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Ali FEM, Ibrahim IM, Althagafy HS, Hassanein EHM. Role of immunotherapies and stem cell therapy in the management of liver cancer: A comprehensive review. Int Immunopharmacol 2024; 132:112011. [PMID: 38581991 DOI: 10.1016/j.intimp.2024.112011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/08/2024]
Abstract
Liver cancer (LC) is the sixth most common disease and the third most common cause of cancer-related mortality. The WHO predicts that more than 1 million deaths will occur from LC by 2030. Hepatocellular carcinoma (HCC) is a common form of primary LC. Today, the management of LC involves multiple disciplines, and multimodal therapy is typically selected on an individual basis, considering the intricate interactions between the patient's overall health, the stage of the tumor, and the degree of underlying liver disease. Currently, the treatment of cancers, including LC, has undergone a paradigm shift in the last ten years because of immuno-oncology. To treat HCC, immune therapy approaches have been developed to enhance or cause the body's natural immune response to specifically target tumor cells. In this context, immune checkpoint pathway inhibitors, engineered cytokines, adoptive cell therapy, immune cells modified with chimeric antigen receptors, and therapeutic cancer vaccines have advanced to clinical trials and offered new hope to cancer patients. The outcomes of these treatments are encouraging. Additionally, treatment using stem cells is a new approach for restoring deteriorated tissues because of their strong differentiation potential and capacity to release cytokines that encourage cell division and the formation of blood vessels. Although there is no proof that stem cell therapy works for many types of cancer, preclinical research on stem cells has shown promise in treating HCC. This review provides a recent update regarding the impact of immunotherapy and stem cells in HCC and promising outcomes.
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Affiliation(s)
- Fares E M Ali
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt; Michael Sayegh, Faculty of Pharmacy, Aqaba University of Technology, Aqaba 77110, Jordan.
| | - Islam M Ibrahim
- Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt
| | - Hanan S Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Emad H M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut, 71524, Egypt
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Ibrahim IM, Ahmed MI, Abdelkader HM, Elsherbini MM. An optimized design for motivated broadband LPDA antenna. Sci Rep 2024; 14:7413. [PMID: 38548789 PMCID: PMC10978828 DOI: 10.1038/s41598-024-57449-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
This paper presents a super wideband and high-gain log periodic dipole array (LPDA) antenna. The overall structure of the antenna was constructed using microwave studio computer simulation technology. The optimal sizes of the planned antenna are 39 × 10× 0.254 mm3. The engineered antenna arrangement is implemented on an RT5880 substrate as a dielectric medium. The LPDA is arranged in four arms that are equally spaced on both lines. The main 50Ω feeder line is partially grounded at the back of the substrate. A combination of circular director units is being studied and tuned in a regular pattern at a predefined distance from the antenna. An improvement in gain of 3 dBi is the response of the director units. The Conformist LPDA is adjusted to achieve a wide range of millimeter wave bands ranging from 40 to over 70 GHz. The antenna resonates at 60 GHz, where the maximum realized gain of 14.97 dBi is attained. The antenna was tested for utilization in the V-band involving wireless personal area network (WPAN) applications recommended by IEEE 802.11ad and IEEE 802.15.3c. The outcomes of the constructed antenna elements' tests and simulations agree fairly well. The proposed layout works better than previous efforts in this field.
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Affiliation(s)
- Islam M Ibrahim
- Department of Electrical Engineering, Shoubra Faculty of Engineering, Benha University, Cairo, 11629, Egypt
- Department of Electrical Engineering, The Egyptian Academy for Engineering and Advanced Technology (EAEAT), Cairo, 3056, Egypt
| | - Mohamed I Ahmed
- Microstrip Department, Electronics Research Institute, El-Nuzha, Cairo, 11843, Egypt
- Electronics and Communication Program, Faculty of Engineering, Egypt University of informatics, New Administrative Capital, Knowledge City, Egypt
| | - Hala M Abdelkader
- Department of Electrical Engineering, Shoubra Faculty of Engineering, Benha University, Cairo, 11629, Egypt
| | - M M Elsherbini
- Department of Electrical Engineering, Shoubra Faculty of Engineering, Benha University, Cairo, 11629, Egypt.
- Department of Electrical Engineering, The Egyptian Academy for Engineering and Advanced Technology (EAEAT), Cairo, 3056, Egypt.
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Sharawi ZW, Ibrahim IM, Abd-Alhameed EK, Althagafy HS, Jaber FA, Harakeh S, Hassanein EHM. Baicalin and lung diseases. Naunyn Schmiedebergs Arch Pharmacol 2024; 397:1405-1419. [PMID: 37725153 DOI: 10.1007/s00210-023-02704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
Studies focusing on natural products have been conducted worldwide, and the results suggest that their natural ingredients effectively treat a wide range of illnesses. Baicalin (BIA) is a glycoside derived from the flavonoid baicalein present in Scutellaria baicalensis of the Lamiaceae family. Interestingly, BIA has been shown to protect the lungs in several animal models used in numerous studies. Therefore, we fully analyzed the data of the studies that focused on BIA's lung protective function against various injuries and included them in this review. Interestingly, BIA exhibits promising effects against acute lung injury, lung fibrosis, pulmonary embolism, and lung remodelling associated with COPD, LPS, and paraquat insecticide. BAI exhibits anticancer activity against lung cancer. Additionally, BIA potently attenuates lung damage associated with infections. BIA primarily exerts its therapeutic effects by suppressing inflammation, oxidative stress immune response, and apoptosis pathways. Nrf2/HO-1, PI3K/Akt, NF-κB, STAT3, MAPKs, TLR4, and NLRP3 are important targets in the pulmonary therapeutic effects of BIA on different lung disease models. Consequently, we recommend using it in future potential clinical applications, its contribution to treatment guidelines, and translating its promising effects to clinical practice in lung diseases.
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Affiliation(s)
- Zeina W Sharawi
- Biological Sciences Department, Faculty of Sciences, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Islam M Ibrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Esraa K Abd-Alhameed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Hanan S Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Fatima A Jaber
- Department of Biology, College of Science, University of Jeddah, P.O. Box 80327, Jeddah, 21589, Saudi Arabia
| | - Steve Harakeh
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Yousef Abdul Lateef Jameel Chair of Prophetic Medicine Application, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Emad H M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt.
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Madkor HR, Abd El-Aziz MK, Abd El-Maksoud MS, Ibrahim IM, Ali FEM. Stem Cells Reprogramming in Diabetes Mellitus and Diabetic Complications: Recent Advances. Curr Diabetes Rev 2024; 20:CDR-EPUB-136860. [PMID: 38173073 DOI: 10.2174/0115733998275428231210055650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/09/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The incidence of diabetes mellitus (DM) is dramatically increasing worldwide, and it is expected to affect 700 million cases by 2045. Diabetes influences health care economics, human quality of life, morbidity, and mortality, which were primarily seen extensively in developing countries. Uncontrolled DM, which results in consistent hyperglycemia, may lead to severe life-threatening complications such as nephropathy, retinopathy, neuropathy, and cardiovascular complications. METHODOLOGY In addition to traditional therapies with insulin and oral anti-diabetics, researchers have developed new approaches for treatment, including stem cell (SC) therapy, which exhibits promising outcomes. Besides its significant role in treating type one DM (T1DM) and type two DM (T2DM), it can also attenuate diabetic complications. Furthermore, the development of insulin-producing cells can be achieved by using the different types of SCs, such as embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and multiple types of adult stem cells, such as pancreatic, hepatic, and mesenchymal stem cells (MSC). All these types have been extensively studied and proved their ability to develop insulin-producing cells, but every type has limitations. CONCLUSION This review aims to enlighten researchers about recent advances in stem cell research and their potential benefits in DM and diabetic complications.
