Ramses Wassef - Academia.edu (original) (raw)
Papers by Ramses Wassef
Annales De Chirurgie, 1996
Suite aux restrictions budgetaires des hopitaux, le virage ambulatoire est devenu un «modus viven... more Suite aux restrictions budgetaires des hopitaux, le virage ambulatoire est devenu un «modus vivendi» pour les chirurgiens. Le but de cette etude est d'examiner la faisabilite et les resultats de la chirurgie anale en un jour. Cent quarante et un patients consecutifs ont subi une chirurgie anale en une periode de 12 mois par un seul chirurgien : 108 en un jour (77%) et 33 admis pour plus d'un jour (23 %) : 19 a cause de la complexite de l'intervention (sphincteroplastie 8, fistule complexe 5, fistule recto-vaginale 3), 9 d'urgence et 5 pour des raisons variees. Des 108 patients ambulatoires tous ont quitte l'hopital le meme jour sauf deux : retention urinaire et operation plus extensive que prevu. Trois autres patients ont presente une retention urinaire ; ils ont ete catheterises et congedies le meme jour. Les quatre retentions urinaires (3 femmes, un homme, âge de 29 a 49 ans) sont survenues apres anesthesie rachidienne. Trois patients sont revenus dans les 24 h...
Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal h... more Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (+/-SD) of 72+/-21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4+/-3.9 mmHg to 8.4+/-3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, ...
The American Journal of Surgery, 2020
BACKGROUND Intimidation constitutes a learning barrier for undergraduates and its reporting rate ... more BACKGROUND Intimidation constitutes a learning barrier for undergraduates and its reporting rate to authorities remains suboptimal. METHODS A randomized controlled trial was conducted to evaluate the effectiveness of three interventions designed to increase reporting by undergraduates during their surgical rotation. As adjuncts to a standardized lecture, participants were assigned to a simulated intimidation scenario, a video of intimidation events, or a control group. Surveys were completed before the interventions, and at the end of the rotation. RESULTS Of the 119 included participants, 17.6% reported that they had been intimidated during their previous rotation as compared to 37.0% after the surgical rotation. There were no statistically significant differences in the reporting of intimidation between the groups. However, 65.5% of all participants declared feeling more at ease to report intimidation, yet the reporting rate remained low. CONCLUSION Intimidation during clerkship persists as a frequent problem although the best method to increase its reporting remains unclear.
Journal of Clinical Oncology, 2018
e15692Background: Watch and wait protocol in patients with complete clinical response after neo-a... more e15692Background: Watch and wait protocol in patients with complete clinical response after neo-adjuvant therapy for rectal cancer has shown encouraging results with adequate follow up, allowing pa...
Frontiers in Immunology, 2019
Journal of the Canadian Association of Gastroenterology, 2018
Journal of Leukocyte Biology, 2015
Current Problems in Surgery, 1986
L'unión médicale du Canada, 1983
Canadian journal of surgery. Journal canadien de chirurgie, 1982
Possible intra-abdominal injuries were sought in 101 patients admitted with blunt abdominal traum... more Possible intra-abdominal injuries were sought in 101 patients admitted with blunt abdominal trauma. The serum amylase level was measured in the first 12 hours after the accident. Twenty-five patients had hyperamylasemia; 18 underwent laparotomy and 7 were treated conservatively. At laparotomy all 18 patients exhibited at least one serious intra-abdominal lesion, and there was a total of 28 lesions in the who group (including only four pancreatic injuries). The mean value of the serum amylase for those who had laparotomy was 1190 IU, while it was only 363 IU for those not operated upon. The authors conclude that hyperamylasemia in blunt abdominal trauma is not specific to pancreatic injury, but may suggest the presence of a serious intra-abdominal lesion.
Transplantation, 1986
L'utilisation concomitante d'une emulsion lipidique comme source calorique et de ciclospo... more L'utilisation concomitante d'une emulsion lipidique comme source calorique et de ciclosporine ne semble pas alterer le profil pharmacocinetique normal de la ciclosporine
The Journal of allergy and clinical immunology, 2014
Small-Bowel Transplantation, 1986
As a result of recent literature resports, there has been renewed interest in small- intestinal t... more As a result of recent literature resports, there has been renewed interest in small- intestinal transplantation. Studies from both our own laboratory and others have shown that there has been increased survival following small-intestinal transplantation, particularly with the use of eyclosporine as an immunosuppressant. However, in reviewing the literature of long-term animal survivors, little work has been done in large animals to answer questions regarding absorptive function following small- intestinal transplantation.
