Search PubMed⌕ Search

Biomedical subjects

R Saadia

Publications and source records attributed to R Saadia.

At least 19 recordsLinked to original sources
PubMed2002

The ArtAssist Device in chronic lower limb ischemia. A pilot study.

BACKGROUND: Patients with chronic critical limb ischemia following a failed bypass graft or with non-reconstructable distal disease diagnosed angiographically, have a very poor prognosis. This is a prospective pilot study to assess the influence of the ArtAssist Device on pedal blood flow and amputation rate. METHODS: Thirty-three legs in 25 patients were evaluated. Ten legs presented with rest pain, and 23 legs with tissue loss. Nine legs had previously undergone bypass surgery. RESULTS: At a mean follow-up of 3 months, 14 (42%) legs were amputated, and 19 (58%) were saved. Eleven of the amputated legs were in patients with chronic renal failure, a known risk factor. The amputation rate, excluding this group, was 13.6% (3/22). Toe pressures measured initially and after 3 months on the pump showed a significant improvement (p=0.03). Forty percent of patients presenting with rest pain improved, while 26% of foot ulcers healed on the pump. Mortality rate was 12%. CONCLUSIONS: The results from this prospective study are encouraging but need to be validated in a larger prospective randomized study.

Aged↗
PubMed2001

Gunshot injuries of the extrahepatic biliary ducts.

OBJECTIVE: To assess our management of gunshot injuries of the extrahepatic biliary ducts. DESIGN: Retrospective study. SETTING: Urban teaching hospital, South Africa. SUBJECTS: 17 patients who were found to have gunshot injuries of the extrahepatic bile ducts, January 1993-June 1998. INTERVENTIONS: Packing and damage control, staged repair, or definitive repair. MAIN OUTCOME MEASURES: Morbidity and mortality: Three of the 17 died intraoperatively or postoperatively from causes unrelated to the biliary injury. Of the 14 survivors, 3 were managed initially with packing and damage control, 7 by staged repair, and 4 by definitive biliary repair. Eleven patients had a Roux-en-Y biliary jejunostomy, of whom 1 developed a late biliary stricture related to a postoperative anastomotic leak. End-to-end anastomosis of the bile duct was done for 2 patients and they both developed late biliary strictures. Ligation of the injured duct and cholecystojejunostomy was done for I patient. CONCLUSION: Roux-en-Y biliary-jejunal anastomosis is appropriate in the treatment of gunshot injuries of the extrahepatic biliary ducts as there is always a degree of tissue loss and some debridement is required, making it difficult to do a tension-free anastomosis.

Adult↗
PubMed2000

Débridement of gunshot wounds: semantics and surgery.

Débridement is a well established modality for management of gunshot wounds. The word "débridement" is originally French. It was used for the first time during the eighteenth century in the surgical context and meant "wound incision." For French surgeons, it has retained to this day its original meaning. In medical English, though, the use of the term has been marred by persisting confusion about its definition. Two quite different surgical procedures still compete for the definition of débridement: wound incision and wound excision. These procedures are also at the center of a modern controversy about the management of gunshot wounds. The orthodox doctrine, inherited from military surgeons, consists of aggressive tissue excision around the bullet track. This radical policy is being challenged by advocates of a more conservative approach. Minimal tissue excision is sufficient and safe in many cases provided careful monitoring of the wound is instituted. Wound incision alone to relieve tension and allow drainage is possible in certain cases. The tug-of-war between excision and incision is outlined herein with reference to the semantic tribulations of the word "débridement" and the implications for patient care.

Debridement↗
PubMed2000

Non-operative treatment of abdominal gunshot injuries.

BACKGROUND: Non-operative treatment is a management option that challenges the traditional mandatory laparotomy for abdominal gunshot injuries. METHODS: All published relevant clinical reports were retrieved by searching through the Medline database and manually. The theoretical arguments in favour of non-operative management as well as the results of the reviewed reports are analysed and evaluated. RESULTS AND CONCLUSION: Patients with proven non-penetration of the abdominal cavity can be offered conservative treatment with a satisfactory outcome. Greater caution should be exercised in the presence of a documented visceral injury until the safety of this option has been established by further clinical trials.

Abdominal Injuries↗
PubMed2000

Transmediastinal gunshot injuries.

BACKGROUND: Transmediastinal gunshot injuries are a rarely reported injury. Until recently, assessment of the thoracic aorta by angiography preceded the investigation of the esophagus. This order has been recently debated. METHODS: There were 118 patients with potential transmediastinal injuries included in this retrospective study. Unstable patients who were unresponsive to resuscitation were taken to the operating room without previous investigation. Stable patients were routinely investigated initially for injury of the aorta and then for injury of the esophagus. RESULTS: There were 51 patients who underwent urgent thoracotomy/sternotomy. In 27, the hemorrhage was of mediastinal origin; 17 of these patients died of intraoperative bleeding. Eight of the patients had aortic injury, and only one of this group survived. There were 57 stable patients who were investigated initially for injury of the aorta by angiography. It was positive in only one patient who underwent an operation with good results. An investigation of the esophagus followed and revealed esophageal injury in 17 patients. All of them were treated operatively, 15 of them with satisfactory outcome. CONCLUSIONS: Angiography should at present precede esophageal investigations. There is a need for shortening the time between admission and operation. Other modalities that could expedite the investigation of the thoracic aorta and the esophagus should be prospectively evaluated in multi-center studies.

Adolescent↗
PubMed1999

Multiple organ failure. How valid is the "two hit" model?

