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Objetivo: Determinar los factores asociados a la mortalidad en pacientes con trauma abdominal abierto atendidos en el servicio de cirugía del Hospital Nacional Hipólito Unanue. Enero – diciembre 2015. Métodos: Se realizó un estudio no experimental, analítico, observacional, retrospectivo y de diseño transversal; en un población comprendida por 102 pacientes; llevado a cabo en el servicio de emergencia del departamento de Cirugía del Hospital Nacional Hipólito Unanue. Resultados: La edad promedio de la población evaluada fue de 27.19; en su mayoría de sexo masculino los cuales eran población económicamente activa. El distrito de mayor procedencia fue El Agustino. El hallazgo clínico de mayor frecuencia es el dolor abdominal; encontrándose además que la taquicardia, la hipotensión y la taquipnea fueron variables asociadas a la mortalidad p <0.05. La hemoglobina promedio hallada fue de 4mg/dl asociada a la mortalidad; mientras que el hematocrito con un valor de 14.3%; asimismo la lesión de un órgano fue el más predominante; siendo el intestino delgado el de mayor frecuencia 40.3% y el hígado el que estuvo asociado a mayor mortalidad. La causa más frecuente de trauma abdominal abierto fue la herida por arma blanca 69.4; mientras que la herida por arma de fuego la que mayor mortalidad presentó. Conclusiones: La agresión física por arma blanca ocasionó un mayor número de lesiones abdominales abierta, seguidas por las heridas por PAF. Por lo cual se propone mayor promoción y prevención dirigidas a disminuir la violencia social y mayor concientización de la población.

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Un Aneurisma de Aorta Abdominal (AAA) es definido como una dilatación de la arteria aorta de al menos 1.5 veces el diámetro medido a nivel de las arterias renales. En muchos individuos el valor normal a este nivel es de 2.0 cm (rango 1.4 a 3.0 cm); un diámetro mayor de 3.0 cm es generalmente considerado aneurisma. La historia natural de estos aneurismas es la de expansión y eventual ruptura. Los aneurismas se expanden una tasa promedio de 0.3 a 0.4 cm por año 1-8. La resección electiva es considerada para AAA que han alcanzado un diámetro de 5.0 a 5.5 cm 9-12, para aquellos que incrementan en diámetro más de 0.5 cm dentro de un periodo de 6 meses, o para aquellos que son sintomáticos (mayor sensibilidad o dolor abdominal y/o lumbar) 11, 13. Sin embargo, el riesgo de intervención quirúrgica debe ser valorado contra el potencial beneficio. La mortalidad perioperatoria para reparación quirúrgica de aneurisma aórtico varía entre 2.7 y 5.8% 14,15. La mortalidad se incrementa sustancialmente cuando la cirugía es realizada de emergencia debido a ruptura, y en el marco de condiciones comórbidas tales como edad avanzada, insuficiencia renal, cirrosis o enfermedad cardiopulmonar 8,16-18.

MMed, Faculty of Health Sciences, University of the Witwatersrand / Postoperative pain is prevalent and not optimally managed in most patients. Pain can lead to adverse emotional and systemic consequences. Numerous device orientated studies have been done in other countries looking at the effect of infusions of local anaesthetic at the wound site postoperatively via an elastomeric pump. There have however been no similar studies done in South Africa. The aims of this study was to assess whether the use of an incisional wound catheter and 0.39% bupivacaine infusion in patients post total abdominal hysterectomy for a 30 hour period will decrease opioid requirements compared to a control group having only systemic analgesia. Pain intensities were also documented at set observation periods. The opioid requirements between the 2 groups were comparable however the participants who had the bupivacaine infusion in their incisional site had less pain intensity scores until 6 hours post operation and had less pain intensity on movement at 30 hours post operation. A bupivacaine infusion in the incisional site decreases pain intensity in the above mentioned parameters but does not reduce opioid requirements.

