PubMed Health⌕ Search

Biomedical subjects

P G Jani

Publications and source records attributed to P G Jani.

15 recordsLinked to original sources
PubMed2006

Pattern and outcome of abdominal injuries at Kenyatta National Hospital, Nairobi.

OBJECTIVE: To establish the pattern and results of interventions in patients with abdominal injuries requiring admission. DESIGN: A descriptive, prospective, hospital-based study involving observation of patients from admission to final outcome of management as either discharged or deceased. SETTING: Kenyatta National Hospital, a tertiary teaching and referral hospital in Nairobi, Kenya, from November 2004 to February 2005 in the adult general surgical wards. PATIENTS: Eighty consecutive admissions of adult patients with either blunt or penetrating abdominal injuries. MAIN OUTCOME MEASURES: Type and cause of injury, demographic data, temporal parameters, morbidity and mortality. RESULTS: The 80 patients had a male to female ratio of 12.3:1, the majority were in the third decade of life with a range 15-56 years and mean of 28.2 years. Penetrating to blunt abdominal injuries had 2:1 ratio with the leading causes of injury being stab wounds, gunshot wounds and road traffic accidents. Blunt abdominal injuries had a higher tendency to extra-abdominal injuries. Duration prior to presentation to hospital and surgery depended on severity of injury. Modes of management varied between attending surgical firms. There was a 20% change in the mode of management and a 16.1% rate of negative laparotomy. Penetrating injuries had a better interventional outcome. Penetrating abdominal injuries had higher rates of complications while the blunt injuries had higher rates of mortality. Overall, both the complication and mortality rates were 12.5%. Correlates of mortality included delay before surgery, associated injuries, need for blood transfusion, admission to intensive care unit and duration prior to admission. Abdominal injury patients stayed an average of 6.4 days with the blunt injuries with complications staying close to twice as much as their penetrating counterparts. CONCLUSION: Abdominal injuries are a predominantly male disease with the majority in the third decade of life. As opposed to previous studies, gunshot wounds are now a significant cause of abdominal injuries in Kenyatta National Hospital (KNH). The rate-of negative laparotomies has come down by 10% over the past 15 years. The outcome of management depends on the severity and type, of injury sustained.

Abdominal Injuries↗
PubMed2005

Surgical implications of abdominal pain in patients presenting to the Kenyatta National Hospital casualty department with abdominal pain.

OBJECTIVE: To determine the local aetiological spectrum of surgically relevant causes of abdominal pain. DESIGN: A prospective descriptive study was carried out. SETTING: Kenyatta National Hospital, Nairobi, Kenya during the month of October 2002. SUBJECTS: Patients aged 13 years and older presenting to the casualty department with abdominal pain were followed through the hospital system to determine whether they would undergo laparotomy and, in those cases who underwent laparotomy, to determine the nature of the pathology found at laparatomy. RESULTS: Abdominal pain was a presenting complaint in 1557 (16.7%) of patients presenting to the casualty department during the study period. Abdominal pain accounted for 17.9% (398 out of 2225 patients) of all admissions via the casualty department. Laparotomy was performed on 68 (4.4%) of patients who presented with abdominal pain to the casualty department. In female patients presenting with abdominal pain, the incidence of ectopic pregnancy and acute appendicitis was 65.3% and 16.3% respectively. The incidence of neoplasia found at laparatomy, for abdominal pain, on patients admitted to the general surgical ward was 3.0%. The incidence of neoplasia, as a cause of abdominal pain resulting in laparatomy was 3.3%. CONCLUSION: The results highlight the fact, with respects to abdominal pain, that there are significant differences between the disease patterns in different geographical locations. Assuming the converse could adversely affect the management of patients with abdominal pain locally.

Abdomen↗
PubMed2005

Acute colonic pseudo obstruction (Ogilvie's syndrome): case report.

Ogilvie's syndrome was first described by Sir Heneage Ogilvie in 1948 and is a rare disorder comprising acute colonic pseudo obstruction (ACPO) with gross dilation of the caecum and right hemicolon (occasionally extending to the rectum) without an anatomic lesion that obstructs the aboral flow of intestinal contents. A sixty five year old female with ACPO, perforation and septic shock is presented. A retrospective confirmation of the diagnosis was made after surgery at which a grossly dilated caecum and colon were seen and a right hemicolectomy carried out. Preoperative radiological investigations had shown a dilated caecum with massive faecal loading of the colon.

Acute Disease↗
PubMed2004

Endoscopic variceal band ligation: a local experience.

OBJECTIVE: To evaluate the results of endoscopic variceal band ligation (EVBL) in the local set-up. DESIGN: Retrospective analysis of data of all patients who had EVBL. SETTING: Patients having EVBL at the office endoscopy suite. The Nairobi Hospital, the Aga Khan Hospital and M.P. Shah Hospital. METHODS: The varices were diagnosed at oesophagogastroduodenoscopy (OGD) in patients with hemetemesis and EVBL performed after xylocaine throat spray and intravenous pethidine and bendiazepam sedation. Majority of the patients had EVBL performed on an outpatient basis on weekly intervals until variceal obliteration. RESULTS: A total of 43 patients underwent 119 EVBL sessions at which 523 varies were banded. Four patients had active bleeding and the rest had EVBL for secondary prophylaxis. The variceal kill time was shorter and the transfusion requirements were less and none of the patients developed oesophageal strictures. CONCLUSION: Endoscopic variceal band ligation was noted to give better results in the management of patients with oesophagealvarices in the local set-up, when compared to sclerotherapy in the past.

