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Biomedical subjects

V A Jebara

Publications and source records attributed to V A Jebara.

72 records · Page 4Linked to original sources
PubMed1989

Penetrating wounds to the heart: a wartime experience.

Forty-nine war casualties with penetrating cardiac wounds were treated at the Hôtel-Dieu de France University Hospital between April 1975 and December 1987. All the wounds were caused by high-velocity missiles. An aggressive approach was utilized. Emergency room thoracotomy was performed in 17 "lifeless" patients, 4 of whom survived. Twenty-seven of the 32 patients who were in stable enough condition to undergo initial repair in the operating room survived. Overall survival was 63% (31/49). No intracardiac injuries were diagnosed in survivors, and no cardiac reoperations were required. Careful analysis of the trajectory of the missile or missiles and a portable chest roentgenogram were the most important factors for diagnosing a penetrating wound to the heart and for predicting potential associated injuries.

Adolescent↗
PubMed1989

Modified Danielson technique for recurrent aortic valve endocarditis.

Recurrent aortic valve endocarditis is frequently associated with paravalvular ring abscess that destroys the annulus. In occasional cases, the degree of necrosis, destruction of the annulus, and the presence of intramyocardial abscesses make it impossible to seat a new prosthesis. Danielson reported initial success in treating such patients by translocating the aortic valve to the ascending aorta and placing vein grafts to the coronary arteries. We recently treated a 17-year-old patient suffering recurrent aortic valve endocarditis using Danielson's technique, which we modified by implanting the left main coronary artery directly into the conduit. We believe that in young patients this modification can offer a beneficial alternative.

Adolescent↗
PubMed1989

Aberrant right subclavian artery aneurysm: report of a case and review of the literature.

Aneurysms of an aberrant subclavian artery are rare. They are usually secondary to atherosclerosis. Dysphagia is the most common presenting symptom. The diagnosis of these lesions is most easily established by CT scan. Biplane arteriography is necessary in order to clearly analyze the aortic arch and its branches. Surgical resection is usually indicated. Numerous procedures have been proposed to treat these lesions and controversy exists concerning the best surgical technique. We treated a patient who suffered from an aneurysm of an aberrant subclavian artery. The surgical technique is detailed as well as a review of all the cases of the literature.

Aged↗
PubMed1989

[Right ventricular assistance by intrapulmonary counterpulsation].

Right ventricular failure is relatively frequent and constitutes one of the causes of post-operative heart failure. Few drugs are available to treat right ventricular failure. We present a simple and effective means of mechanical support available in all cardiovascular units: counterpulsation in the pulmonary artery. Our experience and a review of the literature have enabled us to determine the indications for this method to support a failing heart.

Assisted Circulation↗
PubMed1989

[Thoracic splenosis. Review of the literature apropos of a case].

Thoracic splenosis consists of autotransplantation of splenic tissue in the thorax following thoraco-abdominal trauma. The authors report a case of thoracic splenosis in a 35 year old woman who suffered a thoraco-abdominal gunshot wound 12 years previously. Sixteen cases of thoracic splenosis have been reported in the literature. Always asymptomatic, the thoracic lesions were discovered by chance on chest x-rays performed for various reasons 9 to 32 years after the initial trauma. Surgery was required in 13 patients in order to establish the diagnosis. In 2 cases Tc99 and Indium 111 isotope scans revealed the diagnosis, avoiding the need for surgery.

Adult↗
PubMed1989

[Tumor calcinosis. Review of the literature: apropos of a case].

Tumoral calcinosis is an uncommon disease of unknown etiology characterized by the presence of single or multiple lobulated, para-articular, cystic soft tissue productions. Hyperphosphatemia is the only biological abnormality which can be detected. The honeycomb roentgenographic pattern is characteristic. CT scan and ultrasound are useful in showing the extra-articular location of the mass. The treatment is surgical and the prognosis is good.

Calcinosis↗
PubMed1989

[Postoperative iatrogenic coronaro-ventricular fistula].

Acquired coronary cardiac fistulas are rare. To date, thirty cases have been published in the literature, all secondary to thoracic trauma. The right cardiac chambers were more frequently involved. A recent continuous cardiac murmur is the most constant finding. Nontreated, these lesions tend to induce coronary insufficiency and congestive heart failure. 22 of the 30 reported cases were managed surgically. We hereby report a case of postoperative coronary cardiac fistula secondary to left ventricular venting, in which the fistula involved the left ventricular cavity.

Aortic Valve↗
PubMed1989

[Cardiac wounds. Experience from 10 years of war. Apropos of 32 cases treated surgically].

