Scielo RSS <![CDATA[South African Journal of Surgery]]> http://www.scielo.org.za/rss.php?pid=0038-236120090003&lang=en vol. 47 num. 3 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Taking the tension out of portal hypertension</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000300001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Early rebleeding and death at 6 weeks in alcoholic cirrhotic patients with acute variceal bleeding treated with emergency endoscopic injection sclerotherapy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000300002&lng=en&nrm=iso&tlng=en BACKGROUND: This study evaluated the incidence of rebleeding and death at 6 weeks after a first episode of acute variceal haemorrhage (AVH) treated by emergency endoscopic sclerotherapy in a large cohort of alcoholic cirrhotic patients. METHODS: From January 1984 to December 2006, 310 alcoholic cirrhotic patients (242 men, 68 women; mean age 51.7 years) with AVH underwent 786 endoscopic variceal injection treatments (342 emergency, 444 elective) during 919 endoscopy sessions in the first 6 weeks after the first variceal bleed. Endoscopic control of initial bleeding, variceal rebleeding and survival at 6 weeks were recorded. RESULTS: Endoscopic intervention controlled AVH in 304 of 310 patients (98.1%). Seventy-five patients (24.2%) rebled, 38 (12.3%) within 5 days and 37 (11.9%) within 6 weeks. No patient scored as Child-Pugh A died. Seventy-seven (24.8%) Child-Pugh B and C patients died, 29 (9.3%) within 5 days and 48 (15.4%) between 6 and 42 days. Mortality increased exponentially as the Child-Pugh score increased, reaching 80% when the score exceeded 13. CONCLUSION: Despite initial control of variceal haemorrhage, 1 in 4 patients (24.2%) rebled within 6 weeks. Survival at 6 weeks was 75.2% and was influenced by the severity of liver failure, with most deaths occurring in Child-Pugh grade C patients. <![CDATA[<b>Selective observational management of penetrating neck injury in Northern Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000300003&lng=en&nrm=iso&tlng=en BACKGROUND: The most appropriate management of penetrating neck injury (PNI) remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution. METHODS: The study was conducted between 1991 and 2006. Patients whose injuries penetrated platysma were included. Following resuscitation, physical signs were utilised to select patients for exploration or observation. Investigations were based on physical signs which, with details of injured structures, treatments and outcomes, were recorded. RESULTS: There were 225 patients of whom 209 (93.0%) were men. Their mean age was 28 years. The majority (74.2%) of cases were stab wounds, and the balance (25.8%) were gunshot injuries. In 37.8% and 27.6% of patients, injuries were sustained during armed civilian conflicts and robberies, respectively. Patients with no signs of significant injuries (37.8%) were treated by observation. Overall, 52.4% underwent neck exploration; injuries requiring repair were found in 87.3% of these patients. Physical signs as a basis of detecting significant injury had a sensitivity of 97.2% and specificity of 87.4%. Overall mortality was 4.0%. CONCLUSION: Physical examination can accurately select patients with PNI who can be safely managed by observation. Physical signs can also identify patients who require further diagnostic evaluations. <![CDATA[<b>Aortocaval fistula - rare complication of ruptured abdominal aortic aneurysms</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000300004&lng=en&nrm=iso&tlng=en BACKGROUND: The most appropriate management of penetrating neck injury (PNI) remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution. METHODS: The study was conducted between 1991 and 2006. Patients whose injuries penetrated platysma were included. Following resuscitation, physical signs were utilised to select patients for exploration or observation. Investigations were based on physical signs which, with details of injured structures, treatments and outcomes, were recorded. RESULTS: There were 225 patients of whom 209 (93.0%) were men. Their mean age was 28 years. The majority (74.2%) of cases were stab wounds, and the balance (25.8%) were gunshot injuries. In 37.8% and 27.6% of patients, injuries were sustained during armed civilian conflicts and robberies, respectively. Patients with no signs of significant injuries (37.8%) were treated by observation. Overall, 52.4% underwent neck exploration; injuries requiring repair were found in 87.3% of these patients. Physical signs as a basis of detecting significant injury had a sensitivity of 97.2% and specificity of 87.4%. Overall mortality was 4.0%. CONCLUSION: Physical examination can accurately select patients with PNI who can be safely managed by observation. Physical signs can also identify patients who require further diagnostic evaluations. <![CDATA[<b>Ogilvie's syndrome, beta-blockers and burns</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000300005&lng=en&nrm=iso&tlng=en BACKGROUND: The most appropriate management of penetrating neck injury (PNI) remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution. METHODS: The study was conducted between 1991 and 2006. Patients whose injuries penetrated platysma were included. Following resuscitation, physical signs were utilised to select patients for exploration or observation. Investigations were based on physical signs which, with details of injured structures, treatments and outcomes, were recorded. RESULTS: There were 225 patients of whom 209 (93.0%) were men. Their mean age was 28 years. The majority (74.2%) of cases were stab wounds, and the balance (25.8%) were gunshot injuries. In 37.8% and 27.6% of patients, injuries were sustained during armed civilian conflicts and robberies, respectively. Patients with no signs of significant injuries (37.8%) were treated by observation. Overall, 52.4% underwent neck exploration; injuries requiring repair were found in 87.3% of these patients. Physical signs as a basis of detecting significant injury had a sensitivity of 97.2% and specificity of 87.4%. Overall mortality was 4.0%. CONCLUSION: Physical examination can accurately select patients with PNI who can be safely managed by observation. Physical signs can also identify patients who require further diagnostic evaluations. <![CDATA[<b>Eponymous yet anonymous</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612009000300006&lng=en&nrm=iso&tlng=en BACKGROUND: The most appropriate management of penetrating neck injury (PNI) remains controversial. This study was conducted to determine the accuracy and safety of physical examination as the basis of selective observational management of PNI at our institution. METHODS: The study was conducted between 1991 and 2006. Patients whose injuries penetrated platysma were included. Following resuscitation, physical signs were utilised to select patients for exploration or observation. Investigations were based on physical signs which, with details of injured structures, treatments and outcomes, were recorded. RESULTS: There were 225 patients of whom 209 (93.0%) were men. Their mean age was 28 years. The majority (74.2%) of cases were stab wounds, and the balance (25.8%) were gunshot injuries. In 37.8% and 27.6% of patients, injuries were sustained during armed civilian conflicts and robberies, respectively. Patients with no signs of significant injuries (37.8%) were treated by observation. Overall, 52.4% underwent neck exploration; injuries requiring repair were found in 87.3% of these patients. Physical signs as a basis of detecting significant injury had a sensitivity of 97.2% and specificity of 87.4%. Overall mortality was 4.0%. CONCLUSION: Physical examination can accurately select patients with PNI who can be safely managed by observation. Physical signs can also identify patients who require further diagnostic evaluations.