My own liver patients, written up and published
Twenty three people I treated in Beirut, my name first on the paper, including the ones that went badly. It is free to open and free to read.
23of my own liver patients, published
Is there a way to do this without an operation?
Often there is.
A radiologist who treats.
- No operation.
- Nothing is cut out.
- The organ stays where it is.
It is the whole of what I do.
Which one is yours?
Not one of mine? I will tell you that, and where to go.
A question costs you a message. Nothing is decided today.
23 of my own liver patients, written up and published. Cureus, 2020.
01Who I am
Where I learned this, and where I do it.
- I trained in radiology in New York, then in Pittsburgh, and came home.
- I teach it at the University of Balamand.
- I have published my own results, with my name first on the paper.
- Two hospitals in Beirut, one department, every week.
- One road runs to the problem.Everything else in there has its own.
- I close that one road.No cut, and no operation.
- The rest carries on.The organ stays where it is, and so does everything around it.
02The five
Find the one that is yours.
Fibroids and bleedingYou have been given a date, and they are taking the uterus with it.
They gave you a date. They told you the fibroid comes out and the uterus goes with it. You have had your children, so nobody expected you to mind.
Asking me costs you a message. You keep your date.
Your uterus stays where it is. So do the small ones, and that matters more than it sounds. Cut out the big fibroid and the small ones grow into its place. Closing the road closes it to all of them, on the same afternoon.
A woman called the programme with surgery booked in ten days, like yours, and asked me for something I had to refuse her. Watch me say no.
What it spares you
- No incision, and the uterus stays.
- Far less likely to need a transfusion, odds ratio 0.07.
- Shorter procedure, shorter stay, faster back to normal, in every study that measured it.
What it costs you
- Between 15 and 32 in every 100 need further surgery within two years, against about 7 after hysterectomy or myomectomy.
- At ten years, 35 in every 100 had had a hysterectomy anyway.
- At ten years, 78 in every 100 were satisfied or very satisfied, against 87 after hysterectomy.
An enlarged prostateUp three or four times a night, and there is a date in the diary for an operation.
You know the number. Three, some nights four. Nobody has asked you for it.
You agree to nothing by writing to me. Nothing is decided today.
Here is the thing most men are too polite to ask me, and I am not lowering my voice. Your friend is right about his own operation.
I was filmed explaining this one on television, and the segment sits on my hospital’s channel. Arab Hospital Magazine interviewed me about it in June 2023.
What it spares you
- No general anaesthetic. Nothing passed through the urethra. A day case.
- Ejaculatory problems are about half as likely, risk ratio 0.51. Erections are comparable either way.
What it costs you
- You are about three times more likely to need treating again, risk ratio 3.20.
- At five years the operation relieved more: symptom score down 11.6 points against 7.8, flow up 9.3 against 3.6.
- Only 18 of 48 men reached that five year visit, so the long term evidence is thinner than the confidence it is usually quoted with, on both sides.
The operation relieves more. This costs you less. Which trade is right is a conversation, not a web page.
Read all of it, in my words Ask me about the prostate on WhatsAppVaricoceleThe semen analysis that came back poor while you were trying. Or the ache that is gone by morning and back by evening.
A doctor pressed on your left side, asked you to cough, and said not to worry. Or a report came back with bad numbers and somebody said varicocele and operation in one breath.
You can write without deciding anything. Nobody is examined for asking.
If it is the ache: blood sitting where it should not, and when the vein is closed the evenings change first.
If you are the other man, you did not come about a sperm count. You came because it has been two years and something has finally been named. It is real, and I can close it. If it turns out this was not your answer, that does not mean there is no answer.
What I can show you is not about varicocele. I sat in an MTV studio taking live calls from strangers, on air, about their bodies. Whatever you type to me is less than that.
What it spares you
- Fewer complications overall, odds ratio 0.65. No general anaesthetic, no incision, home the same day.
- Hydrocele, the characteristic complication of the operation, is close to eliminated, odds ratio 0.19.
What it costs you
- It comes back more often, odds ratio 1.37. Surgical ligation is better at making it stay fixed.
Check it yourself, on PubMed
41137990It also works after a ligation that failed.
Read all of it, in my words Ask me about varicocele on WhatsAppLiver tumoursA scan found something, surgery is off the table, and everyone is asking you what happens now.
Somebody told your father his tumour cannot be cut out, then said a long word you wrote down, almost certainly radioembolization. That one is mine.
