Hotel Dieu de France

Beirut, Lebanon

Hotel Dieu de France

Beirut, Lebanon
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Abu-Rustum R.S.,Center for Advanced Fetal Care | Daou L.,Hotel Dieu de France | Abu-Rustum S.E.,Nini Obstetrics and Gynecology
Journal of Ultrasound in Medicine | Year: 2010

Objective. The purpose of this series was to determine the sensitivity of ultrasonography in early gestation (UEG) using nuchal translucency (NT) and the 4-chamber view (4CV) in the early diagnosis of congenital heart defects (CHDs). Methods. This was a retrospective chart review of all patients presenting for UEG between 2002 and 2009. At our center, a survey of fetal anatomy is performed at the time of the NT assessment at 11 weeks to 13 weeks 6 days. A second-trimester scan (STS) is done at 20 to 23 weeks and a third-trimester scan at 32 to 35 weeks. Suspected cases of CHDs were evaluated by a pediatric cardiologist. All neonates were examined at birth by a pediatrician, and when clinically indicated, fetal echocardiography was performed. Results. A total of 1370 fetuses were scanned. Congenital heart defects were identified in 8 (0.6%). Nuchal translucency was above the 95th percentile for gestational age (GA) in 6 of 8, and the 4CV was abnormal in 6 of 8. Ultrasonography in early gestation detected 75% fetuses with CHDs, and 25% were detected by an STS. Conclusions. Our study emphasizes the importance of UEG in the detection of CHDs. In this small unselected lowrisk population, UEG detected 75% of CHDs. Nuchal translucency was above the 95th percentile for GA, the 4CV was abnormal, or both in all 8 cases with CHDs. © 2010 by the American Institute of Ultrasound in Medicine.


Abu-Rustum R.S.,Center for Advanced Fetal Care | Daou L.,Hotel Dieu de France | Abu-Rustum S.E.,Nini Obstetrics and Gynecology
Journal of Ultrasound in Medicine | Year: 2010

Objective. We sought to determine the sensitivity of the first-trimester scan in the early diagnosis of aneuploidy and structural fetal anomalies in an unselected low-risk population. Methods. This was a retrospective chart review of all patients having first-trimester scans between 2002 and 2009. At our center, a survey of fetal anatomy is performed at the time of nuchal translucency assessment at 11 weeks to 13 weeks 6 days. A second-trimester scan is done at 20 to 23 weeks and a third-trimester scan at 32 to 35 weeks. Isolated sonographic findings of choroid plexus cysts and echogenic intracardiac foci were excluded. Lethal anomalies and those requiring immediate surgical intervention at birth were considered major structural anomalies. All scans were performed by a single sonologist certified by the Fetal Medicine Foundation. All neonates were examined at birth by a pediatrician. Results. Our study included 1370 fetuses. Six cases of aneuploidy (0.4%) were detected. The first-trimester scan detected 5 of 6 cases of aneuploidy (83%), confirmed by karyotype. There were 36 cases of structural fetal anomalies (2.6%); 20 (1.5%) were major anomalies. The first-trimester scan detected 16 of 36 (44%); 20 (56%) were identified by second- or third-trimester scans. The first-trimester scan detection rate for major structural anomalies was 14 of 20 (70%). The 5 that were missed by the first-trimester scan were detected by a second-trimester scan. Conclusions. Our study emphasizes the importance of the first-trimester scan in the early detection of aneuploidy and structural fetal anomalies. In this small unselected low-risk population, the first-trimester scan detected 83% of aneuploidies and 70% of major structural anomalies. Our results are comparable to previously published studies from other centers and further exemplify the invaluable role of the first-trimester scan in the early detection of aneuploidy and structural anomalies in an unselected low-risk population. © 2010 by the American Institute of Ultrasound in Medicine.


Maalouf E.,Hotel Dieu de France | Moutran R.,Mount Lebanon Hospital | Maatouk S.,Hotel Dieu de France
Dermatology Online Journal | Year: 2012

We report the case of a 44-year-old, heterosexual, man, who presented for lesions of the face that appeared 3 days earlier; the eruption was associated with a burning sensation. He had sexual intercourse 12 days prior to presentation with a new partner. On clinical examination, there were confluent vesicules and a few pustules localized on the cheeks, forehead, nose, mouth, and ears. A swab for immunofluorescence (IF) came back as positive for HSV-2. The patient was treated with oral acyclovir. The lesions were healed when he was seen for follow-up 1 week later. The virus responsible for herpes is a double-stranded DNA virus named Herpes simplex virus (HSV). The virus generally enters damaged epithelium or mucosal surfaces, secondary to abrasions or trauma. Most primary orolabial infections occur during childhood as herpetic gingivostomatitis. However, there are forms that could be more atypical. The spread of the virus was probably promoted by shaving the beard. In immunocompromised patients or those with skin barrier disorders, HSV infection tends to disseminate and is accompanied by visceral involvement. Hence, the need to detect a state of immunodepression (including AIDS) in any patient with diffuse herpes infection. Three oral antiviral agents are commonly used: acyclovir, famciclovir, and valaciclovir. © 2012 Dermatology Online Journal.


