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Beirut, Lebanon

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. Source


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. Source


Naja Z.M.,Makassed General Hospital | Ziade F.M.,Lebanese University | El-Rajab M.A.,Makassed General Hospital | Naccash N.,Hotel Dieu de France
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. Source


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. Source


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. Source

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