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Biomedical subjects

R Saadia

Publications and source records attributed to R Saadia.

At least 19 recordsLinked to original sources
PubMed2000

Non-operative treatment of abdominal gunshot injuries.

BACKGROUND: Non-operative treatment is a management option that challenges the traditional mandatory laparotomy for abdominal gunshot injuries. METHODS: All published relevant clinical reports were retrieved by searching through the Medline database and manually. The theoretical arguments in favour of non-operative management as well as the results of the reviewed reports are analysed and evaluated. RESULTS AND CONCLUSION: Patients with proven non-penetration of the abdominal cavity can be offered conservative treatment with a satisfactory outcome. Greater caution should be exercised in the presence of a documented visceral injury until the safety of this option has been established by further clinical trials.

Abdominal Injuries↗
PubMed1999

Multiple organ failure. How valid is the "two hit" model?

Inflammatory "one hit" and "two hit" models have recently been proposed to account for the development of multiple organ failure (MOF) in trauma and critically ill surgical patients when no source of infection can be found. In the "one hit" model, the initial insult is so massive that a systemic inflammatory response syndrome is triggered and leads rapidly to MOF. In the "two hit" scenario, initially less severely injured patients eventually develop MOF as a result of a reactivation of their inflammatory response caused by an adverse and often minor intercurrent event. At first sight, the theory is attractive because it seems to fit commonly observed clinical patterns. Indeed, injured patients often respond to initial resuscitation but, after an insult of some sort, develop organ dysfunction and die. The "two hit" model is furthermore mirrored at the cellular level. Inflammatory cells are indeed susceptible of being primed by an initial stimulus and reactivated subsequently by a relatively innocuous insult. However, in the absence of clinical and biological corroboration based on cytokine secretion patterns, these models should not be accepted uncritically.

Animals↗
PubMed1999

Organisation of hospital responses for the trauma epidemic.

The caseload of the Department of Surgery (Baragwanath Hospital, Johannesburg, South Africa) is characterised by a singularly heavy trauma component. Penetrating injuries account for the majority of cases. The management of penetrating trauma is not as demanding as that of blunt trauma, yet the sheer number of cases, over the past four decades, has imposed a clinical burden that has never been met by commensurate resources. The organisation of the hospital and departmental responses has manifested itself on two different levels. The first one is the structural and functional deployment of insufficient staff, facilities and equipment to cope as flexibly as possible with the trauma epidemic. The second one is the gradual adaptation of the clinical management philosophy to ensure that the best possible quality of care is provided to the majority of trauma victims, with the full knowledge that better resources would sometimes have elicited a different clinical approach.

Hospitals, University↗
PubMed1999

Controversies in management of penetrating injuries of the pancreas.

The management of penetrating pancreatic injuries is still beset by controversy, especially with regard to the role of pancreatography, the most appropriate operation, the type of drainage and the adjunctive role of ocreotide. The recommendations of various experts are outlined and evaluated in the light of the authors' personal experience. Consensus is easily achieved for very minor and very severe injuries. Most management discussions center around those injuries resulting in parenchymal disruption of a degree of severity sufficient to raise doubts about the integrity of the main pancreatic duct.

Drainage↗
PubMed1998

Good clinical research practice: what is it and is it possible in the intensive care unit?

With the growing quest for answers to vexing dilemmas in critically ill patients, more intensive care units are embarking on clinical research. This places increasing importance on Good Clinical Research Practice (GCRP), a set of guidelines drawn up by the Pharmaceutical Industry to assist investigators in conducting ethical, reliable scientific studies. GCRP is a combination of good basic management skills allied to ethical principles for scientific research. Based on the principles of the Declaration of Helsinki, it consists of three tenets: patient protection (ethics), credible data (science) and data control. This article describes GCRP specifically relating it to the intensive care situation, illustrating some of the concepts with practical examples. With a minimum of extra time and effort these basic principles can be integrated as routine into all research projects.

Clinical Trials as Topic↗
PubMed1997

Gunshot injuries of the abdominal aorta: a continuing challenge.

This is a retrospective study of 57 patients with gunshot injuries of the abdominal aorta. The aortic repair was achieved by various means: lateral aortorraphy, patch aortoplasty and graft insertion. There was an 85 per cent mortality rate from bleeding or secondary coagulopathy directly related to the aortic injuries. The need for resuscitative thoracotomy, shock, lack of response to fluid resuscitation and intraperitoneal bleeding were directly related to mortality. We feel that shortening of prehospital transfer time will increase the absolute number of patients surviving this grave injury.

Adolescent↗
PubMed1997

Management of penetrating injuries of the cervical trachea.

This is a report of a 2-year experience with the management of penetrating injury of the cervical trachea. There were 29 cases. The respiratory status of the patient on admission dominated the initial management: 12 patients required emergency intubation and were immediately taken to operation, while 17 patients were more stable and could be subjected to the preoperative assessment of the oesophagus. Associated injuries were significant and dominated the postoperative morbidity and mortality. Primary repair of the trachea, without tracheostomy, was successful in a relatively high proportion of patients (55%).

Adult↗
PubMed1997

Laparoscopic inguinal hernia repair by an intraperitoneal onlay mesh technique using expanded PTFE: a prospective study.

