Introduction

The supernumerary registrar experience in KwaZulu-Natal

The critical shortage of medical professionals in Africa, more especially sub-Saharan Africa, has been a perennial problem. Great efforts have since been made to improve the number of doctors trained on the continent by concentrating on strengthening primary healthcare in the region. As primary healthcare standards continue to improve in sub- Saharan Africa, the need for specialist care will inevitably increase as well. Currently, there is a shortage of medical specialists in many sub-Saharan African countries and even in countries where specialists practise, these individuals are concentrated in urban areas.

Damage control surgery of the critical Jehovah’s Witness patient – a narrative review

Trauma contributes significantly to morbidity and mortality worldwide. Internationally, trauma remains the leading cause of death from the first to the fifth decades of life. At least one-fifth of this occurs in Africa. South Africa has a high burden of trauma-related injuries. There is no current trauma database in South Africa, but extrapolation from hospital and mortuary records reported between 33 000 and 50 000 trauma-related injuries in 2007 and 2009 respectively. Most of these injuries occur as a result of violence and traffic incidents. For every one mortality, there are approximately 10–30 trauma survivors.

Spectrum of coagulation profiles in severely injured patients – a subgroup analysis from the fluids in resuscitation of severe trauma trial

Uncontrolled bleeding is responsible for the majority of preventable deaths in the severely injured. Traumainduced coagulopathy (TIC) is widely accepted as a major contributing factor to worsening bleeding in these patients. TIC is a multiple phenotypic pathological state, characterised by impaired coagulation, fibrinolysis, and overall vascular homeostasis after endothelial injury due to trauma. Both states of hypercoagulopathy and hypocoagulopathy may occur after trauma and fall under the umbrella term TIC.

Significant differences in functional outcome between upper and lower limbs after vascular trauma of the extremities

Approximately 1.6% to 4.4% of all civilian traumas involve vascular injuries; their frequency has tended to increase in recent years and the extremities are affected in 26.5% to 34%. Amputations following these injuries decreased from 72.5% in 1946 to about 46% to 8% in military settings and 14.7% to 1.9% in civilian centres. Peripheral vascular trauma nonetheless remains a challenging life and limb-threatening injury demanding rapid diagnosis and intervention.

High-grade renal trauma in children and adolescents can be successfully managed non-operatively

There has been a radical change in the management of intra-abdominal solid organ injury in children over the last fifty years, from an operative approach to a non-operative management (NOM) strategy. This transition has been supported by ongoing improvements in imaging, as well as by advances in interventional radiology and critical care.

The profile and outcome of small bowel atresia at Universitas Academic Hospital

Intestinal atresia can be defined as a congenital absence of what should be a patent lumen, resulting in either a complete obstruction or a stenosis. The worldwide incidence of intestinal atresia ranges between 2.5 and 3 per 10 000 live births. Associated anomalies are not uncommon and occur in up to 50% in those with duodenal atresia. This includes growth retardation, prematurity and cardiac lesions. The frequency of associated congenital anomalies is less in those with jejunal and ileal atresia.

Development and internal validation of the survival time risk score in patients treated for oesophageal cancer with palliative intent in South Africa

Oesophageal squamous cell carcinoma (OSCC) is endemic in South Africa, with certain regions of the country being part of the high incidence African OSCC corridor. The prognosis of OSCC is known to be poor, and survival beyond a few months in this group of patients is rare.

Outcomes of haemorrhagic radiation proctitis at a South African tertiary hospital

Radiation therapy (radiotherapy) is a vital modality for the treatment of malignancy. Radiotherapy can be used as monotherapy or part of multi-modal therapy. Its beneficial effects against malignancy are usually offset by its unintended complications. One of the commonly seen complications is radiation-induced enteritis, which is defined as direct inflammation of the gastrointestinal (GI) mucosal membranes.

Retroperitoneoscopic adrenalectomy – introducing a new surgical technique in South Africa

Laparoscopic adrenalectomy (LA), first performed in 1992, is safer, more effective and less invasive than traditional open posterior and transabdominal approaches. The technique ensures a rapid return to baseline daily activity, is associated with minimal blood loss, less postoperative pain and reduced surgical time. Therefore, the laparoscopic approach is superior to the traditional open methods and is established as the gold standard for adrenal surgery.

South African surgical trainees Master of Medicine dissertation survey

The introduction of structured research programmes amongst surgical trainees has changed the research culture towards evidence-based medicine. It aims to create critical thinking specialists with research appraisal skills. The American Surgical Society Blue Ribbon committee acknowledges that surgery’s future depends on prioritising research. Furthermore, the Accreditation Council of Graduate Medical Education (ACGME) has identified medical knowledge as a core competency, making research an important addition to the general surgery curriculum.

Broad responses and attitudes to having music in surgery (the BRAHMS study) – a South African perspective

Music can be ubiquitously heard emanating from operating theatres (OTs) throughout the world. Commonplace as it is, there is disagreement in the literature regarding the benefits or harms of music in this setting. Surgery can be a stressful exercise that warrants expert execution of both technical and non-technical skills (such as communication, teamwork and rapid decision making) under pressure. The feeling of stress and managing its flow-on effect on performance is one that unites all surgeons in their experience.

Point-of-care ultrasound assessment of a swollen limb following snakebite envenomation – an adjunct to avoid fasciotomy

A 27-year-old man arrived at the emergency department approximately 2 hours after a bite on the left wrist from a puff adder (Bitis arietans), complaining of severe pain and swelling extending into the left axilla. He was fully conscious; his airway was self-maintained, and no respiratory distress was present. Vital signs included a blood pressure of 149/56 mmHg, pulse rate of 84 beats/minute, though the radial pulse was difficult to palpate. His respiratory rate was 16 breaths per minute.

Borrowing from the Burrow’s – using discarded tissue to improve lip reconstruction

A 72-year-old male presented with a fungating cutaneous squamous cell carcinoma. The mass measured 3.5 cm x 3 cm and involved approximately 80% of the upper lip, including the entire philtrum, columella base, and extended onto the edge of the nasal sill bilaterally.

Blindness and ophthalmoplegia from metastatic breast carcinoma

A 70-year-old female presented with a 6-month history of blindness in the right eye and loss of sensation on the ipsilateral forehead. The patient had previously been diagnosed with a locally advanced (cT4b N2 M0), oestrogen receptor positive, HER-2 negative invasive duct carcinoma of the left breast in 2011. She had completed six cycles of neoadjuvant chemotherapy (5 fluorouracil, epirubicin and cyclophosphamide) followed by a left total mastectomy and level II axillary lymph node dissection in 2012.

Operating room fires – a South African ENT perspective and recommendations

We would like to bring to the attention of the surgical community the results of a survey we conducted amongst the ear, nose and throat (ENT) community regarding the rare but potentially fatal airway fires in the operating room and highlight the need for attention to be given to the prevention and management of all operating room fires.

Accreditation

Health Professions Council of South Africa

MDB015/068/01/2023

3 Clinical

Certification

Attempts allowed: 2

70% pass rate





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South African Journal of Surgery - Vol 61 no 1 - 2023