S Afr J Surg
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Observational Study
Time since injury is the major factor in preventing tranexamic acid use in the trauma setting: An observational cohort study from a major trauma centre in a middle-income country.
Haemorrhage is responsible for about a third of in-hospital trauma deaths. The CRASH-2 trial demonstrated that early administration of tranexamic acid, ideally within 3 hours, can reduce mortality from trauma-associated bleeding by up to 32%. ⋯ The majority (74%) of bleeding trauma patients did not present within the timeframe allowed for safe administration of tranexamic therapy. Of those who did, most would have benefited from even earlier commencement of therapy. This raises the possibility that tranexamic acid may be more effective on a population basis if incorporated into prehospital rather than in-hospital protocols; future studies should explore the benefits and risks of this approach.
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The role of regional anaesthesia in cleft lip surgery in the developing world is not well documented. ⋯ Regional anaesthesia for cleft lip surgery in patients >14 years of age was well tolerated and associated with few complications. It is a safe and effective option when used as the sole anaesthetic modality for cheiloplasty in the developing world.
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Multicenter Study
Severity of upper-limb panga injuries and infection rates associated with early v. late tendon repair.
Panga or machete attacks are a common cause of significant upper-limb trauma in South Africa. Pangas are a multipurpose household tool used predominantly for foraging and agricultural purposes and are highly contaminated. While some centres advocate immediate primary repair if no concern exists regarding the risk of infection, others delay definitive repair until satisfied there is no evidence of infection. ⋯ Our results indicate indicate that panga injuries can be repaired safely at first presentation with no increased risk of infection or re-rupture.
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A bile leak is an infrequent but potentially serious complication after biliary tract surgery. Endoscopic intervention is widely accepted as the treatment of choice. This study assessed the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy and biliary stenting in the management of postoperative bile leaks. ⋯ Three-quarters of bile leaks after laparoscopic cholecystectomy were due to CD leaks (with or without retained stones) or lesser bile duct injuries and were amenable to definitive endoscopic therapy. Nineteen patients (16.8%) had major injuries that required operative intervention.
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Clinical Trial
The use of diverting colostomies in paediatric peri-anal burns: experience in 45 patients.
Peri-anal burns are common in children. Continual exposure to enteric organisms may lead to a contaminated burn wound, invasive sepsis, graft loss, scar contracture, anal and urinary malfunction, and delayed discharge from hospital. Use of a temporary diverting colostomy has been advocated to reduce complications. ⋯ Diverting colostomy has therapeutic advantages in a select group of paediatric burns patients in whom continual faecal soiling poses a threat to both graft and life.