Traumatic superior mesenteric arteriovenous fistula

CITATION: Du Toit, D.F & Rademan, F. 1987. Traumatic superior mesenteric arteriovenous fistula - a case report. S Afr Med J, 71(9):587-588.The original publication is available at http://www.samj.org.zaENGLISH ABSTRACT: In a case of traumatic superior mesenteric arteriovenous fistula resulting from a stab wound in the abdomen clinical signs of high-output cardiac failure or portal hypertension were absent. Selective angiography was useful in confirming and locating the fistula. The patient made a good recovery after resection of the aneurysm and fistula and insertion of a prosthetic graft.AFRIKAANSE OPSOMMING: Geen opsomming beskikbaarPublisher’s versio

A tale of two sit-bones: The cyclist’s ischial hygroma (Perineal nodular induration)

The ischial hygroma, also known as a perineal nodular induration, is a relatively rare and mostly cycling-specific injury that is often incorrectly diagnosed and managed. Here two cases with divergent managements are described to highlight the spectrum of treatment available to manage this condition. The presentation, assessment and management of two cases of perineal nodular induration are discussed.The management options, namely surgical excision vs conservative management, with saddle pressure mapping highlight that there is no single optimal method and that a multidisciplinary approach should be applied to treat these injuries successfully. Perineal nodular induration should be investigated appropriately to exclude less benign causes of perineal masses. Conservative management and surgical excision can both be successful. Clinicians should be familiar with the assessment and management of this relatively rare but debilitating condition in competitive cyclists.Keywords: cycling, perineal injur

A tale of two sit-bones: The cyclist’s ischial hygroma (Perineal nodular induration)

The ischial hygroma or perineal nodular induration is a relatively rare and cycling specific injury that is often incorrectly diagnosed and managed. We highlight two cases with divergent managements to highlight the spectrum of treatment available to manage this rare condition. We describe the presentation, assessment and management of two cases of pernineal nodular induration. The management (surgical excision vs conservative management with saddle pressure mapping) highlight that there is no single optimal management and a multidisciplinary approach should be applied to treat these injuries successfully. Perineal nodular induration should be investigated appropriately to exclude less benign causes of perineal masses. Both conservative management and surgical excision can be successful. Clinicians should be familiar with assessment and management options for this relatively rare but debilitating condition in competitive cyclists. &nbsp

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Splenic rupture caused by a cricket ball. A case report

CITATION: Du Toit, D.F. & Rademan, F. 1987. Splenic rupture caused by a cricket ball - a case report. S Afr Med J, 71(12):796.The original publication is available at http://www.samj.org.zaENGLISH ABSTRACT: A 14-year-old boy presented with a ruptured spleen after being injured by a cricket ball during a match. A typical picture of splenic rupture with intra-abdominal haemorrhage was evident on admission to hospital. At emergency laparotomy splenorrhaphy was not feasible because of a deep hilar laceration and splenectomy was performed.Publisher’s versio