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Biomedical subjects

A Rauff

Publications and source records attributed to A Rauff.

At least 19 recordsLinked to original sources
PubMed1992

Surgical management of right colon diverticulitis.

The infrequent occurrence of right colon diverticulitis in the developed West has led to a controversy in the management of this disease. In Singapore, we continued to avoid colectomy whenever possible because this disease is usually nonprogressive. We reviewed 68 patients treated by conservative surgery to evaluate the effectiveness of this treatment policy. Almost 70 percent of our patients were below 40 years of age, and the clinical presentation was indistinguishable from acute appendicitis. Diverticulectomy was done only for inflamed and perforated diverticula (25 cases), while the nonperforated diverticulum was left alone (40 cases). The inflammation invariably responded to antibiotic therapy. Only three patients had colonic resection since a malignant neoplasm could not be excluded. There were no adverse sequelae over a mean follow-up period of three and one-half years, except for one patient who had recurrent attacks of right colon diverticulitis necessitating colectomy. With this policy of management we encountered no mortality, and morbidity was acceptable.

Adult↗
PubMed1992

A study of 245 infected surgical wounds in Singapore.

The aims of the study were to correlate the laboratory detection rate of wound infections with the actual wound infection rate, and to analyse the bacteriology of these wounds to provide a rationale for antibiotic usage in prophylaxis and treatment of surgical wound infections. The wound infection rate in a general surgical unit was determined using the most comprehensive surveillance available to us and was correlated with the laboratory detection rate. A correlation coefficient of 0.8 was obtained, allowing a reasonable estimation of the actual wound infection rate from laboratory data. Review of the bacteriology of consecutive infected surgical wounds over a 4 year period in a university hospital, revealed that the commonest organisms cultured were Staphylococcus aureus, Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, enterococci and beta-haemolytic streptococci. Methicillin-resistant S. aureus (MRSA) caused 50% of all staphylococcal wound infections. All MRSA isolates were sensitive to fusidic acid and vancomycin. All the non-MRSA isolates of S. aureus were sensitive to cephalexin. Some 89% of E. coli were sensitive to gentamicin, with 93% and 100% sensitive to cefuroxime and ceftriaxone respectively. Klebsiella isolates have shown an increased resistance to aminoglycosides, with a new strain from one patient, isolated in 1990, resistant to penicillins, aminoglycosides and third generation cephalosporins. Pseudomonas spp., enterococci and beta-haemolytic streptococci did not show a change in resistance patterns over the same time period.

Anti-Bacterial Agents↗
PubMed1992

Splenic abscess.

Isolated splenic abscess is an uncommon condition. Seven cases seen between 1980 and 1990 are reviewed. The clinical presentation is non-specific and diagnosis is usually delayed. Computerized tomography allowed for accurate diagnosis in all cases. Pseudomonas species as a causative organism is reported to be rare, but were present in three of the present cases. Antibiotic therapy alone is insufficient and splenectomy remains the treatment of choice.

Abscess↗
PubMed1992

A descriptive study of emergencies admitted to a surgical department.

A study was undertaken to evaluate the pattern of emergency admissions and their management by the surgical firm in a medium size (700 beds) general hospital. Over a three month period, 258 patients were admitted to one surgical team that was on take every third day. All patients were entered into a protocol that was updated daily by a registrar. In four (13.3%) of the 30 days on take, patients had to be referred to a nearby hospital due to shortage of emergency beds. The accuracy of diagnosis by the Accident and Emergency (A&E) resident, surgical resident and surgical team were 75.7, 77.2 and 88.4% respectively. The mean delay before attendance by an intern after admission was 47 (SD +/- 29) mins. Forty-four (17%) of these admissions were probably unnecessary. A further 22 (8.5%) patients had to be referred to other disciplines, indicating an initial wrong diagnosis. A substantial number of investigations were unnecessarily done on an emergency basis. Ninety-three (36.0%) patients required surgery. The median duration of hospital stay was three days. The overall morbidity was 4.2% and mortality 1.2%. The study was valuable in revealing the deficiencies in the existing emergency service; leading to new proposals to achieve our ultimate aim of providing high quality patient care.

