More than 60 years of Organised Trauma Care: The Johannesburg Trauma Unit at Charlotte Maxeke Johannesburg Academic Hospital
The Johannesburg Hospital was opened in 1923 with a casualty department and wards. It was then known as Johannesburg General Hospital, commonly referred to as “The Gen” by many. In 1960, the Head of the Department of Surgery, Prof. DJ Du Plessis, recognised the need to organise trauma care. He is quoted saying, “A large proportion of the patients arriving in the hospital appear to have suffered traumatic injury,” and thus noted the need to reserve a separate area for the care of these patients.
Tutankhamun – Africa’s first reported road traffic crash victim?
The most famous of all the Egyptian pharaohs was Tutankhamun, also known as King Tut, who died aged 18 in January 1343 BC. King Tut is famous because his tomb was left in almost perfect condition and contained wonderful treasures upon its discovery. The tomb permitted discovering the world of ancient Egypt. However, the cause of King Tut’s death remains wrapped in a mystery.
Adverse events associated with the use of indwelling devices in surgical patients
The publication of To Err is Human at the turn of the millennium highlighted the fact that significant harm is incurred by patients secondary to human error and adverse events in health care. This contributed to the patient safety movement and encouraged several interventions designed to promote patient safety. Despite these efforts, the modern healthcare environment remains a relatively unsafe one when compared with other high-risk settings, such as the aviation industry and nuclear submarines.
The impact of the COVID-19 pandemic on presentation of surgical disease in paediatric patients at a tertiary centre in Cape Town, South Africa
The emergence of the novel coronavirus SARS-CoV-2 towards the end of 2019 in Wuhan, China, and the subsequent expansion towards a global pandemic has had far-reaching consequences on healthcare provision. Compared to the adult population, children have proven to be less susceptible to infection and severe disease, possibly due to a lower expression of angiotensin-converting enzyme-2 (ACE-2) receptors within the nasal passages and, therefore, fewer viral binding sites.
Factors influencing outcome in patients with perforated peptic ulcer disease at a South African tertiary hospital
Peptic ulcer disease (PUD), defined as a digestive tract injury that results in a mucosal break greater than 3–5 mm with penetration extending to the submucosal layer, has been on the decline since the advent of proton pump inhibitors and H Pylori eradication regimens. Patients who suffer from PUD can follow a variable clinical course, ranging from rapid recovery with medical management to those who develop complications of bleeding, perforation or gastric outlet obstruction.
The incidence and management of complications following stenting of oesophageal malignancies
Oesophageal carcinoma is the eighth most common cancer and the sixth most frequent cause of cancer-related death worldwide, with developing nations making up more than 80% of total cases and deaths. The highest incidence rates are found in Asia and sub-Saharan Africa, and South Africa is amongst the countries with the highest incidence rates globally. Over 50% of patients with oesophageal cancer present late with advanced, incurable or inoperable disease. In South Africa, well over 90% of patients with squamous cell oesophageal cancer present with high-grade dysphagia at primary presentation.
Technical success of endoscopic stenting for malignant gastric outlet obstruction
Most gastric outlet obstruction (GOO) cases (50–80%) presenting to endoscopy units today are due to malignant obstruction. While gastric and pancreatic malignancies are the most common causes of malignant GOO, lymphomas, duodenal, biliary tract, ampullary and metastatic malignancies may all cause GOO. Although the overall incidence of gastric cancer appears to be declining in the western hemisphere, the proportion it now contributes to the aetiology of GOO has increased since benign peptic ulcer disease (PUD) as primary aetiology has markedly decreased.
Outcomes of complex burn injury patients managed at two primary and one tertiary level burns facilities in the Western Cape province of South Africa – a retrospective review
The Western Cape health department stratifies burn management into primary, secondary and tertiary levels of care. Referral criteria for specialised care maximise benefit to the patient and resource allocation. The Tygerberg Hospital burns unit (TBU) is a specialist tertiary centre, catering for adult patients (over 13 years old). The TBU drains all provincial hospitals in the Western Cape and is managed by a plastic surgeon, a senior medical officer, two surgical registrars, and one intern.
HIV associated malignancies presenting as acute pancreatitis: a case series
Pancreatic malignancies may present as acute pancreatitis (AP) in 2% of cases. The malignancies are diagnosed at initial presentation or over a varying period thereafter. Non-pancreatic malignancies may also be associated with hyperamylasaemia. In HIV-positive patients, there is an association with AIDS defining malignancies (Kaposi’s sarcoma, high grade B-cell non-Hodgkin’s lymphoma).
Small bowel metastasis from embryonal rhabdomyosarcoma of the extremity – a case report
A previously well 17-year-old male was referred for investigation of a left forearm mass which had been progressively enlarging over 1 year. There was associated significant unintentional weight loss as well as intermittent pain and paraesthesia in the affected arm.
Successful management of a thoracoabdominal impalement injury
A 63-year-old female was brought to casualty with a history of alleged accidental fall onto an iron rod six hours before. On primary survey, the patient’s airway was patent, and her respiratory rate was 36/minute with saturation maintaining at 88% in room air. Oxygen support was started. Air entry was reduced on the left side of the chest with equivocal resonance. She was hypotensive with initial blood pressure of 80/40 mmHg. The patient responded to intravenous fluids and did not require a blood transfusion. The patient was catheterised after primary evaluation.
Transverse colon volvulus – a case report and literature review
A 46-year-old male presented with bloating and watery stools for several weeks. Prior to presentation, he was admitted to a different facility, where a colonoscopy was performed after which he was discharged. A colonic resection had been performed two years previously for sigmoid volvulus. Clinical examination demonstrated a right sided distended abdomen and tympanic bowel sounds. C-reactive protein (CRP) was elevated at 187 mg/l