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1.
Niger J Clin Pract ; 24(5): 667-673, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34018975

RESUMO

OBJECTIVE: : We aimed to study the factors affecting the mortality of trauma patients who underwent whole-body computerized tomography (CT) on Emergency department (ED) time frames in a developing emergency care system. Materials and Methods: This is a retrospective analysis of adult patients who received WBCT from August to November for two consecutive years (2014 and 2015). Non-parametric statistical methods were used to compare the patients who died and survived. The Backward logistic regression model was used to define factors significantly affecting mortality. RESULTS: : During 2014, 200 patients out of 827 (24.1%) received WBCT. During 2015, 263 patients out of 951 (27.6%) received WBCT. Four hundred sixteen patients were entered into the analysis. The overall mortality was 3.4% (7% in 2014 and 1% in 2015, P = 0.002). Significant factors found in backward logistic regression model defining factors affecting mortality were ISS (p < 0.0001), Glasgow Coma Scale (GCS) (p = 0.001). CT location (outside the ED in 2014, inside the ED in 2015) showed a very strong trend for affecting mortality (p = 0.054). Patients who had WBCT in the ED had lower ISS (p < 0.0001). CT imaging in the ED decreased ED to CT time 15.5 minutes (p < 0.0001), but admission time was 75.5 minutes longer. CONCLUSIONS: ISS and GCS were the main factors predicting mortality in patients who received WBCT. Patients received more WBCT imaging and physicians showed a tendency to order WBCT for less severe patients when the CT located in the ED. CT location did not show a significant effect on mortality, but on some operational time frames.


Assuntos
Tomografia Computadorizada por Raios X , Imagem Corporal Total , Adulto , Serviço Hospitalar de Emergência , Escala de Coma de Glasgow , Humanos , Estudos Retrospectivos
2.
Eur J Trauma Emerg Surg ; 44(4): 561-565, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28849365

RESUMO

BACKGROUND: We aimed to study the value of new physiological variables compared with ISS and GCS as predictors for trauma mortality in a high-income developing country having a young population. METHODS: Data of 1008 consecutive trauma patients who were included in Al-Ain City Road Traffic Collision Registry were analyzed. Demography of patients, systolic blood pressure, heart rate, shock index, shock index age (SIA), blood pressure age index (BPAI), Glasgow Coma Scale (GCS), injury severity score (ISS), and in-hospital mortality were analyzed. Univariate analysis was used to compare those who died with those who survived. Significant factors were then entered into a backward logistic regression model to define factors predicting mortality. RESULTS: 80.3% of the patients were males. The median (range) age of patients was 26 (1-78) years. Significant factors that predicted mortality were GCS (p < 0.0001), SIA (p = 0.003), ISS (p = 0.007), and BPAI (p = 0.022). CONCLUSIONS: The physiological variables including GCS and shock index age were better predictors for trauma mortality comparted with ISS in our young population. A large global multi-centric study could possibly define an accurate global formula that uses both anatomical and physiological variables for predicting trauma mortality.


Assuntos
Acidentes de Trânsito/mortalidade , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Lactente , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros , Fatores de Risco , Análise de Sobrevida , Emirados Árabes Unidos/epidemiologia
5.
Afr Health Sci ; 13(3): 731-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24250314

RESUMO

BACKGROUND: Critically-ill trauma patients have a high mortality. OBJECTIVE: To study the factors affecting the mortality of ICU trauma patients treated at Al-Ain Hospital, United Arab Emirates (UAE). METHODS: All trauma patients who were admitted to the ICU were prospectively collected over three years (2003-2006). Univariate and multivariate analysis were used to compare patients who died and who did not. Gender, age, nationality, mechanism of injury, systolic blood pressure and GCS on arrival, the need for ventilation, presence of head or chest injuries, AIS for the chest and head injuries and the ISS were studied. RESULTS: There were 202 patients (181 males). The most common mechanism of injury was road traffic collisions (72.3 %). The overall mortality was 13.9%. A direct logistic regression model has shown that factors that affected mortality were decreased GCS (p < 0.0001), mechanism of injury (p = 0.004) with burns having the highest mortality, increased age (p = 0.004), and increased ISS (p = 0.02). The best GCS that predicted mortality was 5.5 while the best ISS that predicted mortality was 13.5. CONCLUSION: Road traffic collision is the most common cause of serious trauma in UAE followed by falls. Decreased GCS was the most significant factor that predicted mortality in the ICU trauma patients.


