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Biomedical subjects

T E Madiba

Publications and source records attributed to T E Madiba.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of outcome in patients requiring surgery for liver trauma.

INTRODUCTION: Severe bleeding from liver injury is one of the major causes of mortality in patients with abdominal trauma. The study was undertaken to assess factors that influence outcome following liver trauma. PATIENTS AND METHODS: This is a prospective study of patients with liver injury treated in one surgical ward at King Edward VIII Hospital over a 7-year period (from 1998 to 2004). Data collected included demographics, intra-operative findings, operative management and outcome. RESULTS: Of a total of 478 patients with abdominal trauma, 105 (22%) were found to have liver injuries, of whom only 7 were female. Their mean age was 27.81+/-10.33 years. Injuries were due to firearms (70), stabs (26) and blunt trauma (9). Nineteen patients presented with shock (systolic BP 6h in 47 patients. Forty patients required ICU management (38%) and the mean ICU stay was 6.55+/-5.65 days. Twenty patients (19%) needed a re-laparotomy for various reasons. The complication rate was 37% and the mortality rate was 20% (23% for firearms, 44% for blunt trauma and 4% for stabs). The mortality rate in patients with shock was 58% compared to 12% in those who were not shocked (p<0.0001). Mortality rate was 2, 23 and 63% for Injury Severity Score (ISS) 20, respectively (group 1 versus group 2 p=0.015; group 1 versus group 3 p<0.0001 and group 2 versus group 3 p=0.001). Mortality rates for delay 6h were 28 and 9%, respectively (p=0.008). Associated injuries led to a higher mortality (3% versus 27%; p=0.006). Hospital stay was 11.27+/-12.09 days. CONCLUSIONS: Liver injuries occurred in 22% of abdominal injuries. Injury mechanism, delay before surgery, shock on admission, grade of injury, associated injury and ISS are significantly associated with outcome.

Adolescent↗
PubMed2005

Selective conservatism in trauma management: a South African contribution.

Trauma in South Africa has been termed the malignant epidemic. This heritage was the result of a violent colonial legacy which spawned the apartheid system of injustice and the struggle against it The Apartheid regime created overcrowding, unemployment, social stagnation, and the disruption of normal family life. These were the catalysts for the incredible amount of criminal and interpersonal conflict in South Africa over the last 50 years. African townships such as Soweto in Johannesburg and Umlazi in Durban were crime-ridden ghettoes where the apartheid police were more interested in fueling the "black on black" violence rather than trying to curb it. Baragwanath (Chris Hani-Baragwanath) and King Edward the VIII Hospital in Durban were the "trauma care epicenters" on the fringes of these huge urban conurbations. Both were designated black hospitals and both were underfunded and dilapidated. Even the architecture was similar, with prefabricated, poorly ventilated structures serving as wards and clinics in both institutions. Trauma volumes consisted of between 10 and 20 laparotomies on weekend nights at the height of political unrest. This led to vast individual experience in several areas of trauma typified by Demetriades' experience with 70 penetrating cardiac injuries. In this setting of limited resources and an overwhelming volume of trauma, selective conservatism as a surgical philosophy took root and has profoundly influenced the way the world manages trauma. We detail and illustrate the evolution of this approach and its continued application.

Humans↗
PubMed2005

Perforated gastric ulcer--reappraisal of surgical options.

BACKGROUND: The available operative procedures for perforated gastric ulcer are gastrectomy, ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution. PATIENTS AND METHODS: Seventy-two patients (mean age 43 years, 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. RESULTS: Partial gastrectomy was performed in 27 patients, ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18% (26% for gastrectomy, 19% for ulcer excision and 5% for patch closure). Shock on admission (p = 0.006) and Candida (p = 0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. CONCLUSION: Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases.

Adult↗
PubMed2004

Disseminated nocardiosis masquerading as abdominal tuberculosis.

A 32-year-old patient was admitted with a community-acquired pneumonia. She had clinical evidence of AIDS and chest X-ray features consistent with pulmonary tuberculosis. While in the ward she developed an acute abdomen necessitating laparotomy, at which a diagnosis of abdominal tuberculosis was made. Sputum and intraoperative pus specimens grew a multiresistant Nocardia brasiliensis. Microbiological investigations for tuberculosis were negative. The patient died after a short ICU admission from multiple organ dysfunction syndrome.

