George Saad

Metastasis of colorectal carcinoma to the testes: clinical presentation and possible pathways.

Distant metastasis from colorectal carcinoma most often occurs in the liver and lungs. Metastasis to bones, adrenals, lymph nodes, brain, and skin has also been reported. Metastatic colorectal carcinoma to the testes is very uncommon. Even more uncommon is testicular metastasis from rectal carcinoma. Researchers throughout the last few decades have not acquired a clear understanding of the lymphatic pathways involved in reported cases of testicular metastasis from primary colorectal carcinoma. These cases may present with testicular complaints after or even before the diagnosis of colorectal cancer; this is why it is crucial to differentiate between primary testicular tumor and a secondary one from a colorectal primary. We searched the English medical literature using the MEDLINE/PUBMED database from 1950 through January 2010. Our search yielded 33 cases of testicular metastasis from rectal or colonic carcinoma. These cases are reviewed and summarized. This paper reviews the literature for all cases of testicular metastasis from colonic and rectal adenocarcinomas shedding light on the possible pathways of metastasis. We recommend that physicians be aware of the risk of metastasis from the colorectal region to the testis in their evaluation of patients with testicular symptoms in the setting of colorectal carcinoma.

Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy.

Objective:To evaluate 30-day postoperative outcomes in laparoscopic (LS) versus open splenectomy (OS). Summary Background Data:LS has generally been associated with lower rates of postoperative complications than OS. However, evidence mainly comes from small studies that failed to adjust for the confounding effects of the underlying indication or clinical condition that may have favored the use of one technique over the other. Methods:A retrospective cohort study of patients undergoing splenectomy in 2008 and 2009 using data from the American College of Surgeons National Surgical Quality Improvement Program database (n = 1781). Retrieved data included 30-day mortality and morbidity (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thromboembolism, and major bleeding outcomes), demographics, indication, and preoperative risk factors. We used multivariate logistic regression to assess the adjusted effect of the splenectomy technique on outcomes. Results:A total of 874 (49.1%) cases had LS and 907 (50.9%) had OS. After adjusting for all potential confounders including the indication and preoperative risk factors, LS was associated with decreased 30-day mortality [OR (odds ratio): 0.39, 95% CI: 0.18–0.84] and postoperative respiratory occurrences (OR: 0.46, 95% CI: 0.27–0.76), wound occurrences (OR: 0.37, 95% CI: 0.11–0.79), and sepsis (OR: 0.52, 95% CI: 0.26–0.89) when compared with OS. Patients who underwent LS also had a significantly shorter total length of hospital stay and were less likely to receive intraoperative transfusions compared with patients who underwent OS. Conclusions:LS is associated with more favorable postoperative outcomes than OS, irrespective of the indication for splenectomy or the patients clinical status.

Laparoscopic repair of a left paraduodenal hernia presenting with acute bowel obstruction: report of a case.

An internal hernia is any protrusion of a solid organ or a hollow viscus through a defect within the abdominal cavity. Paraduodenal hernias (PDHs) are rare; however, they are the most common form of internal hernias. We present a case of a left PDH in a 59-year-old healthy woman who presented with acute bowel obstruction. The PDH was diagnosed preoperatively using computed tomography scan. Laparoscopic exploration of the abdomen was then performed for reduction of the hernia. Using this approach, we managed to close the defect with intracorporeal continuous suturing with the aim of avoiding future incarceration. The patient was discharged 60 hours postoperation in a good condition, compared with 3 to 28 days postoperation reported in most of the literature. Our search of the english language literature revealed only 16 reported cases of laparoscopic repair of PDH. We believe that laparoscopic treatment of PDH in experienced hands is recommended in selected cases as it decreases the morbidity and significantly shortens the hospital stay.

Clinicopathologic and immunohistochemical characteristics of male breast cancer: a single center experience.