Assuntos
Cuidados Críticos , Mortalidade Hospitalar , Ferimentos e Lesões/mortalidade , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/mortalidade , Causas de Morte , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Emirados Árabes Unidos/epidemiologia , Ferimentos e Lesões/classificação , Ferimentos e Lesões/etiologia , Adulto Jovem
6.
Afr Health Sci ; 13(3): 762-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24250319

RESUMO

BACKGROUND: Human pancreatico-duodenal injuries caused by camels are extremely rare. OBJECTIVE: We report three patients who sustained camel-related pancreatico-duodenal injuries and review the literature on this topic. RESULTS: A 32-year camel caregiver was kicked by a camel which then stepped on his abdomen trying to kill him. The patient's abdomen was soft and lax. CT scan of the abdomen showed free retroperitoneal air. Laparotomy revealed a complete tear of the anterior wall of the second part of duodenum which was primarily repaired. A 40-year camel caregiver was directly kicked into his abdomen by a camel. He developed traumatic pancreatitis which was treated conservatively. A 31-year-old male fell down on his abdomen while riding a camel. Abdominal examination revealed tenderness and guarding. Abdominal CT Scan showed complete transection of the neck of the pancreas which was confirmed by laparotomy. The patient had distal pancreatectomy with preservation of the spleen. All patients were discharged home in good condition. CONCLUSION: These cases demonstrate the misleading presentation of the camel-related pancreatico-duodenal injuries and their unique mechanism of injury.


Assuntos
Camelus , Duodeno/lesões , Pâncreas/lesões , Pancreatite/etiologia , Ferimentos não Penetrantes/etiologia , Acidentes por Quedas , Adulto , Animais , Humanos , Laparotomia , Masculino , Pancreatectomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/cirurgia
7.
Afr Health Sci ; 13(2): 393-401, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24235941

RESUMO

BACKGROUND: Laparoscopic surgery is important for gynaecological practice and became the method of choice for many gynaecological procedures having advantages over open surgery. OBJECTIVES: To report our modified teaching methods, and evaluation of the gynaecological laparoscopy courses in United Arab Emirates. METHODS: Fifty five participants attended four 3-full day comprehensive hands-on gynaecological laparoscopic skills courses. Non-expensive dry/wet models have been developed for teaching. All participants were evaluated at the end of the course through MCQs and practical laparoscopic exercises. All participants filled out a questionnaire reflecting their opinion on various aspects of the course at its completion. Ethical approval has been received by Research and Ethics Committee of Al-Ain Medical District, Al-Ain, UAE. RESULTS: Fourteen participants had no laparoscopic experience, 35 had experience at level I and six had experience at level II. There was a statistically significant difference of the MCQ mark between the three levels of experience (p = 0.05, Kruskal Wallis test) but not for the practical part, p = 0.9, Kruskal Wallis test). The courses were highly valued having an overall average rating of 3.8 out of 4. CONCLUSION: A multimodality non expensive course for teaching gynaecological laparoscopy was highly successful in United Arab Emirates. Models used may be useful for training gynaecological laparoscopy in developing countries. The long term effects of our courses on clinical practice have yet to be evaluated.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Laparoscopia/educação , Competência Clínica , Currículo , Feminino , Humanos , Estatísticas não Paramétricas , Emirados Árabes Unidos
8.
Afr Health Sci ; 13(4): 893-8, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24940309

RESUMO

BACKGROUND: Modern medicine has allowed physicians to support the dying terminally-ill patient with artificial means. However, a common dilemma faced by physicians in general, and intensivist in particular is when to limit or withdraw aggressive intervention. OBJECTIVE: To study the effect of training background and seniority on Do-not to resuscitate (DNR) decisions in the Middle East. METHODS: Anonymous questionnaire sent to members of the Pan Arab Society of Critical Care. RESULTS: The response rate was 46.2%. Most of the responders were Muslim (86%) and consultants (70.9%). Majority of the responders were trained in western countries. Religion played a major role in 59.3% for making the DNR decision. DNR was considered equivalent to comfort care by 39.5%. In a futile case scenario, Do Not Escalate Therapy was preferred (54.7%). The likelihood of a patient, once labeled DNR, being clinically neglected was a concern among 46.5%. Admission of DNR patients to the ICU was acceptable for 47.7%. Almost one-half of the responders (46.5%) wanted physicians to have the ultimate authority in the DNR decision. Training background was a significant factor affecting the interpretation of the term no code DNR (P< 0.008). CONCLUSION: Training background and level of seniority in critical care provider does not impact opinion on most of end of life issues related to care of terminally-ill patients. However, DNR is considered equivalent to comfort care among majority of Middle Eastern trained physicians.