Adult↗
PubMed2003

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

BACKGROUND: There are differing views regarding the management of oesophageal injuries with some authors advocating mandatory operation while others prefer a selective, conservative approach. This study was undertaken to establish whether conservative management of cervical oesophageal injuries is safe and effective. PATIENTS AND METHODS: This is a retrospective study carried out over 5 years (1994-1998). Of 1358 patients with neck trauma, 220 presented with odynophagia, of whom 28 were shown on contrast swallow to have cervical oesophageal injury (17 stabs, 11 firearms). Median age was 26 years (range, 11-44 years). There were 23 males (M:F ratio, 6:1). All patients with contained extravasation were managed non-operatively irrespective of the delay from injury to admission. Repair was undertaken in patients with major disruption and those requiring exploration for another reason. Associated tracheal injuries were repaired primarily with or without tracheostomy. Patients were fed using fine bore enteral feeding tubes. Oral feeding was recommenced after a water soluble contrast swallow had confirmed healing. RESULTS: All patients presented with odynophagia. Seven had clinical surgical emphysema, and 15 had retropharyngeal air on lateral neck X-ray. Chest X-ray showed surgical emphysema in 8, haemothorax in 2 and pneumothorax in 2. Seventeen patients were managed non-operatively. Sixteen recovered with no complications, while one developed local sepsis. Eleven patients underwent exploration (debridement in 7 and primary repair in 4). There were 6 associated tracheal injuries, all of whom underwent primary repair with tracheostomy performed in four. Thirteen patients were admitted to the intensive care unit. Median duration of enteral tube feeding was 18 days (range, 5-40 days) and median hospital stay was 18 days (range, 6-91 days). Two patients with firearm injuries died from associated injuries. CONCLUSION: Non-operative management of penetrating injuries to the cervical oesophagus is safe and effective.

Adolescent↗
PubMed2003

Anal sphincter reconstruction for incontinence due to non-obstetric sphincter damage.

OBJECTIVE: To assess the outcome after anal sphincteroplasty in patients with anal incontinence following non-obstetric anal sphincter damage. DESIGN: A prospective study carried out in an urban teaching hospital over five years (1994-1998). PATIENTS AND METHODS: Fourteen patients, median age of 30 years, all undergoing anal sphincter reconstruction. The procedure was performed under general or regional anaesthesia. Operative management was (i) excision of the scar tissue and apposition of the cut ends of the sphincter or (ii) a reefing technique. RESULTS: Sphincter damage was as a result of trauma in nine cases, haemorrhoidectomy in two cases, sepsis in two and failed recto-vaginal fistula repair in one case. In six patients with traumatic sphincter damage a colostomy was performed at original operation. The other eight presented with incontinence, four of whom required a diverting colostomy prior to repair. The median delay between sphincter injury and repair was six months (range 4-120). The posterior approach was used in eight patients, an anterior approach in five and both approaches in one. Non-absorbable suture material was used in six and absorbable material was used in eight patients. Twelve of the 14 patients had scar tissue at the site of damage requiring excision. Two post-haemorrhoidectomy patients underwent the reefing technique. Eleven patients (79%) were completely continent after initial repair. Two required further repair resulting in complete continence. One patient remained with mild incontinence. CONCLUSION: Anal sphincter reconstruction for non-obstetric anal incontinence produced good short-term results.

Adolescent↗
PubMed2003

Amoebic liver abscess--results of a conservative management policy.

OBJECTIVE: To evaluate the safety and efficacy of conservative management of amoebic liver abscesses. DESIGN: A prospective study carried out over a 1-year period. SETTING: Inpatients and outpatients in a tertiary referral institution. SUBJECTS: Amoebic liver abscess was diagnosed on clinical, ultrasonographic, and serological features. All patients were treated with metronidazole. The indication for ultrasound-guided aspiration of the abscess was failure to improve clinically within 48-72 hours. MAIN OUTCOME MEASURES: Clinical improvement, clinical deterioration and failure of clinical improvement (persistent pain). RESULTS: In total 178 patients (male-to-female ratio 5:1) with 203 abscesses were treated during this period. Of these, 23 patients required percutaneous aspiration and 150 patients were managed without intervention and clinically resolved spontaneously. Abscesses requiring aspiration tended to be larger than those managed without aspiration (10.7 cm v. 8.2 cm) (p = 0.003). There were no complications following aspiration. Mean hospital stay was longer (12.3 days) for patients who underwent aspiration compared with those who did not (6.7 days) (p = 0.031). Only 5 patients presented with ruptured abscesses, 1 cutaneously and 4 intraperitoneally, with the only death in this latter category. CONCLUSION: Conservative medical management of amoebic liver abscess is safe. Percutaneous ultrasound-guided aspiration is indicated only in patients who fail to improve clinically after 48-72 hours rather than on rigid criteria.

Adult↗
PubMed2002

The management of cecal volvulus.

