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Biomedical subjects

R Saadia

Publications and source records attributed to R Saadia.

At least 73 records · Page 4Linked to original sources
PubMed1990

Gut barrier function and the surgeon.

There is accumulating evidence that multiple organ failure is not always the result of an established septic focus. Increasing attention has centred on the gut as a reservoir of bacteria (and bacterial endotoxins) that can traverse the intestinal mucosal barrier (a process called 'bacterial translocation') and initiate the septic state. Although the link between haemorrhagic shock and sepsis was recognized decades ago, the full experimental demonstration of this phenomenon is more recent. It was shown to occur in three main settings: physical disruption of the gut mucosa, impaired defence mechanisms and altered gut microbial ecology. Conditions such as haemorrhagic shock, burns, protein malnutrition and sepsis are seen in the severely ill surgical patient or the multiply injured, and are known to cause various combinations of circumstances favourable to bacterial translocation and endotoxin absorption. These may play an important role in the mortality of the critically ill.

Animals↗
PubMed1990

Abdominal wall reconstruction after open management of the septic abdomen.

The increasing popularity of open management of the septic abdomen has generated a challenge that the surgeon is forced to face more frequently. The typical presentation is that of a patient with a full-thickness abdominal wall defect occurring after a protracted, severe illness. The various methods of reconstruction of the abdominal wall are reviewed and evaluated. The reconstruction should only be attempted once intra-abdominal sepsis is controlled, re-exploration of the peritoneal cavity is no longer necessary and organ support is discontinued. Although various methods of reconstruction are described, the recommended technique consists of either medial advancement of the rectus abdominis muscle or direct application of split-thickness skin grafts. Mid-line abdominal defects may also be repaired with tensor fasciae latae or rectus femoris flaps.

Abdominal Muscles↗
PubMed1989

Postoperative gastric ischaemia.

This review discusses postoperative gastric ischaemia after detailed consideration of the gastric blood supply and the effects of devascularization. Special consideration is given to gastric remnant necrosis, lesser curve ischaemia after highly selective vagotomy, and gastric ischaemia after other operations.

Animals↗
PubMed1989

The place of intraoperative antegrade colonic irrigation in emergency left-sided colonic surgery.

The healing of colonic or colorectal anastomoses depends, at least partially, on the volume of fecal residue. Intraoperative antegrade colonic irrigation enables the surgeon to prepare the colon adequately at the time of surgery and to perform safely an immediate resection and primary anastomosis in obstructive lesions of the left colon. Its indications have been extended to other left-sided colonic emergencies, especially perforation and hemorrhage. The technique is described in this study and its value is assessed in the light of available experimental and clinical evidence.

Anastomosis, Surgical↗
PubMed1989

Emergency room arteriography: a useful technique in the assessment of peripheral vascular injuries.

Emergency room arteriography is a useful aid in the assessment of limbs for possible vascular injury. It can be performed quickly by junior staff in the emergency room, using simple equipment, thereby avoiding the delays commonly associated with formal radiology suite arteriography. It can also be performed in units which lack formal arteriographic facilities, and resuscitation procedures need not be interrupted while this procedure is being performed. The resulting pictures are adequate for immediate diagnosis of vascular lesions and are of great value to the trauma surgeon. This pilot study of 50 cases confirms that emergency room arteriography is a safe and effective means of diagnosis in the resuscitation area and that the films are as useful as formal angiography for immediate diagnosis of vascular lesions of a traumatic nature.

Angiography↗
PubMed1988

Aggressive treatment of severe diffuse peritonitis: a prospective study.

In a prospective study of 22 patients with diffuse peritonitis managed by the method of electively staged multiple laparotomies, the abdomen was left open in 9 patients. The patients were selected on the basis of the severity of their intra-abdominal infection: only massive faecal peritonitis, postoperative peritonitis and pancreatic abscesses were included. These amounted to only 9 per cent of all patients with intra-abdominal infection treated over a 2-year period. Up to seven re-operations were required per patient. In view of a high mortality rate of 32 per cent, the superiority of this aggressive management strategy over conventional methods is not fully established.