Adult↗
PubMed1992

The impact of HLA match transfusions and presensitization on renal transplantation in the cyclosporine era.

The successful engraftment of a renal transplant is dependent on multiple factors, immunological factors being of major importance. Specifically, histocompatibility, lymphocytotoxic antibodies and pretransplant blood transfusions have been shown to play a major role in determining graft outcome in renal transplant recipients receiving Azathioprine-Prednisolone immunosuppression. The impact of the immunosuppressive drug, Cyclosporine on graft outcome in relation to established risk factors were examined among 116 cadaveric and 34 living related renal allograft recipients from our center. Histoincompatibility and pretransplant blood transfusions did not significantly affect graft survival among cadaveric transplant recipients. Similarly, graft survival was not significantly different between two haplotype-matched and less well-matched living-related graft recipients (75% versus 96.5% respectively). On the other hand, lymphocytotoxic antibodies remained a major risk factor for immunologically mediated graft loss among cadaveric graft recipients (48.0% versus 92.2% four year graft survival among those with and without antibodies respectively). These results suggest that Cyclosporine has abrogated some immunological risk factors in renal transplantation.

Adult↗
PubMed1992

Informed patient consent--historical perspective and a clinician's view.

Informed patient consent, in this day and age, is usually taken for granted, poorly understood, and inadequately practised. Historically, informed patient consent is relatively new to medical practice, as there was no such consent during the times of the ancient Egyptians, the ancient Greeks or Romans. The culture of individual rights as part of a social trend and evolution of human civilisation with landmarks such as the American Revolution two centuries ago also brought along greater patient awareness of their health and persons as well as their rights in the investigations, treatment and research of their illnesses. The rationale and elements in the practice of informed patient consent is part of this trend. However, there are moral and legal dilemmas involved. Discussion is needed, and though the practice of such consent may sometimes be difficult, the spirit of its application should never be compromised.

Comprehension↗
PubMed1991

Primary resection and anastomosis in obstructed descending colon due to cancer.

Intraoperative colonic irrigation followed by one-stage resection is gaining popularity as the optimal surgical treatment for left-sided colonic obstruction. However, its efficacy and potential hazards have not been adequately tested in obstruction due to colonic cancer. We analyzed the early results of 23 consecutive patients with obstructive left-sided colonic carcinoma treated by primary resection and anastomosis following intraoperative antegrade colonic lavage. Two patients (8.6%) died, one from complication of anastomotic leakage. The significant postoperative complications were chest infection in three (13%) and wound infection in seven (30.4%). The average hospital stay was 16.5 days. The results of this study suggest that intraoperative bowel irrigation permits one-stage resection and anastomosis to be conducted with reasonable safety provided care is taken in operative techniques.

Adenocarcinoma↗
PubMed1991

'A bridge too far ...'. Case report.

An elderly man was assaulted and sustained facial injuries with fractures of the mandible and left zygoma. An unusual complication of aspiration of an intact four-unit metal bridge is reported. Immediate retrieval was done under general anaesthesia by rigid bronchoscopy. The technique is described. The importance of careful clinical and radiographic examination is stressed.

Bronchoscopy↗
PubMed1991

Acute gall bladder perforation--a dilemma in early diagnosis.

Gall bladder perforation is a rare complication of cholecystitis. A definitive diagnosis is uncommon before surgery and the morbidity and mortality associated with this condition are high. We report six patients with gall bladder perforation to show the difficulty of making an early diagnosis. The history and the clinical findings of these patients are reviewed to highlight diagnostic pitfalls.

Adult↗
PubMed1991

An in vitro assessment of human fetal pancreatic islets of Langerhans in culture.

