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Acute mesenteric ischemia after cardio-pulmonary bypass surgery

World Journal of Gastroenterology 2008年第35期14卷 5361-5370页

作者： Bassam Abboud ronald daher Joe Boujaoude Department of General Surgery Hotel Dieu de France HospitalFaculty of MedicineSaint-Joseph UniversityBeirut 16-6830Lebanon Department of Gastroenterology Hotel Dieu de France HospitalFaculty of MedicineSaint-Joseph UniversityBeirut 16-6830Lebanon

Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, isthe only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

关键词： Acute mesenteric ischemia Non-occlusive Cardio-pulmonary bypass Laparotomy Prognosis Mortality

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New trends in colorectal surgery: Single port and natural orifice techniques

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World Journal of Gastroenterology 2014年第48期20卷 18104-18120页

作者： ronald daher Elie Chouillard Yves Panis Department of General and Digestive Surgery Poissy/Saint-Germain Medical Center 78300Poissy France Department of Colorectal Surgery Beaujon Hospital Assistance Publique Hopitaux de Paris University Denis Diderot (Paris VII) 75013 Clichy France

Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.

关键词： Surgery Colon Rectum Cancer Laparoscopy Single-port Natural orifice transluminal endoscopic surgery

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Consequences of dysthyroidism on the digestive tract and viscera

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World Journal of Gastroenterology 2009年第23期15卷 2834-2838页

作者： ronald daher Thierry Yazbeck Joe Bou Jaoude Bassam Abboud Department of General Surgery Hotel Dieu de France Hospital Faculty of Medicine Saint-Joseph University Beirut 16-6830 Lebanon Department of Gastroenterology Hotel Dieu de France Hospital Faculty of Medicine Saint-Joseph University Beirut 16-6830 Lebanon

Thyroid hormones def ine basal metabolism throughout the body, particularly in the intestine and viscera. Gastrointestinal manifestations of dysthyroidism are numerous and involve all portions of the tract. Thyroid hormone action on motility has been widely studied, but more complex pathophysiologic mechanisms have been indicated by some studies although these are not fully understood. Both thyroid hormone excess and def iciency can have similar digestive manifestations, such as diarrhea, although the mechanism is different in each situation. The liver is the most affected organ in both hypo-and hyperthyroidism. Specifi c digestive diseases may be associated with autoimmune thyroid processes, such as Hashimoto's thyroiditis and Grave's disease. Among them, celiac sprue and primary biliary cirrhosis are the most frequent although a clear common mechanism has never been proven. Overall, thyroid-related digestive manifestations were described decades ago but studies are still needed in order to conf irm old concepts or elucidate undiscovered mechanisms. All practitioners must be aware of digestive symptoms due to dysthyroidism in order to avoid misdiagnosis of rare but potentially lethal situations.

关键词： Hypothyroidism Hyperthyroidism Gastroin-testinal motility Intestine Liver Viscera

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An exceptional cause of left lower quadrant abdominal pain

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World Journal of Gastroenterology 2009年第27期15卷 3451-3451页

作者： Bassam Abboud ronald daher Department of General Surgery Hotel-Dieu de France HospitalBoulevard Alfred Naccache Beirut 16-6830 Lebanon

Acute appendidtis is an exceptional cause of left lower quadrant abdominal pain. Computed tomography scan is the key to its diagnosis and helps to establish its early treatment. We present a case of a 35-year-old male patient who presented acute appendicitis with redundant and loosely attached cecum which was diagnosed based on his left lower quadrant abdominal pain.

关键词： Abdominal pain Left lower quadrant Appendicitis Cecum Computed tomography scan Surgery

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Digestive manifestations of parathyroid disorders

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World Journal of Gastroenterology 2011年第36期17卷 4063-4066页

作者： Bassam Abboud ronald daher Joe Boujaoude Department of General Surgery Hotel Dieu de France HospitalFaculty of MedicineSaintJoseph UniversityBeirut 166830Lebanon Department of Gastroenterology Hotel Dieu de France HospitalFaculty of MedicineSaint-Joseph UniversityBeirut 166830Lebanon

The parathyroid glands are the main regulator of plasma calcium and have a direct influence on the digestive *** disturbances often result in unknown long-standing *** main manifestation of hypoparathyroidism is steatorrhea due to a deficit in exocrine pancreas *** association with celiac sprue may contribute to *** causes smooth-muscle atony,with upper and lower gastrointestinal symptoms such as nausea,heartburn and *** and peptic ulcer were strongly linked before the advent of proton pump ***,this association remains likely only in the particular context of multiple endocrine neoplasia type 1/Zollinger-Ellison *** contrast to chronic pancreatitis,acute pancreatitis due to primary hyperparathyroidism is one of the most studied *** causative effect of high calcium level is confirmed and the distinction from secondary hyperparathyroidism is *** digestive manifestations of parathyroid malfunction are often overlooked and serum calcium level must be included in the routine workup for abdominal symptoms.