El Barouky J.,University Pierre and Marie Curie | Fournier-Bidoz N.,University Pierre and Marie Curie | Mazal A.,University Pierre and Marie Curie | Fares G.,Hotel Dieu de France | Rosenwald J.-C.,University Pierre and Marie Curie
Physica Medica | Year: 2011

Purpose: The possibility of using the Gafchromic® EBT films parallel to incident electron beams was assessed in order to facilitate quality assurance tests for electron dose calculation algorithms. Materials and methods: Calibration curves were made for electron energies of 6, 9 and 12MeV. A set-up was suggested for EBT film irradiation parallel to the beam, and the dose measurements were compared to Ionization Chamber (IC) measurements in standard and small electrons beams. A more complex Quality Assurance (QA) set-up was performed with the cylindrical CARPET® phantom in order to test our Treatment Planning System (TPS) (Eclipse, Varian Medical Systems, Palo Alto, California) for the clinical situation of a chest wall electron beam therapy. Two dimensional dose distribution and gamma index results were compared to the calculated distribution given by the TPS. Results: The reproducibility was found to be better than 1.5%. We found that applying strong pressure and aligning carefully the film edge with the phantom surface, as recommended for radiographic films, did not completely eliminate the air gap effect. Adding an ultrasound transmission gel and 2 complementary EBT films on the surface gave satisfactory results. The absolute dose for the reference 10×10cm2 field was always within 1% of IC measurements and for smaller elongated fields (5×10, 4×10 and 3×10cm2) the mean difference was -1.4% for the three energies. The mean difference with the IC measurements in R100, R90 and R50 was 0.9mm for all fields and for the three energies. The mean difference in the width of the 90% and the 50% isodoses at R100 was 0.6mm. With the CARPET® phantom set-up very good agreement was found in the 2D dose distribution; 99% of the points satisfied the γ<1 criteria (3%-3mm). Conclusion: EBT films parallel to the beam axis could be used for absolute measurements of 2D dose distribution if ultrasound gel and overlying perpendicular films are added on the phantom surface. © 2010 Associazione Italiana di Fisica Medica.


Moutran R.,Hotel Dieu de France
Cutis; cutaneous medicine for the practitioner | Year: 2012

Various treatment options are available for basal cell carcinoma (BCC). We report a case of a patient with a nodular BCC on the nose who was treated with combination therapy consisting of cryotherapy with liquid nitrogen followed by imiquimod cream 5% 5 times weekly for 6 weeks. Clearance of the lesion was histologically confirmed.


Naja Z.M.,Makassed General Hospital | Ziade F.M.,Lebanese University | El-Rajab M.A.,Makassed General Hospital | Naccash N.,Hotel Dieu de France | Ayoubi J.-M.,Hopital Foch
Anesthesia and Analgesia | Year: 2013

BACKGROUND: Paravertebral blocks (PVBs) have been introduced as an alternative to general anesthesia for breast cancer surgeries. The addition of clonidine as an adjuvant in PVBs may enhance quality and duration of analgesia and significantly reduce the consumption of analgesics after breast surgery. In this prospective randomized double-blind study, we assessed the significance of adding clonidine to the anesthetic mixture for women undergoing mastectomy. METHODS: Sixty patients were randomized equally into 2 groups, both of which received PVB block, either with or without clonidine. Analgesic consumption was noted up to 2 weeks after the operation. A visual analog scale was used to assess pain postoperatively during the hospital stay, and a numeric rating scale was used when patients were discharged. RESULTS: Analgesic consumption was significantly lower in the clonidine group 48 hours postoperatively with 95% confidence interval (CI) for the difference (-69.5% to -6.6%). Pain scores at rest showed significant reduction in the clonidine group during the period from 24 to 72 hours postoperatively with 95% CI for the ratios of 2 means (1.09-3.61), (2.04-9.04), and (2.54-16.55), respectively, with shoulder movement at 24, 48, and 72 hours postoperatively 95% CI for the ratio of 2 means (1.10-3.15), (1.32-6.38), and (1.33-8.42), respectively. The time needed to resume daily activity was shorter in the clonidine group compared with the control group with 95% CI for the ratio of 2 means (1.14-1.62). CONCLUSION: The addition of clonidine enhanced the analgesic efficacy of PVB up to 3 days postoperatively for patients undergoing breast surgery. Copyright © 2013 International Anesthesia Research Society.