A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Physiotherapy Johannesburg, 2017 / This research makes a meaningful contribution to the development of effective injury prevention strategies among adolescent cricket pace bowlers. This dissertation, specifically investigated two screening procedures, the Functional Movement Screen (FMS) and ultrasound measured abdominal wall muscle thickness, both of which aim to predict injury among the general and sporting population. More specifically, the dissertation investigated the applicability of these screening procedures to adolescent cricket pace bowlers. Adolescent pace bowlers are prone to injury due to the high load and complex nature of the bowling action as well the risk factors associated with the adolescent growth spurt. Studies related to the validity of the FMS in terms of the prediction of injuries among various sporting disciplines have been conducted but none among cricket pace bowlers. Studies related to the association between abdominal wall muscle morphometry (i.e. thickness at rest and during the performance of abdominal drawing in manoeuvre (ADIM), as measured by ultrasound imaging (USI), and injury among professional and amateur cricket pace bowlers have had conflicting results and limited research related to abdominal muscle morphometry among the adolescent pace bowlers exist. Adolescent pace bowlers that were injury free at the start of the season were recruited for this study. Details related to the nature of past injuries as well as injuries sustained during the season were monitored and recorded over a three month period. Included in this dissertation are three original papers. The first two investigated the association between prospective in-season injury and the two above mentioned screening procedures. The third investigated the concurrent validity of FMS overhead deep squat (DS) when observer rating was compared to kinematic analysis. The first paper (Chapter 4) investigated the association between muscle morphometry of transverse abdominis (TA), internal oblique (IO) and external oblique (EO), as measured by USI, at the start of the season and in-season injury. Results indicated that non-dominant internal oblique is thicker than dominant IO (p=0.01, effect size (ES) =0.65) in injury free pace bowlers but that non-dominant and dominant internal oblique (p=0.47; ES=0.24) is symmetrical in injured pace bowlers. Based on these findings we concluded that asymmetry in IO thickness may play a protective role against injury rather than being a predisposing risk factor to injury. The second paper (Chapter 5) investigated the association between pre-season total FMS score and in-season injury among adolescent pace bowlers. Results indicated that there was no significant difference in total pre-season FMS scores of bowlers that sustained injuries during the season and those that remained injury free (p=0.58). Also, a total FMS score of 14 (the score previously found to be an accurate cut-off score) does not provide the sensitivity needed to assess injury risk among adolescent pace bowlers. It was therefore concluded that the FMS was not associated with in-season injury among adolescent pace bowlers and that the usefulness of this tool in the prediction of injuries among these cricketers is doubtful Paper 3 (Chapter 7) investigated the concurrent validity of the overhead DS included in the FMS when observer rating is compared to kinematic analyses. The FMS attempts to systematically score the quality of movements, among other the DS, based on specific criteria. The developers of the FMS suggest that specific mechanics related to the DS differ between levels of scoring. There were significant differences in the degree to which the torso was flexed forward, away from the vertical (p=0.03), where groups 3 and 2 (i.e. those participants who scored a rating of 3 and 2 respectively for the performance of the DS) remained more upright compared to Group 1. There was also a significant difference in the degree to which the femur passed the horizontal line (p=0.05) between the three groups. At the point of deepest descent, the femurs of Groups 3 and 2 were below the horizontal while that of Group 1 remained above. The findings of this part of the study suggest that, while raters correctly identified differences in biomechanics between groups for two of the scoring criteria (femur below horizontal and feet remaining flat on floor or board) , they did not rate the groups correctly for the remaining criteria. The concurrent validity of the observer rating of the FMS DS is therefore questionable. In conclusion, the high load nature and complexity of the pace bowling action together with the intrinsic risk factors related to the adolescent growth spurt, expose school boy cricket pace bowlers to injury. The ability of these screening procedures to accurately identify individuals at risk of sustaining injuries are therefore of the utmost importance. Despite the popularity of the FMS, the concurrent validity of this screening tool and its lack of association with in- season injury among adolescent pace bowlers brings the use of FMS into question. Symmetry, not asymmetry, of the IO and under-, not over-activation of the dominant TA muscles were associated with in-season injuries among pace bowlers. All of the above conflicting findings pose uncertainty regarding the applicability of these screening procedures to injury prediction among adolescent cricket pace bowlers. / MT2017

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Background and purposes: Carbon dioxide is the common gas material to establish pneumoperitoneum to provide working space for laparoscopic surgeries, but possesses risks of reduced cardiac output and hypercarbia in cases with limited cardiopulmonary reserve. For such cases, we design a novel trocar to reduce the intrabdominal pressure, so as to perform the same operation safely. Animals and Methods: The novel trocar has four flexible leaflets that can be fixed as ¡§extended status¡¨ to hold the inner surface of abdominal wall. When the trocar was tracted upward with iron wires, the abdominal wall can be elevated. The lowest pressure of pneumoperitoneum with the usage of the novel trocar was tested first. We found the pressure was dependent on the target organ. Laparoscopic cholecystectomy was performed to compare the advantage of the novel trocar over the conventional trocar because it is one of the most commonly performed surgeries. Totally 6 pigs were used. They were divided into two groups: 3 pigs as the control group receiving operation with the conventional trocars (group C) under 15 mm Hg pneumoperitoneum, and another 3 with the novel trocar (group N) under 5 mm Hg pneumoperitoneum. Results: The total operation time was significantly longer in group N but the precise dissection time was comparable with group C. No surgical complication was noted in both groups and the blood loss was minimal. The hypercarbia was of a much lesser degree in group N compared to that in group C. Conclusions: Our preliminary data show that with the novel trocar, the laparoscopic cholecystectomy could be smoothly completed under a lesser pressure of 5 mm Hg CO2 pneumoperitoneum in pigs.

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