Cecal volvulus is second only to sigmoid volvulus in its frequency of occurrence. Diagnostic doubt is not uncommon in cecal volvulus; nonoperative decompression is rarely achievable; and if gangrene supervenes, mortality rises appreciably. Resection is mandatory for gangrene and a grossly distended, thin-walled cecum. Cecopexy and cecostomy seem less-effective and more morbid options than resection and anastomosis for viable bowel. However, their role needs reappraisal in the light of advances in minimally invasive techniques.

Cecal Diseases↗
PubMed2002

Renal trauma secondary to stab, blunt and firearm injuries--a 5-year study.

OBJECTIVE: To review our experience of renal trauma at King Edward VIII Hospital, Durban. DESIGN: Retrospective study over 5 years. SETTING: Tertiary referral hospital in an urban area. PATIENTS: One hundred and seventy-four patients presenting with renal injuries treated at King Edward VIII Hospital. INTERVENTIONS: One hundred and thirty-six patients underwent laparotomy, while 38 were managed conservatively. RESULTS: There were 174 patients with renal injuries (148 male, median age 26 years). Eighty-seven injuries were from firearms, 43 from stabs and 44 from blunt trauma. Of 136 patients who underwent surgery, 60 were managed conservatively at laparotomy, 26 underwent renorrhaphy, 40 nephrectomy and 10 heminephrectomy. There was a 33% complication rate following surgery. The mortality rate was 20% (24%, 21% and 12% for firearm, stab and blunt injuries, respectively). There was no statistically significant difference in mortality for firearm, stab and blunt injuries. Furthermore, there was no difference in mortality and morbidity between those with associated organ injuries and those with isolated injuries (29% v. 21% and 30% v. 16%, respectively), but the difference in mortality became significant when patients with isolated injuries who did not undergo surgery were included (P = 0.0083). CONCLUSION: Renal injuries either in isolation or in association with other injuries carry a high mortality and morbidity rate. Firearm injury patients have a large number of associated injuries and have the highest complication rate. Operative strategy should be conservative unless the kidney is unsalvageable.

Adult↗
PubMed2002

Sliding hiatal hernia with intrathoracic stomach and obstructed colon.

A 61-year-old woman was admitted to hospital with features of subacute bowel obstruction. Contrast enema and computed tomography (CT) scanning showed evidence of a diaphragmatic hernia. The patient underwent thoraco-laparotomy which revealed a sliding hiatal hernia with transverse colon in the hernial sac. Repair of the defect and segmental resection of the colon were performed, with good postoperative recovery.

Barium Sulfate↗
PubMed2001

Isolated amoebic appendicitis.

Amoebiasis, a disease of worldwide distribution, is endemic in tropical countries with suboptimal sanitation facilities. Isolated amoebic appendicitis (IAA) is regarded as a rare manifestation of the disease globally. Because there are no defined clinical features that distinguish IAA from bacterial appendicitis, diagnosis is usually dependent on histopathological examination. A 9-year retrospective study was undertaken to investigate the clinicopathological aspects of IAA. The main complaints were fever and abdominal pain. None of the patients had dysentery. The pre-operative clinical diagnosis was acute appendicitis and acute abdomen in 13 and 8 patients, respectively. In all cases the intra-operative diagnosis was acute appendicitis. Gross pathological appraisal revealed peritonitis and perforation in 19 and 17 cases, respectively. Histopathological examination of these appendices demonstrated appendiceal ulceration, transmural mixed inflammation, haematophagous amoebic trophozoites and necrosis in all cases. Vascular pathology comprised venous and capillary luminal plugging (11 cases), necrotising small vessel vasculitis (11 cases), thrombophlebitis of medium sized veins (9 cases) and arteritis with associated thrombosis (1 case). Organising fibrinopurulent peritonitis was present in 19 cases. Two appendices that appeared normal macroscopically demonstrated ulceration and inflammation that were confined to the mucosa and submucosa. All of 18 patients who were treated with metronidazole survived without further surgery, while three patients who were untreated succumbed to the disease. Appendicectomy, accurate histopathological appraisal thereof and optimal, timely management of IAA were critical to the favourable outcome in the present study.

Adult↗
PubMed2001

Penetrating chest injuries in the firearm era.

