PubMed Health⌕ Search

Biomedical subjects

S Sivapragasam

Publications and source records attributed to S Sivapragasam.

At least 19 recordsLinked to original sources
PubMed1993

Fat embolism syndrome following long bone fractures.

During the period August, 1979 to December, 1992, 14 patients with the Fat Embolism Syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these, 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation must be instituted if serious neurological complications and death are to be avoided.

Adolescent↗
PubMed1992

Thymectomy in myasthenia gravis. The Jamaican experience.

Forty-five patients with myasthenia gravis (MG) were subjected to thymectomy by the median sternotomy technique and were followed up for 4,380 patient months. No operative deaths occurred and 93.3% of the patients benefited from surgery with 28.8% achieving remission. Forty patients (88.5%) showed improvement within one month, and 73% of those who achieved remission did so in the first 2 years. Outcome was not affected by thymic pathology except in one patient who had a thymoma removed. These results confirm the value of thymectomy in the management of MG patients with generalised disease and the efficacy of the simple median sternotomy procedure.

Adolescent↗
PubMed1991

Myasthenia gravis in Jamaica. Clinical, immunological and genetic studies.

Clinical, immunological and genetic parameters were studied in 73 Jamaican patients with myasthenia gravis (MG). The reported bimodal clinical distribution of females with early onset of disease and males with late onset was not observed. The female to male ratio was 2:1. The most frequent manifestations of disease were ptosis (84.9%), general muscle weakness (68.5%), bulbar symptoms (41.1%) and diplopia (32.9%). Unusual presenting features such as unilateral ptosis, recurrent chest infection and stumbling while walking resulted in diagnosis being missed in 5.8% of cases. The sensitivity of radioimmunoassay in detecting acetylcholine receptor antibody (AchR-Ab) in sera from a subgroup of 35 MG patients was 71.4% whilst that of the ELISA was only 14.2%. There was no correlation between concentration of AchR-Ab and severity of disease. Similarly, there was no association between HLA-type, thymic pathology and course of disease. HLTV-I could not be implicated in the pathogenesis of this disease. There was a paucity of other associated autoimmune conditions among MG patients. Thymectomy was an important therapeutic modality in that improvement was observed in 22 cases and remission in 11.

Adolescent↗
PubMed1983

Pregnancy in patients after homograft cardiac valve replacement.

Thirteen pregnancies in ten patients with homograft cardiac valves resulted in 11 healthy infants, one spontaneous abortion, one elective termination of pregnancy, and the stillbirth of one member of a twin pregnancy. Two forceps deliveries and three cesarean sections were performed and routine antibiotic prophylaxis at the time of delivery was utilized to prevent infective endocarditis in all patients. No hemorrhagic or teratogenic complications were observed, and this was considered directly related to the fact that anticoagulant therapy was rendered unnecessary with the homograft valve--a distinct advantage. A more permissive policy of allowing pregnancy in young women with homograft cardiac valves is suggested by the satisfactory outcome of the pregnancies reported here.

Abortion, Induced↗
PubMed1982

Hemodynamic improvement after peritoneovenous shunting in nephrogenic ascites.

A patient being treated by regular hemodialysis for end-stage renal failure had nephrogenic ascites. Despite attempts at fluid removal by ultrafiltration, progressive hypotension and low cardiac output eventually reduced fistula flow so much that hemodialysis became almost impossible. The insertion of a peritoneovenous shunt resulted in reduction of ascites and 78% increase in cardiac output, with consequent correction of hypotension and improvement of fistula flow. Peritoneovenous shunting is a simple and beneficial form of treatment for nephrogenic ascites that does not respond to fluid removal by dialysis.

Ascites↗