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Biomedical subjects

R Saadia

Publications and source records attributed to R Saadia.

At least 37 records · Page 2Linked to original sources
PubMed1996

Diaphragmatic herniation after penetrating trauma.

A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury.

Adult↗
PubMed1996

Gunshot injuries of the head of the pancreas: conservative approach.

This study is comprised of 48 patients with gunshot injuries of the head of the pancreas, many of which were high velocity injuries. The purpose of this study was to evaluate our management policy for these injuries based on our recent wide experience. Patients with grade II and III injuries underwent conservative surgery, with 0% and 21% postoperative mortality, respectively, directly related to the pancreatic injury. For patients in whom the duodenum was involved, pyloric exclusion was applied depending on the grade of the duodenal injury. We concluded that moderate gunshot injuries of the head of the pancreas (grade II) can be safely treated by débridement and suture repair, with or without drainage. Severe (grade IV) injuries warrant a pancreaticoduodenectomy. Most grade III injuries can be treated by débridement and drainage unless an associated severe duodenal injury is present, in which case resection may be indicated.

Adult↗
PubMed1996

Gunshot arterial injuries to the groin: comparison of iliac and femoral injuries.

In a prospective study of 69 patients with gunshot arterial injuries to the groin, there were 18 patients with iliac and 51 with femoral artery injuries. In the former group, the majority of patients were admitted with gross physiological derangement that did not respond to pre-operative resuscitation, so were taken directly to theatre. There was a 39 per cent peri-operative mortality. A prompt operation is mandatory to improve the chances of survival of patients with this injury. In the latter group all patients responded to pre-operative resuscitation and in the great majority, the diagnosis was established by the presence of 'hard' signs of arterial injury alone. There was a 4 per cent amputation rate and no mortality.

Adolescent↗
PubMed1996

Selective surgical management of zone II gunshot injuries of the neck: a prospective study.

BACKGROUND: The management of penetrating neck trauma remains controversial, with many studies supporting either mandatory exploration or selective conservatism. METHODS AND RESULTS: This is a prospective study of 75 patients with gunshot injuries to zone II of the neck. Forty patients (53.3%) underwent immediate exploration because of clinical indications or positive initial investigations. A 7.5% incidence of unnecessary explorations, a 5% mortality rate, and average hospital stay of 10.5 days were noted. Thirty-five patients with negative clinical or investigational findings underwent observation with constant monitoring. A 5.7% incidence of missed injuries, no mortality, and an average hospital stay of 3.5 days were noted for these patients. CONCLUSIONS: We suggest that conservative management in gunshot injuries confined to zone II of the neck selectively supplemented by appropriate investigations is a viable proposition in this type of injury. Further contemporary studies reporting specifically on this injury will enable us to reach statistically significant conclusions.

Adolescent↗
PubMed1996

Penetrating injuries of the iliac arteries: a South African experience.

BACKGROUND: We did a retrospective study of 62 patients with penetrating injuries of the iliac arteries. METHODS: The cause of injury was gunshot wound in 85.5% and stabbing in 14.5%. The arterial repair was achieved by various means: lateral arteriorrhaphy, end-to-end anastomosis, and polytetrafluoroethylene interposition grafts. RESULTS: There was a 42% mortality rate from exsanguination or secondary coagulopathy directly related to the arterial injury. Persistent shock, resuscitative thoracotomy, free intraperitoneal hemorrhage, and the number of vascular injuries were directly related to mortality. CONCLUSIONS: A high index of suspicion, aggressive resuscitation, and prompt surgery are necessary to improve the chances of surviving this ominous injury.

Anastomosis, Surgical↗
PubMed1996

Volvulus of the sigmoid colon at Baragwanath Hospital.

Fifty-six patients treated for sigmoid volvulus over a period of 5 years are reviewed. The purpose of this study is to evaluate our management policy and to compare it with other studies, particularly from other parts of Africa. The patients were evaluated by retrospective allocation into one of three treatment modalities. Patients with clinical evidence of ischaemia underwent a Hartmann's procedure. There was a 33% mortality rate in this group. In those patients who had sigmoidoscopic reduction, a second-stage sigmoidectomy and primary anastomosis were performed. The results in this group were excellent. In the group of patients with failed sigmoidoscopic resection the majority underwent a Hartmann's procedure with a mortality rate of 15%.

Adult↗
PubMed1996

Perforation of the gastro-intestinal tract by a foreign body. A case report.

Most ingested foreign bodies pass through the gastro-intestinal tract without giving rise to complications. If they become lodged in a narrow segment of the gastro-intestinal tract, perforation may occur. The resulting morbidity depends on the further route of the penetrating object and whether septic sequelae ensue. This article describes an unusual case of foreign body perforation with a protracted clinical course. It emphasises that there are no insurmountable barriers in the pathway of foreign bodies.

Adult↗
PubMed1996

Duration of antibiotic treatment in surgical infections of the abdomen. Antibiotics and the gut.

The inflammatory response of the body to a variety of insults is indistinguishable from that to infection. Antibiotics are neither innocuous nor are they a substitute for correct surgical management. In this paper we stress the side effects of antibiotics particularly affecting the gut and, by means of patient stratification, propose a goal oriented approach to antibiotic use, in conjunction with basic surgical strategies, for the management of intra-abdominal infection.

Anti-Bacterial Agents↗
PubMed1996

Penetrating injuries of the abdominal inferior vena cava.