BACKGROUND: firearm wounds of the chest are now common at our institution. The management algorithm for firearm wounds has not been evaluated for this mode of injury. METHODS: records of all patients with penetrating chest injuries admitted to an urban tertiary hospital over 1 year were retrieved and analysed. RESULTS: there were 473 stab and 116 firearm wounds. In comparison to stab injuries firearm wounds had significantly more normal X-rays (14 vs. 5%), fewer pneumothoraces (15 vs. 37%), and more contusions (43 vs. 2%). The frequency of haemothoraces (34 vs. 23%) and haemopneumothoraces (36 vs. 35%) was similar in both groups. Stabbing caused all the 18 cardiac injuries. Associated abdominal injuries occurred in 8% of stab and 34% of firearm injuries. Pneumothoraces due to firearms were uncommon and rarely required drainage. More pneumothoraces were treated nonoperatively among firearm injuries in contrast to stabbing injuries where the opposite applied. The management of haemothorax and haemopneumothorax was similar in both groups that fulfilled the criteria for drainage. The rate of ICU admission was higher and the hospital-stay longer following firearm injuries. Fifty-nine patients died (10% of the total), 33 (28%) from the firearm injuries and 26 (6%) from stab-wounds. Early deaths were 1 and 3% for stabs and firearms, respectively. CONCLUSIONS: patients with firearm injuries reaching hospital suffered three times higher mortality and a longer ICU and hospital stay than those with stab injuries. However, early mortality was similar for both modes of injury and validates the continued application of the stab wound derived management algorithm to all modes of injury.

Adolescent↗
PubMed2001

Thyroid carcinoma at King Edward VIII Hospital, Durban, South Africa.

BACKGROUND: Western literature depicts papillary carcinoma as the most common thyroid malignancy followed by follicular carcinoma. OBJECTIVE: To assess the clinical pattern of thyroid carcinoma among African and Indian patients. SETTING: King Edward VIII Hospital, Durban, South Africa. DESIGN: A retrospective study. SUBJECTS: One hundred patients with thyroid carcinoma treated at a tertiary teaching hospital between 1990 and 1997. RESULTS: Seventy seven patients were Africans and 23 were Indians. The male to female ratio was 1:6. Ninety eight patients presented with goitre with or without regional lymph node involvement or distant disease. The duration of symptoms ranged from one to 360 months. The mean age at presentation was 48.6 +/- 16.0 years. Follicular carcinoma was the most common malignancy among African patients (68%), followed by papillary carcinoma (16%), anaplastic carcinoma (13%) and medullary carcinoma (2.6%). Papillary carcinoma was the most common malignancy among Indian patients (57%) followed by follicular carcinoma and medullary carcinoma. There was no anaplastic carcinoma among Indian patients. Fifty five patients underwent lobectomy with 32 undergoing subsequent completion thyroidectomy. Nine patients had near total thyroidectomy, 27 were offered total thyroidectomy as primary surgery and eight had biopsy only. The in-hospital mortality was 8%. Recurrence rate was 8%. CONCLUSION: Most patients present long after the development of symptoms. Follicular carcinoma is the most common thyroid malignancy among Africans. Further studies are required to explain this phenomenon.

Adolescent↗
PubMed2001

Pouchitis following restorative proctocolectomy for ulcerative colitis: incidence and therapeutic outcome.

BACKGROUND: Pouchitis is a significant sequel of restorative proctocolectomy. This study was undertaken to document the incidence of pouchitis at the Edinburgh Royal Infirmary and to assess outcome of treatment with metronidazole. METHODS: Patients who developed pouchitis following restorative proctocolectomy for ulcerative colitis form the basis of this study. Pouchitis was suspected if patients developed diarrhoea with or without blood, mucus or pus. Diagnosis was confirmed with pouch endoscopy and biopsy. RESULTS: From 1990 to 1999 (10 years) 139 patients underwent restorative proctocolectomy and ileo-anal pouch anastomosis (135 J pouches and 4 W pouches). Their median age was 35 years (range 13-74). There were 68 females and 71 males. The indication for operation was failed medical treatment in 104 patients and toxic megacolon in 35. Forty-seven patients (34%) developed pouchitis (21 females and 26 males). Symptoms were diarrhoea (35), diarrhoea, mucus and pus (5) and diarrhoea and blood (7). Symptoms of pouchitis started at an average of 33.51 + 29.2 months (range 2-102, median 18). All patients were treated with metronidazole for a minimum of one month. Thirty-six patients (77%) resolved on metronidazole alone. Nine patients (19%) went on to develop chronicity and were managed by long-term metronidazole (and/or ciprofloxacin). A further 2 patients (4%) had treatment resistant pouchitis and required pouch excision. CONCLUSION: Pouchitis is common following restorative proctocolectomy for ulcerative colitis. Treatment with metronidazole is associated with improvement in the majority of cases. In patients with chronic pouchitis maintenance of remission is possible with antibiotics. A high index of suspicion is advocated in patients who develop severe diarrhoea following this procedure.

Adolescent↗