South African Journal of Surgery最新文献_第8页

The impact of the COVID-19 pandemic on presentation of surgical disease in paediatric patients at a tertiary centre in Cape Town, South Africa. COVID-19 大流行对南非开普敦一家三级医疗中心儿科病人外科疾病表现的影响。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01 Epub Date: 2023-10-17 DOI: 10.36303/SAJS.4060

C Kohler, B Banieghbal

{"title":"The impact of the COVID-19 pandemic on presentation of surgical disease in paediatric patients at a tertiary centre in Cape Town, South Africa.","authors":"C Kohler, B Banieghbal","doi":"10.36303/SAJS.4060","DOIUrl":"10.36303/SAJS.4060","url":null,"abstract":"Background: Children are less susceptible to infection with SARS-CoV-2 and subsequent severe disease, yet especially vulnerable to the indirect effects of the pandemic. A constrained healthcare service, combined with the societal and behavioural changes observed during the pandemic, is likely to have altered the presentation of paediatric surgical disease. The objective was to investigate the impact of the COVID-19 pandemic on the volume of paediatric surgical admissions, the severity of disease and the type of surgical pathology treated at our centre.Methods: A retrospective cohort study compared paediatric surgical admissions in an eleven-month period before COVID-19 to the same period during the pandemic. Comparisons in volume and diagnoses were based on the number of admissions. Predetermined criteria for severity of disease using triage scores, intraoperative findings and intensive care admissions were compared.Results: A total of 1 810 admissions were recorded, 1061 in the pre-COVID group and 749 during COVID. Emergency admissions reduced by 9.2%, most notably due to a reduction in trauma, caustic ingestions and constipation. There was an increase in incarcerated inguinal hernias and helminth-related pathologies. Significantly more intussusceptions failed pneumatic reduction requiring surgical intervention with bowel resection. There was a two-fold increase in patients requiring emergency intensive care.Conclusion: Paediatric surgical volumes at our centre decreased during the COVID-19 pandemic. There was evidence of more advanced disease on presentation of inguinal hernias and intussusception and a generalised increased demand for emergency ICU admission.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes of complex burn injury patients managed at two primary and one tertiary level burns facilities in the Western Cape province of South Africa - a retrospective review. 南非西开普省两家一级烧伤医疗机构和一家三级烧伤医疗机构收治的复杂烧伤患者的治疗效果--回顾性分析。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01 Epub Date: 2023-10-25 DOI: 10.36303/SAJS.4061

S W Carolissen, W Kleintjes, F Gool, S Gilbert

{"title":"Outcomes of complex burn injury patients managed at two primary and one tertiary level burns facilities in the Western Cape province of South Africa - a retrospective review.","authors":"S W Carolissen, W Kleintjes, F Gool, S Gilbert","doi":"10.36303/SAJS.4061","DOIUrl":"10.36303/SAJS.4061","url":null,"abstract":"Background: This study aimed to compare factors contributing to a positive outcome of adult burn injury patients managed at two primary and one tertiary level Western Cape hospitals. These patients from the primary hospitals (PLHs) met the referral criteria for specialised care at the Tygerberg Hospital burns unit (TBU) but were not accepted or were accepted late.Methods: A total of 1034 adult burn injury patients seen at two primary level (\"A\" and \"B\") hospitals and the TBU between 2016 and 2019 were retrospectively analysed. One hundred and eleven (111) primary level patients (\"A\" 71, \"B\" 40) met the criteria for referral to the TBU. The outcomes and factors contributing to positive outcome of these patients were compared with the 859 patients treated at the TBU during the same period.Results: Patients treated at the TBU showed longer theatre waiting times, more operations, and higher complication and death rates than their primary level counterparts. The PLHs showed no factors significantly contributing to hospital discharge. At TBU, pregnancy status, younger age, hot water burns, lower abbreviated burns severity index (ABSI) score, and longer time to theatre were associated with hospital discharge. A shortage of beds was the main reason for denial of admission to the TBU.Conclusion: The PLHs showed good outcomes in managing severe burn injuries, although no significant contributors to a positive outcome were identified. Patient- and facility-related factors contributed to positive outcomes at the TBU. Upgrading both the Western Cape's primary level capabilities and the TBU's accessibility and efficiency are necessary to improve burns services.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors influencing outcome in patients with perforated peptic ulcer disease at a South African tertiary hospital. 影响南非一家三级医院消化性溃疡穿孔患者预后的因素。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01 Epub Date: 2023-10-17 DOI: 10.36303/SAJS.4005