This is a retrospective study of 74 patients with penetrating injuries of the abdominal inferior vena cava; the cause of injury was gunshot in 91% and stabbing in 9%. Of the patients, 77% underwent lateral venorrhaphy, 5% underwent infrarenal ligation of the inferior vena cava (IVC), and 18% died perioperatively before any caval repair could be carried out. There was an overall perioperative mortality of 39%. Persistent shock, the site of the venous injury, particularly in the retrohepatic position, and the number of associated vascular injuries were directly related to mortality. Irrespective of the improvements in resuscitation and the various operative methods available, penetrating trauma of the abdominal IVC remains a life-threatening injury.

Abdominal Injuries↗
PubMed1995

Outcome of a strict policy on emergency department thoracotomies.

OBJECTIVE: To audit emergency department thoracotomies from January 1981 to May 1993. DESIGN: Retrospective analysis of case records. SETTING: A large (3000-bed) tertiary care academic hospital; the department of general surgery (including trauma) consists of 360 beds. PATIENTS: All patients who underwent a thoracotomy in the emergency department during the above period. INTERVENTION: An emergency department thoracotomy was performed on trauma patients with recordable vital signs and rapid deterioration and on patients with uncontrollable bleeding or profound hypotension not responsive to resuscitation. The procedure was performed either on the resuscitation trolley in the emergency department or in the adjacent operating room. MAIN OUTCOME MEASURES: Survival and subsequent neurological function after thoracotomy. RESULTS: There were 312 stab injuries, 358 gunshot injuries, and 176 blunt injuries. Survival occurred in 26 stab-wound cases (8.3%), in 16 gunshot cases (4.4%), and in one blunt injury case (0.6%). There was one patient with neurological impairment in each of the three injury groups. Those with penetrating chest injuries had the best survival rate (20%), and the survival rate for penetrating abdominal trauma was 6.8%. CONCLUSIONS: Emergency department thoracotomies have a definite role in the management of trauma patients. The best results are obtained in patients with penetrating chest injuries.

Adult↗
PubMed1995

Penetrating injuries of the femoral artery.

This is a retrospective study of 106 patients with penetrating injuries to the femoral artery. The cause of injury was gunshot in 82 per cent, stabbing in 13 per cent and pellets in 5 per cent. We believe that angiography is unnecessary in patients with 'hard' signs of vascular injury: 97 patients underwent immediate exploration with positive findings. The presence of 'soft' signs alone mandates angiography as five of 12 patients with suspected injury were saved a negative exploration. Proximity of injury was a poor predictor of arterial injury. There were four amputations. Ligation of the femoral vein is not reliably associated with amputation but it was an aggravating factor in the setting of severe arterial disruption and delay to surgery.

Adolescent↗
PubMed1995

Distal pancreatectomy for gunshot injuries of the distal pancreas.

This study comprised 57 patients with gunshot injury of the distal pancreas. There were 16 grade II, 29 grade III and 12 grade IV pancreatic injuries. The intraoperative mortality rate was 12 per cent. Patients with the most severe grade II injuries and all those with grade III and IV injuries had distal pancreatectomy and splenectomy, with a 14 per cent fistula formation rate and 2.3 per cent postoperative mortality rate directly related to the pancreatic injury. The remaining patients with grade II injuries were managed by debridement and drainage; there were no fistulas or deaths. The method of closure of the pancreatic resection margin is unrelated to fistula formation, and identification of the duct for ligation is unnecessary. Liberal use of distal pancreatectomy with splenectomy for gunshot injuries of the distal pancreas is suggested.

Adult↗
PubMed1995

Penetrating injuries of the brachial artery.

This is a retrospective study of 72 patients with non-iatrogenic penetrating injuries of the brachial artery treated between 1991 and 1993. The mechanism of injury was stabbing in 39 per cent, a bullet in 51 per cent, pellets in 4 per cent and a dog bite in 6 per cent. We believe that angiography is rarely indicated, as in all our patients the diagnosis was made on clinical grounds. The proximity of the injury to neurovascular bundles was a poor predictor of arterial injury. One month after discharge 95 per cent of the patients had palpable distal pulses. Long-term morbidity is mainly attributed to associated nerve injuries.

Adolescent↗
PubMed1995

Gunshot injuries of the liver: the Baragwanath experience.

BACKGROUND: This study comprised 304 patients with gunshot injuries of the liver, many of which from high-velocity firearms. The purpose of this study is to evaluate our management policy in gunshot injuries of the liver in light of our recent wider experience. METHODS: All grade I and II injuries and most grade III injuries were managed by simple operative measures, without postoperative mortality directly related to the liver trauma. RESULTS: Grade III, IV, and V injuries had 8.5%, 52%, and 16% resectional debridement rates and 8.5%, 38%, and 84% perihepatic packing rates, respectively. In the resectional debridement group the postoperative mortality rate was 15% (half the deaths were directly caused by the hepatic injury). The postoperative mortality rate in the perihepatic packing group was 31.5% of which 45% of deaths were due to ongoing bleeding, 27.5% to sepsis, and 27.5% to associated trauma. The septic complications were less common when packs were removed early. CONCLUSIONS: We suggest that resectional debridement and perihepatic packing should be liberally applied in the most severe grade III, most grade IV, and grade V gunshot injuries of the liver and that perihepatic packing should be removed as early as the physiologic derangements are corrected. Our experience with grade VI injuries is very limited, and their management should be studied in larger series.

Adolescent↗