Search PubMed⌕ Search

Biomedical subjects

D Maharaj

Publications and source records attributed to D Maharaj.

At least 19 recordsLinked to original sources
PubMed2005

The accuracy of urine dipsticks as a screening test for proteinuria in hypertensive disorders of pregnancy.

BACKGROUND: Proteinuria is used as a criterion in the classification system for hypertensive disorders of pregnancy including preeclampsia. The aim of the study was to evaluate the accuracy of dipstick urinalysis in a single voided urine sample and in an aliquot of a 24-hour urine collection in the assessment of proteinuria in hypertensive pregnant women, using the 24-hour urine protein excretion as the gold standard. METHODS: One hundred ninety-eight women who presented with hypertension in pregnancy were recruited at the antenatal clinic at King Edward VIII Hospital in Durban, South Africa, a tertiary referral center. Exclusion criteria included women with eclampsia, urinary tract infection, and chronic renal disease. Routine dipstick urinalysis (Bayer) was performed by midwives for proteinuria, and a 24-hour urine specimen was collected for quantitative protein assessment. A laboratory technician performed urine dipstick test for protein on a mixed aliquot of the 24-hour urine specimen. This result, together with that of the screening dipstick urinalysis, was compared to the 24-hour urine protein excretion. RESULTS: The results of the 198 patients were analyzed, of the total, 72 had preeclampsia. Using a value of = 0.3 g protein excretion per 24 hours (1 + to 4 + on urine dipsticks) as positive, sensitivity, specificity, and predictive values for dipstick urinalysis were calculated. The positive predictive value for dipstick urinalysis ranged from 64.9% (single voided urine sample) to 94.2% (24-hour urine aliquot). The negative predictive value ranged from 75.2% (single voided urine sample) to 84.2% (24-hour urine aliquot). CONCLUSION: Dipstick urinalysis is not very accurate: therefore, all women presenting with hypertension during pregnancy should have a 24-hour urine protein measurement.

Adult↗
PubMed2003

Autologous stem cell transplantation in multiple myeloma patients <60 vs >/=60 years of age.

The role of autologous stem cell transplantation (AuSCT) in older multiple myeloma patients is unclear. Using data from the Autologous Blood and Marrow Transplant Registry, we compared the outcome of 110 patients >/=the age of 60 (median 63; range 60-73) years, undergoing AuSCT with that of 382 patients <60 (median 52; range 30-59) years. The two groups were similar except that older patients had a higher beta(2)-microglobulin level at diagnosis (P=0.016) and fewer had lytic lesions (P=0.007). Day 100 mortality was 6% (95% confidence interval 4-9) and 1-year treatment-related mortality (TRM) was 9% (6-13) in patients <60 years, compared with 5% (2-10) and 8% (4-14), respectively, in patients >/=60 years. The relapse rate, progression-free survival (PFS) and overall survival (OS) in the two groups were also similar. Multivariate analysis of all patients identified only an interval from diagnosis to AuSCT >12 months and the use of two prior chemotherapy regimens within 6 months of AuSCT as adverse prognostic factors. Our results indicate that AuSCT can be safely performed in selected older patients: the best results were observed in patients undergoing AuSCT relatively early in their disease course.

Adult↗
PubMed2003

Open mini-access ureterolithotomy: the treatment of choice for the refractory ureteric stone?

OBJECTIVE: To report the experience in one centre of the efficacy and safety of open mini-access ureterolithotomy (MAU) and to discuss relevant current indications. PATIENTS AND METHODS: MAU was undertaken in 112 patients (mean age 38 years, range 26-57) between 1991 and 2001; the details and outcomes are reviewed. The mean (range) stone size was 12 (8-22) mm, with 30 stones in the upper, 69 in the mid- and 13 in the lower ureter. In 15 cases the stones were impacted and there were signs of infection in the proximal ureter. RESULTS: MAU was successful in 111 patients; the one failure was caused by proximal stone migration early in the series. The mean (range) operative duration was 28 (10-44) min and the hospital stay 42 (24-72) h; 33 patients were in hospital for 24 h, 72 for 48 h and seven for 72 h. The blood loss was minimal, at 50 (30-150) mL. The drain was removed after 5 (5-7) days. Patients reported using opioid or nonsteroidal anti-inflammatory analgesia for a mean of 4 (1-7) days after surgery. The mean time to resumption of work was 16 (8-35) days. CONCLUSIONS: MAU is a safe and reliable minimally invasive procedure; its role is mainly confined to salvage for failed first-line stone treatments but in selected cases, where a poor outcome can be predicted from other methods, it is an excellent first-line treatment.

Adult↗
PubMed2003

Late small bowel obstruction after blunt abdominal trauma.

Blunt abdominal trauma with intraperitoneal injury usually presents acutely. On rare occasions, such patients can present later on with features of small bowel obstruction due to stricture formation. It is thought that such a delayed stricture is due to subclinical bowel perforation, localised gut ischaemia, or injury to the mesenteric vasculature. This case demonstrates the mesenteric vascular injury theory to be the cause of the bowel stricture.

Abdominal Injuries↗
PubMed2003

Delayed repair of a fractured penis: a new technique.

