Browsing by Author "Karpelowsky, J S"

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    Basic principles in the management of thermal injuries
    (2008) Karpelowsky, J S; Rode, Heinz
    Although this article focuses predominantly on the management of paediatric burns, many of the principles and management protocols are universal and can be used for adults. Burns are defined as the coagulate destruction of tissue by thermal, chemical or electrical injury. This simplistic definition does, however, fail to incorporate the significant short- and long-term sequelae of these injuries, and the devastating social, functional and cosmetic consequences resulting from burn wounds
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    Medical consent for a minor - an alternative proposal
    (Health and Medical Publishing Group, 2006) Rode, H; Karpelowsky, J S
    Under current South African law, in terms of Child Care Act 74 of 1983,1 consent for elective surgery, HIV testing and therapy can only be given by the biological mother, married father or legal guardian of a minor. Where the consent of a parent or legal guardian cannot be obtained, permission for a medical procedure must be sought from the Minister of Social Development if in the opinion of a medical practitioner the procedure is necessary, i.e. consent by proxy. While we can accept that the intention of the law is to protect the welfare of the child, we find that this prejudices those patients requiring consent via the social service department. This procedure has in the past often led to delays and/or cancellations of the intended surgery or institution of appropriate therapy. It is a protracted pathway and at times a frustrating endeavour.
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    Resuscitation in major burns: The problem of fluid creep
    (2009) Rogers, A D; Karpelowsky, J S; Argent, A; Millar, A J; Rode, H
    We have noticed an alarming tendency for burn patients to be over-resuscitated, and we believe that protocols should be reviewed in light of our own and international experience. We recently managed an 8-year-old boy with 52% fullthickness burns, who developed abdominal and limb compartment syndromes during the period of resuscitation. The fluid volumes infused above those calculated were 1.6 and 4.7 litres on days 1 and 2 respectively to maintain haemodynamic stability and urine output above 2 ml/kg/h. Within 48 hours of the injury, he developed poor peripheral perfusion and a distended abdomen; the intravesical pressure was 32 mmHg and the abdominal perfusion pressure 23 mmHg. Abdominal decompression and three limb fasciotomies were performed, but small-bowel and lower limb muscle necrosis had developed. The patient deteriorated rapidly despite inotropic support and died.
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    Surgical complications of bacille Calmette-Guérin (BCG) infection in HIV-infected children: Time for a change in policy?
    (Health and Medical Publishing Group, 2008) Karpelowsky, J S; Alexander, A G; Dix Peek, S; Millar, A J W; Rode, H
    AIM: Bacille Calmette-Guérin (BCG) immunisation is well established as part of the South African national expanded programme for immunisation (EPI). The World Health Organization (WHO) currently recommends that BCG be given to all asymptomatic infants irrespective of HIV exposure at birth but does not recommend BCG vaccination for children with symptomatic HIV infection. This approach, however, has led to HIV-infected neonates who are asymptomatic at birth, developing severe vaccine-related complications. We present a surgical case series, representative of a minority of the cases in circulation, in support of a change to the timing of BCG administration to HIV-exposed neonates. METHODS: A case series of 17 HIV-infected patients with surgical complications of BCG vaccination. RESULTS: Seventeen patients are presented. The first two illustrate disseminated systemic BCG infection, resulting in BCG infection of the lymph nodes, liver, spleen and tibia, and the second with gastrointestinal involvement causing bowel obstruction. The other 15 patients represent a series of severe ulcerating lymphadenitis secondary to BCG. CONCLUSION: The risks of BCG in HIV-infected infants are significant. Current recommendations are not satisfactory, and a change in policy is required to prevent the harmful effects of this vaccine in a high-risk group of patients. We believe that there is sufficient need to adequately stratify patients and vaccinate them according to a protocol that takes impaired immunity into consideration.