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Affiliation(s)
- Hafez R Madkor
- Department of Biochemistry, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt 71524
| | | | | | - Islam M Ibrahim
- Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, Egypt 71524
| | - Fares E M Ali
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, Egypt 71524
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Hassanein EHM, Ibrahim IM, Abd-Alhameed EK, Sharawi ZW, Jaber FA, Althagafy HS. Nrf2/HO-1 as a therapeutic target in renal fibrosis. Life Sci 2023; 334:122209. [PMID: 37890696 DOI: 10.1016/j.lfs.2023.122209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023]
Abstract
Chronic kidney disease (CKD) is one of the most prevalent chronic diseases and affects between 10 and 14 % of the world's population. The World Health Organization estimates that by 2040, the disease will be fifth in prevalence. End-stage CKD is characterized by renal fibrosis, which can eventually lead to kidney failure and death. Renal fibrosis develops due to multiple injuries and involves oxidative stress and inflammation. In the human body, nuclear factor erythroid 2-related factor 2 (Nrf2) plays an important role in the expression of antioxidant, anti-inflammatory, and cytoprotective genes, which prevents oxidative stress and inflammation damage. Heme oxygenase (HO-1) is an inducible homolog influenced by heme products and after exposure to cellular stress inducers such as oxidants, inflammatory chemokines/cytokines, and tissue damage as an outcome or downstream of Nrf2 activation. HO-1 is known for its antioxidative properties, which play an important role in regulating oxidative stress. In renal diseases-induced tissue fibrosis and xenobiotics-induced renal fibrosis, Nrf2/HO-1 has been targeted with promising results. This review summarizes these studies and highlights the interesting bioactive compounds that may assist in attenuating renal fibrosis mediated by HO-1 activation. In conclusion, Nrf2/HO-1 signal activation could have a renoprotective effect strategy against CKD caused by oxidative stress, inflammation, and consequent renal fibrosis.
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Affiliation(s)
- Emad H M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt.
| | - Islam M Ibrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Esraa K Abd-Alhameed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Zeina W Sharawi
- Biological Sciences Department, Faculty of Sciences, King AbdulAziz University, Jeddah, Saudi Arabia
| | - Fatima A Jaber
- Department of Biology, College of Science, University of Jeddah, P.O. Box 80327, Jeddah 21589, Saudi Arabia
| | - Hanan S Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
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Hassanein EHM, Ibrahim IM, Abd El-Maksoud MS, Abd El-Aziz MK, Abd-Alhameed EK, Althagafy HS. Targeting necroptosis in fibrosis. Mol Biol Rep 2023; 50:10471-10484. [PMID: 37910384 PMCID: PMC10676318 DOI: 10.1007/s11033-023-08857-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023]
Abstract
Necroptosis, a type of programmed cell death that resembles necrosis, is now known to depend on a different molecular mechanism from apoptosis, according to several recent studies. Many efforts have reported the possible influence of necroptosis in human disorders and concluded the crucial role in the pathophysiology of various diseases, including liver diseases, renal injuries, cancers, and others. Fibrosis is the most common end-stage pathological cascade of several chronic inflammatory disorders. In this review, we explain the impact of necroptosis and fibrosis, for which necroptosis has been demonstrated to be a contributing factor. We also go over the inhibitors of necroptosis and how they have been applied to fibrosis models. This review helps to clarify the role of necroptosis in fibrosis and will encourage clinical efforts to target this pathway of programmed cell death.
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Affiliation(s)
- Emad H M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt.
| | - Islam M Ibrahim
- Graduated Student, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt
| | - Mostafa S Abd El-Maksoud
- Graduated Student, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt
| | - Mostafa K Abd El-Aziz
- Graduated Student, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt
| | - Esraa K Abd-Alhameed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Hanan S Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
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Hassanein EHM, Althagafy HS, Baraka MA, Abd-Alhameed EK, Ibrahim IM. Pharmacological update of mirtazapine: a narrative literature review. Naunyn Schmiedebergs Arch Pharmacol 2023:10.1007/s00210-023-02818-6. [PMID: 37943296 DOI: 10.1007/s00210-023-02818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
Mirtazapine (MTZ) is an antidepressant drug with an exceptional pharmacological profile. It also has an excellent safety and tolerability profile. The present review provides a pharmacological update on MTZ and summarizes the research findings of MTZ's effects on different diseases. MTZ is hypothesized to have antidepressant effects because of the synergy between noradrenergic and serotonergic actions and is effective in treating major depressive disorder and depression associated with epilepsy, Alzheimer's disease, stroke, cardiovascular disease, and respiratory disease. In cancer patients, MTZ significantly reduced sadness, nausea, sleep disruption, and pain and improved quality of life. Also, it has promising effects on Parkinson's disease, schizophrenia, dysthymia, social anxiety disorder, alcohol dependency, posttraumatic stress disorder, panic disorder, pain syndromes, obsessive-compulsive disorder, and sleep disorders. Additionally, MTZ is potentially therapeutic in different situations associated with depression, such as liver, kidney, cardiovascular, respiratory, infertility, heavy metal-induced neurotoxicity, and pruritus. Potent antioxidative, anti-inflammatory, and anti-apoptotic bioactivities mediate these promising effects. These positive outcomes of the scientific investigations motivate more and more clinical trials for a golden exceptional antidepressant in different conditions.
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Affiliation(s)
- Emad H M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt.
| | - Hanan S Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Mohammad A Baraka
- Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt
| | - Esraa K Abd-Alhameed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Islam M Ibrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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Hassanein EHM, Abd El-Maksoud MS, Ibrahim IM, Abd-Alhameed EK, Althagafy HS, Mohamed NM, Ross SA. The molecular mechanisms underlying anti-inflammatory effects of galangin in different diseases. Phytother Res 2023. [PMID: 37246827 DOI: 10.1002/ptr.7874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/30/2023]
Abstract
When used as an alternative source of drugs to treat inflammation-associated diseases, phytochemicals with anti-inflammatory properties provide beneficial impacts. Galangin is one of the most naturally occurring flavonoids. Galangin has many biological activities, such as anti-inflammatory, antioxidant, antiproliferative, antimicrobial, anti-obesity, antidiabetic, and anti-genotoxic activities. We observed that galangin was well tolerated and positively impacted disease underlying inflammation for the renal, hepatic, central nervous system, cardiovascular, gastrointestinal system, skin, and respiratory disorders, as well as ulcerative colitis, acute pancreatitis, retinopathy, osteoarthritis, osteoporosis, and rheumatoid arthritis. Galangin anti-inflammatory effects are mediated mainly by suppressing p38 mitogen-activated protein kinases, nuclear factor-kappa B, and nod-like receptor protein 3 signals. These effects are confirmed and supported by molecular docking. Clinical translational research is required to accelerate the bench-to-bedside transfer and determine whether galangin can be utilised as a safe, natural source of pharmaceutical anti-inflammatory medication for humans.
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Affiliation(s)
- Emad H M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Asyut, Egypt
| | | | | | - Esraa K Abd-Alhameed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni Suef, Egypt
| | - Hanan S Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Nesma M Mohamed
- Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Asyut, Egypt
- Department of Pharmacognosy, Faculty of Pharmacy, Badr University in Assiut, Asyut, Egypt
| | - Samir A Ross
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, The University of Mississippi, University, Mississippi, USA
- Department of BioMolecular Sciences, Division of Pharmacognosy, School of Pharmacy, University of Mississippi, University, Mississippi, USA
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Althagafy HS, El-Aziz MA, Ibrahim IM, Abd-Alhameed EK, Hassanein EM. Pharmacological updates of nifuroxazide: Promising preclinical effects and the underlying molecular mechanisms. Eur J Pharmacol 2023; 951:175776. [PMID: 37192715 DOI: 10.1016/j.ejphar.2023.175776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
Nifuroxazide (NFX) is a safe nitrofuran antibacterial drug used clinically to treat acute diarrhea and infectious traveler diarrhea or colitis. Recent studies revealed that NFX displays multiple pharmacological effects, including anticancer, antioxidant, and anti-inflammatory effects. NFX has potential roles in inhibiting thyroid, breast, lung, bladder, liver, and colon cancers and osteosarcoma, melanoma, and others mediated by suppressing STAT3 as well as ALDH1, MMP2, MMP9, Bcl2 and upregulating Bax. Moreover, it has promising effects against sepsis-induced organ injury, hepatic disorders, diabetic nephropathy, ulcerative colitis, and immune disorders. These promising effects appear to be mediated by suppressing STAT3 as well as NF-κB, TLR4, and β-catenin expressions and effectively decreasing downstream cytokines TNF-α, IL-1β, and IL-6. Our review summarizes the available studies on the molecular biological mechanisms of NFX in cancer and other diseases and it is recommended to translate the studies in experimental animals and cultured cells and repurpose NFX in various diseases for scientific evidence based on human studies.
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Affiliation(s)
- Hanan S Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Islam M Ibrahim
- Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
| | - Esraa K Abd-Alhameed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - EmadH M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt.