This prospective trial was initiated to assess laparoscopic inguinal hernia repairs by an intraabdominal intraperitoneal onlay mesh (IPOM) technique. An IPOM method utilizing 10 x 7.5-cm expanded polytef (PTFE) patches was used to repair 52 inguinal hernias in 50 patients. There were two patients with bilateral defects. Fourteen were direct and 38 were indirect hernias. There was one patient with bladder perforation, one with strangulation of the small bowel that entered the sac of a recurrent defect, and five patients with other minor complications. There were two recurrences. The follow-up period ranged from 7 to 31 months. The operating time ranged from 35 to 180 min and was 35-60 min in 40 patients. The postoperative pain was minimal in 40 patients. Our conclusions are as follows: This IPOM method was less time consuming in theater time than other laparoscopic methods. There was minimal postoperative pain in the majority of cases. The hospital stay was shorter in comparison with the standardized stay for conventional methods. The case with recurrence and strangulation raises some questions as to the safety of this method. Hospital costs of conventional herniorrhaphies were lower (63%) than those of this laparoscopic method.

Adolescent↗
PubMed1996

Diaphragmatic herniation after penetrating trauma.

A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury.

Adult↗
PubMed1996

Gunshot injuries of the head of the pancreas: conservative approach.

This study is comprised of 48 patients with gunshot injuries of the head of the pancreas, many of which were high velocity injuries. The purpose of this study was to evaluate our management policy for these injuries based on our recent wide experience. Patients with grade II and III injuries underwent conservative surgery, with 0% and 21% postoperative mortality, respectively, directly related to the pancreatic injury. For patients in whom the duodenum was involved, pyloric exclusion was applied depending on the grade of the duodenal injury. We concluded that moderate gunshot injuries of the head of the pancreas (grade II) can be safely treated by débridement and suture repair, with or without drainage. Severe (grade IV) injuries warrant a pancreaticoduodenectomy. Most grade III injuries can be treated by débridement and drainage unless an associated severe duodenal injury is present, in which case resection may be indicated.

Adult↗
PubMed1996

Gunshot arterial injuries to the groin: comparison of iliac and femoral injuries.

In a prospective study of 69 patients with gunshot arterial injuries to the groin, there were 18 patients with iliac and 51 with femoral artery injuries. In the former group, the majority of patients were admitted with gross physiological derangement that did not respond to pre-operative resuscitation, so were taken directly to theatre. There was a 39 per cent peri-operative mortality. A prompt operation is mandatory to improve the chances of survival of patients with this injury. In the latter group all patients responded to pre-operative resuscitation and in the great majority, the diagnosis was established by the presence of 'hard' signs of arterial injury alone. There was a 4 per cent amputation rate and no mortality.

Adolescent↗
PubMed1996

Selective surgical management of zone II gunshot injuries of the neck: a prospective study.

BACKGROUND: The management of penetrating neck trauma remains controversial, with many studies supporting either mandatory exploration or selective conservatism. METHODS AND RESULTS: This is a prospective study of 75 patients with gunshot injuries to zone II of the neck. Forty patients (53.3%) underwent immediate exploration because of clinical indications or positive initial investigations. A 7.5% incidence of unnecessary explorations, a 5% mortality rate, and average hospital stay of 10.5 days were noted. Thirty-five patients with negative clinical or investigational findings underwent observation with constant monitoring. A 5.7% incidence of missed injuries, no mortality, and an average hospital stay of 3.5 days were noted for these patients. CONCLUSIONS: We suggest that conservative management in gunshot injuries confined to zone II of the neck selectively supplemented by appropriate investigations is a viable proposition in this type of injury. Further contemporary studies reporting specifically on this injury will enable us to reach statistically significant conclusions.

Adolescent↗
PubMed1996

Penetrating injuries of the iliac arteries: a South African experience.

BACKGROUND: We did a retrospective study of 62 patients with penetrating injuries of the iliac arteries. METHODS: The cause of injury was gunshot wound in 85.5% and stabbing in 14.5%. The arterial repair was achieved by various means: lateral arteriorrhaphy, end-to-end anastomosis, and polytetrafluoroethylene interposition grafts. RESULTS: There was a 42% mortality rate from exsanguination or secondary coagulopathy directly related to the arterial injury. Persistent shock, resuscitative thoracotomy, free intraperitoneal hemorrhage, and the number of vascular injuries were directly related to mortality. CONCLUSIONS: A high index of suspicion, aggressive resuscitation, and prompt surgery are necessary to improve the chances of surviving this ominous injury.

Anastomosis, Surgical↗
PubMed1996

Volvulus of the sigmoid colon at Baragwanath Hospital.

Fifty-six patients treated for sigmoid volvulus over a period of 5 years are reviewed. The purpose of this study is to evaluate our management policy and to compare it with other studies, particularly from other parts of Africa. The patients were evaluated by retrospective allocation into one of three treatment modalities. Patients with clinical evidence of ischaemia underwent a Hartmann's procedure. There was a 33% mortality rate in this group. In those patients who had sigmoidoscopic reduction, a second-stage sigmoidectomy and primary anastomosis were performed. The results in this group were excellent. In the group of patients with failed sigmoidoscopic resection the majority underwent a Hartmann's procedure with a mortality rate of 15%.

Adult↗