J J Nanack, L Ferndale

{"title":"Factors influencing outcome in patients with perforated peptic ulcer disease at a South African tertiary hospital.","authors":"J J Nanack, L Ferndale","doi":"10.36303/SAJS.4005","DOIUrl":"10.36303/SAJS.4005","url":null,"abstract":"Background: Perforated peptic ulcer (PPU) is associated with significant morbidity and mortality, particularly in low to middle income countries. This study aimed to scrutinise the clinical course of patients diagnosed with PPU and identify modifiable factors to improve outcomes.Methods: A retrospective review of the hybrid electronic medical record (HEMR) database at Grey's Hospital was performed. All patients diagnosed with PPU between January 2013 and December 2020 were entered into the study. The variables collected include age, ethnicity, comorbid profile, Boey score, type of surgery performed and complications. These factors were analysed to determine the factors responsible for morbidity and mortality.Results: One hundred and ninety four patients were diagnosed with PPU during the study period. Six patients were treated non-operatively, all of whom survived. In the surgically treated group, omental patch repair was performed in 159 (84.5%) patients, and primary closure in 26 (13.8%) patients. The leak rate was 32% in the cohort that underwent relaparotomy and the overall mortality was 14%. There was no significant relationship between the type of repair performed and outcome. All patients had a Boey score of 1 or more. The following factors were found to increase the probability of in-hospital mortality: age > 40 years (OR: 8.49, 95% CI 2.46-29.29 p < 0.01), female gender (OR: 2.509, CI 0.98-6.37, p = 0.048), need for relaparotomy (OR: 0.398, CI 0.17-0.91, p = 0.027) and Boey score > 1 (OR: 46.437, CI 6.13-350.28, p < 0.01). A Boey score > 1 was the only variable that increased the likelihood of finding a leaking repair at relaparotomy (p < 0.01).Conclusion: The Boey score was a significant predictor of mortality and leak rate in our patients with PPU. Adding age as a variable may improve the ability to predict mortality in our setting, while the impact of gender and ethnicity needs further investigation.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transverse colon volvulus - a case report and literature review. 横结肠空卷--病例报告和文献综述。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01 Epub Date: 2023-10-25 DOI: 10.36303/SAJS.4069

L Niksch, M Lockwood, P L van Rooyen, N A Niksch, L Lorentz

引用次数: 0

More than 60 years of Organised Trauma Care: The Johannesburg Trauma Unit at Charlotte Maxeke Johannesburg Academic Hospital. 有组织的创伤护理 60 多年：夏洛特-马克塞克约翰内斯堡学术医院的约翰内斯堡创伤科。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01

M S Moeng, K D Boffard

引用次数: 0

Technical success of endoscopic stenting for malignant gastric outlet obstruction. 内镜支架治疗恶性胃出口梗阻的技术成功。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01

D Tait, M F Scriba, C Robinson, E G Jonas, G E Chinnery

{"title":"Technical success of endoscopic stenting for malignant gastric outlet obstruction.","authors":"D Tait, M F Scriba, C Robinson, E G Jonas, G E Chinnery","doi":"","DOIUrl":"","url":null,"abstract":"Background: Palliation of irresectable malignant gastric outlet obstruction (GOO) using self-expanding metal stents (SEMS) is gaining popularity with high technical success rates. The aim of this study was to review and compare GOO stenting for malignancy with other series.Methods: A retrospective review of all patients undergoing pyloroduodenal stenting for malignant GOO at Groote Schuur Hospital, 1 March 2018-31 August 2021, evaluating demographics, technical success, pathology, and stentrelated complications was done.Results: One hundred and fourteen patients, of which 38.6% were female, were included, with gastric malignancies (74.6%) being the most frequent underlying pathology. Median age was 64 years (IQR 53-70 years), with 48.2% having at least one comorbidity. The majority (96 patients; 85.7%) required only one stent. In total, 132 stent insertion attempts were undertaken. Three technical failures were experienced (one incorrect stent placement and two failed insertions), equating to a 97.4% technical success rate. Four immediate complications occurred (3.1%): two related to sedation, one incorrect stent placement and an oesophagogastric junction perforation with procedural death. Fifteen delayed complications occurred: 13 tumour in-growth blockages, one stent fracture and one case of poor radial stent expansion. Stent blockages occurred at a median of 107 days (IQR 80-275 days). Salvage stenting was 100% successful in 14 cases requiring re-stenting.Conclusion: Technical insertion success rates of primary and salvage duodenal stenting for malignant GOO are on par with international high-volume units. The leading pathology locally is gastric adenocarcinoma, with palliative stenting remaining a feasible and accessible option.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Small bowel metastasis from embryonal rhabdomyosarcoma of the extremity- a case report. 胚胎性末端横纹肌肉瘤的小肠转移--病例报告。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01 Epub Date: 2023-10-17 DOI: 10.36303/SAJS.4120

P Joubert, M Mihalik

引用次数: 0

Adverse events associated with the use of indwelling devices in surgical patients. 手术患者使用留置装置的相关不良事件。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01