关键词： Dysparathyroidism Hypoparathyroidism Hyperparathyroidism Digestive manifestations Steatorrhea Pancreatitis Pepticulcer

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Pulsed lavage in joint arthroplasty: A systematic review and metaanalysis

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World Journal of Orthopedics 2024年第3期15卷 293-301页

作者： Mohammad daher Gaby Haykal Marven Aoun Marc Moussallem Ali Ghoul Jean Tarchichi Amer Sebaaly Department of Orthopedics Saint Joseph UniversityBeirut 1001Lebanon

BACKGROUND Knee and hip osteoarthritis affects millions of people around the world and is expected to rise even more in frequency as the population *** arthroplasty is the surgical management of choice in these *** ossi-fication and radiolucent lines formation are two frequent problems faced in hip and knee replacements *** studies show that the usage of pulsed lavage may prevent their *** To compare pulsed lavage to standard lavage in joint *** PubMed,Cochrane,and Google Scholar(page 1-20)were searched till December *** comparative studies were *** clinical outcomes evaluated were the heterotopic ossification formation in hip replacements,radiolucent lines formation,and functional knee scores in knee *** Four studies met the inclusion criteria and were included in this *** lavage was shown to reduce the formation of radiolucent lines(P=0.001).However,no difference was seen in the remaining outcomes CONCLUSION Pulsed lavage reduced the formation of radiolucent lines in knee *** difference was seen in the remaining ***,the clinical significance of these radiolucent lines is poorly *** conducted randomized controlled studies and cost-effectivity studies are needed to reinforce these findings.

关键词： Knee arthroplasty Hip arthroplasty Pulsed lavage Syringe lavage Heterotopic ossification Radiolucent lines

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Laparoscopic treatment of complicated colonic diverticular disease:A review

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World Journal of Gastrointestinal Surgery 2016年第2期8卷 134-142页

作者： ronald daher Elie Barouki Elie Chouillard Department of Digestive and Minimally Invasive Surgery Poissy/Saint-Germain-en-Laye Medical Center Department of General and Minimally Invasive Surgery Poissy/Saint-Germain Medical Center

Up to 10% of acute colonic diverticulitis may necessitate a surgical intervention. Although associated with high morbidity and mortality rates,Hartmann's procedure(HP) has been considered for many years to be the gold standard for the treatment of generalized peritonitis. To reduce the burden of surgery in these situations and as driven by the accumulated experience in colorectal and minimally-invasive surgery,laparoscopy has been increasingly adopted in the management of abdominal emergencies. Multiple case series and retrospective comparative studies confirmed that with experienced hands,the laparoscopic approach provided better outcomes than the open surgery. This technique applies to all interventions related to complicated diverticular disease,such as HP,sigmoid resection with primary anastomosis(RPA) and reversal of HP. The laparoscopic approach also provided new therapeutic possibilities with the emergence of the laparoscopic lavage drainage(LLD),particularly interesting in the context of purulent peritonitis of diverticular origin. At this stage,however,most of our knowledge in these fields relies on studies of low-level evidence. More than ever,well-built large randomized controlled trials are necessary to answer present interrogations such as the exact place of LLD or the most appropriate sigmoid resection procedure(laparoscopic HP or RPA),as well as to confirm the advantages of laparoscopy in chronic complications of diverticulitis or HP reversal.

关键词： Diverticulitis Laparoscopy Emergent Lavage Drainage Peritonitis Purulent Stercoral Complicated Perforation

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Antioxidants Enzymes Activities and NO Levels in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis—A Comparative Study

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Journal of Biosciences and Medicines 2024年第2期12卷 50-59页

作者： Natalia Cristina Aparecida Ribeiro e Ribeiro Anderson Martins Tavares Jaslana Hainfellner da Silva João Paulo Lima daher Salim Kanaan Luciene de Carvalho Cardoso-Weide Laboratory of Neuroplasticity Neurobiology Department Biology Institute Federal Fluminense University Rio de Janeiro Brazil Postgraduate Program in Medical Sciences School of Medicine Federal Fluminense University Rio de Janeiro Brazil School of Biology UNIVERSO—Salgado de Oliveira University Rio de Janeiro Brazil Department of Pathology Faculty of Medicine Federal Fluminense University Rio de Janeiro Brazil