Antibiotic Prophylaxis↗
PubMed2003

Superior mesenteric artery syndrome: case report.

Superior Mesenteric Artery Syndrome (SMAS) is caused by trapping of the third part of the duodenum between Superior Mesenteric Artery (SMA) and aorta as result of narrowing of the angle between the two vessels due to acute loss of mesenteric fat which is secondary to rapid weight loss. A fifteen year old caucasian female on a mountain climbing expedition with an acute on chronic upper gastrointestinal obstruction is presented. The diagnosis was confirmed with a barium meal and at surgery, a bypass procedure performed to relieve the obstruction.

Adolescent↗
PubMed2002

Pharyngoesophageal (Zenker's) diverticulum: case report.

Pharyngoesophageal pulsion diverticulum is the most common of all oesophageal diverticuli and is characterised by dysphagia, regurgitation, gurgling sounds in the neck and aspiration. This is a report of an 80-year old female who presented with progressive dysphagia, weight loss and recurrent bouts of pneumonitis. A barium swallow showed a pharyngoesophageal diverticulum and an upper endoscopy confirmed a wide ostium and no other pathology. She underwent surgical pharyngoesophageal diverticulectomy and cricopharyngeal myotomy under general anaesthesia and made complete recovery with total relief of dysphagia.

Aged↗
PubMed2001

Morgagni hernia: case report.

This is a case report of an elderly woman who presented with a history of epigastric pain and persistent vomiting diagnosed initially as a duodenal ulcer, later as a pyloric stenosis and at laparotomy was found to have an anterior diaphragmatic hernia with gastric volvulus. Hernia of Morgagni occurs through a congenital defect in the diaphragm but usually presents in adulthood. It could be an incidental diagnosis or can present with obstructing symptoms of the herniated viscera. Treatment is surgical with reduction of hernia and repair of the diaphragmatic defect. If misdiagnosed, this can lead to considerable morbidity and occasionally mortality due to the obstructed/strangulated hernial contents.

Abdominal Pain↗
PubMed2001

Dieulafoy's lesion: case report.

A sixty-year old male patient was referred to the author as a case of massive rectal bleeding after haemorrhoidectomy. He underwent urgent total colonoscopy and bleeding Dieulafoy's lesion was identified as a source of haemorrhage. Injection with dilute adrenalin in and around the bleeding lesion was carried out with prompt haemostasis and no recurrence. High index of suspicion and early therapeutic endoscopic intervention is extremely useful in this rare but important cause of massive gastrointestinal bleeding.

Acute Disease↗
PubMed2001

Plummer Vinson syndrome: case report.

Plummer Vinson syndrome is characterised by dysphagia, iron deficiency, anaemia and oesophageal web or webs. This is a case report of a 33 year old Asian female who presented with slowly progressive dysphagia and a long history of iron deficiency anaemia. The anaemia was confirmed on repeated haemograms and a barium swallow revealed an upper oesophageal web. Upper gastrointestinal endoscopy and forceful dilatation were necessary to effect relief of dysphagia.

Adult↗
PubMed2000

Out-patient palliative therapy for advanced cancer of the oesophagus.

OBJECTIVE: To establish an economical, safe and effective palliative mode of treatment in cases of advanced cancer of the oesophagus. DESIGN: A retrospective study on patients with carcinoma of the oesophagus treated with endoscopic pulsion intubation. SETTING: Out-patient treatment at the author's surgery at the Hurlingham Medicare Plaza, Nairobi. SUBJECTS: Seventy three patients with a histologically confirmed diagnosis of carcinoma of oesophagus. INTERVENTION: Endoscopic pulsion intubation with endoprosthesis placement to relieve dysphagia. RESULTS: Marked improvement in dysphagia by at least two grades within six hours of intubation. No major complication or procedure associated mortality. CONCLUSION: Endoscopic pulsion intubation is safe, economical and very effective palliative mode of treatment in advanced cases of cancer of the oesophagus.

Adult↗
PubMed1998

Outpatient experience with oesophageal endoscopic dilation.

Between March 1990 and August 1997, outpatient endoscopic balloon dilation was performed for oesophageal strictures which developed secondary to malignancies, peptic strictures, post surgical narrowing, achalasia cardia, corrosive ingestion and other causes. A total of 169 dilations were performed in the 92 cases with an average of 1.8 dilation/case (Range 1 to 8). Dilation was possible in all 92 cases without the need for fluoroscopic monitoring. Twenty three (13.6%) of the dilations were performed using pneumatic balloon while in 146(86.4%) cases wire guided metal olives were used. There were nine minor complications which were treated with medication on an outpatient basis and four major complications which required inpatient care. Three of these had perforation of the oesophagus and one died. One other patient developed aspiration pneumonia and subsequently died.

Adolescent↗
PubMed1997

Oesophageal variceal banding: report of the first eight cases in Kenya.

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Adult↗