Ethics and surgery during the COVID-19 pandemic: principles are no different

CITATION: Banieghbal, B. & Al-Benna, S. 2020. Ethics and surgery during the COVID-19 pandemic: principles are no different. South African Journal of Surgery, 58(3):122, doi:10.17159/2078-5151/2020/v58n3a3348.The original publication is available at: http://www.scielo.org.zaEthics can perhaps falsely give the appearance of being a complex subject, but in clinical terms it is really about forming a judgment based on the available facts of an individual case and assessing the relative risks, burdens and benefits of different courses of action. This task is done by making reference to appropriate ethical and legal frameworks. While additional training may be needed to gain familiarity with these frameworks, it is not necessary for practicing healthcare professionals to be expert in these fields. Surgeons need to be aware of ethical and legal issues that apply to a case as they execute the process of consultation and decision makingPublisher's versio

Radiological response and histological findings in nephroblastoma: Is the any correlation?

Middleton, Pamela, et al. "Radiological response and histological findings in nephroblastoma: Is the any correlation?" African Journal of Paediatric Surgery, vol. 17, no. 3, July-Dec. 2020, p. 39"The original publication is available at :www.afrjpaedsurg.orgIntroduction: The Sociétè Internationale d'Oncologie Pédiatrique advocates for neoadjuvant chemotherapy in the management of nephroblastoma. Postoperatively, histological findings are used to assign risk classification to resected tumours. The aim of this study is to compare the response demonstrated by pre-operative imaging to the amount of necrosis seen on histology postoperatively. Patients and methods: About 33 patients with nephroblastoma over a 10 year period had adequate imaging and histology records for this study. Three methods were used to assess tumour change following neoadjuvant therapy and were compared with histological records. 1. An estimation of necrosis, 2. Surface areas of apparent necrosis within the tumour measured on static imaging, 3. The change in volume of the mass. Pearson coefficient was calculated to measure the correlation between histologically observed necrosis and radiological changes. Results were considered significant if P< 0.05. Results: There was no correlation between radiological changes on pre-operative imaging and the percentage of necrosis seen on histology. Change in tumour size on radiological studies showed a moderate correlation to percentage tumour necrosis on histology but was unable to predict tumour risk classification. Conclusions: In nephroblastoma, there is a moderate correlation between the decrease in size of a mass noted on imaging following chemotherapy and the degree of necrosis found postoperatively on histology. Change in tumour size cannot be used to predict histological risk classification. It is not possible to predict the histological risk classification of a nephroblastoma based on the changes demonstrated on non-contrasted magnetic resonance imaging or computed tomography preoperatively

Increasing abdominal pressure with and without PEEP: effects on intra-peritoneal, intra-organ and intra-vascular pressures

Intra-organ and intra-vascular pressures can be used to estimate intra-abdominal pressure. The aim of this prospective, interventional study was to assess the effect of PEEP on the accuracy of pressure estimation at different measurement sites in a model of increased abdominal pressure

Increasing abdominal pressure with and without PEEP: effects on intra-peritoneal, intra-organ and intra-vascular pressures

Intra-organ and intra-vascular pressures can be used to estimate intra-abdominal pressure. The aim of this prospective, interventional study was to assess the effect of PEEP on the accuracy of pressure estimation at different measurement sites in a model of increased abdominal pressure

Physiological marker and surgical ligation of patent ductus arteriosus in neonates

Background: In preterm infants, immediate complications of surgical closure of a patent ductus arteriosus (PDA) are often serious and due to haemorrhage or ligation of incorrect structures. The aim of this study was to measure blood pressure (BP) changes during ligation and hence introduce a novel physiological marker to alert surgeons to the ligation of incorrect structures. Materials and Methods: This study included 146 preterm babies (≤35 weeks of gestation) who underwent surgical PDA closure of a left-to-right unidirectional PDA between June 2006 and December 2015. The median weight was 920 g (range, from 520 to 2200 g). In all cases, the PDA was test cross-clamped, and the lower limb or umbilical artery BP was recorded before ligation. Results: Based on preoperative echocardiography, the PDA diameter range was 2-4 mm in 135 cases and 5-6 mm in 11 cases. During test clamping of the PDA, a 20-60% rise in mean BP was recorded. The lower figure was observed with smaller PDAs. Conclusion: It is estimated that the mean BP should rise by 10% for every mm of PDA diameter during test clamping and ligation of the PDA, irrespective of weight or age. The absence of this expected rise in mean BP indicates that an incorrect structure might have been clamped

Simplified preformed silo bag crafted from standard equipment in African Hospitals

Silo bags are synthetic, flexible silicone bags used to cover and protect the bowel of neonates born with gastroschisis. They are transparent, which enables clinicians to visualise bowel colour and allows for gentle reduction until closure. Silo bags are expensive, and different sizes are needed depending on the gastroschisis size. Currently, tertiary hospitals in low-income countries experience great difficulty in purchasing these bags. Therefore, in this article, we present a method for creating a preformed silo bag by utilising readily available disposable equipment in secondary or tertiary hospitals. The disposable equipment required includes a 200- or 500-ml saline or blood bag, 16- or 18-Fr silicone/latex Foley catheter, Opsite® and 2-0 silk suture. The saline bag is cut and opened transversely. The Foley catheter is cut corresponding to the diameter of the saline bag opening, and both ends of the catheter piece are connected to each other to create a 'circle', which is used as the base for the opening. The edge of the saline bag is turned inside out around the catheter and then securely closed with a continuous suture, which fixes the folded part of the bag to the catheter. These silo bags are cheap and easily and quickly prepared at any centre in Africa and very similar to manufactured silo bags, which are comparatively costly and difficult to procure in limited-resource environments