RESUMO
PURPOSE: The purpose of this paper was to introduce a new registry in a developing country by describing the demographics, management and 30-day outcomes of patients undergoing ventral hernia repair in the public and private healthcare sectors of South Africa. METHODS: This study was a retrospective review of a prospectively maintained hernia registry from the 1st of February 2019 to 29th of February 2020. RESULTS: 353 ventral hernia repair cases were recorded of which 47% were incisional hernias and the remainder were primary hernias. The median age was 54 years with even distribution of males and females. Half of the patients were obese with a median BMI of 31 kg/m2. The private sector performed 190 cases (54%) and the public sector 163 cases (46%). The public sector had more current smokers undergoing elective repairs, 28% vs 15%, p = 0.01 and performed more emergency repair cases, 21% vs 8%, p < 0.01. The majority (89%) of hernias were repaired with mesh and one-third were repaired laparoscopically. 30 day follow up was obtained in 30% of cases, the private sector had better follow up rates (42% vs 14%). CONCLUSION: Participation in the HIG (SA) registry was low with poor follow up over the first year. Ongoing prospective data capture on the HIG (SA) hernia registry will continue to provide further insights into hernia repair practices in South Africa.
Assuntos
Hérnia Ventral , Laparoscopia , Feminino , Setor de Assistência à Saúde , Hérnia Ventral/epidemiologia , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Recidiva , Sistema de Registros , Estudos Retrospectivos , África do Sul/epidemiologia , Telas CirúrgicasRESUMO
BACKGROUND: Tracheostomal stenosis is a distressing complication with a high incidence rate post laryngectomy. We aimed to assess the deltopectoral flap (DPF) for tracheostomal stenosis correction in irradiated patients. METHODS: Six patients with tracheostomal stenosis, 3 of whom developed restenosis after prior use of local flaps, were managed using a DPF to reconstruct the defect following a vertical incision release of the stenotic band down to the inferior tracheal cartilaginous ring. Healing absence of restenosis, alleviation of the symptoms of difficulty in breathing and clearance of secretions were considered a successful composite endpoint. RESULTS: Over a median follow-up period of 11 months all patients maintained patency, and symptoms of difficulty in breathing and clearing of secretions were alleviated. CONCLUSION: The deltopectoral flap is a rapid, reliable flap for the management of tracheostomal stenosis in irradiated patients. It brings well-vascularised tissue into the site of reconstruction and, in the short term, stomal patency and symptom relief were achieved.
Assuntos
Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos , Traqueostomia/efeitos adversos , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Humanos , Neoplasias Hipofaríngeas/radioterapia , Neoplasias Laríngeas/radioterapia , Laringectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapiaRESUMO
Background: Information about plastic surgery procedures is becoming more easily accessible everyday as the influence of social media expands rapidly. Plastic surgeons may use these platforms to advertise their practices and facilitate patient education. This study aimed to investigate the online presence of South African plastic surgeons with regard to personal practice websites and social media profiles. Methods: Plastic surgeons listed on the Association of Plastic, Reconstructive and Aesthetic Surgeons of South Africa (APRASSA) website were searched for on the internet. Professional websites were examined for links to social media (Facebook, Instagram, Twitter). Personal profiles on Facebook, Twitter and Instagram were excluded.Results: The total number of South African plastic surgeons listed on the APRASSA website totaled 148 at the time of collation. Three surgeons (2%) had direct links to their personal website on the APRASSA listing. Sixty-four plastic surgeons (42.7%) had websites directly related to their plastic surgery practice. Of those, only 15 provided links to any form of social media. Twelve surgeons had links to a Facebook page (18.75%) pertaining to their practice. Eleven had links to a Twitter profile (17.8%), and only one had links to an Instagram account (1.6%).Conclusion: The role of social media in the plastic surgery community appears to have significant implications for the future of the specialty. Adoption of these platforms is necessary to maintain interaction with patients and colleagues in the digital age
Assuntos
Pacientes , Mídias Sociais , África do Sul , Cirurgia PlásticaRESUMO
BACKGROUND: Preoperative, intraoperative and follow-up guidelines for managing occult carcinoma in reduction mammoplasty specimens are scant METHODS: We retrospectively analysed the records and pathology reports of 200 patients who had undergone reduction mammoplasty at two major public hospitals in Johannesburg, South Africa, during 2009-2014. Demographic data, their history of breast cancer and preoperative screening, the surgical techniques used and pathological reports were included. In all cases preoperative screening for breast cancer had been negative. RESULTS: All the patients were female, mean age 37.1 years, range 20-84 (standard deviation 11.9). All reductions were performed using standard techniques. Benign pathology was observed in 98 patients (49%) and malignant pathology in four (2%). The most common benign pathology observed was fibrocystic disease, and the most common malignant pathology ductal carcinoma in situ. Patient age correlated significantly with benign or malignant disease. CONCLUSIONS: Reduction mammoplasty produces tissue that should always be sent for pathological assessment. Patients should be stratified by risk, as doing so helps in selecting both the surgical setting and the approach to pathological analysis of the specimen. While the incidence of occult carcinoma in reduction mammoplasty specimens is low, all patients undergoing the procedure should be informed that tissue will be sent for pathological examination, allowing them to prepare to receive possible news of breast cancer and be adequately equipped for subsequent decision-making.