Transplantation, 1985
The absorption of oral cyclosporine (CsA) was studied in a canine small intestinal transplantatio... more The absorption of oral cyclosporine (CsA) was studied in a canine small intestinal transplantation model. Absorption of CsA was almost absent in bowel-resected dogs. Autotransplanted dogs showed a persisting malabsorption of CsA (mean peak of 687 +/- 348 ng/ml vs. 1683 +/- 154 ng/ml in control dogs). Allotransplanted dogs with normal graft histology showed a similar malabsorption (mean increase in CsA level: 833 ng/ml), whereas allotransplanted dogs with rejection of the graft showed a markedly decreased absorption (mean increase: 368 +/- 31 ng/ml). In two autotransplanted dogs pretreated with olive oil alone, CsA absorption increased over four weeks to a mean peak of 2215 +/- 5 ng/ml. We conclude that oral CsA is absorbed through the small intestine. Absorption of CsA is decreased after autotransplantation and allotransplantation, and rejection of the graft impedes it further. Regular administration of olive oil alone enhances absorption of oral CsA in a canine model.
Gastroenterology, 2003
ABSTRACT The aim of this study was to report results of TIPS (transjugular intrahepatic portosyst... more ABSTRACT The aim of this study was to report results of TIPS (transjugular intrahepatic portosystemic shunt) in 5 consecutive children with cystic fibrosis and monitor long-term follow-up results. Five cystic fibrosis patients with multinodular cirrhosis of the liver and complications of portal hypertension (repeated variceal bleeding refractory to endoscopic treatment) underwent TIPS creation. There were 3 males and 2 females aged 8 to 18 years (median 14 yrs), their weight range was 27-51 (median 40) kg. A routine TIPS technique was used. The patients were followed by ultrasonography. The TIPS was successfully performed in all five patients. The mean portosystemic pressure gradient was reduced from 17 to 10 mmHg. There were no deaths related to the procedure. No clinical or laboratory signs of bleeding into the gastrointestinal tract were observed in any patient within the first 30 days following TIPS. There was recurrent bleeding 6 times and asymptomatic stenoses were revealed by ultrasonography 15 times during a follow-up period of 15-81 (median 70) months. All stenoses were successfully dilated. One patient had liver transplantation 15 months after TIPS. Two patients died 6.7 years and 4.5 years following the placement of TIPS due to respiratory insufficiency. Symptomatic portal hypertension was successfully managed with TIPS in long-term follow-up; multiple reinterventions were required for shunt stenoses. TIPS served as a bridge to liver transplantation in one case.
World Journal of Surgery, 1991
Hepatic encephalopathy is a major complication of portal-systemic shunts with an incidence rangin... more Hepatic encephalopathy is a major complication of portal-systemic shunts with an incidence ranging up to 52%. A small fraction of these patients are refractory to medical therapy. Shunt ligation and colonic procedures are the main surgical approaches. The goal of the latter is to diminish the colonic absorption of nitrogenous substances which are involved in the pathophysiology of hepatic encephalopathy. Six patients, whose average age was 55.7 +/- 2.6 years, were operated for severe postshunt encephalopathy requiring 4.3 +/- 0.9 admissions for a total duration of 76 +/- 26 days over 1-11 years. One patient had undergone a splenoral shunt and 5 had a portacaval shunt. One ligation of the shunt and 5 colon exclusions were performed. The average postoperative hospital stay was 21.5 +/- 3.9 days. The mean follow-up was 47 +/- 20 months. The patient with the shunt ligation remains free of encephalopathy 94 months after the procedure and has not bled from his esophageal varices. Among the 5 colon exclusion patients, there were 1 death and 3 complications. Three patients were completely relieved of their hepatic encephalopathy. One of those 3 died of a subarachnoid hemorrhage 28 months after the surgery. The fourth still needs medication to control a persistent, although improved, encephalopathy that required 2 further hospitalizations. Colon exclusion is a useful intervention in very selected cases. It has a lower operative mortality than total colectomy and the advantage over shunt ligation of not reestablishing hypertension in the portal system.
Transplantation, 1986
A case of small intestinal allotransplantation is described. Cyclosporine and Solumedrol were use... more A case of small intestinal allotransplantation is described. Cyclosporine and Solumedrol were used for immunosuppression. A hemolytic episode occurred, caused by anti-A antibodies derived from graft lymphocytes. Sudden severe encephalopathy developed on the ninth postoperative day, followed by intractable hypotension and death. Hepatic and splenic microinfarcts were identified on postmortem examination. Allograft rejection was identified by serial stomal biopsies and correlated with a rise in monocyte procoagulant activity, a potentially useful serologic marker of rejection. The absence of an anatomic circuit for recycling of cyclosporine did not alter serum radioimmunoassay/high-performance liquid chromatography ratios.