H Wain, S Wall, D L Clarke

{"title":"Adverse events associated with the use of indwelling devices in surgical patients.","authors":"H Wain, S Wall, D L Clarke","doi":"","DOIUrl":"","url":null,"abstract":"Background: Indwelling devices (IDs) are ubiquitous in modern healthcare and may often be associated with morbidity. This paper investigates adverse events related to IDs in surgical patients, which are generally placed into patients either to administer therapy, manage outputs or for specific therapeutic benefit.Methods: A retrospective electronic database-based assessment of all adverse events relating to IDs was undertaken from December 2012 to August 2021. All events were categorised by device type, event type, and event severity.Results: A total of 11 130 morbidities were captured over the study period. Of those, 2 195 entries pertained to an ID with 2 402 reported adverse events affecting 1 592 patients. Two-thirds occurred in males and injuries occurred in patients age ranging from eight days to 93 years, with an average age of 36 years. The most frequently implicated devices were surgical drains (including intercostal chest drains), accounting for 491 (20.44%) of adverse events. Central venous catheters (CVCs) and intravenous cannulae were involved in 374 (15.57%) and 332 (13.83%) events, respectively. Unplanned removal (346, 13.91%), output not measured (319, 12.82%), injury (314, 12.62%), and blockage (279, 11.21%) were the most common error types. The majority of adverse events were considered minor, however 27 (1.1%) patients experienced organ dysfunction as a result of an ID-related adverse event, and seven (0.3%) died.Conclusions: Morbidity related to IDs in surgical patients is a relatively frequent occurrence. Standardisation of ID insertion and care, staff education, and improvements in communication have been identified as the most important strategies by which we can limit error-associated morbidity in patients with IDs.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The incidence and management of complications following stenting of oesophageal malignancies. 食道恶性肿瘤支架置入术后并发症的发生率和处理方法。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01

G Teyangesikayi, M F Scriba, S Viranna, E G Jonas, G E Chinnery

{"title":"The incidence and management of complications following stenting of oesophageal malignancies.","authors":"G Teyangesikayi, M F Scriba, S Viranna, E G Jonas, G E Chinnery","doi":"","DOIUrl":"","url":null,"abstract":"Background: Oesophageal stenting effectively palliates malignant dysphagia with reported high technical and clinical success rates approaching 90% and a low, though often problematic, complication frequency. This study aimed to benchmark success rates, the incidence and management of complications at a tertiary interventional endoscopy centre.Methods: This single centre three-year (March 2018-March 2021) study reviewed demographics, tumour histology/ position, and early and late complications of palliative oesophageal stenting. A multivariate analysis of tumour position association with complications was performed.Results: A total of 297 patients (73.4% squamous cell carcinoma) underwent 354 stent insertion attempts. Immediate technical insertion success rate was 97.5% with dysphagia improvement achieved in all successful insertions (100% clinical success rate). Three hundred and forty-six (98.6%) were fully covered stents, with 17 (4.8%) placed for tracheaoesophageal fistulae. Twenty-one (6.0%) immediate insertion-related complications occurred, including two oesophageal perforations, but no insertion-related mortalities. Late complications occurred in 73 (20.8%) with tumour overgrowth (10.1%) and stent migration (6.1%) being the most frequent. Of all 354 stents, 75.2% had no documented complications for the lifetime of that stent, while 68 complications required re-intervention, equating to a re-intervention rate of 19.4% per stent insertion. Stent migration was significantly higher in distal tumours (11.8% vs 1.8%, p < 0.001), while discomfort necessitating same-day stent removal was higher in proximal tumours starting at < 20 cm from the incisors (16.7% vs 0.5%, p < 0.001).Conclusion: Oesophageal stenting for malignant dysphagia is peri-procedurally safe and effective. Outcomes reported from this South African cohort compare favourably to high-volume international units.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful management of a thoracoabdominal impalement injury. 成功处理一起胸腹部撞击伤。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01 Epub Date: 2023-10-25 DOI: 10.36303/SAJS.4088

A J Philip, D V Sneha, N Theckumparampil, S Jagdish

{"title":"Successful management of a thoracoabdominal impalement injury.","authors":"A J Philip, D V Sneha, N Theckumparampil, S Jagdish","doi":"10.36303/SAJS.4088","DOIUrl":"10.36303/SAJS.4088","url":null,"abstract":"A 63-year-old female presented to the hospital with a history of alleged accidental fall onto a rusted iron rod. She was hypotensive but stable. Cooling of the rod while cutting the protruding part was performed as per basic trauma life support (BTLS) access. Following resuscitation, she was re-evaluated clinically and radiologically, and prepared for surgery. The iron rod trajectory was shown on computed tomography (CT) scan to be entering through the left popliteal fossa, then traversing the abdominal cavity with injury to the descending colon and the left dome of the diaphragm. At laparotomy the iron rod was removed under vision. The laceration to the left dome of the diaphragm was repaired. The perforation of the descending colon was identified and repaired. Colostomy was deferred as there was no peritoneal contamination. The penetrating thigh wound was debrided. Her recovery was uneventful. She was discharged on postoperative day 15. She came for follow-up as out-patient after 3 weeks and the thigh wound had healed. Impalement injuries are rare and often severe. Most impalement injuries require a multidisciplinary approach. Adequate early resuscitation, proper evaluation and early surgical management is ideal. Immediate stabilisation of the foreign body from the time of encounter is essential. Removal under anaesthesia is mandatory.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0