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Ali FE, Ibrahim IM, Ghogar OM, Abd-alhameed EK, Althagafy HS, Hassanein EH. Therapeutic interventions target the NLRP3 inflammasome in ulcerative colitis: Comprehensive study. World J Gastroenterol 2023; 29:1026-1053. [PMID: 36844140 PMCID: PMC9950862 DOI: 10.3748/wjg.v29.i6.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/29/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
One of the significant health issues in the world is the prevalence of ulcerative colitis (UC). UC is a chronic disorder that mainly affects the colon, beginning with the rectum, and can progress from asymptomatic mild inflammation to extensive inflammation of the entire colon. Understanding the underlying molecular mechanisms of UC pathogenesis emphasizes the need for innovative therapeutic approaches based on identifying molecular targets. Interestingly, in response to cellular injury, the NLR family pyrin domain containing 3 (NLRP3) inflammasome is a crucial part of the inflammation and immunological reaction by promoting caspase-1 activation and the release of interleukin-1β. This review discusses the mechanisms of NLRP3 inflammasome activation by various signals and its regulation and impact on UC.
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Affiliation(s)
- Fares E.M Ali
- Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
| | - Islam M. Ibrahim
- Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
| | - Osama M Ghogar
- Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
| | - Esraa K. Abd-alhameed
- Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 12345, Egypt
| | - Hanan S. Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah 12345, Saudi Arabia
| | - Emad H.M. Hassanein
- Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt
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Hassanein EHM, Ibrahim IM, Abd-Alhameed EK, Mohamed NM, Ross SA. Protective effects of berberine on various kidney diseases: Emphasis on the promising effects and the underlined molecular mechanisms. Life Sci 2022; 306:120697. [PMID: 35718235 DOI: 10.1016/j.lfs.2022.120697] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 05/28/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
Berberine (BBR) is a pentacyclic benzylisoquinoline alkaloid that can be found in diversity of medicinal plants. BBR has a wide range of pharmacological bioactivities, in addition when administrated orally, it has a broad safety margin. It has been used as an antidiarrheal, antimicrobial, and anti-diabetic drug in Ayurvedic and Chinese medicine. Several scholars have found that BBR has promising renoprotective effects against different renal illnesses, including diabetic nephropathy, renal fibrosis, renal ischemia, renal aging, and renal stones. Also, it has renoprotective effects against nephrotoxicity induced by chemotherapy, heavy metal, aminoglycosides, NSAID, and others. These effects imply that BBR has an evolving therapeutic potential against acute renal failure and chronic renal diseases. Hence, we report herein the beneficial therapeutic renoprotective properties of BBR, as well as the highlighted molecular mechanism. In conclusion, the studies discussed throughout this review will afford a comprehensive overview about renoprotective effect of BBR and its therapeutic impact on different renal diseases.
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Affiliation(s)
- Emad H M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut, Egypt
| | | | - Esraa K Abd-Alhameed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Nesma M Mohamed
- Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt.
| | - Samir A Ross
- National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA; Division of Pharmacognosy, Department of BioMolecular Sciences, School of Pharmacy, University of Mississippi, University, MS 38677, USA
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Abstract
BACKGROUND Differentiation between benign and malignant exudative pleural effusion remains a clinical challenge. Recently, several markers have been reported to increase the diagnostic accuracy of malignant pleural effusion, with controversial results. METHODS Patients with exudative pleural effusion were divided into 2 groups: a malignant pleural effusion group (39 patients) diagnosed by malignant cells in pleural fluid cytology or by malignant infiltration of the pleura on pleural biopsy, and a benign pleural effusion group (51 patients) with neither malignant cells in pleural fluid cytology nor malignant infiltration of the pleura on pleural biopsy. Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 were determined in both serum and pleural fluid samples, using commercially available enzyme-linked immunosorbent assay kits. RESULTS The etiology of malignant pleural effusion in the malignant group was breast cancer in 43.6% and bronchogenic carcinoma in 25.6%. There was a statistically significant difference between the 2 groups regarding sex, with more males in the benign group. There was no significant difference between groups regarding age. The median levels of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 were higher in the malignant group than in the benign group, and the differences were highly significant in both pleural fluid (p < 0.001) and serum (p < 0.001). CONCLUSION Matrix metaloproteinase-9 and tissue inhibitor of metalloproteinase-1 in serum and pleural fluid samples might be valuable markers for differentiating benign from malignant pleural effusions.
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Affiliation(s)
- Amr M Allama
- Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Sheben El-Kom, Egypt
| | - Dalia H Abou-Elela
- Clinical Pathology Department, Faculty of Medicine, Menoufia University, Sheben El-Kom, Egypt
| | - Islam M Ibrahim
- Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Sheben El-Kom, Egypt
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Ibrahim IM, Frere A, Alcekelly MM. P1696Clinical value of QRS spatial dispersion in non-ST elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
More than 40% of patients with non-ST Elevation Myocardial Infarction (NSTEMI) have multi-vessel disease with the rate of in-hospital emergent bypass surgery ranging from 11–13%. So, rapid scoring is critical for optimum management even before P2Y12 loading.
Purpose
We aimed to determine the role of QRS dispersion at emergency department, as a simple and rapid sign, in predicting coronary anatomy complexity and in-hospital outcome.
Methods
192 (126 males, age 57.4±6.8 years) patients with NSTEMI and QRS duration <120 ms who underwent coronary angiography were included. QRS dispersion was automatically measured.
Results
Using Spearman's rank correlation, SYNTAX score was found to be positively correlated with admission HR (r 0.54, p value <0.001), maximum HsTnT level (r 0.523, p value <0.001), age (r 0.262, p value 0.015), male gender (r 0.286, p value 0.005), QRS dispersion (r 0.248, p value 0.015), QTc dispersion (r 0.289, p value 0.01), and Grace score (r 0.247, p value 0.015). ROC curve analyses for prediction of SYNTAX score >33 were done for variables with significant correlation. By multivariate logistic regression, male gender (OR 5.042, 95% CI 1.633 –15.567, p value 0.005), admission HR >80 bpm (OR 1.088, 95% CI 1.024 –1.157, p value 0.017) and QRS dispersion >20ms (OR 1.020, 95% CI 1.003 –1.037, p value 0.02) were independent predictors of SYNTAX score >33 (table). Patients with QRS dispersion >20 ms had in-hospital higher Killip class (P<0.001), recurrent ischemia (P 0.003), serious ventricular arrhythmias (P 0.01) and higher GRACE score (P<0.001).
Binary logistic regression for prediction of SYNTAX score >33 Variables Univariate analysis Multivariate analysis OR (95% CI) P value OR (95% CI) P value Age >61 (years) 1.337 (1.019–4.392) 0.015 0.953 (0.878–1.033) 0.242 Male gender 4.851 (2.014–5.301) 0.001 5.042 (1.633–15.567) 0.005 HR >80 (bpm) 3.945 (1.706–6.953) 0.002 1.088 (1.024–1.157) 0.017 QRS dispersion >20 (ms) 2.911 (0.617–13.738) 0.013 1.020 (1.003–1.037) 0.02 QTc dispersion >53 (ms) 6.101 (1.926–19.323) 0.002 2.378 (1.890–2.561) 0.043 Maximum HsTnT >1105 (ng/L) 3.837 (0.236–8.965) 0.004 2.785 (2.501–3.012) 0.034 Grace Score >112 (points) 7.122 (0.632–12.216) <0.001 2.912 (2.703–3.309) 0.030
Conclusion
In NSTEMI, QRS dispersion was positively correlated with SYNTAX score and a cut-off value of 20 ms independently predicted SYNTAX score >33. Regarding in-hospital outcome, QRS dispersion >20 ms was associated with in-hospital higher Killip class, recurrent ischemia, serious ventricular arrhythmias and higher GRACE score
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Affiliation(s)
| | - A Frere
- Zagazig University, Zagazig, Egypt
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14
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Ibrahim IM, Elaziz MEA, El-Hag-Aly MA. Early Autologous Blood-Patch Pleurodesis versus Conservative Management for Treatment of Secondary Spontaneous Pneumothorax. Thorac Cardiovasc Surg 2018; 67:222-226. [PMID: 29672817 DOI: 10.1055/s-0038-1642028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Autologous blood-patch pleurodesis has been effectively utilized as a treatment option for the condition of secondary spontaneous pneumothorax (SSP). Moreover, it can be used with persistent air leak, with or without residual air space. However, there have been no robust reports for the optimal timing for autologous blood-patch pleurodesis. The aim of this study is to compare early autologous blood-patch pleurodesis with conservative management of SSP. METHODS We conducted a randomized controlled study at the Menoufia University Hospital. A total of 47 patients with SSP were randomly allocated into two groups: group A (23 patients) received intrapleural instillation of 50 mL autologous blood 3 days after insertion of chest drain and group B (24 patients) managed conservatively. The duration required for air leak to seal, chest drainage duration, length of hospital stay, and the incidence of complications were compared and statistically analyzed. RESULTS The duration of air leak, duration to drain removal, and length of hospital stay were all significantly shorter in group A than in group B. CONCLUSION Early intrapleural instillation of autologous blood is successful in sealing air leak in patients with SSP with persistent air leak, who are not fit or not willing to undergo surgery. It is superior to conservative treatment or late instillation of autologous blood, even if their lungs are not fully expanded.