Adult↗
PubMed1988

Intraoperative peritoneal lavage.

The successful management of the contaminated or septic abdomen rests on at least three tenets: The use of systemic perioperative antibiotics, the control of the source of infection and the aspiration of the gross contaminants. The additional use of any modality of IOPL is well entrenched in modern surgical practice. It does, however, owe more to force of habit or prejudice than to sound scientific evidence. Most, if not all, experimental or clinical studies suggesting the benefits of IOPL suffer from many deficiencies, some of which we made a point of emphasizing. In broad terms, one could recognize three major pitfalls invalidating these studies. First, the design of some of the experimental studies bears no resemblance to clinical situations. For example, laparotomy was omitted in either both arms of the trial or in the control arm. Second, far too frequently, the data were drawn from retrospective or uncontrolled trials. Although the value of such studies cannot be denied, the literature is replete with examples of perpetuation of erroneuos concepts through lack of properly designed prospective, randomized controlled studies. Third, many of the trials were performed before the revolutionary introduction of perioperative antibiotics in clinical practice. Of greater concern is the existence of studies which, for unexplained reasons, have ignored this principle. From this review, it seems that neither the benefit nor the safety of IOPL with crystalloid or antiseptic solution has been established beyond any reasonable doubt. The theory for the addition of judicious antibiotics to the IOPL may be stronger, although no absolute proof exists to suggest that this practice will decrease mortality rates from intra-abdominal infections. Obviously, there is a need for well constructed, controlled, prospective clinical trials to examine the role of IOPL in modern surgical groups of patients assembled under the label intra-abdominal infection. Until some stratification of peritonitis in various clinical studies is undertaken, either by how ill the patient is or the source of contamination and its duration, it will be difficult to compare studies from different centers.

Humans↗
PubMed1988

Local treatment of carcinoma of the rectum.

LE is a management modality offered, at present, to less than 5 per cent of all patients with carcinoma of the rectum. It is indicated, as a primary curative procedure, in the subgroup of patients with early lesions of a favorable histologic grade. It has also been used, for palliation, in patients with overt disseminated malignant disease or in patients too old or too ill, or both, to withstand a radical operation or unwilling to accept a colostomy. Various techniques have been described and can be divided into two categories: excision of the intact tumor, best suited for a curative procedure when tumor characteristics can be accurately determined, and tumor destruction therapy, more generally used for palliation. The results of local excision, compared with those of radical operations, are very good when a strict selection policy is implemented and coupled with adequate patient follow-up study.

Adenocarcinoma↗
PubMed1986

Perforated peptic ulcer at the J.G. Strijdom Hospital. A retrospective study of 99 patients.

This is a retrospective analysis of 99 patients with perforated peptic ulcer treated in the Department of Surgery at the J. G. Strijdom Hospital over a 6-year period. The incidence of this condition is increasing in our population. The mortality rate for perforated peptic ulcer remains high (12.1%). Forty-three per cent of our patients were suffering from a major medical illness at the time of perforation, with a mortality rate of 25.6%. The mortality rate for relatively fit patients was 1.8%. While more conservative surgery is indicated for high-risk patients, a definitive ulcer operation can be performed safely in patients who are not suffering from a major medical illness. Our selective operative policy is discussed.

Adult↗
PubMed1986

Management of gallstone ileus. A report of 3 cases.

Three cases of gallstone ileus are reported and the literature reviewed. There seems recently to be a trend towards conservative surgery aiming at relief of the obstruction only. Definitive surgery to deal with a biliary-enteric fistula, should be undertaken primarily only in fit patients; and should be considered as a second stage procedure only in those patients who develop biliary complications.

Aged↗
PubMed1986

The 'sandwich technique' in the management of the open abdomen.

A management technique of the open abdominal wound is described. It consists of a 'sandwich' composed of a Marlex mesh and an Op-Site wound dressing with interposition of suction tubes. Such a technique prevents evisceration, protects the skin, decreases evaporation, allows accurate fluid replacement, facilitates nursing and adds to the patient's comfort.

Abdomen↗