Writing to me books nothing. And no, livers are not a line on a list here. I published my own liver patients in 2020, twenty three of them, treated in Beirut, free to read tonight, including the ones that went badly.
Where it works best is narrow: one tumour, no bigger than about eight centimetres, still inside the liver. There, nearly nine of every ten shrank, and some of those people reached a surgery or a transplant they had been refused.
MTV Lebanon put me on air, live, and I explained this treatment to the country. You can watch me do it.
What it spares you
- Against drug treatment in advanced disease, severe side effects were far less common: 27.7 in every 100 against 50.6.
- Pooling all three trials, severe treatment related events ran at 28.9 in every 100 against 43.3.
What it costs you
- It did not extend life. Two trials measured survival against sorafenib and both were negative, 8.0 months against 9.9 and 8.8 against 10.0.
- In colorectal secondaries it improved control in the liver and response, and left overall survival unchanged at 14.0 months against 14.4, while severe events rose from 49.3 in every 100 to 68.4.
Not longer, but with fewer of the months spent ill. For a family deciding how a parent spends a year, that is not a small thing.
Read all of it, in my words Ask me about the liver on WhatsAppPelvic pain, and normal scansWorse by the evening, worse on your feet, and every scan normal. It has a name: pelvic congestion.
Heaviest by the evening, worst on the days you were on your feet, worse the week before your period. It does not show on a scan of your womb.
Writing to me starts nothing. You do not have to tell me six years to ask one question.
Your scans came back normal because a scan of the uterus is not a scan of the veins. They answer different questions, and nobody has asked yours. I look at the veins themselves. Either they are leaking or they are not. That is a finding, not an opinion.
Whatever happens, you leave with a scan of your own veins and an answer about them. That is the thing nobody has given you yet.
What it spares you
- Across 21 studies and 1 308 women, about 75 in every 100 had substantial early pain relief, which generally increased over time. Repeat procedures were uncommon and coils moved in under 2 in every 100.
What it costs you
- The same review says the quality of that evidence is low, and that the link between leaking pelvic veins and chronic pelvic pain has not been established.
Check it yourself, on PubMed
The review, on PubMedThe evidence here is not as strong as I would like. Most women in these studies got substantially better. The first thing I will do is take the pain seriously enough to scan for a cause.
Read all of it, in my words Ask me about pelvic pain on WhatsApp03Who this is not for
If you want to be pregnant, a myomectomy is probably the better operation.
The evidence points that way and it is not close enough to argue about. Live births were more likely after myomectomy, and quality of life at two years was better. If that is your situation, I will say so in the room and tell you who to see.
Pregnancy after embolization happens and is usually normal. Across 24 studies, 40.5 in every 100 women who wanted a pregnancy had at least one, and about a third of pregnancies were lost. That is not nothing, and it is not the first option if a baby is the point.
If the priority is the most symptom relief a prostate can get, the operation gives more. If a liver secondary is the problem and the question is time rather than control, this does not buy time.
04The day
Local anaesthetic, light sedation, and one day in hospital.
- 1
You are seen, scanned and discussed. For a liver tumour a board of radiologists, oncologists and surgeons decides before anything is booked, and I am one voice in that room rather than the only one.
- 2
On the day, a puncture at the wrist or the groin. Local anaesthetic and light sedation. You are not put under.
- 3
The catheter is steered to the vessel that feeds the problem, under live imaging, and that vessel is closed.
- 4
One day in hospital. No incision to heal and no stitch to remove.
- 5
Symptoms usually settle over about two weeks rather than overnight.
Ask me what your day would look like
Nothing is booked by asking.
05On record
Check me out here.
Written up
23
patients of mine in one paper, the ones that went badly included
Published
2020
in Cureus, free to open and free to read
In the catalogue
2006 & 2009
my name in the University of Balamand’s own one
On film
99 sec
my hospital’s own channel, and MTV Lebanon live
Filmed, and named on screen
Written down, and open to read
Teaching radiology at the University of Balamand
I am listed in the Department of Radiology in their catalogue for 2006, and again for 2009. Anyone can open it.
06Ask me
Tell me what is happening, in your own words.
- I will tell you whether it is one of mine.
- If it is not, I will tell you who to see.
- Asking for a parent? Send the scan report with it.
Hello Dr Yammine. I have been told I may need an operation and I would like to know whether this is something you treat.
It comes to my phone. I read it myself.
I read it myself, and I answer it myself.
Ask me on WhatsApp or call +961 3 936 343A question costs you a message. Nothing is decided today.
Where I see patients