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T Mokoena

Publications and source records attributed to T Mokoena.

At least 19 recordsLinked to original sources
PubMed1996

Prognosis in posttraumatic acute renal failure is adversely influenced by hypotension and hyperkalaemia.

OBJECTIVE: To see if it is possible to predict mortality in isolated post-traumatic acute renal failure. DESIGN: Retrospective study 1984-1990 inclusive. SETTING: Teaching hospital, South Africa. SUBJECTS: Thirty-nine patients who developed isolated post-traumatic acute renal failure out of 106526 admissions for trauma. INTERVENTIONS: Standard aggressive management of traumatic injury and acute renal failure. MAIN OUTCOME MEASURE: Death. RESULTS: Fifteen of the 39 patients who developed post-traumatic acute renal failure died (39%). Blunt trauma from assaults was a major cause of acute renal failure (16/39, 41%). Hypotension and hyperkalaemia were the two main predictors of death having a mortality of 63% and 52%, respectively. CONCLUSION: Clinicians should be aware of the risks of hypotension and hyperkalaemia in injured patients. Preventive measures such as aggressive resuscitation and timely correction of serum electrolyte concentrations are essential in such patients.

Acute Kidney Injury↗
PubMed1996

Ectopic kidney presenting as appendix mass or abscess.

Renal ectopia is very rare and its associated pyelonephritis can simulate an appendix mass/ abscess or colonic tumour which may result in needless surgical exploration, as illustrated by our experience with 3 cases reported in this article. Careful ultrasonography and urinalysis can obviate this confusion and save unnecessary operation.

Female↗
PubMed1995

Diagnostic difficulties in patients with a ruptured bladder.

Isolated bladder rupture has an insidious presentation which results in delayed diagnosis and management. Forty-four patients, of mean age 33.3 years, were seen over a period of 7 years. There was a history of trauma in 33 patients, although this was minor in 20. Alcohol intoxication, head injury or paraplegia could have led to lack of sensation of the distending and subsequently injured bladder in 18 patients. The mean delay between an identifiable incident or presentation and diagnosis was 5.4 days. The mean admission or preoperative levels of blood urea and creatinine were raised to 19.6 mmol/l and 362 mumol/l respectively in those with a delayed diagnosis. The diagnosis was made by voiding cystourethrography in 36 patients and by laparotomy in eight. When blood urea and creatinine concentrations are increased in a patient with an ill-defined abdominal ailment and a history of trauma or drunkenness, ruptured bladder should be considered.

Adolescent↗
PubMed1995

Gunshot injuries of the liver: the Baragwanath experience.

BACKGROUND: This study comprised 304 patients with gunshot injuries of the liver, many of which from high-velocity firearms. The purpose of this study is to evaluate our management policy in gunshot injuries of the liver in light of our recent wider experience. METHODS: All grade I and II injuries and most grade III injuries were managed by simple operative measures, without postoperative mortality directly related to the liver trauma. RESULTS: Grade III, IV, and V injuries had 8.5%, 52%, and 16% resectional debridement rates and 8.5%, 38%, and 84% perihepatic packing rates, respectively. In the resectional debridement group the postoperative mortality rate was 15% (half the deaths were directly caused by the hepatic injury). The postoperative mortality rate in the perihepatic packing group was 31.5% of which 45% of deaths were due to ongoing bleeding, 27.5% to sepsis, and 27.5% to associated trauma. The septic complications were less common when packs were removed early. CONCLUSIONS: We suggest that resectional debridement and perihepatic packing should be liberally applied in the most severe grade III, most grade IV, and grade V gunshot injuries of the liver and that perihepatic packing should be removed as early as the physiologic derangements are corrected. Our experience with grade VI injuries is very limited, and their management should be studied in larger series.

Adolescent↗
PubMed1994

Pattern of diverticular disease among Africans.

Diverticular disease of the colon was found to be a rare but emerging clinical problem among Urban Africans where 26 patients were recorded in this 5 year retrospective study, giving a hospital prevalence of 5 per 100,000 admissions. The pattern was different from that reported in Western communities in that, while diverticula were left sided in 77% of cases, 62% were right sided and 73% presented with haemorrhage. This confirms a reported experience among African Americans. We would like to postulate that it might be the pattern during a transition from traditional to Western diet.

Adult↗
PubMed1994

Selective surgical management in penetrating neck injuries.

OBJECTIVE: To evaluate selective operative management in penetrating neck trauma. DESIGN: A chart review. SETTING: A university-affiliated hospital in Johannesburg, South Africa. PATIENTS: All adults admitted to the hospital between January 1988 and June 1993 with a penetrating neck wound. Excluded were patients in whom there was no suspicion of an occult injury that might need further investigation. There were 755 patients in the study. INTERVENTIONS: Immediate surgical exploration (group A, 613 patients) and observation with constant monitoring (group B, 142 patients). MAIN OUTCOME MEASURES: Unnecessary explorations in group A and missed significant injuries in group B. RESULTS: In group A there was a 3% incidence of unnecessary explorations, and 4.2% of the patients died. In group B there was a 9.1% incidence of missed injuries, and 2.8% of the patients died as a result of the delayed diagnosis. Overall the death rate was 4%. CONCLUSION: Selective operative intervention for penetrating neck trauma results in fewer negative explorations and a death rate comparable to those of series that support mandatory neck exploration.

Adolescent↗
PubMed1994

Haemorrhage--the main presenting feature of diverticular disease of the colon in blacks.