Assuntos
Atitude do Pessoal de Saúde , Cuidados Críticos , Tomada de Decisões , Pessoal de Saúde/psicologia , Ordens quanto à Conduta (Ética Médica) , Doente Terminal , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Oriente Médio , Inquéritos e Questionários
9.
Afr Health Sci ; 12(4): 557-62, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23515566

RESUMO

OBJECTIVES: To analyze the concept of "case series" in the medical literature compared with case reports. METHODS: A PubMed search for articles published during 2009 which had "case series" in their title was performed. A total number of 621 articles were retrieved. 586 papers were included in the analysis and 35 were excluded (18 were commentary letters, 5 were not in English, and twelve could not be retrieved by our Library). The number of patients and category of these articles were analyzed. RESULTS: The median (range) of the number of cases of articles having "case series" in their title was 7 (1-6432) cases. 186/ 586 articles had less than 5 cases (31.7%, 95% CI (28.3-35.1%)). The median (range) of the number of cases of articles having "case report" as their publication type was 4 (1-178) cases. Out of the 219 articles categorized as case reports 114 (52.1%, 95% CI (45.6-58.6%)) had less than five cases. CONCLUSIONS: The concept of "case series" is not well defined in the literature and does not reflect a specific research design. We suggest that a case series should have more than four patients while four paitents or less should be reported individually as case reports.


Assuntos
Publicações , Editoração , Projetos de Pesquisa , Humanos , Masculino
10.
Afr Health Sci ; 11(2): 296-300, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21857866

RESUMO

BACKGROUND: Solitary lateral cervical cystic mass is an uncommon presentation of papillary thyroid carcinoma. OBJECTIVES: To report our recent experience in the diagnosis and management of papillary thyroid carcinoma presenting as a lateral neck cyst. METHODS: Patients who had papillary thyroid carcinoma and presented as a painless lateral neck cyst at the Department of Surgery, Al-Ain Hospital, from April 2005 to June 2009 were retrospectively studied. Their clinical presentation, diagnosis and management were reviewed. RESULTS: Five patients were studied. No thyroid nodules were clinically palpable in all patients. Fine needle aspiration cytology from the cyst was positive for papillary thyroid carcinoma in three patients (60 percent). Two patients were diagnosed after excisional biopsy. Three patients had total thyroidectomy with modified radical neck dissection and postoperative radioactive iodine ablation. Two patients preferred to travel overseas for treatment. Thyroid histopathological examination has shown papillary thyroid carcinoma in all operated patients with multiple microscopic foci in two of them. This was associated with multiple bilateral cervical lymph node involvement. CONCLUSIONS: Metastatic papillary thyroid carcinoma presenting as a neck cyst is a diagnostic challenge. Excisional biopsy is indicated if fine needle aspiration cytology was inconclusive so as to rule out malignancy.


Assuntos
Carcinoma Papilar/patologia , Cistos/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Biópsia por Agulha Fina , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/cirurgia , Cistos/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Esvaziamento Cervical , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Singapore Med J ; 52(5): e96-9, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21633761

RESUMO

We report two rare cases of tracheobronchial injury (TBI) following endotracheal intubation. Both intubations were easy and performed by experienced anaesthetists. The injuries for both cases were possibly caused by the tip of an endotracheal tube. A 27-year-old woman regurgitated copiously during induction of general anaesthesia for a Caesarean section. She had a full-thickness TBI 2 cm above the carina, which was repaired through an open thoracotomy. A 68-year-old woman undergoing left mastectomy was intubated with a 7.5-mm endotracheal tube for general anaesthesia. 24 hours after extubation, the patient developed widespread subcutaneous emphysema. There was no associated respiratory distress, and the patient was treated conservatively. The fragile tracheal tissue associated with pregnancy and old age was possibly a contributing factor for injury. Both patients recovered well. Surgical and non-surgical methods can be safely used after careful consideration of the patient's clinical, radiological and endoscopic findings.