Annales De Chirurgie, 1996
Suite aux restrictions budgetaires des hopitaux, le virage ambulatoire est devenu un «modus viven... more Suite aux restrictions budgetaires des hopitaux, le virage ambulatoire est devenu un «modus vivendi» pour les chirurgiens. Le but de cette etude est d'examiner la faisabilite et les resultats de la chirurgie anale en un jour. Cent quarante et un patients consecutifs ont subi une chirurgie anale en une periode de 12 mois par un seul chirurgien : 108 en un jour (77%) et 33 admis pour plus d'un jour (23 %) : 19 a cause de la complexite de l'intervention (sphincteroplastie 8, fistule complexe 5, fistule recto-vaginale 3), 9 d'urgence et 5 pour des raisons variees. Des 108 patients ambulatoires tous ont quitte l'hopital le meme jour sauf deux : retention urinaire et operation plus extensive que prevu. Trois autres patients ont presente une retention urinaire ; ils ont ete catheterises et congedies le meme jour. Les quatre retentions urinaires (3 femmes, un homme, âge de 29 a 49 ans) sont survenues apres anesthesie rachidienne. Trois patients sont revenus dans les 24 h...
Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal h... more Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (+/-SD) of 72+/-21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4+/-3.9 mmHg to 8.4+/-3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, ...
The American Journal of Surgery, 2020
BACKGROUND Intimidation constitutes a learning barrier for undergraduates and its reporting rate ... more BACKGROUND Intimidation constitutes a learning barrier for undergraduates and its reporting rate to authorities remains suboptimal. METHODS A randomized controlled trial was conducted to evaluate the effectiveness of three interventions designed to increase reporting by undergraduates during their surgical rotation. As adjuncts to a standardized lecture, participants were assigned to a simulated intimidation scenario, a video of intimidation events, or a control group. Surveys were completed before the interventions, and at the end of the rotation. RESULTS Of the 119 included participants, 17.6% reported that they had been intimidated during their previous rotation as compared to 37.0% after the surgical rotation. There were no statistically significant differences in the reporting of intimidation between the groups. However, 65.5% of all participants declared feeling more at ease to report intimidation, yet the reporting rate remained low. CONCLUSION Intimidation during clerkship persists as a frequent problem although the best method to increase its reporting remains unclear.
Journal of Clinical Oncology, 2018
e15692Background: Watch and wait protocol in patients with complete clinical response after neo-a... more e15692Background: Watch and wait protocol in patients with complete clinical response after neo-adjuvant therapy for rectal cancer has shown encouraging results with adequate follow up, allowing pa...
Frontiers in Immunology, 2019
Journal of the Canadian Association of Gastroenterology, 2018
Journal of Leukocyte Biology, 2015
Current Problems in Surgery, 1986
L'unión médicale du Canada, 1983
Canadian journal of surgery. Journal canadien de chirurgie, 1982
Possible intra-abdominal injuries were sought in 101 patients admitted with blunt abdominal traum... more Possible intra-abdominal injuries were sought in 101 patients admitted with blunt abdominal trauma. The serum amylase level was measured in the first 12 hours after the accident. Twenty-five patients had hyperamylasemia; 18 underwent laparotomy and 7 were treated conservatively. At laparotomy all 18 patients exhibited at least one serious intra-abdominal lesion, and there was a total of 28 lesions in the who group (including only four pancreatic injuries). The mean value of the serum amylase for those who had laparotomy was 1190 IU, while it was only 363 IU for those not operated upon. The authors conclude that hyperamylasemia in blunt abdominal trauma is not specific to pancreatic injury, but may suggest the presence of a serious intra-abdominal lesion.
Transplantation, 1986
L'utilisation concomitante d'une emulsion lipidique comme source calorique et de ciclospo... more L'utilisation concomitante d'une emulsion lipidique comme source calorique et de ciclosporine ne semble pas alterer le profil pharmacocinetique normal de la ciclosporine
The Journal of allergy and clinical immunology, 2014
Small-Bowel Transplantation, 1986
As a result of recent literature resports, there has been renewed interest in small- intestinal t... more As a result of recent literature resports, there has been renewed interest in small- intestinal transplantation. Studies from both our own laboratory and others have shown that there has been increased survival following small-intestinal transplantation, particularly with the use of eyclosporine as an immunosuppressant. However, in reviewing the literature of long-term animal survivors, little work has been done in large animals to answer questions regarding absorptive function following small- intestinal transplantation.
