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Biomedical subjects

R Rasaretnam

Publications and source records attributed to R Rasaretnam.

15 recordsLinked to original sources
PubMed1977

Traumatic lesions of the duodenum.

Injuries of the duodenum are relatively uncommon on account of the organ's size and position. Since most of it is retroperitoneal, lesions involving it give rise to such subtle physical and radiological signs that the diagnosis is often overlooked in the early phase after injury. Twenty-six cases of duodenal injury are reviewed, 18 of which were due to penetrating wounds and the remaining 8 to blunt trauma. Anterior penetrating wounds were usually associated with other intraperitoneal lesions which caused more obvious physical signs and thus drew attention to the necessity for exploration. On the other hand, both blunt trauma and posterior stab wounds frequently caused isolated retroperitoneal duodenal lesions where the diagnosis was not evident on admission, but in which the insidious and progressive development of symptoms and signs drew attention to the need for laparotomy. Early repair combined with drainage of the retroperitoneal space resulted in a good result in 23 of 26 cases, 4 of whom, however, developed a temporary lateral duodenal fistula. Two of the 3 deaths were in patients who presented late and had associated pancreatic injuries while the third was due to an abdominal vascular injury.

Adolescent↗
PubMed1976

Tropical intussusception in adults.

In contrast with the incidence in Britain and the United States, about 50% of intussusceptions in Sri Lanka occur in adults, the maximum age incidence being in the fourth decade. Seventy-six cases of intussusception in adults are analysed in this paper, 62 of which were of the caecocolic type, which though only rarely described in the West, have also been frequently reported from other tropical countries. The clinical picture was characteristic, and a mass was palpable in 90% of the patients, facilitating diagnosis without ancillary investigations. On the basis of the histological examination of resected specimens it is concluded that amoebic granulomatous formation in the dependent "diverticulum" of the caecum is the predisposing cause of the caecocolic intussusception, accounting for the chronicity of a large number of cases. Irrespective of the duration of the illness, gangrene did not occur in any of the cases if this type, although resection was occasionally required on account of irreducibility. In view of the proliferation of fibrous tissue in the wall of the caecum, complete evagination of the intussusception can only be achieved by surgical exploration and manipulation, the results of which are excellent.

Adolescent↗
PubMed1976

Cervico-mediastinal lymphangioma.

Two cases of cervico-mediastinal lymphangioma ppesenting in adults are reported. In one the lesion originated in the mediastinum and only when advanced showed extension into the neck. The other was associated with a cervical cystic hygroma. Both wwer relieved by one-stage excision. Although they are benign, the tendency of these lesions is to become progressively larger, and to infiltrate between the vital structures in the neck and mediastinum. These features, and the importance of early surgery, are illustrated by the patients we now report.

Adolescent↗
PubMed1976

Spontaneous haemothorax in a mild haemophiliac.

Spontaneous haemothoraxis is a very rare presenting manifestation in haemophilia, only four previous cases being recorded in the English literature. The clinical features and management of such a case by intercostal tube drainage in a previously unrecognized haemophiliac are described.

Adult↗
PubMed1975

Recurrent pleural effusion in chronic relapsing pancreatitis.

A case of recurrent pleural effusion occurring in a patient with chronic relapsing pancreatitis is presented. Although it is one of the less common manifestations of the pleuroplumonary complications of pancreatitis, the presence of such a lesion is of diagnostic importance when the enzyme content of the effusion is elevated above the levels in the serum. In most of the reported cases resolution has occurred with conservative therapy, but failure to do so necessitated subtotal pancreatectomy, following which the patient made an uneventful recovery.

Chronic Disease↗
PubMed1975

Selective surgery for abdominal stab wounds.

The value of selective surgery for abdominal stab wounds was assessed in a prospective study of 226 patients admitted over an 18-month period. Two died soon after admission and before operation, the indications for which were signs of peritoneal irritation or haemorrhage, evisceration of bowel and omental protrusion. Of the 226 patients, 113 were selected for immediate surgery, which was carried out within 3 hours of admission. There were 12 deaths (10-6 per cent). Of the 111 patients initially selected for observation, 47 (42-3 per cent) underwent delayed operation with 4 deaths (8-5 per cent), but in only 1 (2-1 per cent) of these patients could the delay have influenced the adverse result. There were no deaths in the 64 patients treated conservatively. The overall mortality rate of patients who were initially selected for observation was 3-9 per cent. One hundred and fifty patients underwent laparotomy, positive findings justifying operation being present in 134 (89 per cent). Six patients required thoractomy for concomitant thoracic injuries, including 2 patients who required cardiorraphy. Four other patients required combined thoracic and abdominal exploration. The selection of patients for either conservative or operative management was based entirely on clinical criteris; abdominal X-rays were not helpful in the early diagnosis of visceral lesions. The indications for operation were evident within 12 hours of admission in 156 of the 160 patients who were treated surgically. A substantial reduction in the incidence of 'negative laparotomy' can be made by this process of selection, and without an associated increase in the morbidity and mortality rates.

Abdominal Injuries↗
PubMed1975

Leiomyosarcoma of the mediastinum.

A case of leiomyosarcoma of the posterior mediastinum is presented; 2 other malignant and 7 benign smooth muscle tumours of the mediastinum have been collected from the literautre. The tendency for blood-borne and local recurrence in the leiomyosarcomas is demonstrated. Various theories for the origin of these tumours are examined.

Cell Nucleus↗
PubMed1975

Penetrating injuries of the neck.

In view of the close arrangement of a large number of vital structures in the neck, penetrating wounds in this region should be considered as potentially lethal. Nineteen cases of injury to great vessels and food and air passages which required repair are analysed. There were 4 deaths, giving an overall mortality of 21 per cent. Two of these were injuries of the subclavian and innominate veins when prolonged delay for resuscitation was probably the main reason for the deaths. The third was in a patient with tracheal injury in whom a coexistent oesophageal lesion was missed and the fourth a case of spinal cord injury. When adequate exposure cannot be obtained by exploration of the neck, median sternotomy or anterior thoracotomy is advisable.

Blood Vessels↗
PubMed1975

Constrictive pericarditis following mild non-penetrating trauma.

A case of constrictive pericarditis developed within twenty-four days of mild, blunt thoracic trauma. Rapid progression from traumatic pericarditis to constriction is documented with clinical evidence, electrocardiographic changes and cardiac catheterisation data. Other manifestations of pericardial reaction after blunt chest trauma are reviewed briefly.

Child↗
PubMed1975

Silent mitral regurgitation.

The occurrence of significant mitral regurgitation whithout the characteristic auscultatory signs, particularly the holosystolic murmur and the third heart sound, is unusual. It becomes of considerable importance when it occurs in combined lesions of the mitral valve, and more so in those areas where the treatment of mitral stenosis is by closed mitral valvotomy. Two cases of silent mitral incompetence are presented. The features that should have indicated the coexistence of regurgitation with mitral stenosis were cardiomegaly with considerable dilatation of the left atrium, and lesser degrees of right ventricular hypertrophy on electrocardiography for the severity of mitral stenosis and evidence of biventricular hypertrophy.

Adult↗
PubMed1975

Liver injuries.

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Adult↗