Assuntos
Intubação Intratraqueal/efeitos adversos , Traqueia/lesões , Adulto , Idoso , Broncoscopia/métodos , Enfisema/patologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/cirurgia , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
Eur Surg Res ; 46(3): 127-32, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21304233

RESUMO

AIM: To evaluate peritoneal resorption capacity for lipopolysaccharide (LPS) and interleukin-6 (IL-6) in a model of chemical peritonitis. METHODS: Zymosan peritonitis was induced in anesthetized rats. LPS was injected intraperitoneally to different groups at 4 h (n = 10), 8 h (n = 9), 12 h (n = 9), and 24 h (n = 9) after peritonitis and to a control group (n = 8). Similarly, IL-6 was injected intraperitoneally to different groups at 4 h (n = 9), 8 h (n = 10), 12 h (n = 10), and 24 h (n = 10) after peritonitis, and to a control group (n = 10). Plasma levels of LPS or IL-6 were measured immediately after intraperitoneal injections of LPS or IL-6, respectively, and at 5, 15, 30, 45, and 60 min later. RESULTS: There was no change over time in plasma LPS levels in the groups receiving LPS intraperitoneally (p = 0.4). There was highly significant change over time in the IL-6 level in the studied time periods in the groups receiving IL-6 intraperitoneally (p < 0.0001). There was an increase in the plasma IL-6 level when sampled at 4 h after peritonitis. CONCLUSION: There was a reduction of resorption capacity of inflamed peritoneum for inflammatory mediators in acute chemical peritonitis.


Assuntos
Interleucina-6/farmacocinética , Lipopolissacarídeos/farmacocinética , Peritonite/induzido quimicamente , Peritonite/fisiopatologia , Animais , Mediadores da Inflamação/administração & dosagem , Mediadores da Inflamação/sangue , Mediadores da Inflamação/farmacocinética , Interleucina-6/administração & dosagem , Interleucina-6/sangue , Lipopolissacarídeos/administração & dosagem , Lipopolissacarídeos/sangue , Masculino , Peritônio/patologia , Peritônio/fisiopatologia , Peritonite/patologia , Ratos , Ratos Wistar , Zimosan/toxicidade
13.
Singapore Med J ; 51(11): e184-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21140106

RESUMO

Acute gastric dilatation due to superior mesenteric artery syndrome in healthy individuals is extremely rare. A 17-year-old girl who complained of epigastric pain for two days following excessive eating was admitted to our hospital. She was nauseated but was unable to vomit. Succussion splash was positive. Bedside ultrasonography revealed a hyperactive duodenum, a distended stomach compressing on the inferior vena cava and a narrowed angle between the superior mesenteric artery (SMA) and the aorta. Abdominal computed tomography imaging confirmed the above findings. The angle between the aorta and SMA was only eight degrees. Gastrograffin follow-through showed complete obstruction of the third part of the duodenum. 3,500 ml of fluid was immediately drained through the nasogastric tube. Another gastrograffin study conducted five days later showed normal results. Bedside ultrasonography thus proved to be useful for both the diagnosis and management of superior mesenteric artery syndrome.


Assuntos
Duodenopatias/diagnóstico por imagem , Duodeno/diagnóstico por imagem , Dilatação Gástrica/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagem , Doença Aguda , Adolescente , Diatrizoato de Meglumina , Duodenopatias/etiologia , Duodeno/patologia , Feminino , Dilatação Gástrica/etiologia , Humanos , Fatores de Risco , Síndrome da Artéria Mesentérica Superior/complicações , Ultrassonografia , Veia Cava Inferior
14.
Scand J Surg ; 98(1): 41-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19447740

RESUMO

AIMS: The aim of this study was to evaluate the effects of early rapid control of multiple bowel perforations on cardiovascular function in combined abdominal missile trauma and haemorrhagic shock compared with conventional surgery. METHODS: Eighteen anesthetised pigs were injured with a standardised abdominal missile trauma. The animals were bled to a mean arterial pressure of 50 mm Hg for 30 minutes, after which they were resuscitated and had laparotomy. They were divided into conventional surgery group (n=9) with primary resection and anastomosis of bowel -injuries and early rapid multiple bowel ligation group (n?=?9). Repeated measurement analysis of variance was used for analysis. RESULTS: There was profound hypotension, reduced cardiac output, increased vascular resistance and lactic acidaemia in both groups. Lactic acidaemia persisted longer in the early rapid multiple bowel ligation group. There were no significant differences in mean arterial pressure, cardiac output , stroke volume or systemic vascular resistance between the groups. The mean operation time was significantly shorter in the early rapid multiple bowel ligation group (13.3 (1.5) (SEM) minutes, compared with 116.4 (1.74) (SEM) minutes in the conventional surgery group, p =0.001). CONCLUSIONS: Damage control principles have shortened the operating time in our model but did not improve the cardiovascular function and caused more lactic acidaemia than conventional repair.