Inflammatory "one hit" and "two hit" models have recently been proposed to account for the development of multiple organ failure (MOF) in trauma and critically ill surgical patients when no source of infection can be found. In the "one hit" model, the initial insult is so massive that a systemic inflammatory response syndrome is triggered and leads rapidly to MOF. In the "two hit" scenario, initially less severely injured patients eventually develop MOF as a result of a reactivation of their inflammatory response caused by an adverse and often minor intercurrent event. At first sight, the theory is attractive because it seems to fit commonly observed clinical patterns. Indeed, injured patients often respond to initial resuscitation but, after an insult of some sort, develop organ dysfunction and die. The "two hit" model is furthermore mirrored at the cellular level. Inflammatory cells are indeed susceptible of being primed by an initial stimulus and reactivated subsequently by a relatively innocuous insult. However, in the absence of clinical and biological corroboration based on cytokine secretion patterns, these models should not be accepted uncritically.

Animals↗
PubMed1999

Organisation of hospital responses for the trauma epidemic.

The caseload of the Department of Surgery (Baragwanath Hospital, Johannesburg, South Africa) is characterised by a singularly heavy trauma component. Penetrating injuries account for the majority of cases. The management of penetrating trauma is not as demanding as that of blunt trauma, yet the sheer number of cases, over the past four decades, has imposed a clinical burden that has never been met by commensurate resources. The organisation of the hospital and departmental responses has manifested itself on two different levels. The first one is the structural and functional deployment of insufficient staff, facilities and equipment to cope as flexibly as possible with the trauma epidemic. The second one is the gradual adaptation of the clinical management philosophy to ensure that the best possible quality of care is provided to the majority of trauma victims, with the full knowledge that better resources would sometimes have elicited a different clinical approach.

Hospitals, University↗
PubMed1999

Controversies in management of penetrating injuries of the pancreas.

The management of penetrating pancreatic injuries is still beset by controversy, especially with regard to the role of pancreatography, the most appropriate operation, the type of drainage and the adjunctive role of ocreotide. The recommendations of various experts are outlined and evaluated in the light of the authors' personal experience. Consensus is easily achieved for very minor and very severe injuries. Most management discussions center around those injuries resulting in parenchymal disruption of a degree of severity sufficient to raise doubts about the integrity of the main pancreatic duct.

Drainage↗
PubMed1998

Good clinical research practice: what is it and is it possible in the intensive care unit?

With the growing quest for answers to vexing dilemmas in critically ill patients, more intensive care units are embarking on clinical research. This places increasing importance on Good Clinical Research Practice (GCRP), a set of guidelines drawn up by the Pharmaceutical Industry to assist investigators in conducting ethical, reliable scientific studies. GCRP is a combination of good basic management skills allied to ethical principles for scientific research. Based on the principles of the Declaration of Helsinki, it consists of three tenets: patient protection (ethics), credible data (science) and data control. This article describes GCRP specifically relating it to the intensive care situation, illustrating some of the concepts with practical examples. With a minimum of extra time and effort these basic principles can be integrated as routine into all research projects.

Clinical Trials as Topic↗
PubMed1997

Gunshot injuries of the abdominal aorta: a continuing challenge.

This is a retrospective study of 57 patients with gunshot injuries of the abdominal aorta. The aortic repair was achieved by various means: lateral aortorraphy, patch aortoplasty and graft insertion. There was an 85 per cent mortality rate from bleeding or secondary coagulopathy directly related to the aortic injuries. The need for resuscitative thoracotomy, shock, lack of response to fluid resuscitation and intraperitoneal bleeding were directly related to mortality. We feel that shortening of prehospital transfer time will increase the absolute number of patients surviving this grave injury.

Adolescent↗
PubMed1997

Management of penetrating injuries of the cervical trachea.

This is a report of a 2-year experience with the management of penetrating injury of the cervical trachea. There were 29 cases. The respiratory status of the patient on admission dominated the initial management: 12 patients required emergency intubation and were immediately taken to operation, while 17 patients were more stable and could be subjected to the preoperative assessment of the oesophagus. Associated injuries were significant and dominated the postoperative morbidity and mortality. Primary repair of the trachea, without tracheostomy, was successful in a relatively high proportion of patients (55%).

Adult↗
PubMed1997

Laparoscopic inguinal hernia repair by an intraperitoneal onlay mesh technique using expanded PTFE: a prospective study.

This prospective trial was initiated to assess laparoscopic inguinal hernia repairs by an intraabdominal intraperitoneal onlay mesh (IPOM) technique. An IPOM method utilizing 10 x 7.5-cm expanded polytef (PTFE) patches was used to repair 52 inguinal hernias in 50 patients. There were two patients with bilateral defects. Fourteen were direct and 38 were indirect hernias. There was one patient with bladder perforation, one with strangulation of the small bowel that entered the sac of a recurrent defect, and five patients with other minor complications. There were two recurrences. The follow-up period ranged from 7 to 31 months. The operating time ranged from 35 to 180 min and was 35-60 min in 40 patients. The postoperative pain was minimal in 40 patients. Our conclusions are as follows: This IPOM method was less time consuming in theater time than other laparoscopic methods. There was minimal postoperative pain in the majority of cases. The hospital stay was shorter in comparison with the standardized stay for conventional methods. The case with recurrence and strangulation raises some questions as to the safety of this method. Hospital costs of conventional herniorrhaphies were lower (63%) than those of this laparoscopic method.

Adolescent↗