Le Journal medical libanais. The Lebanese medical journal, 2004
Pulmonary Langerhans'cell histiocytosis belongs to the spectrum of the Langerhans'cell hi... more Pulmonary Langerhans'cell histiocytosis belongs to the spectrum of the Langerhans'cell histiocytosis. The common point is tissue infiltration by Langerhans' cell granuloma. But the pulmonary type occurs predominantly in young adults and is associated with tobacco. The most frequently encountered symptoms are cough and dyspnea. Twenty-five to 35% of the cases are incidental findings. 20% of cases present with extra-thoracic lesions including skin, bone and hypothalamo-pituitary axis. On scanning images the lung parenchyma is infiltrated at the beginning by stellar nodules of less than 10 mm, which evolve either gradually to form cysts or towards remission, spontaneous or induced by the treatment. With pulmonary function testing, the two types of anomalies (obstruction and restriction) are observed. The reduction in diffusing capacity observed in 60 to 90% of the cases reflects the pulmonary vascular involvement. Detection of more than 5% of CD-1a cells in bronchioloalveol...
Le Journal medical libanais. The Lebanese medical journal, 2002
Throughout a 2-year period, children who presented at Hôtel-Dieu de France emergency department (... more Throughout a 2-year period, children who presented at Hôtel-Dieu de France emergency department (ED) with acute asthma were analyzed prospectively and data on their environment, family and personal history as well as treatment were recorded. Treatment delivered at the ED, response and further outcome were analyzed. Out of 2024 children aged less than 15 years, 96 (5%) had acute asthma attack. Their median age was 4 years and M/F ratio was 2:1. Median age at onset of asthma was 2 years. Only 66 patients were recognized as asthmatics and 20% were given regular inhaled daily treatment. Current attack was mild in 45%, moderate in 45% and severe in 10% of cases. Home treatment before ED admission was often inadequate. Nine patients required hospital admission after failure of treatment at the ED. Within a median follow-up of 12 months, half of the patients experienced further attacks sometimes requiring ED care (27%) or hospital admission (8%). These data highlight the fact that asthma i...
Le Journal medical libanais. The Lebanese medical journal, 2002
Gastroesophageal reflux (GER) is a common situation that can express with digestive, extra-digest... more Gastroesophageal reflux (GER) is a common situation that can express with digestive, extra-digestive, respiratory or otolaryngologic symptoms. Some chronic pulmonary disorders include in their setting GER as well. This review will address pathogenesis, clinical signs, complications and treatment of GER with a special focus towards the pulmonologist field. GER is a physiological post-prandial phenomenon of limited duration. It is induced by transient lower esophageal sphincter relaxation (tLESR) or by factors that impede LES function by reducing its tone or disrupting its contractions. Extra-digestive symptoms are caused by vagal stimulation through common autonomic pathways to the esophagus and bronchi. This reflex is triggered by gastric acid stimulation of esophageal receptors and by acid micro-aspirations into the airways. The responsibility of GER towards respiratory symptoms is often difficult to attest despite thorough investigations. Results of one to three-month treatment tr...
An 81-year-old non smoking patient is admitted with cough, fever and poor general status. The rad... more An 81-year-old non smoking patient is admitted with cough, fever and poor general status. The radiologic evaluation reveals a right parahilar mass, and trans-bronchic biopsy confirms its tumoral nature. Immunohistochemical analysis establishes the diagnosis of high grade primary pulmonary lymphoma. The rare nature of this disease, its non-specific clinical presentation and particular prognosis are discussed in this article.
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ, 2012
Waterpipe smoking and its association with chronic bronchitis has not been assessed in Lebanon. T... more Waterpipe smoking and its association with chronic bronchitis has not been assessed in Lebanon. This case-control study in Beirut in 2009/2010 evaluated this relationship: 274 cases of chronic bronchitis and 559 controls without the condition aged > or = 40 years were enrolled. Data were collected by questionnaire on: sociodemographic characteristics, respiratory symptoms, smoking (waterpipe and cigarette) and nicotine dependence. ANOVA, Student, Kruskal-Wallis, chi-squared and Fisher exact tests were used when applicable and logistic regression analysis was carried out. Previous waterpipe smoking (OR = 6.4), previous mixed smoking (OR = 38.03) and current mixed smoking (OR = 7.68) were significantly associated with chronic bronchitis (P < 0.001 for all) but current exclusive waterpipe smokingwas not (OR = 1.87, 95% CI: 0.74-4.72). Current waterpipe dependence was significantly associated with chronic bronchitis (OR = 3.74, P < 0.001). After adjustment for covariates/confou...