RESUMO
PURPOSE: To verify whether there was a significant correlation between central corneal thickness (CCT) and visual field damage in patients with primary open angle glaucoma (POAG). METHODS: A total of 99 eyes with POAG were consecutively recruited. Patients were classified as glaucomatous based on visual field and optic nerve head damage. All underwent applanation tonometry, Humphrey perimetry, and measurement of CCT with ultrasonic pachymetry. Based on CCT value, the sample was split at the mode in two groups (group 1<535 microm, n=49; group 2>or=535 microm, n=50). RESULTS: Entire cohort: mean CCT 554 microm+/-45.03; mean deviation (MD) -6.68 dB+/-7.32; pattern standard deviation (PSD) 5.33+/-3.75; intraocular pressure (IOP) 17.91+/-4.16 mmHg with treatment. Group 1: CCT was 504.8 microm+/-30.8; MD -9.01 dB+/-8.72; PSD 6.38+/-3.99; IOP 18.02 mmHg+/-4.66. Group 2: mean CCT 574.6 microm+/-35.03; MD -4.39 dB+/-4.70; PSD 4.25+/-3.19; IOP 17.79 mmHg+/-3.57. A significant difference was found between the two groups for both MD and PSD. Linear regression analysis showed a significant correlation between CCT and PSD (P<0.001). CONCLUSIONS: Our data show that patients with a thinner cornea had a worse MD and PSD. As a thinner CCT causes an underestimation of the true IOP, there may be a delay in the diagnosis of POAG or an inadequate estimate of the clinical course despite apparently desirable IOP applanation readings.
Assuntos
Córnea/patologia , Glaucoma de Ângulo Aberto/patologia , Campos Visuais , Adulto , Idoso , Topografia da Córnea/métodos , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Pessoa de Meia-Idade , Estudos Prospectivos , Tonometria Ocular/métodosRESUMO
This prospective trial was initiated to assess laparoscopic inguinal hernia repairs by an intraabdominal intraperitoneal onlay mesh (IPOM) technique. An IPOM method utilizing 10 x 7.5-cm expanded polytef (PTFE) patches was used to repair 52 inguinal hernias in 50 patients. There were two patients with bilateral defects. Fourteen were direct and 38 were indirect hernias. There was one patient with bladder perforation, one with strangulation of the small bowel that entered the sac of a recurrent defect, and five patients with other minor complications. There were two recurrences. The follow-up period ranged from 7 to 31 months. The operating time ranged from 35 to 180 min and was 35-60 min in 40 patients. The postoperative pain was minimal in 40 patients. Our conclusions are as follows: This IPOM method was less time consuming in theater time than other laparoscopic methods. There was minimal postoperative pain in the majority of cases. The hospital stay was shorter in comparison with the standardized stay for conventional methods. The case with recurrence and strangulation raises some questions as to the safety of this method. Hospital costs of conventional herniorrhaphies were lower (63%) than those of this laparoscopic method.
Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia , Politetrafluoretileno/uso terapêutico , Telas Cirúrgicas , Adolescente , Adulto , Idoso , Custos Hospitalares , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos ProspectivosRESUMO
BACKGROUND: The management of penetrating neck trauma remains controversial, with many studies supporting either mandatory exploration or selective conservatism. METHODS AND RESULTS: This is a prospective study of 75 patients with gunshot injuries to zone II of the neck. Forty patients (53.3%) underwent immediate exploration because of clinical indications or positive initial investigations. A 7.5% incidence of unnecessary explorations, a 5% mortality rate, and average hospital stay of 10.5 days were noted. Thirty-five patients with negative clinical or investigational findings underwent observation with constant monitoring. A 5.7% incidence of missed injuries, no mortality, and an average hospital stay of 3.5 days were noted for these patients. CONCLUSIONS: We suggest that conservative management in gunshot injuries confined to zone II of the neck selectively supplemented by appropriate investigations is a viable proposition in this type of injury. Further contemporary studies reporting specifically on this injury will enable us to reach statistically significant conclusions.
Assuntos
Lesões do Pescoço , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Feminino , Humanos , Complicações Intraoperatórias/mortalidade , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Segurança , África do Sul/epidemiologia , Ferimentos por Arma de Fogo/mortalidadeRESUMO
A study was made of 45 patients with diaphragmatic herniation after penetrating trauma. In 29 the diagnosis was established during the first admission (early presentation) and in 16 during a subsequent admission (delayed presentation). The mortality rate in the early presentation group was 3 per cent compared with 25 per cent in the delayed presentation group. The presence of gangrenous or perforated abdominal viscus in the chest cavity was the single most common and severe aggravating factor. The need for diagnosis of diaphragmatic herniation during the initial admission is emphasized. As isolated diaphragmatic injuries provide few helpful clinical features to aid diagnosis, appropriate investigations and good follow-up are of paramount importance in preventing late herniation of intra-abdominal viscera through a penetrating diaphragmatic injury.
Assuntos
Hérnia Diafragmática Traumática/etiologia , Complicações Pós-Operatórias , Ferimentos por Arma de Fogo/complicações , Ferimentos Perfurantes/complicações , Adulto , Feminino , Hérnia Diafragmática Traumática/mortalidade , Hérnia Diafragmática Traumática/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos por Arma de Fogo/cirurgia , Ferimentos Perfurantes/cirurgiaRESUMO
This is a retrospective study of 173 patients with gunshot injuries of the major arteries of the extremities. A selective policy for the use of angiography was followed. The arterial repair was achieved by various means: primary end-to-end anastomosis, vein interposition graft, and polytetrafluoroethylene (Teflon) interposition grafts. Overall, there were nine amputations in the lower limb. Ninety-eight percent of the patients had a palpable pulse on discharge. There were 3 preoperative deaths, 1 intraoperative death, and 5 postoperative deaths (overall perioperative mortality, 3.5%). We conclude that the results of vascular extremity gunshot injuries are satisfactory when standard methods of management are used. Morbidity and mortality can be further reduced by prompt admission to appropriate centers.
Assuntos
Traumatismos do Braço/cirurgia , Artérias/lesões , Artérias/cirurgia , Traumatismos da Perna/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Anastomose Cirúrgica , Braço/irrigação sanguínea , Feminino , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno/uso terapêutico , Estudos Retrospectivos , África do SulRESUMO
Quality assurance in trauma care is of major importance in assessing the efficacy of a trauma service and in identifying areas for improvement. Trauma scores and the TRISS methodology are at present the most accurate tools for quality assurance purposes. In this prospective study, the TRISS methodology was used to analyse the results in a group of 629 patients with penetrating trauma.
Assuntos
Escala de Gravidade do Ferimento , Auditoria Médica , Ferimentos Penetrantes , Escala Resumida de Ferimentos , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Estudos Prospectivos , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/terapiaRESUMO
An experimental study was carried out to investigate the effect of a period of hypovolaemia prior to surgery on healing of the right and left colon of the baboon. Colonic healing was assessed in three ways: in terms of (i) anastomotic leakage, (ii) hydroxyproline concentrations and (iii) breaking strength. The results suggest that hypovolaemia before surgery affects the right and left colon similarly.
Assuntos
Volume Sanguíneo , Colo/cirurgia , Anastomose Cirúrgica , Animais , Colo/fisiopatologia , Feminino , Lateralidade Funcional , Hidroxiprolina/análise , Papio , Resistência à Tração , CicatrizaçãoRESUMO
This was a prospective, randomized study of 123 patients with penetrating abdominal injuries. The patients received ceftriaxone or cefoxitin for 24 h (in the presence of colonic injury, 48 h). The overall incidence of abdominal sepsis was 7.3 per cent (ceftriaxone 5 per cent, cefoxitin 9.5 per cent, P greater than 0.05). Colonic injury was the most important risk factor for the development of septic complications. Other factors, such as the weapon used, a prehospital time longer than 4 h, shock on admission, multiple organ injuries, and small bowel perforation, did not influence the incidence of sepsis.