Transplantation, 1985
The absorption of oral cyclosporine (CsA) was studied in a canine small intestinal transplantatio... more The absorption of oral cyclosporine (CsA) was studied in a canine small intestinal transplantation model. Absorption of CsA was almost absent in bowel-resected dogs. Autotransplanted dogs showed a persisting malabsorption of CsA (mean peak of 687 +/- 348 ng/ml vs. 1683 +/- 154 ng/ml in control dogs). Allotransplanted dogs with normal graft histology showed a similar malabsorption (mean increase in CsA level: 833 ng/ml), whereas allotransplanted dogs with rejection of the graft showed a markedly decreased absorption (mean increase: 368 +/- 31 ng/ml). In two autotransplanted dogs pretreated with olive oil alone, CsA absorption increased over four weeks to a mean peak of 2215 +/- 5 ng/ml. We conclude that oral CsA is absorbed through the small intestine. Absorption of CsA is decreased after autotransplantation and allotransplantation, and rejection of the graft impedes it further. Regular administration of olive oil alone enhances absorption of oral CsA in a canine model.
Gastroenterology, 2003
ABSTRACT The aim of this study was to report results of TIPS (transjugular intrahepatic portosyst... more ABSTRACT The aim of this study was to report results of TIPS (transjugular intrahepatic portosystemic shunt) in 5 consecutive children with cystic fibrosis and monitor long-term follow-up results. Five cystic fibrosis patients with multinodular cirrhosis of the liver and complications of portal hypertension (repeated variceal bleeding refractory to endoscopic treatment) underwent TIPS creation. There were 3 males and 2 females aged 8 to 18 years (median 14 yrs), their weight range was 27-51 (median 40) kg. A routine TIPS technique was used. The patients were followed by ultrasonography. The TIPS was successfully performed in all five patients. The mean portosystemic pressure gradient was reduced from 17 to 10 mmHg. There were no deaths related to the procedure. No clinical or laboratory signs of bleeding into the gastrointestinal tract were observed in any patient within the first 30 days following TIPS. There was recurrent bleeding 6 times and asymptomatic stenoses were revealed by ultrasonography 15 times during a follow-up period of 15-81 (median 70) months. All stenoses were successfully dilated. One patient had liver transplantation 15 months after TIPS. Two patients died 6.7 years and 4.5 years following the placement of TIPS due to respiratory insufficiency. Symptomatic portal hypertension was successfully managed with TIPS in long-term follow-up; multiple reinterventions were required for shunt stenoses. TIPS served as a bridge to liver transplantation in one case.
World Journal of Surgery, 1991
Hepatic encephalopathy is a major complication of portal-systemic shunts with an incidence rangin... more Hepatic encephalopathy is a major complication of portal-systemic shunts with an incidence ranging up to 52%. A small fraction of these patients are refractory to medical therapy. Shunt ligation and colonic procedures are the main surgical approaches. The goal of the latter is to diminish the colonic absorption of nitrogenous substances which are involved in the pathophysiology of hepatic encephalopathy. Six patients, whose average age was 55.7 +/- 2.6 years, were operated for severe postshunt encephalopathy requiring 4.3 +/- 0.9 admissions for a total duration of 76 +/- 26 days over 1-11 years. One patient had undergone a splenoral shunt and 5 had a portacaval shunt. One ligation of the shunt and 5 colon exclusions were performed. The average postoperative hospital stay was 21.5 +/- 3.9 days. The mean follow-up was 47 +/- 20 months. The patient with the shunt ligation remains free of encephalopathy 94 months after the procedure and has not bled from his esophageal varices. Among the 5 colon exclusion patients, there were 1 death and 3 complications. Three patients were completely relieved of their hepatic encephalopathy. One of those 3 died of a subarachnoid hemorrhage 28 months after the surgery. The fourth still needs medication to control a persistent, although improved, encephalopathy that required 2 further hospitalizations. Colon exclusion is a useful intervention in very selected cases. It has a lower operative mortality than total colectomy and the advantage over shunt ligation of not reestablishing hypertension in the portal system.
Transplantation, 1986
A case of small intestinal allotransplantation is described. Cyclosporine and Solumedrol were use... more A case of small intestinal allotransplantation is described. Cyclosporine and Solumedrol were used for immunosuppression. A hemolytic episode occurred, caused by anti-A antibodies derived from graft lymphocytes. Sudden severe encephalopathy developed on the ninth postoperative day, followed by intractable hypotension and death. Hepatic and splenic microinfarcts were identified on postmortem examination. Allograft rejection was identified by serial stomal biopsies and correlated with a rise in monocyte procoagulant activity, a potentially useful serologic marker of rejection. The absence of an anatomic circuit for recycling of cyclosporine did not alter serum radioimmunoassay/high-performance liquid chromatography ratios.