Abstract:  Male breast cancer (MaleBC) is a rare tumor that has been insufficiently described in the Middle East. The purpose of this study is to report the first MaleBC series in Lebanon, describing its clinicopathologic and immunohistochemical phenotype, and how it compares with MaleBC in the West and with female breast cancer in Lebanon and the Middle East. Forty‐seven cases of MaleBC were reviewed. Results showed younger ages at presentation (62 years versus 67 years), higher incidence of lobular carcinoma (6% versus 1%), and more frequent p53 positivity and axillary node metastases in our series than in those reported about MaleBC. Other results such as higher estrogen receptor (ER) positivity and lower HER‐2/neu over‐expression were comparable to the literature. These findings suggest that MaleBC in our region may represent a biologically different tumor with potentially distinct prognostic and therapeutic implications.

An FEM-predictive tool for simulating the cooling characteristics of freshly paved asphalt concrete layers

Accurate simulation of the cooling characteristics of newly paved asphalt concrete (AC) layers is of particular significance due to its potential use in efficient planning and scheduling of paving works. This study builds on principles of thermodynamics and heat transfer to develop a finite element framework that simulates the actual cooling of newly paved AC layers. For a given set of climatic conditions, such as wind, solar flux and air temperature, the presented model incorporates the effects of conduction, convection and radiation to predict the cooling rates of the pavement. The model is first validated using data acquired from laboratory and field set-ups. Then, the model is used to assess the effect of critical parameters such as layer thickness, time of paving, and material properties on asphalt cooling rates and their impact on paving operations.

Distinctive Presentation of a Diaphragmatic Hernia 15 Years After A Traumatic Insult

Diaphragmatic hernias are well-known sequelae of abdominal and chest wall trauma. However, they may go undiagnosed in the acute setting but present later due to gastrointestinal or respiratory complications. A distinctive presentation of a diaphragmatic hernia 15 years after a traumatic insult is herein described. Management strategies are also discussed.

SENSOR PLACEMENT OPTIMIZATION USING ENSEMBLE KALMAN FILTER AND GENETIC ALGORITHM

A robust methodology is proposed in this study for determining the optimal locations of sensors in a structure to extract the most informative measurement data for the purpose of parameter estimations. First, the Ensemble Kalman Filter (EnKF) is used as a history matching method to predict and update the state and model parameters of the system. Then, a Genetic Algorithm (GA) approach is applied to determine the best locations of the sensors in the system through a minimization procedure, where the objective function to be minimized is represented by the mismatch between the predicted values and the actual measurements. The robustness and efficiency of the proposed method are demonstrated by developing the optimal sensor configuration for a shear building subjected to El Centro earthquake excitation at its base and using synthetic measurements of displacements and velocities of different floors.

Solitary hydatid cyst of the thigh: a challenging diagnosis.

A 53-year-old woman presented with an enlarging mass in the medial aspect of her right thigh. Magnetic resonance imaging suggested an intramuscular hydatid cyst. The cyst was surgically excised. Although muscular hydatidinosis is rare, its resemblance to soft tissue tumors warrants careful diagnosis since any invasive diagnostic measures may lead to fatal complications.

A Stochastic Approach for Optimal Sequencing of Appraisal Wells

The life of a hydrocarbon field can be distinguished by five main stages: exploration, appraisal, development, production, and abandonment. Of particular interest is the appraisal stage, where the use of seismic data in combination with appraisal wells permits the estimation of the initial hydrocarbons in place and the quantification of the associated uncertainties. Because of both the high prices of appraisal-well drilling and the opportunity of maximizing uncertainty reduction during the appraisal stage, optimizing on this stage makes it the biggest setting for maximizing project profitability. Nonetheless, with billions of dollars spent on appraisal activities, limited resources are spent on assessing the value of the gathered information.

Retrovesical hydatid cyst presenting with urinary retention and left kidney atrophy.

Hydatid disease of the urinary tract is uncommon, accounting for only 2-3% of cases. There are very few reported cases in the literature of pelvic hydatid cysts causing obstructive uropathy and renal failure. We report a case of pelvic hydatid cyst in a patient presenting with urinary retention and secondary complete atrophy of one kidney. The patient was treated with surgical excision of this large retrovesical cyst, along with a simple left nephroureterectomy, with rapid improvement of symptoms. Hydatid disease should be taken into consideration in the differential diagnosis of a cystic mass in any anatomic localization, especially in patients from endemic areas.