Publications by authors named "M H Ktari"

14 Publications

Precision of the transpulmonary thermodilution measurements.

Crit Care 2011 Aug 27;15(4):R204. Epub 2011 Aug 27.

AP-HP, Hôpitaux Universitaires Paris-Sud, Service de Réanimation Médicale, Le Kremlin-Bicêtre F-94270, France.

Introduction: We wanted to determine the number of cold bolus injections that are necessary for achieving an acceptable level of precision for measuring cardiac index (CI), indexed global end-diastolic volume (GEDVi) and indexed extravascular lung water (EVLWi) by transpulmonary thermodilution.

Methods: We included 91 hemodynamically stable patients (age 59 (25% to 75% interquartile range: 39 to 79) years, simplified acute physiologic score (SAPS)II 59 (53 to 65), 56% under norepinephrine) who were monitored by a PiCCO2 device. We performed five successive cold saline (15 mL, 6 °C) injections and recorded the measurements of CI, GEDVi and EVLWi.

Results: Considering five boluses, the coefficient of variation (CV, calculated as standard deviation divided by the mean of the five measurements) was 7 (5 to 11)%, 7 (5 to 12)% and 7 (6 to 12)% for CI, GEDVi and EVLWi, respectively. If the results of two bolus injections were averaged, the precision (2 × CV/√ number of boluses) was 10 (7 to 15)%, 10 (7 to 17)% and 8 (7 to 14)% for CI, GEDVi and EVLWi, respectively. If the results of three bolus injections were averaged, the precision dropped below 10%, that is, the cut-off that is generally considered as acceptable (8 (6 to 12)%, 8 (6 to 14)% and 8 (7 to 14)% for CI, GEDVi and EVLWi, respectively). If two injections were performed, the least significant change, that is, the minimal change in value that could be trusted to be significant, was 14 (10 to 21)%, 14 (10 to 24)% and 14 (11 to 23)% for CI, GEDVi and EVLWi, respectively. If three injections were performed, the least significant change was 12 (8 to 17)%, 12 (8 to 19)% and 12 (9 to 19)% for CI, GEDVi and EVLWi, respectively, that is, below the 15% cut-off that is usually considered as clinically relevant.

Conclusions: These results support the injection of at least three cold boluses for obtaining an acceptable precision when transpulmonary thermodilution is used for measuring CI, GEDVi and EVLWi.
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http://dx.doi.org/10.1186/cc10421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387646PMC
August 2011

[Lymphoceles after renal transplantation: Study of risk factors].

Prog Urol 2010 Apr 12;20(4):301-6. Epub 2009 Jun 12.

Service d'urologie, hôpital Charles-Nicolle de Tunis, boulevard 9 Avril, 1008 Tunis, Tunisie.

Aim: To identify the risk factors of post renal transplant lymphocele.

Patients And Method: Over a period of 20 years (1986-2006) we carried out 377 renal transplants on 372 patients. Thirty cases of lymphocele were recorded (8%). The medical history of patients was retrospectively examined in order to identify the risk factors of this complication among the data relating to recipents, donors, the operation itself and post operative incidents. The different parameters liable to correlate with the incidence of lymphocele were subjected to a univaried then multivaried statistical study.

Results: Unifactorial analysis identified four predictive factors related to the incidence of lymphocele. They were the age of the recipient greater or equal to 35 years old, the cadaverous origin of the transplanted organ, the duration of ischemy greater or equal to 24hours for the kidneys of deceased donors, and immunosuppressor treatment associated with Mycophenolate mofetil-Cyclosporine. The only independent risk factor significant in multifactorial analysis was the cadaverous origin of the transplanted organ.

Conclusion: Our study showed that the cadaverous origin of the transplanted organ would appear to play an important role in the genesis of post renal transplant lymphocele. A better preparation of the organs of cadaverous origin before their implantation with meticulous ligature of the hilum of lymph nodes could reduce the incidence of this complication. This observation, as well as the benefit of such a procedure, remains to be confirmed by studies on a larger scale.
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http://dx.doi.org/10.1016/j.purol.2009.05.003DOI Listing
April 2010

A case of ureteral duplication in adult presenting with symptoms of bladder outlet obstruction.

Tunis Med 2008 Jul;86(7):707-9

Service d'Urologie, Hôpital Charles Nicolle, Tuni, Tunisia.

Background: Ureteral duplication is a rare congenital anomaly usually found in childhood. It manifests in various anatomic forms.

Aim: To report a case of a ureteral duplication in adult man and a review of the literature in attempt to categorize this rare entity.

Case: This report describes a case of a Y-type ureteral duplication presenting in a 30-y-old man with symptoms of bladder outlet obstruction.

Conclusion: Ureteral duplication is quite rare but a very distinct entity. It occurs exclusively in children and male adolescents. Its occurrence in adulthood imposes serious diagnostic and therapeutic difficulties.
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July 2008

[Association of benign prostatic hyperplasia and hernia inguinale. A report of 55 cas].

Tunis Med 2006 Dec;84(12):790-3

Service d'Urologie, l'Hôpital Militaire Principal d'Instruction de Tunis.

The Aim: of this study is to evaluate the results of combined surgery of prostatic disease and inguinal hernia repair.

Methods: We report a retrospective study of 55 patients operated in the same operating time for benign prostatic hyperplasia and hernia inguinale, and present our criteria for patient selection, operative technique, and postoperative results.

Results: The mean age of our patient was 69 years with a range of 56 to 85 years. Open suprapubic prostatectomy was done in 53% of cases, transurethral prostatic resection in 47% of cases and prothetic hernioplasty in 60% of cases. The incidence of postoperative wound infection and recurrent hernia was 5,4 % and 6% respectively, witch compares favorably to results of herniorraphy and prostatectomy performed separately. Simultaneous repair of inguinal hernias and surgery of prostatic disease is effective and technically feasible.
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December 2006
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