Fracture of the penis can be managed conservatively or surgically. Conservative management is associated with a high morbidity, and early surgical repair of the fracture is usually recommended in order to prevent complications. Because a fractured penis is swollen throughout its length, it is difficult to identify the fracture site accurately, so a degloving technique is usually used to locate and repair the torn corpus cavernosum; this can lead to further trauma and complications. In cases where extensive swelling makes accurate clinical localisation difficult, delaying the repair for 7-12 days facilitates easy identification and repair of the torn corpus cavernosum. We report three cases where treatment was delayed until the swelling had subsided, when a simple direct repair was successfully carried out.

Adult↗
PubMed2003

The tinkle tale.

The clinical features of urinary calculi are well documented. Several textbooks state the features of passage of a stone per urethra including severe dysuria, straining and strangury. We report on three patients in whom attention was drawn to the passage of a stone by the sound made as the stone hit the bedpan during urination.

Adult↗
PubMed2002

McBurney's point: are we missing it?

A prospective study of 100 post-evacuation barium enemas was done. Films were centered at McBurney's point, with an opaque skin marker at that point. Analysis of these revealed that in only one case (1%) was the base of the appendix at McBurney's point. In 67% it was cephalic and in 32% it was caudal to this point. The limitations of McBurney's point as an anatomical landmark should be recognized. This needs to be highlighted in teaching anatomy, especially to surgical trainees. Planning and choice of surgical incisions should be based on an understanding of these anatomical variations since McBurney's original description was clinical rather than anatomical.

Adolescent↗
PubMed2002

Obturator hernia repair--a new technique.

Obturator hernia is a rare condition with few reports in the world literature. There appears to be no consensus on the ideal approach and repair for such a condition. We report a simple, quick technique via a lower midline incision using an autogenous peritoneal fold. It is ideal for the contaminated case and in settings where mesh is not readily available.

Aged↗
PubMed2002

Symphysiotomy and fetal destructive operations.

Symphysiotomy and fetal destructive operations - while rarely, if ever, performed in developed countries - are an option in developing nations of the world. Problems endemic to developing countries not infrequently predispose to patients arriving at health care facilities in a moribund state with neglected labour. The health care provider then has to decide on the options available to him to deliver the mother by the safest route without incurring morbidity and mortality. Under the circumstances, the outcome for the baby will depend on factors prevalent at the time. If the fetus is alive, then the choice is between a Caesarean section and symphysiotomy, and if the fetus has died, a destructive procedure is an option to abdominal-route delivery which carries considerable risk to the mother. The following review outlines the role of symphysiotomy and fetal destructive operations and their role in modern obstetrics.

Cesarean Section↗
PubMed2002

Closure of traumatic wounds without cleaning and suturing.

BACKGROUND: In less than ideal situations wounds have to be closed without extensive cleaning using sterile adhesive strips (Steristrips). This prospective analyses the efficiency of this technique and compares it to the more conventional approach. METHODS: Altogether 147 lacerations were closed with sterile strips with no wound cleaning. Patients were subsequently followed up for a minimum of three months. RESULTS: The sepsis rate in compliant patients was 1.4% with a total complication rate of 2.7%. CONCLUSION: This technique, while contradicting the "sacred tenets" of wound closure, is a cheap, quick, and effective alternative to routine closure of traumatic wounds in a casualty department.

Adolescent↗
PubMed2002

Rectus sheath haematoma: a new set of diagnostic features.

Rectus muscle haematoma is a well documented clinical entity, but its diagnosis remains elusive. A haematoma within the rectus sheath produces a painful, tender swelling that can mimic an intraperitoneal mass with features of an acute abdomen. Two patients with rectus haematomas presenting after bouts of prolonged coughing are reported. In both cases, clinical features and ultrasound findings suggested the presence of intraperitoneal pathology. However, in both cases consistent findings in the history and examination pointed towards the diagnosis of a rectus haematoma. It is proposed that these simple clinical criteria are diagnostic of a rectus sheath haematoma, and can thereby avert an unnecessary laparotomy.

Aged↗
PubMed2002

Slow decompression of the bladder using an intravenous giving set.

Rapid decompression of the bladder has been associated with complications such as diuresis, hyperkalaemia, haematuria and hypotension. Although these complications are easily managed and rarely clinically significant, clinicians still practise slow decompression using a 'clamping' technique. Slow decompression using a giving set provides a more convenient and less time-consuming way of achieving this goal.

Acute Disease↗
PubMed2001

Peritoneal encapsulation: a preoperative diagnosis is possible.

Peritoneal encapsulation is an exceedingly rare developmental abnormality in which the small intestine is encased in an accessory peritoneal sac between the omentum and mesocolon. Two clinical signs associated with the dense fibrous layer encapsulating the intestine are described. The first is a fixed, asymmetrical distension of the abdomen, which does not vary with peristaltic activity due to the unvarying position of the fibrous capsule. The second is the difference in the consistency of the abdominal wall to palpation. The flat area is firm, due to the dense fibrous capsule and the distended area soft, due to the thin walled distended small intestine with no overlying fibrous layer.

Diagnosis, Differential↗