Assuntos
Traumatismos Abdominais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Intestino Delgado/cirurgia , Traumatismo Múltiplo/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Traumatismos Abdominais/complicações , Acidose Láctica/epidemiologia , Animais , Temperatura Corporal , Hemodinâmica , Ligadura , Modelos Animais , Choque Hemorrágico/etiologia , Choque Hemorrágico/fisiopatologia , Choque Hemorrágico/cirurgia , Choque Traumático/etiologia , Choque Traumático/cirurgia , Suínos , Ferimentos por Arma de Fogo/complicações
15.
Singapore Med J ; 49(10): 827-30, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18946619

RESUMO

INTRODUCTION: Trauma is a major health problem in the United Arab Emirates, and it is the second leading cause of death. Research can help us find solutions for this problem. We evaluated the published literature on trauma from United Arab Emirates to define research areas which need improvement. METHODS: A MEDLINE search for articles on trauma and injury from the United Arab Emirates covering the period 1960-2005 was performed. The content of articles was studied, classified and summarised. RESULTS: 32 articles were found, of which 18 were published in the last six years. 18 articles were on prevention and epidemiology, ten on clinical management and four on education. The first author was affiliated to the university in 19 articles. There were no articles on pre-hospital care, experimental work, trauma systems, trauma registry or post-hospital rehabilitation. CONCLUSION: There is a need for a strategic plan to support research in areas like pre-hospital care, implementation of trauma systems, trauma registries and post-hospital rehabilitations to reduce the socioeconomic impact of trauma in the United Arab Emirates.


Assuntos
Medicina de Emergência/tendências , Pesquisa/organização & administração , Ferimentos e Lesões/terapia , Planejamento em Saúde , Política de Saúde , Prioridades em Saúde , Humanos , Reabilitação/organização & administração , Pesquisa/tendências , Emirados Árabes Unidos , Ferimentos e Lesões/prevenção & controle
17.
Scand J Surg ; 97(3): 243-7, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18812274

RESUMO

PURPOSE: To study the mechanism, management and outcome of patients who had sustained pancreatic trauma. METHODOLOGY: Patients who were treated for pancreatic trauma in Al-Ain Hospital between October 2002 and August 2007 were retrospectively studied. RESULTS: All eleven patients were males having a median age of 30 years (range 24-52 years). Nine had blunt trauma while two had suffered penetrating injury. Three presented with shock. associated injuries were present in nine patients (head, chest, and extremities) while seven had other intra-abdominal injuries. Only one patient had isolated pancreatic injury. Early serum amylase was elevated in six patients. CT abdomen was diagnostic for pancreatic injury in seven patients. Two cases were missed by early CT scan (sensitivity of 78%) while the remaining two patients were taken immediately to the operating theater. All patients underwent laparotomy. Five patients were treated by drainage alone, four had distal pancreatectomy, abdominal packing was performed in one patient and in another gastrocystostomy was carried out. Pancreatic fistula occurred in three patients. Median hospital stay was 25 days (range 12-152 days). Two patients (18%) died. CONCLUSIONS: Blunt trauma is the main cause of pancreatic injury in our country. Early CT scan may miss pancreatic injury in almost a quarter of the patients. Thin sliced CT scan, with special views in a dedicated abdominal pancreatic study, is recommended. A high index of clinical suspicion, depending on the mechanism of injury, is important for diagnosis of pancreatic injury. Mortality is mainly attributable to other associated injuries so simple procedures should initially be adopted for pancreatic injury, especially in haemodynamically unstable patients.


