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A B van As

Publications and source records attributed to A B van As.

14 recordsLinked to original sources
PubMed2004

Inhuman shields--children caught in the crossfire of domestic violence.

BACKGROUND: Child abuse is a worldwide scourge. One of its most devastating manifestations is non-accidental head injury (NAHI). METHODS: This is a retrospective chart review of children presenting to the Red Cross Children's Hospital trauma unit with a diagnosis of NAHI over a 3-year period. RESULTS: Sixty-eight children were included in the study and 2 different groups were identified. Fifty-three per cent of the children were deliberately injured (median age 2 years), while 47% were allegedly not the intended target of the assailant (median age 9 months). The assailant was male in 65% of the intentional assaults and male in 100% of the unintentional assaults, with the intended adult victim female in 85% of the latter cases. Overall, 85% of the assaults were committed in the child's own home. CONCLUSIONS: The high proportion of cases in which a young child was injured unintentionally suggests that these infants effectively become shields in assaults committed by adults. In this context any attempts to deal with child abuse must also address the concurrent intimate partner violence.

Adult↗
PubMed2003

The effects of war on children in Africa.

There is no doubt that the effects of war extend to the most vulnerable members of society, including children. Although armed conflicts occur throughout the world, the African continent seems to be a particular background for civil and international wars. The aim of this study was to identify causes of conflict in Africa and to evaluate the effect of war on children and their health in order to make practical recommendations to health care workers dealing with children in the setting of war. All articles written in the past 5 years concerning "war" and "children" were identified by means of a literature search and internet review. Contrary to common belief, the causes of conflict are complicated and multi-factorial. The effects of war on childhood are disastrous and include severe negative effects on general paediatric health status. Short-term recommendations for health care workers working with children in war include supply of emergency medical infrastructures, basic health care, rehabilitation and education. Long-term recommendations include orchestrating the relief and support efforts from both national governments and international non-profit organisations and speeding up of economic recovery. The causes of conflict in Africa are complex and unlikely to be resolved soon. The effects of war on children are horrendous in many ways, but can be limited by providing timely and appropriate health care.

Africa↗
PubMed2003

The South African experience with ingestion injury in children.

INTRODUCTION: The Red Cross Children's Hospital is the only children's hospital in South Africa. It has a dedicated trauma unit for all children under the age of 13 and serves a population of approximately 2 million inhabitants. As part of the Child Accident Prevention Foundation program we have kept a database of all children treated for trauma in our hospital since 1991. Presently, we have over 88,000 entries in our database. AIM: To study our experience with ingested foreign bodies in children. MATERIALS AND METHODS: A retrospective study was performed using the CAPFSA database of a total of 3677 patients presenting with foreign bodies. The hospital folders were searched using a standardised data extraction form. Only foreign bodies aspirated or ingested were included. RESULTS: To date, 241 folders have been analysed. DEMOGRAPHICS: Both sexes were equally affected (boys 49%). Age ranged between 0 and 12 years, although there was only one child under the age of 1. At the age of 3 years there was a peak in incidence (24% of all cases). Nature of ingested object: Although the objects were from a range of materials, most were metal (40%) or plastic (23%). The most commonly ingested object was a coin (28%), a ball (20%) or bone (8%). The size ranged from 0.1 to 3 cm (as measured by virtual ring), the most common size of an ingested foreign body was 0.5 cm. Anatomical site: The most common anatomical site of impaction was the nose (41%), followed by the oesophagus (20%), the stomach (14%) and bowel (11%). Other anatomical sites included hypopharynx, nasopharynx, bronchus, larynx and oral cavity. Severity of symptoms: Only 0.4% of our cases were assessed as being severe, 14% as moderate, and 44% as mild. Forty-two percent (42%) had no symptoms. Removal: Fifty-seven percent (57%) of ingested foreign bodies were removed surgically, 19% were left in situ, 14% spontaneously dislodged and only 1% was removed by Foley catheter manipulation. CONCLUSION: A presentation with a foreign body is quite common in our patient population, representing approximately 4.2% of all our cases. The majority of ingested foreign bodies produced mild or no symptoms, needed surgical removal and had no complications.

Bronchi↗
PubMed2003

Evisceration through multiple abdominal wall defects following blunt abdominal injury.

We report an unusual case of a posttraumatic evisceration of small and large bowel through 2 holes in the anterior abdominal wall after a motor vehicle accident. Prompt adequate management consists of reestablishing the perfusion of the eviscerated organ if the blood supply is compromised, performing a full laparotomy to exclude intra-abdominal organ injury and meticulous cleaning of the eviscerated organs before reducing them in the abdomen and closing the abdomen in layers.

Abdominal Injuries↗
PubMed2003

Child rape.

Explore the source record for details and available documents.

Child↗
PubMed2002

Gunshots to the neck: selective angiography as part of conservative management.

Trauma units all over the world are faced with an ever-increasing number of gunshot injuries. While the traditional view is that exploration is mandatory for all gunshot wounds to the neck, this issue is now often debated amongst trauma surgeons. The aim of this particular study was to assess the outcome of gunshot wounds to the neck using a selective conservative approach. Haemodynamically stable patients were investigated with angiography. Only when this proved to be positive, the patient was surgically explored. The records of 116 patients presenting with a gunshot to the neck to our trauma unit over a 3-year-period were reviewed. We studied demographics, bullet track, clinical findings, diagnostic investigations, methods of treatment, time in hospital and outcome. Seventy of the 116 patients sustained a direct hit to the neck, in 46 patients the bullet traversed the face or chest first. Eighty-five patients presented with vascular injury, 61 with an injury to the airway, 32 with an injury to the pharynx or oesophagus, and 12 with sustained neurological damage. Angiography was performed in 89 patients and was positive in 12 patients. Lesions occurred in the common carotid artery (seven), the internal carotid artery (three), the external carotid artery (three), the vertebral artery (two) and the subclavian artery (one). Five patients had more than one lesion. In total 18 patients were treated operatively by performing a neck exploration. Four patients had emergency surgery for exsanguinating bleed. Fourteen had surgery after a positive diagnostic study; 12 after angiography, 2 after another positive investigation. Ten (8.6%) patients died; three during resuscitation, three during emergency exploration, two due to respiratory failure, one postoperative and one from the adult respiratory distress syndrome (ARDS). Our results suggest that selective conservative management is a good treatment for gunshot wounds of the neck. In our experience angiography plays a key role in the detection of a major vascular injury requiring surgical exploration. Careful clinical assessment enhanced with the appropriate investigations is the cornerstone for deciding to explore a gunshot wound to the neck.