Haemorrhage is one of the less common presentations of diverticular disease. This retrospective 5-year study of 23 patients has identified it as the main presentation (74%) among South African blacks in whom the disease is uncommon, but emerging as a clinical problem. Women constituted a statistically significant majority of patients with bleeding (76%); this was in excess of their overall proportion among patients with diverticular disease (61%) (P = 0.018).

Adult↗
PubMed1993

Surgical management of retroperitoneal necrotising fasciitis by planned repeat laparotomy and debridement.

Mortality remains high in patients with necrotising fasciitis despite use of modern powerful antimicrobial drug therapy and advances in the care of the critically ill. This is particularly so in patients with intra-abdominal retroperitoneal lesions. While necrotising fasciitis of the integument has been well described, its retroperitoneal (extraperitoneal) location has not been highlighted. Planned repeated laparotomies and debridement have been used in 10 recent patients with only 2 deaths. The initiating incident was caesarean section in 3 patients; perineal sepsis, trauma or intra-uterine death in 2 patients each; and uterine instrumentation to induce early abortion in the remaining patient. All patients received empirical antimicrobial therapy, which was changed when microbial isolates and their sensitivity indicated. Mechanical ventilation support was given to 60% of the patients early on during the illness. All received nutritional supplementation either parenterally or enterally throughout their inhospital treatment. This report focuses on intra-abdominal extraperitoneal necrotising fasciitis and the use of planned repeated laparotomy and debridement in the treatment of retroperitoneal (extraperitoneal) necrotising fasciitis per se and we recommend it as an essential part of the management of this condition.

Adult↗
PubMed1992

Oesophageal tuberculosis: a review of eleven cases.

Tuberculous infection of the oesophagus is rare. This is confirmed by our present review of cases managed in our teaching hospitals over a period of 18 years which uncovered only 11 patients. The main presentation is that of dysphagia whose algorithm of investigation should seek to differentiate tuberculosis from carcinoma, the more common cause of this symptom. Of the 11 patients, 9 presented with dysphagia while 2 had haemorrhage; 7 had an abnormal plain chest radiograph, of whom 4 had a mediastinal mass lesion (3 were lymphadenopathy and one an abscess). All but one had an abnormal radio-contrast oesophagogram, including a mediastinal sinus in two and a traction diverticulum in another two. The mainstay of investigation was oesophagoscopy through which diagnostic biopsy material was obtained in half of the patients. In the other half diagnosis was by either biopsy of associated mediastinal (3) or cervical (1) lymph node masses or by acid fast bacilli positive sputum (1). The diagnosis was established post-mortem in one patient. Treatment was primarily non-operative with standard anti-tuberculosis drug therapy. Two patients underwent a diagnostic thoracotomy and one a drainage of mediastinal abscess together with resection and repair of oesophago-mediastinal sinus during the early part of the series. Outcome of management was very rewarding in 9 patients and death occurred in 2 patients, one of whom had his anti-tuberculosis drug therapy interrupted by severe hepatitis B virus infection. The other death occurred in a patient whose haemorrhage from an aorta-oesophageal fistula was not established ante-mortem. It is recommended that when biopsy material of the oesophagus is unobtainable or non-diagnostic in patients with dysphagia, especially with an abnormal chest radiograph or human immunodeficiency virus infection, effort should be made to obtain biopsy material from associated lymph nodes, even by thoracotomy if necessary, or culture of biopsy from the radiologically abnormal part oesophagus and sputum for mycobacteria, in order to establish the diagnosis of this rare but eminently treatable cause of dysphagia. Clinicians should be aware of tuberculosis of the oesophagus as a possible cause of haematemesis in patients with otherwise unexplained upper gastrointestinal haemorrhage.

Adult↗
PubMed1991

Haemostasis by angiographic embolisation in exsanguinating haemorrhage from facial arteries. A report of 2 cases.

Life-threatening exsanguinating haemorrhage from arteries of the face following trauma is uncommon. When it occurs it is often located in the relatively inaccessible parts of the vessels and requires deep face or neck exploration and ligation of the main feeding vessel. The procedure requires expert head and neck vascular surgery performed under general anaesthesia, which is often not suitable in these haemodynamically unstable patients. In addition, surgery is often rendered more difficult by the associated post-traumatic swelling and disfigurement. Because of these considerations, angiographic embolisation of the bleeding vessels was performed as an alternative to surgical exploration. This report illustrates its use in achieving haemostasis in 2 patients.

Adult↗
PubMed1991

Surgical management of multiple limb gangrene following dehydration in children.

Multiple limb gangrene and auto-amputation without arterial vascular occlusive disease is uncommon. Seven such paediatric patients were managed at King Edward VIII Hospital, Durban, during the 6-year period ending in 1989. The spectrum and degree of limb gangrene ranged from phalangeal necrosis to distal limb mummification affecting one or more limbs. The most affected child had gangrene and mummification of all limbs as well as gangrene of the ear lobes and the tip of the nose. The main associated factor was severe fluid loss--2 children had received herbal enemas, with resultant hypotension, hypoperfusion, hypernatraemia and acidosis, which, it is postulated, led to peripheral thrombosis and the ensuing gangrene. It is suggested that aggressive fluid therapy, including low molecular weight dextran and correction of the metabolic derangement, should form the main thrust of the therapeutic endeavour. Once gangrene is established, surgical debridement and rehabilitation is all that is possible. Using this procedure only 2 patients died in the acute resuscitation phase.

Arm↗