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Affiliation(s)
- Islam M Ibrahim
- Department of Cardiothoracic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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15
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Ibrahim IM, Moustafa ME, Abdelhamid MR. Effect of organic acids precursors on the morphology and size of ZrO 2 nanoparticles for photocatalytic degradation of Orange G dye from aqueous solutions. J Mol Liq 2016. [DOI: 10.1016/j.molliq.2016.08.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Ibrahim IM, Dokhan AL, El-Sessy AA, Eltaweel MF. Povidone-iodine pleurodesis versus talc pleurodesis in preventing recurrence of malignant pleural effusion. J Cardiothorac Surg 2015; 10:64. [PMID: 25947235 PMCID: PMC4423097 DOI: 10.1186/s13019-015-0270-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Malignant pleural effusions continue to be a common problem in patients with metastatic disease, leading to a significant reduction in quality of life with progressive dyspnea, dry cough, chest pain and reduced physical activity. This study was conducted to compare the efficacy, safety, and outcome of Talc Powder Pleurodesis (TPP) with Povidone-iodine Pleurodesis (PIP) through a chest drain as a palliative preventive treatment of recurrent malignant pleural effusion. Methods A total of 39 neoplastic patients with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Twenty-one patients received Talc pleurodesis (group A), and eighteen patients (group B) received Povidone-iodine pleurodesis. The continuous variables were expressed as mean values ± standard deviation (SD) and compared using the unpaired t-test. The discrete variables were expressed as percentage and compared using the chi-square test (χ2) test. p-values of less than 0.05 were considered significant. Results Our study included 11 males and 28 females, the mean age was (71.0 ± 5.0) years for group A and (70.9 ± 5.1) years for group B (non-significant). Post-procedure analgesic requirements were recorded in both groups. Four patients in each group had fever (>38°C) within 48 hours of the procedure. Both groups achieved good symptomatic relief. There were no in-hospital deaths. The mean post-procedure hospital stay was (4.7 ± 1.2) days for group A and (4.2 ± 1.0) for group B (non-significant). At follow-up recurrence of significant pleural effusion requiring intervention was noted in four and five patients in group A and group B, respectively (non-significant difference). Conclusion Povidone-iodine pleurodesis can be considered as a good alternative to Talc pleurodesis for recurrent malignant pleural effusion. The drug is available, cost effective, safe and can be administered through an intercostal drain and repeated if necessary.
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Affiliation(s)
- Islam M Ibrahim
- Cardiothoracic surgery department, Faculty of Medicine, Menoufia University, Yassin Abd El-Ghaffar Street, 32511, Shepin El-Kom, Menoufia, Egypt.
| | - Ahmed L Dokhan
- Cardiothoracic surgery department, Faculty of Medicine, Menoufia University, Yassin Abd El-Ghaffar Street, 32511, Shepin El-Kom, Menoufia, Egypt.
| | - Alaa A El-Sessy
- General surgery department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| | - Mohammed F Eltaweel
- Cardiothoracic surgery department, Faculty of Medicine, Menoufia University, Yassin Abd El-Ghaffar Street, 32511, Shepin El-Kom, Menoufia, Egypt.
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17
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Abstract
The aim of this study was focused on investigating the possible protective effect of erdosteine against gamma radiation-induced renal lesions in male albino rats. Twenty-eight albino rats were divided into four equal groups as follows: control group, irradiated group (animals subjected to whole-body gamma irradiation at a dose of 5 Gy), treated group (each rat received 100 mg/kg body weight once daily, orally by gastric tube, erdosteine for 1 week), and treated irradiated group (each rat received 100 mg/kg body weight once daily, orally by gastric tube, erdosteine for 1 week, then exposed to whole-body gamma irradiation at a dose of 5 Gy). The results revealed that the administration of erdosteine to rats before irradiation significantly ameliorated the changes occurred in kidney function (creatinine and urea) compared with irradiated group. Also the changes in serum tumor necrosis factor α, interleukin 1β, and interleukin 6 activities were markedly improved compared with the corresponding values of irradiated group. Kidney catalase and glutathione peroxidase (GPx) activities and reduced glutathione concentration showed approximately normal level when compared with the irradiated group. The histopathological results showed distinctive pattern of renal lesions in irradiated group, while in treated irradiated group the renal tissues showed relatively well-preserved architecture. Erdosteine acts in the kidney as a potent scavenger of free radicals to prevent or ameliorate the toxic effects of gamma irradiation as shown in the biochemical and histopathological changes and might provide substantial protection against radiation-induced inflammatory damage.
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Affiliation(s)
- A A Elkady
- Health Radiation Research Department, National Centre for Radiation Research and Technology, Cairo, Egypt
| | - I M Ibrahim
- Health Radiation Research Department, National Centre for Radiation Research and Technology, Cairo, Egypt
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18
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Koenig KM, Ivan M, Teferedegne BT, Morgavi DP, Rode LM, Ibrahim IM, Newbold CJ. Effect of dietary Enterolobium cyclocarpum on microbial protein flow and nutrient digestibility in sheep maintained fauna-free, with total mixed fauna or with Entodinium caudatum monofauna. Br J Nutr 2007; 98:504-16. [PMID: 17459191 DOI: 10.1017/s0007114507723930] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Three groups of five wethers with ruminal and duodenal cannulas and maintained as either fauna-free (FF) or inoculated with total mixed fauna (TF) or Entodinium caudatum as a single-species monofauna (EN) were used in an experiment with two 28 d periods. In the first period, the sheep were fed a control barley-based diet (40:60 concentrate to silage DM) and in the second period the diet was supplemented with 187 g DM of Enterolobium cyclocarpum for the last 12 d of the period. The diets of period 1 and 2 were isonitrogenous. There was no effect of fauna on apparent ruminal and total tract organic matter and fibre digestion, but bacterial and microbial N flow and efficiency were improved in FF sheep compared to TF sheep. In period 2, protozoal numbers were reduced between 31 and 88 % 2 h after feeding E. cyclocarpum for the third to twelfth day of supplementation and by an average of 25 % in samples collected over the 24 h feeding cycle. Supplementation of the diet with E. cyclocarpum and the consequent protozoal reduction in TF and EN sheep improved the flow of non-ammonia N and bacterial N to the small intestine and the efficiency of microbial synthesis. However, E. cyclocarpum reduced ruminal organic matter digestion, especially in faunated sheep, and total tract organic matter, N and fibre digestion. Thus, a reduction in the protozoal cell numbers of 25 % was sufficient to achieve the beneficial effects of reduced fauna on the bacterial protein supply, but diet digestibility was reduced.
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Affiliation(s)
- K M Koenig
- Agriculture and Agri-Food Canada, P.O. Box 3000, Lethbridge, Alberta T1J 4B1, Canada.
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19
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El-Bassiouni NE, El Bassiouny AE, Hussein NA, El-Sayed HH, Ibrahim IM, Lotfy MG, Omran SA. The coagulation profile in hepatosplenic schistosomiasis. Blood Coagul Fibrinolysis 1998; 9:189-94. [PMID: 9622218 DOI: 10.1097/00001721-199803000-00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The biological activity of blood coagulation factors II, V, VII, VIII, IX, X, XI and XII, fibrinogen and prekallikrein was assessed in 15 healthy subjects and 60 patients with endemic Egyptian hepatosplenomegaly. The degree of liver disease was graded according to the Child-Pugh classification, the intensity of S. mansoni infection was monitored by determination of circulating schistosome immune complexes (CSIC) level using a monoclonal antibody and hemostasis activation was detected by measurement of hemostatic markers D-dimer and prothrombin fragment 1 + 2 (F1+2). Functional activity of antithrombin III, alpha2-antiplasmin and protein C as well as quantitative determination of plasma concentrations of alpha1-antitrypsin, C1 activator inhibitor and alpha2-macroglobulin were also carried out. The progressive deterioration of liver function which matched the severity of the disease and the intensity of schistosomal infection led to a reduction in anticoagulant proteins (decreases in antithrombin III and protein C) resulting in hypercoagulability and thrombin generation (increased F1+2) subsequently followed by consumption (prolongation of coagulation screening tests, thrombocytopenia, hypofibrinogenemia and decreased factor VIII resulting in hypocoagulability and secondary fibrinolysis (increased D-dimer and decreased alpha2-antiplasmin). A significant decline in fibrinogen and factors VII, XII and prekallikrein was detected in bleeders compared with ascitic patients. The decline in factor XII was closely related to CSIC high titers in all disease groups, but was not correlated to D-dimer or F1+2 concentrations. This suggests that circulating schistosome immune complexes may exert an inhibitory effect on contact factor XII which should be taken into account when considering the reasons for schistosomal coagulopathy and bleeding in hepatosplenic schistosomiasis.
