflux.

Child↗
PubMed1987

[Gastric volvulus in children].

Until 1980, 300 cases of gastric volvulus had been reported in the literature. Of these only 50 had presented in children. The disease is considered rare. We reviewed our experience at Sainte-Justine, in the last 30 years and found 10 cases, all of which diagnosed since 1980. Four patients were under one year of age. The other six were between 3 and 17 years old. In five the presentation was acute and three had had similar previous episodes. In 5 patients the presentation was chronic and in four of these the symptoms dated from birth. Seven associated anomalies were present in 6 cases. Diagnosis was made by x-rays. Eight patients were treated successfully with gastropexy. One premature baby was treated medically. Perhaps this entity is more common than generally thought. It should be suspected in an infant with regurgitation or vomiting and failure to thrive, and in a child with chronic, intermittent or acute upper abdominal pain and distension.

Adolescent↗
PubMed1986

Constipation a commonly unrecognized cause of enuresis.

Constipation was confirmed by history, rectal examination, and rectal manometric studies in 22 of 25 children with enuresis. Treatment of constipation resulted in resolution of enuresis. Uninhibited bladder contractions, observed in enuretic constipated children, were also noted in children with constipation alone, suggesting that constipation is a commonly unrecognized etiologic factor in enuresis.

Child↗
PubMed1986

Constipation associated with vesicoureteral reflux.

Seventeen children who had vesicoureteral reflux underwent urodynamic and rectal manometric studies. All had uninhibited bladder contractions. All had rectal dilatation confirming the presence of constipation by rectal balloon manometry. The recurrent association of constipation with ureteral reflux suggests the possibility of a nonfortuitous association.

Child↗
PubMed1986

Omphalocele: a 25-year experience.

Between 1958 and 1983, 92 neonates with omphalocele were admitted to Ste-Justine Hospital. The male to female ratio was 3:2. Birth weight ranged from 1,450 to 5,100 g (mean 2,786 g). Associated anomalies, apart from malrotation, were present in 45%. They were cardiovascular (18.4%), vesico-intestinal fissure or bladder exstrophy (11.9%), Beckwith Wiedeman (6.5%), and chromosomal abnormalities (7.5%). Seven patients were not treated. Topical applications were used in seven cases (1 survivor). In 65%, primary closure was achieved; the mortality rate was 20% with a mean hospital stay of 17.5 days. Silastic was used in 12 cases with a mortality of 5/12 and a mean hospital stay of 82.1 days. The mean number of reductions was 6.7. Omphalocele rupture did not influence mortality. Prior to 1974 the mortality rate was 50%. Since 1974 it has decreased to 31.5%. The advent of total parenteral nutrition (TPN) was an important factor in decreasing the mortality. Prior to 1974, 23 patients survived, only one with a major associated anomaly (Fallot). After 1973, 35 survived, 13 having a major associated anomaly. Overall mortality was 9% when no other major malformations were present. A retrospective study of 92 cases of omphalocele over a 25-year period reveals an overall mortality rate of 37%. Death was associated almost exclusively with additional congenital anomalies. Birthweight in itself was not a determining prognostic factor. With the advent of TPN and a better knowledge of the mechanical ventilation of the neonate the results are better and involve the survival of a greater number of patients with serious associated malformations.

Birth Weight↗
PubMed1986

The giant omphalocele: a new approach for a rapid and complete closure.

Giant omphaloceles are usually treated in stages. The skin is closed first and the ensuing giant ventral hernia is repaired when the patient is 1 year old or older. This attitude has many advantages, but treatment of the giant ventral hernia may be very difficult and often requires many operations. We have used a new approach to this problem in two cases. A polyamide mesh is glued over the skin of the abdominal wall, thorax, and lumbar regions. The distance between the apposed rectus muscles is then progressively decreased by repeated infolding of the polyamide mesh with running longitudinal sutures on the mesh itself. This progressively reduces the hernial content. When the rectus muscles are sufficiently approximated, a definitive procedure is carried out. In the first patient, the giant hernia was completely closed in 3 weeks and in the second patient, it was closed in 5 weeks. A third patient is presently undergoing the same treatment. This simple bedside technique does not require any antiseptic measure and may replace advantageously the use of prosthetic material in a majority of cases.

Abdominal Muscles↗
PubMed1986

Hirschsprung's disease and urinary tract infection: unrecognized association.

Constipation is associated with and may be an etiologic factor in recurrent urinary tract infection (UTI) in girls. To determine if an increased incidence of urinary infection occurs in constipating illness, we retrospectively analyzed UTI incidence in 146 patients with Hirschsprung's disease. An increased incidence pre- and postoperatively was noted.

Child, Preschool↗
PubMed1986

[Congenital diaphragmatic hernia: have the results truly changed?].

Between 1971 and 1985, 97 patients born with posterolateral diaphragmatic hernia (CDH) were treated in three different centers in Quebec and Montreal (Canada). A retrospective study of these cases shows that with appropriate measures the results can be much less gloomy than they used to be. The series is analysed in order to determine the effect of post-operative thoracic drainage, the effect of the high frequency low volume mechanical ventilation as well as the effect of the serious associated conditions present in a significant number of these patients. Our results indicate that the ipsilateral thoracic drainage has a clear deleterious effect when used systematically++. Out of 52 such patients, 17 survived (32.7%) and 35 died (67.3%); while out of 43 patients who received no thoracic drainage, 25 survived (58.1%) and 18 died (42.8%). This is statistically significant CHI2: (p less than 0.005). If the series is analysed after elimination of the cases with severe associated conditions and taking into account the advent of the high frequency low pressure mechanical ventilation, the figures are even more significant. Fifty-seven patients (57) fall in this category; 28 patients received an ipsilateral thoracic drainage and 29 did not. In the first group 11 survived (39.2%) and 17 died (60.7%) while in the no drainage group 22 survived (75.8%) and 7 died (24.1%). This is statistically significant (p less than 0.005). We believe that with simple measures, it is possible to prevent the return to fetal circulation in a significant number of patients born with CDH and to clearly increase to overall survival rate.

Drainage↗
PubMed1985

Constipation: a cause of enuresis, urinary tract infection and vesico-ureteral reflux in children.

The observation that constipation alone may induce uninhibited bladder contractions in children and is associated with recurrent urinary tract infection in childhood suggests an etiologic association. Rectal distension due to faecal retention in chronic functional constipation causes bladder distortion and may cause stimulation of detrusor stretch receptors resulting in detrusor peroneal dyssynergism. Distortion of the trigonal area may result in failure of ureteral valve competence and allow for vesico-ureteric reflux.

Constipation↗
PubMed1985

Femoral neuropathy after renal transplantation.

We report 2 cases of cadaveric renal transplantation in which the grafts were placed in the right iliac fossa. Postoperatively, both patients complained of ipsilateral thigh weakness. Electromyography and nerve conduction studies indicated femoral nerve neuropathy. Muscle weakness gradually resolved. Difficulty was encountered in placing both grafts, and each kidney and limb were subjected to prolonged ischemia. We suggest that the femoral neuropathy was ischemic in origin.

Adolescent↗