Re: laparoscopic appendicectomy.
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Digestive System Surgical Procedures↗
Biomedical subjects
R Baraza
Publications and source records attributed to R Baraza.
Experience with laparoscopic surgery at the Aga Khan Hospital, Nairobi.
OBJECTIVE: To outline the experience of laparoscopic surgery at the Aga Khan Hospital, Nairobi, and to determine the acceptability and outcome of the various procedures undertaken laparoscopically. DESIGN: A retrospective case analysis. SUBJECTS: Four hundred and seventy eight cases of laparoscopic surgery were undertaken in Nairobi from May 2000 to May 2002 in the presence of the principal author, of these 408 cases (85.35%) were performed at the Aga Khan Hospital in Nairobi. A review of these cases and their outcomes are analysed and presented. EXCLUSIONS: Loss of client records, or follow up, all diagnostic procedures and all procedures performed at the three other private hospitals, namely; Nairobi Hospital, Nairobi Womens' Hospital and the M.P. Shah Hospital, have been excluded in this review. RESULTS: Minimal access surgery will in time find its place amongst the institutions in Kenya. In the last two years 408 cases were undertaken at the Aga Khan Hospital, Nairobi, involving a pool of 48 consultants obstetricians and gynaecologists and general surgeons. The case load increased from 7.0 cases per month in 2000 to 22 cases per month in 2001. Sixty four point four six percent of the patients spent one night in hospital, while 1.96% had conversion to laparotomy intraoperatively. Thirty nine point seven percent of the patients had no previous surgery. The surgical procedures performed included laparoscopic adhesiolysis (34.55%) and tuboplasty (17.89%) for primary or secondary infertility, 33 cases (8.08% ) for the management of ectopic pregnancies, laparoscopic myomectomy (15.44%), ovarian cystectomy (16.91%), ovarian drilling (4.65%), laparoscopic assisted vaginal hysterectomy (15.19%) and total laparoscopic hysterectomy (2.20%). All cases were reviewed by the consultant pool one week after discharge. The major complications encountered included bladder injury (0.49%) and gut injury (0.73%). CONCLUSIONS: Minimal access surgery in gynaecology and general surgery is gaining remarkable ground worldwide and has tremendous potential in Kenya. It is evident that in trained hands, the common gynaecological operations and certain general Surgical procedures can be undertaken safely, laparoscopically. Minimal access surgery is acceptable to the patients and significantly favourable outcomes have been established in all the cases undertaken, thus far. Patient compliance has been excellent in this series.
Abdominal Injuries↗
Nadir neutrophil counts in patients treated for breast cancer with doxorubicin and cyclophosphamide.
OBJECTIVE: To determine the impact on neutrophils if adriamycin is administered at 60 mg/m2 and cyclophosphamide at 600/m2 (AC 60/600); and at 50 mg/m2 and 500 mg/m2 (50/500) in the treatment of breast cancer. DESIGN: Restrospective analysis of nadir neutrophil counts in female mammary carcinoma patients treated with adriamycin/cyclophosphamide combination. SETTING: Hurlingham Oncology Clinic, Nairobi and The Nairobi Hospital between March 1995 and August 1999. SUBJECTS: Eighteen patients with breast cancer were treated either for adjuvant purposes or for metastatic disease. INTERVENTION: Chemotherapy with adriamycin and cyclophosphamide at 60/600 or 50/500. Patients were advised to avoid crowded places and given prophylactic broadspectrum antibiotics whenever grade 4 neutropenia occurred at nadir. RESULTS: Grade 3-4 neutropenia occurred in 75.5% of treatments at 60/600 and in 56.8% of the treatments at 50/500. Febrile neutropenia followed only one treatment and did not result in death. CONCLUSION: Neutropenia is frequent and severe at A/C 60/600 and need to be watched out for. Sepsis on the other hand is prevented if meticulous attention is given and corrective measures taken. A/C 50/500 was associated with less occurrences of neutropenia though still very high. Neutropenia should therefore be checked and steps be taken to prevent sepsis even at this dosage.
Adult↗
Ethics and international research. Kenyan statutory body was unaware of study.
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Controlled Clinical Trials as Topic↗
Re: Article entitled "Legislatory framework for private medical practice in Uganda" by Joseph Konde-Lule and others appearing in this issue of EAMJ.
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Facility Regulation and Control↗
Assessment of collagen film for use in urinary tract surgery.
This investigation assessed a biodegradable collagen membrane which can be sutured around the ureter to prevent urine leakage, thus permitting healing to proceed more rapidly while the membrane itself is resorbed. Following an early in vitro investigation in which collagen was assessed, a more comprehensive survey has now been carried out. Tissue compatibility and biodegradation were assessed by implanting the film into the lumbar muscles of rats; it was then used to cover experimental ureterotomies in New Zealand White rabbits. The data obtained from the rabbits confirmed that a collagen membrane can prevent leakage of urine from the ureter during healing while it itself is biodegraded, indicating that a collagen membrane could be used to repair the injured urinary tract.
Animals↗
Absorption of 1.5% glycine after percutaneous ultrasonic lithotripsy for renal stone disease.
An elderly normotensive man underwent percutaneous ultrasonic lithotripsy for renal stone disease, the procedure lasting three hours and the fragments being washed out with 20 l 1.5% glycine. After two hours the inflation pressure had risen to 25 cm H2O and his blood pressure to 150 mm Hg. Inflation pressure continued to rise until drainage tubes were inserted into the retroperitoneal space, releasing a large volume of fluid, some of which appeared to be from the peritoneal cavity. Shortly after transfer to the recovery area the patient showed signs of the transurethral resection syndrome, with hyponatraemia, hyperkalaemia, and hypertension. He was treated appropriately and survived. Low infusion pressures should be used for irrigation during lithotripsy and 0.9% saline instead of 1.5% glycine. In patients given a general anaesthetic any rise in inflation pressure suggests extravasation of fluid and warrants emergency estimation of the plasma sodium concentration.
Absorption↗
Preliminary development of a collagen membrane for use in urological surgery.
A series of experiments have been carried out in-vitro in order to assess the possibility of using a collagen membrane in the repair of various sections of the urinary tract following operative surgery such as the removal of a stone from the ureter. The collagen film has been tested for its compatability with urine, its ability to prevent leakage of fluid in a simulated wound in-vitro and for its ability to withstand any degradative effect of liver and kidney homogenates. The material was not significantly degraded by either urine or by tissue homogenates and was able to prevent leakage of fluid under the experimental conditions employed. Although some slight build-up of calcium and some trace elements took place after incubation in urine over a six-day period this was not significant. On the basis of the results obtained it has been decided to proceed to in-vivo trials on rabbits using the collagen membrane. The possibility of using such a material in partial nephrectomy operations is discussed.
Animals↗