Thirty-two patients with cardiac wounds from high velocity firearms (bullets or shrapnel) were operated. Seven of these patients who had no cardiac activity on arrival underwent emergency thoracotomy with a mortality of 85%. The other twenty-five patients underwent planned sternotomy with a mortality of 12%. The authors analyse these case with emphasis on the diagnostic and therapeutic management.

Adolescent↗
PubMed1989

Use of surgical glue without replacement in the treatment of type A aortic dissection.

Between 1984 and 1988, 15 patients with type A aortic dissection were treated by direct suturing of the intimal tear and extensive sticking of the dissected aortic layers with surgical (gelatin-resorcin-formaldehyde) glue without prosthetic graft replacement. Aortic incompetence was present in 10 patients, a situation that required valvular replacement in five and valvular repair in five. In 10 patients, the dissection extended to the transverse aortic arch, requiring profound hypothermia and circulatory arrest. All patients survived the operation. Follow-up ranged from 6 to 44 months. All patients were monitored by Doppler echocardiographic studies. In addition, 10 underwent angiography; six, a computed tomographic scan; and five, magnetic resonance imaging. In all patients but two, the ascending aorta and transverse arch had a normal appearance. In three patients, a limited dissection persisted that did not require reoperation. Dissection of the descending aorta was present in 10 patients. One patient required a valvular replacement 18 months after surgery, and one underwent heart transplantation for an associated cardiomyopathy 14 months after surgery. These preliminary results indicate that surgical glue can be used safely and efficiently in type A aortic dissection as an alternative to aortic replacement.

Acute Disease↗
PubMed1988

[Histochemical quantification of muscular ischemia: effect of treatment with naftidrofuryl].

Evaluation of degree of muscle ischemia of a limb and its reversibility is a poorly resolved practical problem, and it has not been clarified whether vasodilatory and circulatory spasmolytic substances possess, in addition to an effect of increasing irrigation, any direct action on muscle cell energy metabolism. An experimental study used histochemical techniques to evaluate oxidative enzyme activity of tissues. The compound tetrazolium nitro-blue (NBT), when reduced by tissue dehydrogenases, has the property of producing a dense non-crystalline blue pigment designated "formazan". During muscle ischemia, the time of appearance of this reaction increases with degree of ischemia through the bias of the decrease or disappearance of succinate-dehydrogenases. Transient ischemia of hindpaw, over 3, 6, 9, 12, 15 and 18 hours, was provoked by tourniquet in 49 rats treated with a vasodilator (naftidrofuryl) and 21 untreated (control) rats. Spontaneous revascularization occurred after removal of the tourniquet. Muscles were studied by microsurgical removal of specimens on removal of tourniquet and 1 and 12 hours and 3, 7 and 14 days after its removal (fig. 1 and 2). Times for staining of muscles with tetrazolium were measured and curves of comparative times established (fig. 3 and 4). Histopathologic specimens were also obtained at the same periods (fig. 5, 6, 7). Results of histochemical studies with tetrazolium and with quantitative determination of degree of cellular anoxia showed the action of naftidrofuryl to be related to mitochondrial metabolism of skeletal muscle, specifically for succinate-dehydrogenase. Clinical application in the determination of therapy and of functional prognosis of an ischemic limb is a possibility by the use of the NBT test in vascular surgery.

Animals↗
PubMed1987

Causalgia: a wartime experience--report of twenty treated cases.

During the 10-year period from 1975 to 1985 20 patients suffering from causalgia were treated. There were 15 men and five women. Ages ranged from 17 to 45 years (mean, 23). All were war casualties injured by high-velocity missiles. The median nerve was involved in eight cases, ulnar nerve in six, brachial plexus in four, sciatic nerve in four, radial nerve in three, and there were multiple nerve injuries in five cases. The diagnosis of causalgia was based on the characteristic clinical picture and was confirmed by sympathetic blocks. All patients were treated by sympathectomy and all had complete dramatic relief in the immediate postoperative period. Followup ranged from 4 months to 10 years (mean, 5.3 yr).

Adolescent↗
PubMedDate not supplied

Traumatic ventricular septal defects. Report of 3 cases with tricuspid valve rupture in 2 cases.

Traumatic ventricular septal defects (TVSD) are rare complications of cardiac trauma. This report describes 3 cases of TVSD secondary to penetrating trauma in 2 patients and to blunt trauma in one case. Echocardiography confirmed the diagnosis in all cases. Surgical correction was performed in the 3 cases. In 2 patients associated tricuspid trauma was present requiring tricuspid valve repair.

Adolescent↗