No standardized sedation protocol is available for flexible bronchoscopy (FB). The aim of this st... more No standardized sedation protocol is available for flexible bronchoscopy (FB). The aim of this study was to evaluate the efficacy and safety of three regimens used for sedation during FB. This randomized double-blind controlled trial assessed patients undergoing bronchoscopy and receiving lidocaine alone (C) or combined with dexmedetomidine (D) or alfentanil (A). Tolerance was assessed using the bronchoscopy score, and level of sedation was assessed using the Nursing Instrument for the Communication of Sedation. Safety was evaluated in terms of pulmonary function and vital signs. A total of 162 patients were enrolled. The bronchoscopy score was identical in all groups. Group D subjects were the most sedated (P = .013), whereas group A subjects were the least agitated. Linear regression showed a negative association between bronchoscopy score and age in A (β = -0.06; P = .001). Positive predictors of bronchoscopy score were female gender (β = 1.96; P = .003) in D and obesity (β = 2.4...
Percutaneous endoscopic gastro-jejunostomy is appropriate for patients with severe neurologic def... more Percutaneous endoscopic gastro-jejunostomy is appropriate for patients with severe neurologic deficit to avoid repeated tube feeding-related aspiration. We describe a modified technique of endoscopic gastro-duodenostomy. This technique was performed in 9 patients with severe neurologic deficit. No fluoroscopy was necessary. The gastrostomy button was pushed across the pylorus into the bulb; a nasogastric tube was then placed in the duodenum under endoscopic control and the button was drawn to the gastric wall. When the gastroduodenal tube migrated or was occluded, the button was placed in the bulb through the pylorus and maintained in this position for alimentation. Placement of the gastro-duodenostomy tube was successful without any complication in 100% of patients. The mean duration of the procedure was 15 min. The tube had to be removed for migration (N = 4) and occlusion (N = 5) after a mean period of 5.8 weeks (range: 2-10). During the follow-up period, no tube feeding-related aspiration was observed. This modified low-cost technique of endoscopic gastro-duodenostomy is simple and efficient.
Le Journal medical libanais. The Lebanese medical journal, 2004
Pulmonary Langerhans'cell histiocytosis belongs to the spectrum of the Langerhans'cell hi... more Pulmonary Langerhans'cell histiocytosis belongs to the spectrum of the Langerhans'cell histiocytosis. The common point is tissue infiltration by Langerhans' cell granuloma. But the pulmonary type occurs predominantly in young adults and is associated with tobacco. The most frequently encountered symptoms are cough and dyspnea. Twenty-five to 35% of the cases are incidental findings. 20% of cases present with extra-thoracic lesions including skin, bone and hypothalamo-pituitary axis. On scanning images the lung parenchyma is infiltrated at the beginning by stellar nodules of less than 10 mm, which evolve either gradually to form cysts or towards remission, spontaneous or induced by the treatment. With pulmonary function testing, the two types of anomalies (obstruction and restriction) are observed. The reduction in diffusing capacity observed in 60 to 90% of the cases reflects the pulmonary vascular involvement. Detection of more than 5% of CD-1a cells in bronchioloalveol...
Le Journal medical libanais. The Lebanese medical journal, 2002
Throughout a 2-year period, children who presented at Hôtel-Dieu de France emergency department (... more Throughout a 2-year period, children who presented at Hôtel-Dieu de France emergency department (ED) with acute asthma were analyzed prospectively and data on their environment, family and personal history as well as treatment were recorded. Treatment delivered at the ED, response and further outcome were analyzed. Out of 2024 children aged less than 15 years, 96 (5%) had acute asthma attack. Their median age was 4 years and M/F ratio was 2:1. Median age at onset of asthma was 2 years. Only 66 patients were recognized as asthmatics and 20% were given regular inhaled daily treatment. Current attack was mild in 45%, moderate in 45% and severe in 10% of cases. Home treatment before ED admission was often inadequate. Nine patients required hospital admission after failure of treatment at the ED. Within a median follow-up of 12 months, half of the patients experienced further attacks sometimes requiring ED care (27%) or hospital admission (8%). These data highlight the fact that asthma i...