Adolescent↗
PubMed2001

Impact of Celsior solution on hepatocellular, reperfusion and endothelial cell injury after liver transplantation.

BACKGROUND: Initially, preservation solutions were developed to maintain cell function of the transplanted organs. However, recently developed preservation solutions also contain a variety of substances to reduce the reperfusion injury. AIM: To study the effect of three different preservation solutions on the liver cell injury, endothelial cell function and reperfusion injury after liver transplantation. MATERIAL AND METHODS: Large White X Landrace pigs of either sex were subjected to orthotopic liver transplantation. Donor livers were flushed and stored in University of Wisconsin Solution, Eurocollins Solution or Celsior Solution for 3 hours. Blood samples were taken at various times post transplantation for assessment of aspartate aminotransferase, hyaluronic acid, malondialdehyde and Vitamin A levels. RESULTS: Serum aspartate aminotransferase levels were lower in the livers preserved in the Wisconsin solution. Plasma malondialdehyde levels were lower and serum Vitamin A levels were higher in the livers preserved in Celsior solution. Serum hyaluronic acid levels increased after liver transplantation but were similar with all three solutions. CONCLUSIONS: There was less hepato-cellular injury in the livers preserved in Wisconsin solution and less reperfusion injury with the Celsior solution. The endothelial cell injury was similar with all three solutions.

Animals↗
PubMed2001

Effect of early arterialization of the porcine liver allograft on reperfusion injury, hepatocellular injury, and endothelial cell dysfunction.

The conventional technique of liver transplantation involves the initial perfusion of the graft with portal blood. However, recent evidence suggests that initial arterialization of the graft may be better. The aim of this study is to evaluate the timing of arterialization on reperfusion injury, hepatocellular injury, and endothelial cell function after liver transplantation. Large white X Landrace pigs (n = 24) were subjected to orthotopic liver transplantation. The animals were randomly assigned to 4 groups, ranging from late arterialization (60 minutes after portal reperfusion) to early rearterialization (20 minutes before portal reperfusion). Aspartate aminotransferase levels continued to increase 4 hours posttransplantation in group 1 (late arterialization), but remained stable after 1 hour posttransplantation in group 4 (early rearterialization). Levels of malondialdehyde doubled in all groups after portal reperfusion with the exception of group 4, in which the liver received arterial blood before portal reperfusion. Vitamin A levels decreased in all groups after revascularization, but the decrease was more pronounced and prolonged in groups 1 and 2 (late arterialization) compared with groups 3 and 4 (early rearterialization). Hyaluronic acid levels continued to increase in all groups until 1 hour posttransplantation except in group 4, in which the level decreased from 20 minutes posttransplantation. Results of this study show that early rearterialization is associated with less hepatocellular damage, less reperfusion injury, and improved liver endothelial cell function. In conclusion, our results indicate that early rearterialization of the graft is beneficial to the transplanted liver.

Animals↗
PubMedDate not supplied

Do diets enriched with oil prevent multiple organ failure in mice?

OBJECTIVE: To examine the effects of various diets supplemented with fat in an experimental model of multiple organ failure in mice. DESIGN: Two randomised laboratory studies. SETTING: University hospital. MATERIAL: 177 female Swiss mice (weight 20-30 g). INTERVENTIONS: Experiment I: 59 mice; 20 received no dietary supplement, 20 received 15% palm oil, and 19 received 14% fish oil plus 1% corn oil, eight weeks before injection of 100 mg zymosan/100 g in 4 ml liquid paraffin; 5 mice in each group killed after 1.5 hours, and the rest on day 12. Experiment II: 118 mice; 29 received no dietary supplement, 30 received 15% palm oil, 30 1% corn oil, and 29 14% fish oil, 12 weeks before injection with zymosan. 20 mice in each group received streptomycin 5 g/l in drinking water starting five days before injection of zymosan and continued until the end of the experiment. All mice killed on day 12. MAIN OUTCOME MEASURES: Mortality, body and organ weights, and culture of peritoneal fluid. Detection of tumour necrosis factor-alpha (TNF-alpha) in plasma. RESULTS: Experiment I: only 5 control mice, 2 in the fish oil, and 7 in the palm oil, groups survived to day 12. Spleens in mice given fish oil were significantly heavier than those that had had palm oil (p = 0.03). Experiment II: 108/118 mice survived until day 12, and most had macroscopic signs of multiple organ failure. Liver weights in the fish oil group were lower than in the control (p = 0.04) and palm oil (p = 0.03) groups, and kidney weights higher than in the corn oil group (p = 0.007); there were no differences in the amounts of TNF-alpha detected in the blood. One culture in each experiment grew bacteria. CONCLUSION: Diets supplemented with fish oil did not prevent multiple organ failure or reduce plasma concentrations of TNF-alpha. Decontamination of the gut did not alter these results.

Animals↗