Assuntos
Traumatismos Abdominais/epidemiologia , Pâncreas/lesões , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adulto , Humanos , Incidência , Laparotomia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatectomia/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Emirados Árabes Unidos/epidemiologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Adulto Jovem
18.
Singapore Med J ; 49(4): 316-9, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18418524

RESUMO

INTRODUCTION: The aim of this study was to evaluate our recent clinical management of mesenteric vascular occlusion (MVO) at Al-Ain Hospital, United Arab Emirates. METHODS: A retrospective study was performed including all patients who were diagnosed to have MVO from December 2001 to May 2005. The records were studied with regard to clinical features, risk factors, diagnosis, treatment, and outcome. RESULTS: Of the 14 patients studied, seven patients experienced mesenteric venous thrombosis (MVT), five patients mesenteric arterial occlusion (MAO), and two patients were found to have both MVT and MAO. The main risk factor for MAO was ischaemic heart disease with atrial fibrillation in four patients (80 percent). No predisposing factors were identified in three patients with MVT (primary MVT 43 percent). Contrast-enhanced computed tomography was performed in all patients and was diagnostic in 12 (86 percent) patients. Seven patients (50 percent) underwent surgery. One patient died on the ninth postoperative day (overall mortality rate 7 percent). Seven patients (50 percent) were successfully managed conservatively, five of them had only MVT, one had combined MVT and MAO, and one had only MAO. CONCLUSION: Early diagnosis and prompt initiation of anticoagulation therapy, with operative intervention when indicated, are essential for a favourable outcome.


Assuntos
Angiografia/métodos , Gangrena/etiologia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Idoso , Anticoagulantes/uso terapêutico , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Humanos , Laparoscopia , Masculino , Oclusão Vascular Mesentérica/complicações , Oclusão Vascular Mesentérica/terapia , Veias Mesentéricas , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Emirados Árabes Unidos , Trombose Venosa/complicações , Trombose Venosa/terapia
19.
Singapore Med J ; 49(1): 54-6, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18204770

RESUMO

INTRODUCTION: The diagnosis of trans-anal rectal injuries is usually delayed because of the patient's denial. Some of these injuries are self-inflicted or caused by criminal assault, leading to delayed presentation. We aimed to study the causes, clinical presentation, management and clinical outcome of transanal rectal injuries. METHODS: The records of 12 patients (nine males) with a median age of 36.5 (range 20-64) years, had trans-anal rectal injury and were treated between 1993 and 2006 at Al-Ain Hospital, were reviewed. RESULTS: Injury was caused by a fall on a sharp object in five patients, by a rectal foreign body in two patients, by a compressed air hose in two patients, by sexual assault in two patients, and by rectal cleansing enema in one patient. Seven patients presented two hours after the injury, four patients within 8-24 hours, and one sexually-assaulted patient presented after seven days. Injuries were in the anterior rectal wall in seven, in the rectosigmoid junction in three, and in the anorectal region in two patients. Ten patients presented with peritonitis, four were in shock, seven had bleeding per rectum, and two had a weak sphincter. The complication rate was significantly higher in the colostomy patients compared with primary repair (5/6 compared with 0/6, p-value is less than 0.02, Fisher's exact test). All patients survived. The median (range) hospital stay was ten (9-72) days. CONCLUSION: Diagnosis of trans-anal rectal injuries is usually delayed because of late presentation. Sexual assault should be suspected following rectal injuries. Colostomy is not always mandatory.


Assuntos
Canal Anal/lesões , Reto/lesões , Ferimentos não Penetrantes/diagnóstico , Ferimentos Penetrantes/diagnóstico , Acidentes por Quedas , Adulto , Colostomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Delitos Sexuais , Resultado do Tratamento , Ferimentos não Penetrantes/terapia , Ferimentos Penetrantes/terapia
20.
Singapore Med J ; 48(12): e308-10, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18043824

RESUMO

Primary umbilical tumours are extremely rare. We report primary serous adenocarcinoma arising from the coelomic mesothelium of the hernial sac. A 60-year-old woman presented with an umbilical swelling of six months duration that became painful in the last three days. Examination revealed a tender umbilical swelling diagnosed as obstructive hernia that needed surgery. When dissecting the sac during surgery, a small subcutaneous abscess was encountered. The sac contained an omentum with a hard nodule at the surface which was excised. Umbilical hernia repair was performed. Histology of the omental nodule revealed serous papillary adenocarcinoma. Chest and abdomen computed tomography, pelvic magnetic resonance imaging, gastroscopy, colonoscopy and laparotomy did not reveal the primary site of the tumour.


Assuntos
Neoplasias Abdominais/patologia , Adenocarcinoma/patologia , Hérnia Umbilical/patologia , Neoplasias Abdominais/cirurgia , Adenocarcinoma/cirurgia , Biópsia por Agulha , Feminino , Seguimentos , Hérnia Umbilical/cirurgia , Humanos , Imuno-Histoquímica , Laparotomia/métodos , Pessoa de Meia-Idade , Medição de Risco , Resultado do Tratamento
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