Le Journal medical libanais. The Lebanese medical journal, 2002
Gastroesophageal reflux (GER) is a common situation that can express with digestive, extra-digest... more Gastroesophageal reflux (GER) is a common situation that can express with digestive, extra-digestive, respiratory or otolaryngologic symptoms. Some chronic pulmonary disorders include in their setting GER as well. This review will address pathogenesis, clinical signs, complications and treatment of GER with a special focus towards the pulmonologist field. GER is a physiological post-prandial phenomenon of limited duration. It is induced by transient lower esophageal sphincter relaxation (tLESR) or by factors that impede LES function by reducing its tone or disrupting its contractions. Extra-digestive symptoms are caused by vagal stimulation through common autonomic pathways to the esophagus and bronchi. This reflex is triggered by gastric acid stimulation of esophageal receptors and by acid micro-aspirations into the airways. The responsibility of GER towards respiratory symptoms is often difficult to attest despite thorough investigations. Results of one to three-month treatment tr...
An 81-year-old non smoking patient is admitted with cough, fever and poor general status. The rad... more An 81-year-old non smoking patient is admitted with cough, fever and poor general status. The radiologic evaluation reveals a right parahilar mass, and trans-bronchic biopsy confirms its tumoral nature. Immunohistochemical analysis establishes the diagnosis of high grade primary pulmonary lymphoma. The rare nature of this disease, its non-specific clinical presentation and particular prognosis are discussed in this article.
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ, 2012
Waterpipe smoking and its association with chronic bronchitis has not been assessed in Lebanon. T... more Waterpipe smoking and its association with chronic bronchitis has not been assessed in Lebanon. This case-control study in Beirut in 2009/2010 evaluated this relationship: 274 cases of chronic bronchitis and 559 controls without the condition aged > or = 40 years were enrolled. Data were collected by questionnaire on: sociodemographic characteristics, respiratory symptoms, smoking (waterpipe and cigarette) and nicotine dependence. ANOVA, Student, Kruskal-Wallis, chi-squared and Fisher exact tests were used when applicable and logistic regression analysis was carried out. Previous waterpipe smoking (OR = 6.4), previous mixed smoking (OR = 38.03) and current mixed smoking (OR = 7.68) were significantly associated with chronic bronchitis (P < 0.001 for all) but current exclusive waterpipe smokingwas not (OR = 1.87, 95% CI: 0.74-4.72). Current waterpipe dependence was significantly associated with chronic bronchitis (OR = 3.74, P < 0.001). After adjustment for covariates/confou...
No standardized sedation protocol is available for flexible bronchoscopy (FB). The aim of this st... more No standardized sedation protocol is available for flexible bronchoscopy (FB). The aim of this study was to evaluate the efficacy and safety of three regimens used for sedation during FB. This randomized double-blind controlled trial assessed patients undergoing bronchoscopy and receiving lidocaine alone (C) or combined with dexmedetomidine (D) or alfentanil (A). Tolerance was assessed using the bronchoscopy score, and level of sedation was assessed using the Nursing Instrument for the Communication of Sedation. Safety was evaluated in terms of pulmonary function and vital signs. A total of 162 patients were enrolled. The bronchoscopy score was identical in all groups. Group D subjects were the most sedated (P = .013), whereas group A subjects were the least agitated. Linear regression showed a negative association between bronchoscopy score and age in A (β = -0.06; P = .001). Positive predictors of bronchoscopy score were female gender (β = 1.96; P = .003) in D and obesity (β = 2.4...
Percutaneous endoscopic gastro-jejunostomy is appropriate for patients with severe neurologic def... more Percutaneous endoscopic gastro-jejunostomy is appropriate for patients with severe neurologic deficit to avoid repeated tube feeding-related aspiration. We describe a modified technique of endoscopic gastro-duodenostomy. This technique was performed in 9 patients with severe neurologic deficit. No fluoroscopy was necessary. The gastrostomy button was pushed across the pylorus into the bulb; a nasogastric tube was then placed in the duodenum under endoscopic control and the button was drawn to the gastric wall. When the gastroduodenal tube migrated or was occluded, the button was placed in the bulb through the pylorus and maintained in this position for alimentation. Placement of the gastro-duodenostomy tube was successful without any complication in 100% of patients. The mean duration of the procedure was 15 min. The tube had to be removed for migration (N = 4) and occlusion (N = 5) after a mean period of 5.8 weeks (range: 2-10). During the follow-up period, no tube feeding-related aspiration was observed. This modified low-cost technique of endoscopic gastro-duodenostomy is simple and efficient.
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Papers by Georges Khayat