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Affiliation(s)
- N E El-Bassiouni
- Haematology Department, Theodor Bilharz Research Institute, Giza, Egypt
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20
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Ibrahim IM, Sussman B, Wolodiger F, Silvestri F. Duodenal perforation: the laparoscopic perspective. N J Med 1998; 95:31-3. [PMID: 9448424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- I M Ibrahim
- Department of Surgery, Englewood Hospital and Medical Center, USA
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21
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Ibrahim IM, Sussman B, Wolodiger F, Silvestri F. Laparoscopic management of iatrogenic colon perforation. N J Med 1997; 94:35-7. [PMID: 9420440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- I M Ibrahim
- Department of Surgery, Englewood Hospital, USA
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22
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Abstract
Laparoscopic gastric surgery is gaining momentum, especially in the treatment of benign disease. Simultaneous endoscopy and laparoscopy allow precise localization of lesions. Because of the stomach's size, mobility, and distensibility, relatively large lesions can be safely excised. Wedge resection for anterior lesions and a transgastric or intragastric approach for posterior lesions are feasible laparoscopically. Two cases of posterior gastric leiomyomas successfully resected laparoscopically are presented. The use of stapling devices greatly facilitates this procedure.
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Affiliation(s)
- I M Ibrahim
- Section of Laparoscopy, Department of Surgery, Englewood Hospital and Medical Center, 375 Engle Street, Englewood, NJ 07631, USA
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23
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Dardik H, Wolodiger F, Silvestri F, Sussman B, Kahn M, Wengerter K, Ibrahim IM. Clinical experience with everted cervical vein as patch material after carotid endarterectomy. J Vasc Surg 1997; 25:545-53. [PMID: 9081137 DOI: 10.1016/s0741-5214(97)70266-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate the clinical efficacy of everted cervical veins used as patches after carotid endarterectomy. METHODS A prospective nonrandomized comparative analysis was performed on patients with either everted cervical veins or saphenous veins as patches after carotid endarterectomy. Two hundred ninety-six patients underwent 329 carotid endarterectomies during an 8 1/2-year period (1987 to 1995). Saphenous vein patches were used in 125 (38%) cases and everted cervical veins in 167 (51%). These two groups were compared clinically and by sonographic surveillance. The mean follow-up of patients in this study was 27 +/- 11 months. RESULTS No significant differences were noted regarding postoperative morbid events between the everted cervical and saphenous vein patch groups. Even at 5 years the percentage of patients without stroke for both groups exceeded 95%. Duplex surveillance studies also showed comparable percentages of recurrent moderate (50% to 69%) and severe (70% to 99%) stenosis, 5.6% and 6.9%, respectively, for everted cervical vein and 5.4% and 6.5%, respectively, for saphenous vein. Cumulative recurrent stenosis-free rates at 5 and 6 years exceeded 82% for each of the patch study groups. CONCLUSIONS Based on the results of this study everted cervical veins are useful adjuncts to carotid endarterectomy, when patch angioplasty is necessary or desirable. Their performance is comparable to that of saphenous veins. Cervical veins are usually available, even when the saphenous vein is absent or inadequate. In addition, good saphenous veins can be spared and lower extremity excisions avoided.
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Affiliation(s)
- H Dardik
- Vascular Surgery Service, Englewood Hospital and Medical Center, NJ 07631, USA
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24
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Saber A, Dardik H, Ibrahim IM, Wolodiger F. The milk rejection sign: a natural tumor marker. Am Surg 1996; 62:998-9. [PMID: 8955234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Early discovery of breast cancer in the lactating female will result in improved survival rates. One such marker is the "milk rejection sign," which has rarely been described and consists of the rejection by the nursing infant of the lactating breast that harbors an occult breast carcinoma. Recognition of this particular sign is vital and will enable early diagnosis and improved prognosis.
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Affiliation(s)
- A Saber
- Department of Surgery, Englewood Hospital and Medical Center, New Jersey 07631, USA
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25
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Abstract
BACKGROUND A retrospective review is given of the authors' experience with a consecutive series of acute small-bowel obstruction unresponsive to medical management. METHODS There were 33 exploratory laparoscopies. The etiology was accurately diagnosed in 100% of the cases. Twenty-five (76%) were secondary to postoperative adhesions, of which 18 (72%) were successfully treated by laparoscopic lysis of adhesions. Minilaparotomy was needed to treat iatrogenic perforation (two), gangrenous bowel (one), and Meckel's diverticulectomy (one). Formal laparotomy was utilized for small-bowel resection (two), malignant adhesions (two), and intolerance of pneumoperitoneum (one). Four cases of incarcerated hernias were treated by conventional herniorrhaphy. RESULTS Overall, 67% of our cases were spared formal laparotomy. CONCLUSION We conclude that laparoscopy is an excellent diagnostic modality in acute small-bowel obstruction, the majority of which can be simultaneously managed laparoscopically. Laparotomy should be reserved for malignant adhesions, surgical misadventure, or when the pathology dictates.
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Affiliation(s)
- I M Ibrahim
- Department of Surgery, Section of Laparoscopic Surgery, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA
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26
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Dardik H, Silvestri F, Alasio T, Berry S, Kahn M, Ibrahim IM, Sussman B, Wolodiger F. Improved method to create the common ostium variant of the distal arteriovenous fistula for enhancing crural prosthetic graft patency. J Vasc Surg 1996; 24:240-8. [PMID: 8752035 DOI: 10.1016/s0741-5214(96)70099-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Successful use of the distal adjunctive arteriovenous fistula (dAVF) for the enhancement of prosthetic graft patency rates in the crural position is critically dependent on the qualitative and quantitative aspects of the arterial and venous runoff. Precise technical performance of the fistula is equally vital to secure optimal results. The purpose of this study was to determine current prosthetic graft patency and limb salvage rates using a modified version of the common ostium dAVF. METHODS The standard method to create the common ostium variant of dAVF has been modified to improve apposition of the "otomy" sites of the artery and vein, avoid twisting and stenosis by terminating the fistula suture line at the artery-vein junctures, reshaping the ovoid ostium to a rectangular shape, and finally, use of multiple interrupted heel-toe sutures. RESULTS Since 1979 we have created 290 fistulas in 281 patients who required leg revascularization procedures. In different time periods we have documented improving graft patency and limb salvage rates. Fistula patency, reflected by annual attrition rates of 13% to 26% per year, continues as a challenge for long-term results. Current 3-year secondary cumulative graft patency and limb salvage rates by life table analysis are 61% and 74%, respectively. The conduit material may play a role with regard to steal phenomena and the need for banding techniques. CONCLUSION Configuration of the adjunctive dAVF may impact on prosthetic graft patency in the crural position. In addition, the type of graft material used for bypass may be instrumental in preventing or precipitating the steal phenomenon. These issues require further study to better understand flow dynamics, patterns of intimal hyperplasia, and blood distribution as a function of conduit material and impedance of the arterial and venous runoff.
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Affiliation(s)
- H Dardik
- Department of Surgery, Englewood Hospital and Medical Center, NJ, USA
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27
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Abstract
Cholecystocolonic fistula is an unusual complication of biliary tract disease. Many of the signs and symptoms of these fistulas are nonspecific, so the diagnosis is often not suspected preoperatively. It is important to make the diagnosis then to prevent fecal contamination when the fistula is divided. We recently encountered a patient who, while undergoing laparoscopic cholecystectomy, was found to have a fistula between the gallbladder and the proximal transverse colon. Important features in the management of this case are (1) maintaining a high index of suspicion for the presence of this complication, (2) use of cholecystography to establish the diagnosis, and (3) use of laparoscopic stapling techniques to divide the fistula while preventing fecal soilage.
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Affiliation(s)
- I M Ibrahim
- Department of Surgery, Englewood Hospital and Medical Center, NJ 07631, USA
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28
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Abstract
Surgical foreign bodies are retained more commonly than is suspected. About 50% will become symptomatic in the form of erosion into the bowel or vessels, fistulae, abscesses, obstruction, bleeding, or chronic pain. Expeditious removal is recommended. Laparoscopic retrieval is feasible especially if discovered early.
