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Biomedical subjects

R Saadia

Publications and source records attributed to R Saadia.

83 records · Page 5Linked to original sources
PubMed1986

The open management of the septic abdomen.

The mortality rate of severe intra-abdominal infections is still very high. The open management of the abdomen is a method of treatment which has gained popularity over the past few years. Its advantages include a better drainage of the peritoneal cavity, a greater protection of the parietes, an improved perfusion of the abdominal viscera and a decrease in postoperative pulmonary complications. It is indicated in patients with severe intra-abdominal sepsis, especially when multiple re-explorations of the abdomen are likely. A variety of techniques, including the use of Marlex mesh have been devised to contend with possible complications: spontaneous fistulas, exogenous bacterial contamination, evisceration and massive fluid losses. The open method of management has not made the treatment of septic abdomen much easier; it requires intensive care support and repeated assessment of the peritoneal cavity. The closure of the abdomen is a problem which must be addressed when the sepsis has subsided. The value of this technique is still difficult to assess in the absence of controlled randomized trials.

Abdomen↗
PubMed1986

Perforated gastric ulcers. A retrospective study of 32 patients.

During the last 6 years the authors have treated 99 patients with perforated peptic ulcers. Sixty-six patients had perforated pyloro-duodenal ulcers, while 32 patients were treated for perforated gastric ulcers, a ratio of 2:1. This article deals with the gastric ulcers treated by a surgical unit in an urban, 600-bed multidisciplinary hospital. The mean age of the patients was 58.7 years. In 71.8 per cent of the patients, the perforation was the first major manifestation of the ulcer disease. Seven patients (21.8%), all in the high-risk group according to the criteria of Boey et al. died. There was no death among the low-risk patient group. Eleven patients, all high-risk, had excision and/or biopsy of the ulcer followed by simple closure; three of these patients died (27.2%). Twenty patients, of whom seven were in the high-risk group, underwent gastrectomy; three deaths occurred (15%). The authors conclude that the underlying general health of the patient is a major determinant of the outcome following gastric ulcer perforation.

Adult↗
PubMed1985

Colonic necrosis in acute pancreatitis. A complication of massive retroperitoneal suppuration.

Colonic necrosis is a rare complication of peripancreatic sepsis following acute pancreatitis. Three patients with colonic necrosis associated with extensive retroperitoneal suppuration are reported. The pathogenesis of this syndrome may be explained by the tendency of pancreatic abscesses to extend widely in the retroperitoneum. Management is discussed, emphasizing the need for an aggressive surgical approach and multiple operations.

Abscess↗
PubMedDate not supplied

Pyloric exclusion in severe penetrating injuries of the duodenum.

This study comprises 74 patients with penetrating injuries of the duodenum. Sixty-three of these had sustained gunshot wounds, many of which were high velocity. The change in the incidence and the severity of the gunshot injuries within the last few years resulted in changes in the operative management of the duodenal wound with gradually improving results. When pyloric exclusion was added to the operative management of grade III duodenal injuries, the postoperative leakage rate was 12%. When only primary repair was done, the leakage rate was 43%. We suggest that pyloric exclusion be added to the treatment of most severe grade II and all grade III gunshot duodenal injuries. The adequacy of primary repair and pyloric exclusion in grade IV injuries requires further study.

Adult↗
PubMedDate not supplied

Management of combined penetrating cardiac and abdominal trauma.

This is a retrospective review of patients with combined penetrating cardiac and abdominal trauma. Clinical presentation patterns are described and a management strategy is outlined. The series comprises 25 patients. On the basis of the mechanism of injury and the prognosis, the patients were divided into two groups: 'low risk' (single high epigastric stab wound) and 'high risk' (multiple stabs, single or multiple gunshot wounds). There were six patients in the low-risk group. Their intra-abdominal injuries were moderately severe. None of this group died. There were 19 patients in the high-risk group. Three underwent emergency-room thoracotomy and died. Of the remaining patients, four underwent a thoracotomy first for cardiac tamponade or massive haemothorax and 12 underwent a laparotomy first because of massive haemoperitoneum. The mortality in this group was 63 per cent. It is essential to recognize the cardiac injury in low-risk patients; the cardiorrhaphy must be performed before the laparotomy. In high-risk patients, the sequence of operations depends on the clinical presentation. Obvious cardiac tamponade or massive haemothorax mandate a thoracic approach first, while severe hypovolaemic shock with a massive haemoperitoneum justifies the performance of a laparotomy first; a transdiaphragmatic pericardiotomy is useful, in these cases, before proceeding to median sternotomy.

Abdominal Injuries↗
PubMedDate not supplied

Clinicopathological trends in colorectal carcinoma in a Black South African population.

The clinico pathological characteristics of colorectal carcinoma in 127 Black South African patients were studied. The main presenting symptoms were altered bowel habits in 70% of the patients, weight loss in 64.3% and abdominal pain in 47.1%. Anaemia was present in 75.7%. There was a 31% incidence of mucinous carcinoma with a particular predilection for the younger age groups. Mucinous tumors were found more commonly in Duke stage C and D than in earlier stages. Tumors arising from a pre-existing adenoma constituted to 5.5% of the lot of patients with cancer colon.

Adenocarcinoma↗