South African Journal of Surgery - Volume 43, Issue 4, 2005
Volume 43, Issue 4, 2005
History of the Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal : general surgeryAuthor J.V. RobbsSource: South African Journal of Surgery 43, pp 154 –157 (2005)More Less
Factors affecting mortality and epidemiological data in patients hospitalised with burns in Diyarbakir, Turkey : general surgerySource: South African Journal of Surgery 43, pp 159 –162 (2005)More Less
<I>Background.</I> Burns continue to be responsible for significant morbidity and mortality in developing countries. In this study we aimed to determine the factors affecting mortality and epidemiological data by examining the records of burned patients. <br><I>Method.</I> The hospital records of 980 patients who were hospitalised in the Burns Unit at Dicle University Hospital (DUH) between June 1994 and July 1999 were examined for factors affecting mortality. Factors evaluated included gender, age, burn type, degree and extent of burn, prognosis and length of hospitalisation (LH). We investigated the relationship (if any) between the demographic data, degree and extent of burns and mortality and morbidity rates. <br><I>Results.</I> The study group consisted of 325 males (33.2%) and 655 females (66.8%). Of the patients 738 (75.3%) were children (age under 15 years), 217 (22.1%) were younger adults (age 15 - 50 years), and 25 (2.6%) were older adults (age over 50 years). The mean age was 11.2 + 14.01 years (range 15 days - 95 years). Of the burns 618 (63.1%) were scalds, 199 (20.3%) burns from a flame and 163 (16.6%) electrical burns. The mean extent of burn was 24.3 + 14.5% (range 1 - 95%). Seven hundred and eighty-seven (80.3%) of the study group made a full recovery, 131 (13.4%) were discharged from hospital after partial recovery, and 62 (6.3%) died. The mean LH was 11.33 ± 8.8 days (range 1 - 67 days). There was a positive correlation between burn extent and mortality (<I>r</I> = 0.35, <I>p</I> < 0.0001) and between age and type of burn (<I>r</I> = 0.60, <I>p</I> < 0.0001). While scalds had the highest frequency among children, flame and electrical burns were most common in the adult and older adult groups. There was also a positive correlation between degree and type of burn (<I>r</I> = 0.32, <I>p</I> = 0.0001), scalds tending to be more superficial while flame and electrical burns were generally more serious. Deaths of patients with extensive burns usually occurred in the first 5 days following injury due to acute renal failure and hypovolaemic shock, while deaths from moderate and minor burns usually occurred after 7 days and were due to wound infection and sepsis. <br><I>Conclusion.</I> We found positive correlations between age and type of burn, degree and type of burn, and the extent of burn and mortality. The overall mortality rate for our unit was 6.3%.
Gunshot injuries of the spine - a review of 49 cases managed at the Groote Schuur Acute Spinal Cord Injury Unit : traumaSource: South African Journal of Surgery 43, pp 165 –168 (2005)More Less
The Acute Spinal Injury Unit, relocated from Conradie Hospital to Groote Schuur Hospital in mid-2003, admitted 162 patients in the first year of its existence. A large number of these injuries were the result of interpersonal violence, particularly gunshot wounds. <br><I>Aim.</I> To review patients with gunshot injuries to the spine, with reference to neurological injury, associated injuries, need for surgery and complications. <br><I>Methods.</I> A comprehensive database is maintained to collect data on all spinal injury admissions. These data, as well as case notes and X-rays, were reviewed for all gunshot spine patients admitted to the Acute Spinal Injury Unit over a year. <br>Forty-nine patients were identified. Thirty-eight were male and 11 female with an average age of 27.5 years (range 15 - 51 + 8.53). The average stay in the acute unit was 30 (4 - 109 + 28) days. <br><I>Results.</I> The spinal injury was complete in 38 and incomplete in 8, with 3 having no neurological deficit. The level was cervical in 13, thoracic in 24 and lumbar in 12. Only 9 patients improved neurologically. The spine was considered stable in 43 cases. Stabilisation was performed in the 6 unstable cases. The bullets were removed in 11 cases as they were in the canal. <br>There were 55 significant associated injuries, viz. 14 haemo-pneumothoraces, 16 abdominal visceral injuries, 3 vascular injuries, 4 injuries of the brachial plexus and 3 of the oesophagus, 2 tracheal injuries, 1 soft palate injury and 11 non-spinal fractures. <BR>Complications included 3 deaths and discitis in 3 cases, pneumonia in 6 and pressure sores in 6. <br><I>Conclusion.</I> Gunshot injuries of the spine are a prevalent and resource-intensive cause of paralysis. There is a high incidence of permanent severe neurological deficit, but usually the spine remains mechanically stable. Most of the management revolves around the associated injuries and consequences of the neurological deficit.
Source: South African Journal of Surgery 43, pp 170 –172 (2005)More Less
This retrospective review of 76 patients with gunshot wounds was undertaken to evaluate the pattern and outcome of civilian gunshot injuries in our region. The extremities were the most commonly affected site (51.5% of all gunshot wounds). Gunshot injuries were most common among young males in the third decade of life, and armed robbery was the cause of gunshot trauma in 69.7% of cases. Time from injury to arrival at hospital was less than 6 hours in 64.4% of cases. Wound exploration and debridement were the mode of treatment in the majority of cases. Hypovolaemia resulting from acute haemorrhage accounted for 52.9% of complications. The mortality rate was 5.3%. It is pertinent to observe that inefficient firearm control is a major factor contributing to civilian gunshot injuries in our region. In addition, high rates of unemployment and poverty in our society may be contributing to the increasing incidence of youth restiveness, armed robbery and associated gunshot injuries. Strong government legislation is required to provide adequate security for the teeming civilian population. The national government should embark on a poverty eradication strategy and engage the youth in gainful employment to reduce the incidence of youth restiveness, armed robbery and firearm-related violence.