The human fetal pancreas is a potential source of islets for transplantation into insulin-dependent diabetic patients. In this study, 35 human fetal pancreas obtained from prostaglandin-induced abortions (12-26 weeks gestation), were placed in culture to determine their capacity to secrete insulin over 30 days. Culture media were sampled twice weekly for insulin and histology was performed serially. Of the 35 pancreases cultured, six were lost due to bacterial contamination, five discarded due to undetectable levels of insulin in culture, nine are still under study, whilst 15 pancreases have been cultured for one month, and insulin studies completed. Three patterns of insulin release were observed: (a) progressive decline (n = 6), indicating non-viable tissue at the onset; (b) delayed decline, indicating significant tissue damage before organ culture (n = 5); and (c) insulin production in vitro over 30 days (n = 4), with viable islets detected histologically. Factors such as gestational age and cold ischaemia time did not correlate with the pattern of insulin secretion observed. This was probably due to a more important variable, not easily assessed, of the period of intrauterine (warm) ischemia. These data suggest: (1) that a small number of fetal pancreases procured from prostaglandin-induced abortuses do yield islets which remain viable in culture over 30 days, and (2) the functional status of islets can be monitored in vivo by measuring insulin secretion, thereby providing a means of identifying tissue suitable for transplantation.

Culture Techniques↗
PubMed1991

A study of the xenogeneic response in an isolated liver perfusion circuit--preliminary observations.

An isolated liver perfusion circuit was developed to study the xenogeneic reaction of human blood to porcine liver, and investigate the feasibility of using such a system for liver dialysis in fulminant hepatic failure. Three experimental groups were studied: a control group where pooled porcine blood was perfused through pig liver (n = 12), a xenogeneic group where banked human blood was perfused through porcine liver (n = 23), and a modified xenogeneic group where decomplemented human blood was perfused through porcine liver (n = 4). The following parameters of liver function were assessed: liver function tests, serum electrolytes, bile and ascites production. In addition, liver histology was assessed at the start and completion of each perfusion experiment. Control experiments established that the use of low perfusion pressures (mean inlet pressure of 29.5 +/- 7.4 mmHg), and low haematocrit of 20.5 +/- 8.9% (n = 14), enabled five hour perfusions to be consistently achieved with maintenance of normal acid base and electrolyte balance. Bile production over 5 hours was 18.8 +/- 8.0 ml in controls (n = 5) and 17.0 +/- 6.7 ml in the xenogeneic (human-pig) circuit (n = 11) (NS). Ascites production was 235.8 +/- 157.3 ml/hr in controls (n = 5) and 205 +/- 142.0 ml/hr in the xenogeneic circuit (n = 7) (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Techniques of ureteric reimplantation in kidney transplantation and its related urological complications.

Two common techniques of ureteric reimplantation for kidney transplantation, the Politano-Leadbetter and the extravesical ureteroneocystostomy are described in detail. Correct techniques of donor ureter harvesting, appropriate method of reimplantation and judicious use of double J stent are also emphasised so as to reduce the urological complications which occurred in about 7% to 15% in most series. More than 90% of urological complications are due to urinary fistulae and ureteric obstruction which carry a significant morbidity and mortality. The causation, diagnosis and management of these complications are reviewed. Early diagnosis and early aggressive surgical treatment is the key to a successful outcome.

Cystostomy↗
PubMed1991

Renal transplantation in Singapore--a brief historical perspective.

Renal transplantation in Singapore has been practised for the last 20 years. It was prompted by the extreme shortage of haemodialysis facilities in 1970. Because of the scarcity of cadaver kidneys, a living related programme was commenced in 1976. Since then, both programmes have run parallel. The renal transplantation programme has been influenced by such factors as importation of cadaver kidneys from abroad and living non-related transplantation programme in neighbouring countries. The great beneficial effects of Cyclosporin A (CyA), was evident in the results from 1986 onwards. It has been necessary to modify and expand the legislative rules to encourage and broaden kidney transplantation in Singapore.

Cadaver↗
PubMed1990

Gastric leiomyosarcomas: a general surgical experience.

Leiomyosarcomas of the stomach are rare malignancies. In Singapore, they account for only 0.7% of all gastric tumours. Nine cases of gastric leiomyosarcomas were treated in this department over a 20 year period from 1968 to 1987. Pre-operative diagnosis was difficult. All our cases' required laparotomy for histological diagnosis. Of the nine cases, there were eight gastrectomies (two repeated). None of the resected cases showed lymph node spread. There was only one long-term survival (8 years).

Aged↗