Assuntos
Traumatismos Abdominais/cirurgia , Cefoxitina/uso terapêutico , Ceftriaxona/uso terapêutico , Pré-Medicação , Ferimentos Penetrantes/cirurgia , Adulto , Infecções Bacterianas/prevenção & controle , Colo/lesões , Feminino , Humanos , Masculino , Traumatismo Múltiplo/complicações , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Fatores de RiscoRESUMO
A case of gastric mucormycosis proven on culture and histologic examination and successfully treated with resectional surgery and Amphotericin B is described.
Assuntos
Hepatopatias , Mucormicose , Pancreatopatias , Úlcera Gástrica , Adulto , Feminino , Humanos , Hepatopatias/patologia , Mucormicose/patologia , Pancreatopatias/patologia , Úlcera Gástrica/patologiaRESUMO
This is a retrospective study of 124 patients with carotid injuries. The common carotid artery was injured in 84% of the patients. Associated trauma to the internal jugular vein was present in 26%. Most patients (56%) were dead on arrival to the hospital and of those who were operated on, the mortality was 22% (overall mortality, 66%). All operative mortalities had severe shock or neurologic deficits on admission. We performed repair on all patients with preoperative neurologic deficits and the mortality was 64%. The use of a shunt did not influence the prognosis. We believe that there is no place for an emergency angiogram in order to diagnose a carotid injury or to plan the operation.
Assuntos
Lesões das Artérias Carótidas , Ferimentos Penetrantes/cirurgia , Adulto , Artérias Carótidas/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Ferimentos Penetrantes/mortalidadeRESUMO
A case of angiosarcoma of the breast in a 39-year-old black woman is described and the presentation, management and clinical course of this rare tumour are discussed.
Assuntos
Neoplasias da Mama/patologia , Hemangiossarcoma/patologia , Adulto , Feminino , Humanos , Metástase NeoplásicaRESUMO
An experimental study investigated the relative healing properties of the unprepared right and left colon of the baboon. Colonic healing was assessed in three ways: anastomostic leakage, hydroxyproline concentration and breaking strength. The results suggest that healing on the two sides of the colon is similar.
Assuntos
Colo/fisiologia , Animais , Colo/análise , Colo/cirurgia , Hidroxiprolina/análise , Masculino , Papio , Resistência à Tração , CicatrizaçãoRESUMO
This is a prospective study of 230 patients with penetrating injuries of the back. The decision to operate or observe was taken exclusively on the abdominal physical findings. One hundred ninety-five patients (85%) did not require operation, 30 (13%) underwent a therapeutic laparotomy, four (1.7%) an unnecessary operation, and one patient (0.4%) had a completely negative laparotomy. The diagnosis and management was delayed in five (2.2%) patients with no serious consequences. Mortality rates were not recorded in this series. The initial physical examination was accurate in 95.2% of the patients. We suggest that penetrating injuries of the back should be assessed in the same way as anterior abdominal injuries. Physical abdominal examination is reliable in detecting significant intra-abdominal injuries.
Assuntos
Lesões nas Costas , Ferimentos Penetrantes/cirurgia , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Hematoma/diagnóstico , Humanos , Intestinos/lesões , Intestinos/cirurgia , Rim/lesões , Rim/cirurgia , Laparotomia , Masculino , Pâncreas/lesões , Pâncreas/cirurgia , Exame Físico , Estudos Prospectivos , Espaço Retroperitoneal , Ferimentos Penetrantes/diagnósticoRESUMO
This study group comprises 73 patients who underwent emergency room resuscitative thoracotomy for cardiac arrest following penetrating chest and neck injuries. Overall, 12 patients (16.4%) were successfully resuscitated but only five (6.8%) left the hospital alive without neurologic defects. None of the 18 cases with no vital signs at all (no cardiac activity, no respiratory efforts, nonreactive pupils) on admission survived. Only one out of the 19 cases with no cardiac activity and with fixed pupils but present respiratory efforts survived (5.3%). Of 14 patients with cardiac arrest but with respiratory efforts and reactive pupils, three survived (21.4%). We suggest that patients with no vital signs on admission to the hospital should not be subjected to resuscitative thoracotomy.