Browsing by Author "Nicol, Andrew John"

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    A Straight Left Heart Border: A New Radiological Sign of a Hemopericardium
    (2014) Nicol, Andrew John; Navsaria, Pradeep Harkison; Beningfield, Steve; Kahn, Delawir
    Background: Detection of a cardiac injury in a stable patient after a penetrating chest injury can be difficult. Ultrasound of the pericardial sac may be associated with a false negative result in the presence of a hemothorax. A filling in of the left heart border inferior to the pulmonary artery, called the straight left heart border (SLHB), is a radiological sign on chest X-ray that we have found to be associated with the finding of a hemopericardium at surgery. The aim of the present study was to determine if this was a reliable and reproducible sign. Methods: This was a prospective study of patients with a penetrating chest injury admitted between 1 October 2001 and 28 February 2009, who had no indication for immediate surgery, and were taken to the operating room for creation of a subxiphoid pericardial window (SPW). The chest X-ray was reviewed by a single trauma surgeon prior to surgery. Results: A total of 162 patients with a possible occult cardiac injury underwent creation of a SPW. Fifty-five of the 162 patients (34 %) were noted to have a SLHB on chest X-ray and a hemopericardium confirmed at SPW. The sensitivity of the SLHB sign was 40 %; specificity, 84 %; and positive predictive value, 89 %. (p = 0.005, Odds ratio 3.48, lower 1.41, upper 8.62). Conclusions: The straight left heart border is a newly described radiological sign that was highly significant in predicting the presence of a hemopericardium and should alert the clinician to a possible occult cardiac injury.
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    The current management of penetrating cardiac trauma
    (2012) Nicol, Andrew John; Kahn, Delawir
    The vast majority of patients with penetrating cardiac injuries do not reach the hospital alive as the pre-hospital mortality rate for these injuries is in the region of 86%. The patients that do reach the hospital alive are potential survivors and it is obviously crucial that any cardiac injury is detected and managed appropriately. Most of these injuries present with either cardiac tamponade or hypovolaemic shock and are relatively straightforward to diagnose and require immediate surgery. There is, however, a group of patients that are relatively stable with an underlying cardiac injury and it is in these patients that a potential or occult cardiac injury needs to be identified.
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    Laparoscopy (to detect occult diaphragm injury) versus clinical and radiological follow up to detect diaphragm injury and herniation, in patients with asymptomatic left thoracoabdominal stab wounds : A prospective randomized controlled study
    (2015) Malherbe, Gideon F; Navsaria, Pradeep H; Nicol, Andrew John
    Background: The need to exclude occult diaphragmatic injury in left thoracoabdominal (TA) stab wounds continues to be controversial. Current trauma guidelines recommend either routine diagnostic thoracoscopy or laparoscopy and repair of an injury if found. Objective: To determine if asymptomatic patients with left sided (TA) stab wounds can be safely treated with careful clinical and chest X-ray follow up to ascertain healing of occult injuries. Methods: A parallel-group, prospective, randomized control study was conducted at the Trauma Centre at the Groote Schuur Hospital from 01 September 2009 through to 01 November 2014. All patients with asymptomatic left TA stab wounds included in the trial were randomized into two groups. Group A underwent diagnostic laparoscopy to exclude a diaphragm injury, and Group B underwent clinical and radiological follow up. Results: Twenty-seven patients were randomized to Group A (n=27) and thirty-one to Group B (n=31). All patients were young males with a median age of 26 years (range from 18 to 48). The incidence of occult diaphragm injury in group A was 29%. Occult injuries found at laparoscopy were all repaired. All patients in group 2 had normal chest X-rays and no symptoms at their last visit. The mean follow up time was 24 months (range of 0 to 58). There was no morbidity nor mortality associated with the conservative management of occult diaphragmatic injuries. The mean hospital stay for the patients in Group A was 5 days (SD 1.3), compared to a mean hospital stay of 2.9 days (SD, 1.5) p < 0.001, in Group B. Conclusions : Clinical and radiological follow up is feasible and appears to be safe in patients with occult diaphragm injuries after left TA stab wounds.
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    A retrospective audit of trauma surgery at a level 1 trauma centre in South Africa
    (2014) Chowdhury, A H M Sharfuddin Mahmud; Nicol, Andrew John
    Includes abstract. Includes bibliographical references.