Biomedical subjects

R T Kuremu

Publications and source records attributed to R T Kuremu.

8 recordsLinked to original sources

PubMed2006

Adhesive intestinal obstruction.

BACKGROUND: Adhesions after abdominal and pelvic surgery are a major cause of intestinal obstruction in the western world and the pathology is steadily gaining prominence in our practice. OBJECTIVE: To determine the magnitude of adhesive intestinal obstruction; to determine the types of previous operations in patients who presented with adhesive intestinal obstruction; to determine the outcome of treatment; and to determine the factors affecting the overall management of adhesion-related intestinal obstruction. DESIGN: Retrospective descriptive study. SETTING: The Moi Teaching and Referral Hospital (MTRH) - Eldoret, Kenya. RESULTS: Ninety three patients were managed for adhesive intestinal obstruction. Of these, 57 were male and 36 were female. Abdominal distension, bilious vomiting, absolute constipation and abdominal pain were the main symptoms. Forty two (45%) patients were operated on, twenty five (59%) of them being operated on more than 72 hours after the start of the symptoms. Eight (9%) patients had ischaemic gut injury by the time of operation. Fluid therapy was inadequately administered in 86 (92%) patients, and their charts were not completely filled. CONCLUSION: Adhesion-related intestinal obstruction is a common problem encountered in the surgical service at the Moi Teaching and Referral Hospital-Eldoret. It is the major cause of intestinal obstruction. Fluid therapy and delayed surgical intervention were the major challenges in the management of these patients.

Adolescent↗

PubMed2005

Gastroschisis: immediate reduction by bianchi procedure at Moi Teaching and Referral Hospital, Eldoret: case report.

This is a report of the only case of gastroschisis that has survived at the Moi Teaching and Referral Hospital in the past five years. Others, who have been referred to this hospital arriving occasionally without the necessary care for this problem in place, have not even managed to survive through the period of resuscitation. The objective of this report is to show that these children can survive. Immediate post-natal care for protruded abdominal organs, fluid resuscitation and adherence to the principles of neonatal transport are essential.

Congenital Abnormalities↗

PubMed2004

Neonatal gastric perforation.

BACKGROUND: Gastric perforation in neonates is a catastrophe associated with high morbidity. Most are due to underlying primary pathology. OBJECTIVES: To review the management of gastric perforation in neonates in Kwa Zulu-Natal, South Africa. DESIGN: Retrospective study of consecutive complete data sets of neonates presenting with gastric perforation. SETTING: Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa. SUBJECTS: Eight neonates treated for gastric perforation between January 1998 and April 2003. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: There was an equal number of males and females. Median birth weight was 2.0 kg with a range of 1.4 to 3.2 kg. Five of the eight neonates were premature. Primary pathologies were associated with perforation in seven of the eight neonates. Prematurity, low birth weight and pneumonia were contributing factors to the poor outcome. Sepsis was a complication in seven of the eight neonates leading to their death (88% mortality). CONCLUSION: Active perinatal management, early treatment of primary pathologies, and protection of the stomach against distension in neonates at risk are essential in the management of neonatal gastric perforation.

Female↗

PubMed2004

Testicular torsion: case report.

This is a report of bilateral testicular torsion. The objective of the report is to highlight the serious implications of misdiagnosis of testicular torsion. Other than loss of the testis due to necrosis in unilateral torsion, immunological damage of the opposite testis occurs. Early, accurate diagnosis, and institution of the appropriate treatment are desirable to prevent total loss of reproductive potential in the affected male.

Adult↗

PubMed2004

Childhood intussusception at the Moi teaching and Referral Hospital Eldoret: management challenges in a rural setting.