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Affiliation(s)
- I M Ibrahim
- Department of Surgery, Englewood Hospital and Medical Center, NJ 07631, USA
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Dardik H, Vazquez R, Silvestri F, Ibrahim IM, Sussman B, Kahn M, Wolodiger F. Experience with a new valvulotome for lower-extremity revascularization procedures by the in situ method. Cardiovasc Surg 1995; 3:193-7. [PMID: 7606406 DOI: 10.1016/0967-2109(95)90894-b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Between November 1990 and November 1992, 50 consecutive cases requiring lower-extremity revascularization by the in situ method were compared with regard to use of two different valve cutters, the Hall valvulotome and the Insitucat. There were no amputations in patients with patent grafts, nor were any infections or false aneurysms noted during the course of this study. In the Insitucat group (n = 25), primary patency was achieved in 19 cases. Five of the six graft failures underwent additional procedures of which three remained patent, adding to the secondary patency rate (22 of 25). The greatest problem with regard to maintaining primary graft patency was that of missed or retained valves, but the incidence of this problem decreased during the course of this study as experience was gained with the catheter in conjunction with angioscopy. Experience with the Insitucat valvulotome has demonstrated its efficacy, though enhanced by monitoring the results with angioscopy. The development and discovery of focal stenotic areas and retained valves by surveillance sonography have resulted in enhanced (assisted) primary graft patency rates. The incidence of these problems appears to be comparable with that occurring with other means of producing valvular incompetence for an in situ reconstruction where valvulotomes of similar design are employed. This was confirmed by comparative analysis with another group of 25 in situ vein bypasses performed during the same time period but during the Hall valvulotome.
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Affiliation(s)
- H Dardik
- Vascular Surgical Service, Englewood Hospital and Medical Center, New Jersey, USA
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30
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Affiliation(s)
- J Nwiloh
- Department of Surgery, Harlem Hospital, New York, New York
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31
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Dardik H, Berry SM, Dardik A, Wolodiger F, Pecoraro J, Ibrahim IM, Kahn M, Sussman B. Infrapopliteal prosthetic graft patency by use of the distal adjunctive arteriovenous fistula. J Vasc Surg 1991; 13:685-90; discussion 690-1. [PMID: 2027208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
From November 1979 through December 1989, 210 distal arteriovenous fistulas were constructed as adjuncts to tibial and peroneal vascular reconstructive procedures in 203 patients threatened with limb loss. Two-year cumulative patency rates were calculated by grouping patients on the basis of changing indications in sequential time periods: group 1 (n = 61): 1979 to 1983, 18%; group 2 (n = 80): 1983 to 1986, 33%; group 3 (n = 69): 1986 to 1989, 44%. Although the therapeutic results observed in these groups are not statistically comparable, they show a perceptible trend. Postoperative arteriography showed that flow is prograde in the distal vessels beyond the distal arteriovenous fistula. Graft surveillance by duplex ultrasonography also confirmed that flow in the distal arteries is prograde and that "steal" does not occur. Peak systolic velocity (174 +/- 38 cm/sec) and mean velocity (92 +/- 23) flow rates are increased in grafts with patent distal arteriovenous fistulas compared to those bypasses with closed distal arteriovenous fistulas (p less than 0.01). There were no differences in the flow measurements for the arteries beyond the distal anastomoses and distal arteriovenous fistulas, confirming the prograde nature of the distal flow. In 22 patients analysis of graft and fistula patency by duplex sonography showed that one fourth of all grafts were patent without fistulas at 1 and 2 years after operation. Alternatively, 68% of patent grafts at 1 year had patent fistulas and 58% had patent fistulas at 2 years. We conclude that the distal arteriovenous fistula will increase graft flow and simultaneously prevent distal arterial overload without causing "steal." This technique should be considered whenever a prosthetic graft is necessary for crural reconstruction and only in selected instances of revascularization with autologous veins.
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Affiliation(s)
- H Dardik
- Vascular Surgical Service, Englewood Hospital, NJ 07631
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Miller N, Dardik H, Wolodiger F, Pecoraro J, Kahn M, Ibrahim IM, Sussman B. Transmetatarsal amputation: the role of adjunctive revascularization. J Vasc Surg 1991; 13:705-11. [PMID: 2027210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Over a 12-year period, 160 transmetatarsal amputations were performed in patients with peripheral vascular occlusive disease. The following groups were defined: group 1 - nonreconstructable disease (n = 40); group 2 - transmetatarsal amputation in conjunction with distal revascularization (n = 99); group 3 - reconstructable disease but transmetatarsal amputation performed without simultaneous revascularization (n = 21). There were nine early deaths in the entire series, for an operative mortality rate of 5.6%. The lowest rate of transmetatarsal amputation healing (24%) occurred in group 1. An 86% healing rate was achieved in group 3, but in seven cases (33%) some type of revascularization was required within 3 months of the amputation. In group 2 the healing rate was 62% but reached 83% where the bypass remained patent for at least 3 months after the amputation. Long-term patency rates also affected healing. Healing was not influenced by the number of local procedures (single vs multiple). The presence of severe infection or extensive necrosis necessitated open transmetatarsal amputation in 89 cases; the remaining 71 amputations involved primary closure. Since many patients were treated at a time when diagnostic modalities as well as the operative indications and techniques differed somewhat from the current practice, much of the information regarding group I patients in particular should be considered as a negative historical control and any conclusion from our data should be adjusted accordingly. Healing after amputation at the transmetatarsal level can be expected in the majority of instances in which revascularization can be performed with predictable patency, even when the standard criteria for performing such amputations are liberalized.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N Miller
- Vascular Surgical Service, Englewood Hospital, NJ
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Wolodiger F, Dardik H, Johnson F, Ibrahim IM. Rupture of arteriovenous fistula after in situ saphenous vein bypass. J Vasc Surg 1991; 13:503-5. [PMID: 2010924 DOI: 10.1067/mva.1991.26674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Residual saphenous vein tributaries function as arteriovenous fistulas after in-situ lower extremity bypass. Whether or not all of these tributaries need to be ligated at the time of bypass is controversial since many will close spontaneously. Other consequences of retained fistulas range from local skin problems to diminished graft flow and ultimate graft thrombosis. A complication not previously reported is rupture of a retained arteriovenous fistula. This unusual and potentially catastrophic complication should be discoverable at an earlier stage by periodic graft surveillance by means of duplex sonography. The routine policy of selective ligation of saphenous vein tributaries needs to be reexamined.
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Affiliation(s)
- F Wolodiger
- Vascular Surgical Service, Englewood Hospital, NJ
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Dardik H, Pecoraro J, Wolodiger F, Kahn M, Ibrahim IM, Sussman B. Interval gangrene of the lower extremity: a complication of vascular surgery. J Vasc Surg 1991; 13:412-5. [PMID: 1999861 DOI: 10.1067/mva.1991.25584] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Interval gangrene, segmental ischemic necrosis proximal to a functioning distal anastomosis, is a rare complication after successful peripheral vascular reconstruction. Previous reports have demonstrated the gravity of this event in that major limb amputation was required in all cases. Two cases are presented to emphasize the need for maintaining segmental collateral circulation after successful distal extremity bypass. Despite a satisfactory result after distal (inframalleolar) bypass of a popliteal aneurysm, one patient had progressive ischemic gangrene of the upper leg and eventually required amputation. The contralateral limb was successfully managed by distal ligation of the superficial femoral artery, which maintained collateral flow from the proximal superficial femoral artery to the knee and leg. The second patient required a microvascular free flap to replace tissue loss and provide vascular graft coverage after initial multiple bypass failures and a final successful remote reconstruction to the dorsal artery of the foot that excluded the popliteal-crural collateral network. Patients with inadequate collateral circulation or disruption of the profundus or geniculate collateral pathways may require revascularization of sequential vascular beds. Recognition of the potential for interval gangrene is essential since the likelihood of its occurrence will increase in proportion to the number of distal bypasses being performed for limb salvage. Although adjunctive procedures will not completely eliminate the possibility of interval gangrene, awareness of this phenomenon with attention to the segmental collateral circulation can decrease the incidence of its occurrence.
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Affiliation(s)
- H Dardik
- Vascular Surgical Service, Englewood Hospital, NJ
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Sussman B, Stahl R, Ibrahim IM, Kahn M, Wolodiger F, Dardik H. Atheroemboli to the lower urinary tract: a marker of atherosclerotic vascular disease--a case report. J Vasc Surg 1990; 12:654-5; discussion 655-6. [PMID: 2243402 DOI: 10.1067/mva.1990.24824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Atheroemboli to the lower genitourinary tract may serve as a marker for disseminated atheroembolic disease, a highly lethal condition. A case presentation and review of our institional experience is presented.