It consists of a retrospective study with twenty-two individuals diagnosed with DRC: fourteen HD and eight CAPD, followed up in the dialysis center of Antonio Pedro University Hospital (HUAP) of Fluminense Federal University (UFF), between 2015 and 2017. Fifteen healthy control (HC) subjects were included, without diagnosed CKD. Patients with HIV positive, hepatitis A, B, and C, pregnant, cancer, smokers, alcoholics and those exposed to X-rays in the last 3 months, were excluded. Objectives: As oxidative stress and endothelial dysfunction may be linked to the higher prevalence of CVD in CKD patients, we measured the activities of the antioxidants enzymes: SOD and GPx and total NO levels in the plasma and serum of end-stage CKD patients undergoing dialysis therapy, comparing with the HC group. Methods: Quantification of NO levels was performed by fluorometric kit, while activities of SOD and GPx were determined using kinetic methods. Results: We found higher plasma SOD activity in HD (8.58 U/ml) and CAPD (10.14 U/ml), compared to C (3.73 U/ml) group, while GPx activity was decreased in HD (115.38 nmol/h/ml) and CAPD (122.76 nmol/h/ml) groups compared to HC group (275.83 nmol/h/ml). Total serum NO concentration was decreased in HD (14.09 pmol/μl) and CAPD (10.26 pmol/μl), compared to non-CKD patients (49.65 pmol/μl). Conclusion: Decreased total serum NO and GPx activities may lead to endothelial dysfunction and consequently a higher prevalence of CVD in CKD patients.

关键词： Hemodialysis CAPD SOD GPx NO

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Gastroesophageal reflux disease, obesity and laparoscopic sleeve gastrectomy: The burning questions

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World Journal of Gastroenterology 2019年第33期25卷 4805-4813页

作者： Halim Bou daher Ala I Sharara Division of Gastroenterology Department of Internal MedicineAmerican University of Beirut Medical Center

Obesity is a global health epidemic with considerable economic *** solutions have become increasingly popular following technical advances leading to sustained efficacy and reduced *** gastrectomy accounts for almost half of all bariatric surgeries worldwide but concerns regarding its relationship with gastroesophageal reflux disease(GERD)has been a topic of ***,including erosive esophagitis,is highly prevalent in the obese *** role of pre-operative endoscopy in bariatric surgery has been *** schools of thought exist on the matter,one that believes routine upper endoscopy before bariatric surgery is not warranted in the absence of symptoms and another that believes that symptoms are poor predictors of underlying esophageal *** debate is particularly important considering the evidence for the association of laparoscopic sleeve gastrectomy(LSG)with de novo and/or worsening GERD compared to the less popular Roux-en-Y gastric bypass *** this paper,we try to address 3 burning questions regarding the inter-relationship of obesity,GERD,and LSG:(1)What is the prevalence of GERD and erosive esophagitis in obese patients considered for bariatric surgery?(2)Is it necessary to perform an upper endoscopy in obese patients considered for bariatric surgery?And(3)What are the long-term effects of sleeve gastrectomy on GERD and should LSG be done in patients with pre-existing GERD?

关键词： Reflux Erosive Acid Bariatric Obesity Gastric bypass Endoscopy

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Current and Future Treatment of Hepatocellular Carcinoma:An Updated Comprehensive Review

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Journal of Clinical and Translational Hepatology 2018年第1期6卷 69-78页

作者： Saleh daher Muhammad Massarwa Ariel A. Benson Tawfik Khoury Gastroenterology and Liver Units Department of MedicineHadassah-Hebrew University Medical CenterJerusalemIsrael

Hepatocellular carcinoma(HCC)is among the leading causes of cancer-related *** principal treatment is surgical resection or liver transplantation,depending on whether the patient is a suitable transplant ***,in most patients with HCC the diagnosis is often late,thereby excluding the patients from definitive surgical *** treatment includes sorafenib,which is the most commonly used systemic therapy;although,it has been shown to only minimally impact patient survival by several *** and radiotherapy are generally *** to the poor prognosis of patients with HCC,newer treatments are needed with several being in development,either in preclinical or clinical *** this review article,we provide an update on the current and future medical and surgical management of HCC.

关键词： HCC Treatments Sorafenib Mortality

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