Richa S.,HOtel Dieu de France
Ethique et Sante | Year: 2013

The autism or autistic disorder characterizes itself by quality abnormalities of social interactions, disturbances of the communication and interests and restricted and repetitive activities. This condition generates a major handicap, lived by the child as early as his younger age. It exists incomplete information given to the parents of the autistic children concerning the handicap of their child. The first inconsistency comes from definition of autism itself which is very complex and has been changed several times to become actually included in pervasive developmental disorders. We can improve the gait of accompaniment of the children, while insisting on adequate information and intelligent delivered to the parents of these children. Suggestions on the improvement of this information will form the essential points that will finish our article. © 2013 Elsevier Masson SAS.


Richa S.,Hotel dieu de France | Fahed M.,Hotel dieu de France | Khoury E.,Hotel dieu de France | Mishara B.,University of Quebec at Montréal
Archives of Suicide Research | Year: 2014

This review focuses on suicide in patients with Autism Spectrum Disorders (ASD) as well as risk factors and comorbidities of persons with ASD who have attempted suicide. Research was conducted by searching PubMed and Psychinfo for articles. Suicide in ASD is largely understudied. Although suicide is common in clinical samples, we have little knowledge of suicide in persons with ASD in the general population. Comorbidity, particularly with depression and other affective disorders or schizoid disorders and psychotic symptoms, is often reported, so it is difficult to determine if suicidality is associated with ASD or the comorbid disorder. Clinical samples suggest that suicide occurs more frequently in high functioning autism. Physical and sexual abuse, bullying, and changes in routine are precipitating events associated with suicide risk. Persons with ASD present risk factors inherent to their diagnosis (deficit in expression of feelings and thoughts), along with risk factors pertaining to the general population (abuse, depression, anxiety, etc.). The inability of persons with Pervasive Developmental Disorder (PDD) to express emotions and thoughts makes the diagnosis of suicidal ideation difficult and demands important adjustments to traditional psychotherapeutic interventions. More research is needed to determine the incidence of suicidal behaviors in persons with ASD, to identify risk and protective factors, as well as to assess the effectiveness of prevention strategies and interventions. © 2014, Copyright International Academy for Suicide Research.


Rizk H.,Hotel Dieu de France | Rassi S.,Hotel Dieu de France
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2011

Objectives: To review the cases encountered in a tertiary care center so as to assess the incidence of foreign body aspiration in the pediatric population and to draw on our experience to improve prevention and early diagnosis. Patients and methods: Retrospective study of 106 children under the age of 15 years, admitted to the Hôtel-Dieu de France hospital for flexible and/or rigid bronchoscopy between November 1998 and January 2010, for suspected foreign body aspiration (FBA). Results: Among the children, 56.6% were aged between one and three years. Peanuts or pistachios were found in 48% of cases. In 73% of cases, the FB was bronchial, and slightly more frequently on the right side (60%); 17.8% of cases presented in emergency immediately after inhalation; 12% presented with life-threatening symptoms; 29% presented within 24 hours and 49% were seen later than 72 hours. In 81% of subjects, a typical penetration syndrome was found on interviewing the parents. Physical pulmonary examination was normal in 21% of patients and chest X-ray in 21.8%. Rigid bronchoscopy was preceded by flexible bronchoscopy in 12% of cases. Parental underestimation of the gravity of the situation was a significant factor in delayed diagnosis. Among the patients, 64% examined 24 hours after inhalation were initially treated for another pathology. Delay in diagnosis and organic vs inorganic FB did not significantly correlate with duration of bronchoscopy. The rate of complications did not significantly increase after a 24-hour diagnostic delay threshold. Conclusion: FB aspiration is a serious problem. A high index of suspicion is required in health care providers (ENT, pediatricians and family physicians). Physician and especially parental education are the main guarantors of significantly reduced morbidity and mortality in this pathology. © 2011 Elsevier Masson SAS. All rights reserved.


Maatouk I.,Hotel Dieu de France | Moutran R.,Hotel Dieu de France | Tomb R.,Hotel Dieu de France
Clinical and Experimental Dermatology | Year: 2012

Netherton syndrome (NS) is a rare and severe autosomal recessive ichthyosis. We report the case of a patient with NS treated successfully with narrowband ultraviolet B (NB-UVB) phototherapy after failure of low-dose oral isotretinoin. A 16-year-old girl born to consanguineous parents presented with severe ichthyosis. On examination of her hair, she was found to have trichorrhexis invaginata. Genetic analysis revealed a SPINK5 mutation specific for NS. The patient's cousin had the same mutation. The patient developed Cushing syndrome after long-term application of topical steroids. She was treated with low-dose oral isotretinoin with no benefit. NB-UVB phototherapy was started, which resulted in marked improvement after 2 months. In conclusion, we report a case of NS with failure of low-dose oral isotretinoin, for which NB-UVB phototherapy, through its apoptosis-inducing and immunomodulatory effects, was effective. However, long-term use of UVB is limited by its potential side-effects. CED © 2012 British Association of Dermatologists.

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