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Affiliation(s)
- B Sussman
- Department of Surgery (Vascular Surgery), Englewood Hospital, NJ
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Yu A, Dardik H, Wolodiger F, Raccuia J, Kapadia I, Sussman B, Kahn M, Pecoraro JP, Ibrahim IM. Everted cervical vein for carotid patch angioplasty. J Vasc Surg 1990; 12:523-6. [PMID: 2231962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Because of the theoretic benefits of autologous vein we undertook an investigation to evaluate cervical veins (facial, external jugular) as patch material after carotid endarterectomy. A device that stimulated both circumferential fixation by sutures and radial tension exerted on in vivo patches was constructed to measure burst strength of tissue. Mean bursting pressure for groin saphenous vein (n = 10) was 94.5 +/- 15.1 pounds per square inch (psi), 75.5 +/- 8.9 psi for ankle saphenous vein (n = 10), 83.3 +/- 14.5 psi for everted (double layer) cervical vein (n = 5) and 10 +/- 3.3 psi for single layer cervical vein (n = 5). No significant differences between saphenous vein at any level and everted (double layer) cervical vein, but all were significantly different from single layer cervical vein (p less than 0.05). From June 1987 through November 1989, 19 patients underwent 21 carotid endarterectomies complemented with adjunctive everted cervical vein patch angioplasty. Indications for surgery were asymptomatic stenosis (53%), transient ischemic attack (29%), and cerebrovascular accident with recovery (18%). All patients were studied after surgery with duplex scanning. Asymptomatic recurrent stenosis was observed in one patient. Transient hypoglossal nerve dysfunction occurred in one other patient. One postoperative death occurred as a result of massive aspiration. These results indicate that everted cervical vein is comparable to the saphenous vein in resistance to bursting and can yield similar results as patch material after carotid endarterectomy. Accordingly, saphenous vein can be spared and lower extremity incisions avoided.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Yu
- Vascular Surgical Service, Englewood Hospital, New Jersey
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Pecoraro JP, Dardik H, Mauro A, Wolodiger F, Drascher G, Raccuia S, Yu A, Kahn M, Sussman B, Ibrahim IM. Epidural anesthesia as an adjunct to retroperitoneal aortic surgery. Am J Surg 1990; 160:187-91. [PMID: 2382772 DOI: 10.1016/s0002-9610(05)80304-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Recent developments in vascular surgery suggest that the retroperitoneal approach to the aorta and the use of epidural anesthesia for lower limb revascularization are associated with decreased morbidity and shorter hospital stays. By combining these principles, we sought to determine if retroperitoneal aortic surgery could be performed under epidural anesthesia and if this might be advantageous. Over a 16-month period, 57 patients underwent aortic surgery via the retroperitoneal (n = 33) or transperitoneal (n = 24) approach. In the former, epidural anesthesia was employed in 10 patients, general anesthesia in 3, and combined epidural anesthesia and general anesthesia in the remaining 20. In the transperitoneal group, general anesthesia was employed in 21 patients and combined epidural anesthesia and general anesthesia in 3. Both groups were similar in age and gender, but risk factors were predominant in the retroperitoneal group. With the exception of one death due to aspiration, there were no significant differences between the transperitoneal and retroperitoneal groups with respect to overall morbidity, pulmonary complications, and length of stay in the intensive care unit and hospital. Despite these findings, we favor the combination of epidural and general anesthesia for retroperitoneal aortic surgery. Morbidity was significantly decreased (p less than 0.05) in low-risk retroperitoneal patients when combined epidural anesthesia and general anesthesia were employed.
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Affiliation(s)
- J P Pecoraro
- Vascular Surgical Service, Englewood Hospital, New Jersey
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Raccuia JS, Neckles S, Butler D, Kahn M, Ibrahim IM. Synchronous intrauterine and ectopic pregnancy associated with clomiphene citrate. Int J Gynaecol Obstet 1990. [DOI: 10.1016/0020-7292(90)90208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Computed tomography in a symptomatic but stable patient enabled preoperative evaluation and even diagnosis of abnormal communications, real or incipient, between the vascular and enteric system. This case demonstrated the effectiveness, ease, and low cost of documenting a primary aortoduodenal fistula. Surgical results were ultimately improved by initiating early intervention and aggressive management. Therapeutic principles included early intervention with aneurysmectomy, duodenorrhaphy, and extra-anatomic bypass. Anatomic graft placement may be acceptable in selected cases.
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Affiliation(s)
- I M Ibrahim
- Department of Surgery, Englewood Hospital, NJ 07631
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Raccuia JS, Neckles S, Butler D, Kahn M, Ibrahim IM. Synchronous intrauterine and ectopic pregnancy associated with clomiphene citrate. Surg Gynecol Obstet 1989; 168:417-20. [PMID: 2652347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although synchronous intrauterine and ectopic pregnancies associated with the use of clomiphene citrate for infertility are rare, the actual incidence might, in fact, be considerably higher than previously thought. The cornerstone for ruling out an extrauterine gestation is the presence of sonographic evidence of an intrauterine pregnancy, as the possibility of concomitant intrauterine and extrauterine gestation is perceived to be statistically rare. This has resulted in an unacceptably high incidence of negative ultrasound interpretations. During a recent 12 month period, four women treated with clomiphene citrate for infertility were diagnosed as having concomitant intrauterine and ectopic pregnancies. Three had pelvic sonograms that were erroneous for the extrauterine component. However, successful evacuation of the products of ectopic gestation was performed in each, despite an immediate preoperative false-negative ultrasound report. Three of the women delivered healthy normal infants at full term, and the fourth woman spontaneously aborted the products of the concomitant intrauterine gestation. All four did well postoperatively, and no gross complications were encountered. Reassessment of ultrasound diagnostic criteria and the use of more sensitive methods, such as endovaginal ultrasound in high risk patients, are indicated for any symptomatic patient using clomiphene citrate for infertility. Awareness of the prevalence of this entity and the limitations of ultrasound will lead to prompt intervention and improved survival rates.
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Affiliation(s)
- J S Raccuia
- Department of Surgery, Englewood Hospital, New Jersey 07062
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Miller N, Dardik H, Wolodiger F, Sussman B, Kahn M, Ibrahim IM. Dual function of the distal arteriovenous fistula for maintenance of arterial and venous prosthetic graft patency in the lower extremity. J Cardiovasc Surg (Torino) 1989; 30:225-9. [PMID: 2708439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Venous hypertension, severe swelling, and tissue necrosis occurred in a limb previously subjected to distal arterial bypass plus adjunctive arteriovenous fistula. Occlusion of the popliteal vein had not been recognized during the early treatment period. Subsequent to identification of this mechanism, limb salvage was achieved with an interposition graft of the popliteal vein using externally supported PTFE. The prereconstruction venous pressure gradient of 29 cm H2O was virtually abolished immediately after reestablishing venous outflow. The distal arteriovenous fistula, initially established to maintain prosthetic arterial graft patency, now serves, in this case, a dual function by additionally maintaining prosthetic venous graft patency. An intact deep venous system is critical for achieving successful arterial reconstruction and to avoid the complications associated with an occluded outflow tract in the face of augmented inflow.
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Affiliation(s)
- N Miller
- Vascular Surgical Service, Englewood Hospital, New Jersey
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Ahmed AS, Amer HA, Ibrahim IM. Influence of dietary mineral imbalance on the incidence of urolithiasis in Egyptian calves. Arch Exp Veterinarmed 1989; 43:73-7. [PMID: 2774811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The influence of certain dietary elements on the urolithiasis syndrome in cattle calves was elucidated. Calcium, phosphorus, and magnesium measurements were conducted on feed rations as well as on serum and urine samples collected from affected and normal calves. Analysis of the rations given to the animals showed phosphorus at higher levels than calcium, indicating mineral imbalance. Serum and urine of urolithic calves were characterised by high phosphorus, calcium, magnesium, urea, and creatinine levels. Physical examination of urine of affected animals showed a high degree of turbidity, a large amount of calcium carbonate, and triple phosphate as well as abundant amount of pus cells and red blood cells. The characteristic clinical symptoms of urine retention were observed. Moreover, some animals were found to urinate through an opening in front of the scrotal region.