OBJECTIVE: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome. DESIGN: A retrospective descriptive study covering the period January 2000 to December 2003. SETTING: Moi Teaching and Referral Hospital, Eldoret. PATIENTS: Thirty six children. RESULTS: Of the 36 children, 28 (78%) were males and eight (22%) females giving a ratio of 3.5:1. Median age was six months with a range of 2-72 months. The duration of symptoms was a mean of 5 days with a range of 1-14 days. Sixty one percent were referrals. Initial diagnosis of intussusception based on signs and symptoms was made in 6 out of 36 (17%) patients. The rest were initially treated for other problems. Decision to refer to surgeons, was based on abdominal distension. Plain x-ray was done in four patients and barium enema in one patient. Seventy five percent of the patients required fluid resuscitation before operation. All patients (100%) were managed operatively. Seventy two percent had ileo-colic intussusception, 8% ile-oileal and 22% colo-colic. Perforation was found in 22% and gangrene in 31%. Sixty seven percent were successfully reduced by "milking" while 33% required resection and anastomosis/or stoma creation. Complications included: anastomatic breakdown, bronchopneumonial renal failure, sepsis, recurrent intussusception and death. Mortality was 14% overall. CONCLUSION: Early diagnosis and presentation coupled with improved peri-operative management are essential in improving outcome.

Child, Preschool↗

PubMed2003

Gastro-intestinal tract perforation in neonates.

BACKGROUND: Gastro-intestinal tract (GIT) perforation in neonates is a serious problem associated with high mortality due to resulting sepsis. Co-morbid factors, eg. prematurity, respiratory problems, low birth weight, and nutritional factors, negatively affect the outcome. OBJECTIVES: To review the management outcome of gastro-intestinal tract perforation in neonates in KwaZulu-Natal and identify factors that require attention for better survival of neonates with GIT perforation. DESIGN: Retrospective study of consecutive complete data sets of patients presenting with a diagnosis of GIT perforation. SETTING: Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of Natal, Durban, South Africa. SUBJECTS: Fifty four neonates treated for gastro-intestinal tract perforation between January 1998 and January 2003. MAIN OUTCOME MEASURES: Morbidity as determined by complications and mortality. RESULTS: More males (69%) were affected than females (31%). The median birth weight was 2.3 kg and median age at presentation was four days. Eighty nine percent were referred from peripheral hospitals. Abdominal distension was the leading symptom and sign (74%). Co-morbid factors were present in 89%, with prematurity as the leading factor (52%). Necrotising enterocolitis (NEC) was the main cause of perforation (33%) and the terminal ileum was the most common site. Most (56%) were treated by excision and primary repair of perforations. Sepsis was the leading complication (44%) and major cause of death (72%). Mortality was highest (56%) in perforations due to other primary pathology followed by NEC (53%). Overall mortality was 46%. CONCLUSION: It is essential to prevent secondary perforations by early recognition and management of primary pathology. Management of pneumoperitoneum in neonates with respiratory difficulties should be included in resuscitation before transfer. Rectal temperature monitoring and herbal enemas should be strongly discouraged.

Anti-Infective Agents↗

PubMed2002

Hydatid disease of the spine: case report.

A rare case of spinal hydatid disease presenting with paraparesis and sensory loss is reported. The patient was treated with albendazole resulting in significant improvement within eight weeks. Investigations and treatment modalities are discussed.

Adult↗

PubMed2002

Surgical management of peptic ulcer disease.

OBJECTIVE: To determine the pattern of surgically managed peptic ulcer disease. DESIGN: A retrospective study. SETTING: Department of Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya. SUBJECTS: Fifty three patients operated on for peptic ulcer disease. RESULTS: The mean age was 47 years with a male/female ratio of 1.7:1. Duodenal ulcer associated complications were the commonest with duodenal ulcer/gastric ulcer ratio of 11.5:1. Most patients had chronic peptic ulcer symptoms with inadequate or no medical treatment. Perforations were the commonest complications (56.6%) followed by gastric outlet obstruction (34.0%). Closure with omental patch was done in 83.3% of perforations while truncal vagotomy and drainage was done in gastric outlet obstruction. Hypostatic pneumonia was the commonest post-operative complication. Seventy one point seven per cent of the patients were free of dyspeptic symptoms during the brief follow-up period. CONCLUSION: Most patients with chronic peptic ulcers had had inadequate treatment and perforation was the most common complication. Repair of perforations with omental patch, and truncal vagotomy and drainage procedure for gastric outlet obstruction, were satisfactory surgical methods offered to patients at the Moi Teaching and Referral Hospital.

Adolescent↗