South African Journal of Surgery - Volume 44, Issue 4, 2006
Volume 44, Issue 4, 2006
Xpand chest drain : assessing equivalence to current standard therapy - a randomised controlled trial : general surgerySource: South African Journal of Surgery 44, pp 132 –135 (2006)More Less
<I>Background.</I> Penetrating chest trauma is a leading cause of admission to South African emergency departments. The resultant pneumo-/haemothoraces are currently routinely treated by means of standard underwater bottle drainage. A South African company, Sinapi Biomedical, recently launched the Xpand chest drain. This device incorporates a one-way valve with a fluid reservoir and permits the detection of an air leak, as well as intrapleural pressure differences. <br><I>Aim.</I> To prove equivalence of the Xpand chest drain compared with standard underwater bottle drainage. <br><I>Methods.</I> In a non-blinded randomised control trial 67 patients with radiological proof of a pneumo- or haemothorax following penetrating chest trauma were divided into two groups. One group received standard underwater drain treatment and the other group had the Xpand chest drain inserted. Time from placement of drain to removal of drain (following radiological proof of resolution) was compared between the two groups. <br><I>Results.</I> The underwater drain group (N = 34) had drainage periods varying from 6 to 280 hours with an average of 81.47 hours, while the Xpand group (N = 33) had drainage periods varying from 13 to 151 hours with an average of 61.04 hours (<I>p</I> = 0.088). <br><I>Conclusions.</I> Although there was a definite improvement in drainage time with the Xpand chest drain, the difference did not reach statistical significance. We have, however, proven that the Xpand chest drain is as effective as a standard underwater drain in treating the sequelae of penetrating chest trauma and therefore recommend it as an alternative to current standard therapy.
Source: South African Journal of Surgery 44, pp 136 –137 (2006)More Less
Umbilical hernias occur frequently in children but complications are rarely reported. This study assessed the incidence of complicated umbilical hernias in our patients, evaluated data for risk factors and reviewed our management in the light of these findings. <br>We conducted a prospective study of all children needing umbilical hernia repair for complications over a period of 15 years. Patients with para-umbilical and other ventral wall hernias were excluded. In total, 389 children had umbilical hernias repaired during this period (average age 6 years); 28 (7%) of these had complicated hernias. symptoms included umbilical pain (100%), vomiting (71%) and constipation (28%). The average age of the complicated group was 3 years. All cases had a painful irreducible umbilical mass. Eleven of the 19 children who had an abdominal radiograph showed radiological evidence of small-bowel obstruction and in 5 children there was radiological evidence of pica. Two patients had ischaemic omentum that required resection. Patients who present with localised abdominal pain or an irreducible umbilical mass should be operated on promptly.
Colostomy in children - an evaluation of acceptance among mothers and caregivers in a developing country : paediatric surgerySource: South African Journal of Surgery 44, pp 138 –139 (2006)More Less
<I>Background.</I> Colostomy is a common procedure performed in children, mostly for anorectal malformation and Hirschsprung's disease. However, acceptance by parents in developing countries is thought to be poor. <br><I>Methods.</I> A prospective evaluation was done to determine the acceptability of colostomy among parents and caregivers, and their attitude towards colostomy in their children. <br><I>Results.</I> During the period January 1999 - January 2004 a structured questionnaire was administered to 57 parents and caregivers of children with colostomies (41 boys and 16 girls). The indication for colostomy was anorectal malformation in 28 children and Hirschsprung's disease in 29. The length of time the children had the colostomy ranged from 3 weeks to 8 years. Forty-four respondents (77%) found the colostomy and its management acceptable. Thirteen (23%) found the colostomy unacceptable, mainly because of a feeling of social isolation. Problems the respondents complained of included disturbing smell (17, 30%), frequent change of the cloth napkin used as colostomy appliance (15, 26%) and intermittent bleeding from the stoma (4, 7%). <br><I>Conclusions.</I> Colostomy in children is acceptable to most parents in our environment. Although some parents found it unacceptable, adequate explanation and counselling may modify their view.
Department of Surgery, University of the Witwatersrand - a brief history : general surgery, South African Journal of Surgery, 44(2) 2006, p.49 : erratumAuthor Martin VellerSource: South African Journal of Surgery 44 (2006)More Less
Source: South African Journal of Surgery 44, pp 144 –146 (2006)More Less
Squamous cell carcinoma has rarely been reported in black african people, with only 11 cases reported in the world literature to date. We report on 2 further cases, the first to be reported in southern Africa, of squamous cell carcinoma in lesions of discoid lupus erythematosus
Source: South African Journal of Surgery 44, pp 148 –155 (2006)More Less
Improvements in imaging studies and a better understanding of the natural history of pancreatic fluid collections (PFCs) have allowed the different types to be clari- fied. Stratification of PFCs into subgroups should help in selecting from the increasing current available treatment options, which include percutaneous, endoscopic and surgical drainage. Percutaneous catheter drainage is safe and effective and should be the treatment of choice in poor-risk patients, and for infected pseudocysts related to acute pancreatitis. Endoscopic drainage should be the first management option in suitable pseudocysts related to chronic pancreatitis, if the necessary expertise is available. The high success rate and current low morbidity of elective open surgery mean that it is still the standard of management in this disease. <br>Laparoscopic approaches are gaining favour, predominantly in drainage of collections in the lesser sac, and long-term data are awaited. The precise application of this modality will need to be critically compared with the low morbidity of mini-laparotomy, which is the current standard after non-operative treatment fails in these patients. <br>It is essential to clearly stratify the different types of pancreatic pseudocysts, in particular with relation to acute or chronic pancreatitis, and perform a valid comparison of the different treatment modalities within groups. In this capacity a precise and transparent classification may provide valuable answers, in particular relating to optimal management according to pseudocyst type.