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Dardik H, Miller N, Adler J, Ganti SR, Myers D, Greweldinger J, Ibrahim IM, Sussman B, Kahn M. Primary and adjunctive intra-arterial digital subtraction arteriography of the lower extremities. J Vasc Surg 1986; 3:599-604. [PMID: 3514971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Standard contrast arteriography (SCA) and intra-arterial digital subtraction arteriography (DSA) were performed during a 26-month period in 459 cases. The DSA group consisted of 22 aortoiliac studies, 66 crural-pedal arch studies, and 227 combinations. In addition, postoperative DSA was performed in 42 patients to evaluate graft patency, morphology, and inflow and runoff circulations. There were no significant differences in the quality of the preoperative aortoiliac studies performed by either SCA or DSA although, in select cases, one or the other of these techniques resulted in a superior study. Distal crural-pedal arch visualization was enhanced with DSA compared with SCA (85% vs. 65%) but when both were compared with their corresponding intraoperative completion arteriograms, the interpretive error rates resulted in comparable accuracies, false positive and negative rates, and predictive values. The likelihood of achieving graft patency in patients who have unsatisfactory preoperative visualization of the distal circulation by DSA is reasonable (11 of 27 patients) but inferior to the number obtained when there is adequate DSA visualization (40 of 53 patients). We conclude that DSA is a valuable adjunct to preoperative SCA but should not be used as the sole criterion for the assessment of operability for limb salvage. Intraoperative prereconstruction arteriography or direct surgical exploration of the crural arteries in patients with inadequate preoperative visualization will result in graft patency in a significant percentage of cases. Intra-arterial DSA for postoperative evaluation of lower limb bypass adds another dimension to analysis of graft structure and status of the host circulatory beds and also provides a method for accurate interpretation of postoperative data.
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Mendes D, Kahn M, Ibrahim IM, Sussman B, Fox R, Dardik H. Omental protection of autogenous arterial reconstruction following femoral prosthetic graft infection. J Vasc Surg 1985; 2:603-6. [PMID: 4009844 DOI: 10.1067/mva.1985.avs0020603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Vascular graft infections in the femoral region that require synchronous revascularization are generally reconstructed with prosthetic grafts via extra-anatomic routes. If in situ revascularization is required, then autologous tissue provides optimal results. A particular challenge in this circumstance is achieving soft tissue coverage of the reconstruction where wide and radical débridement has removed the tissues ordinarily used for this purpose. If muscle flaps are not available or possible, the use of omentum is advocated. The omentum can be easily reached from behind the inguinal ligament and transposed on its bipedicled vascular base for coverage of vital structures in the femoral triangle, thereby obliterating dead space and providing a surface for both temporary and permanent skin coverage. The procedure is quite simple, can be performed rapidly, and should be considered for use in the dire situation that requires soft tissue coverage of exposed vessels in extraperitoneal locations.
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46
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Fox RL, Kahn M, Adler J, Sussman B, Mendes D, Ibrahim IM, Dardik H. Adventitial cystic disease of the popliteal artery: failure of percutaneous transluminal angioplasty as a therapeutic modality. J Vasc Surg 1985; 2:464-7. [PMID: 3158751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Adventitial cystic disease of the popliteal artery is an important cause of peripheral vascular insufficiency in the young and middle-aged man. The pathologic feature is a mucinous cyst located within the adventitia of the artery that expands and secondarily compromises the vessel lumen. Although physiologically quite different, this process is easily mistaken for arteriosclerosis. The clinical history of sudden claudication in a young nonsmoking man, combined with characteristic angiographic features, are important clues to the correct underlying pathology. Treatment generally consists of cyst evacuation or local bypass. This article was prompted by the failure of percutaneous transluminal angioplasty to achieve durable success in controlling this unique type of arterial disease. Subsequent surgical intervention proved satisfactory, lending support to this modality as the treatment of choice.
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Sussman B, Dardik H, Ibrahim IM, Fox R, Mendes D, Kahn M. Improved patient selection for enzymatic lysis of peripheral arterial and graft occlusions. Am J Surg 1984; 148:244-8. [PMID: 6235754 DOI: 10.1016/0002-9610(84)90230-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Intraarterial thrombolysis by remote intravenous or direct intraarterial infusion of streptokinase is possible. The latter may be more effective with a lesser potential for systemic hemorrhagic complications because of the smaller dose administered directly in the area. Fifty patients with prosthetic graft, embolic, and renal artery occlusions were evaluated. Embolic occlusion responded dramatically, particularly since lytic therapy was initiated at an early stage. Patients with severe ischemia or those with simple localized occlusion were best treated by surgical means. Successful thrombolysis was also obtained with renal artery occlusions combined with percutaneous transluminal angioplasty. The management of patients with prosthetic graft occlusion by lytic therapy is complex. Optimal results can be obtained in patients presenting with occluded grafts after the immediate postoperative period and in those in whom previous satisfactory runoff has been demonstrated. Failure of lysis in this group is associated with a high incidence of limb loss due to unreconstructable obliterative disease. Successful lysis of occluded prosthetic grafts will often require corrective angioplasty or surgical revision.
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Dardik H, Sussman BC, Kahn M, Greweldinger J, Adler J, Mendes D, Svoboda J, Ibrahim IM. Lysis of arterial clot by intravenous or intra-arterial administration of streptokinase. Surg Gynecol Obstet 1984; 158:137-40. [PMID: 6695307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Intra-arterial thrombolysis with streptokinase was studied in 38 patients. The indications were peripheral thromboembolism in nine patients (group 1), postreconstruction graft thrombosis in 26 patients (group 2) and renal artery thrombosis in three patients (group 3). The intra-arterial route was used for the first and third groups and in 16 of the second group. The intravenous route was used in the remaining ten patients. Lysis was achieved in all of the group 1 and 3 patients. The latter were also treated with percutaneous transluminal angioplasty after dissolution of thrombus of the renal artery. In group 2 patients, lysis was achieved in eight of 16 patients in whom lytic therapy was instituted within seven days of graft closure. There was no lysis in all ten patients in whom elapsed time was more than seven days. Postlytic angiographic visualization of etiologic mechanisms for thrombosis enabled subsequent successful correction in three of five patients in group 2. Attempts to correct graft failure by surgical treatment when lysis had failed were often unsuccessful (12 of 17). Lytic therapy is most effective for acute embolic occlusion and for thrombosis of less than seven days duration. Although there is no difference in drug efficacy by route of administration, a lesser number of complications (such as, fever and hematoma) occurred with intra-arterial infusion. The effectiveness of lysis is also directly related to the collateral circulation and runoff beyond the occlusion. Lysis is not indicated for severe acute ischemia if surgical treatment is an alternative or if it may cause distal embolism as with complete axillofemoral graft thrombosis. Lytic therapy is least effective for graft thrombosis with pre-existent poor runoff.
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Dardik H, Ibrahim IM, Sussman B, Kahn M, Sanchez M, Klausner S, Baier RE, Meyer AE, Dardik II. Biodegradation and aneurysm formation in umbilical vein grafts. Observations and a realistic strategy. Ann Surg 1984; 199:61-8. [PMID: 6691733 PMCID: PMC1353259 DOI: 10.1097/00000658-198401000-00011] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In a series of 756 glutaraldehyde-stabilized umbilical vein grafts implanted over a 7 1/2-year period, aneurysms were identified in seven cases. The earliest aneurysm was seen at 31 months after implantation and the remainder between 43 and 79 months after surgery. Corrective surgery was performed in five cases and succeeded in four. Although definite mechanisms have not been identified, mechanical fatigue, reversal of aldehyde crosslinks, and immunologic factors may be operative. The pathologic changes include: (1) actual dilation of both graft and mesh with or without intraluminal thrombus and, (2) maintenance of graft diameter with erosion of the umbilical vein and polyester mesh rupture leading to perigraft hematoma and false aneurysm formation. Microscopic examination and infrared spectral analysis confirmed the presence of host-contributed lipid in some specimens. Although this is a low incidence of aneurysm formation, umbilical vein grafts should be selected primarily for patients with limited life expectancy or for whom alternative materials with comparable or superior patency rates are not available or acceptable. Periodic angiography, particularly after 3 or 4 years, is recommended as a routine part of follow-up examinations. Improved graft materials and control of host environmental factors are potential means to reduce the noted degradation.
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50
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Adler J, Ibrahim IM, Goldman M, Thomashow DF. Combined thrombolysis with low-dose streptokinase and angioplasty in the treatment of renal artery occlusion. Urol Radiol 1983; 5:113-6. [PMID: 6225235 DOI: 10.1007/bf02926782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A case of acute renal artery thrombosis superimposed on a stenotic atheromatous lesion treated with low-dose streptokinase thrombolysis and percutaneous transluminal angioplasty is presented. Renal function was promptly improved. This combined approach is recommended in selected elderly and seriously ill patients.
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