OpenUCT :: Browsing by Author "Rode, Heinz"

Browsing by Author "Rode, Heinz"

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Open Access
An evaluation of nutritional practice in a paediatric burns unit
(2010) Vijfhuize, Sanne; Verburg, Manon; Marino, Luise; van Dijk, Monique; Rode, Heinz
Introduction. Burn injuries evoke a systemic metabolic response with profound effects on organ function, susceptibility to infection, wound healing, growth and development, and mortality. Children are especially vulnerable to nutritional deficiencies owing to their limited energy reserves. Methods. We evaluated the feeding practice in a paediatric burns unit. All children admitted to the unit were studied for a minimum of 3 consecutive days. Patients were divided into two groups: those with burns less than 20% (group 1) and burns ≥20% of total body surface area (TBSA) (group 2). Dietary prescriptions, intake, compliance with feeding practices, and the use of supplementary nutrition were assessed. Under-feeding and over-feeding were defined when there was a discrepancy between prescribed and actual food intake. Results. Forty children (mean age 5.8 years) were studied. They sustained between 2% and 55% TBSA burns. Inadequate caloric intake was seen in 19 of 29 patients and in 9 of 11 patients in groups 1 and 2, respectively. In contrast, excess protein supplementation was seen in 24 of 29 group 1 patients and 6 of 11 group 2 patients. The dietician’s food prescription was followed for 170 of 211 days; prescription compliance was correct in only 39 of 211 days. Conclusion. Adequate nutrition is essential for burns patients, but several factors can lead to either under- or over-feeding. A daily dietary consumption chart and evaluation of compliance are essential for each patient. There should be greater acceptability of tube enteral feeding.
Open Access
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
Open Access
The effect of early versus late enteral feeding on the hypermetabolic response of the paediatric burned patient
(2001) Venter, Marcha; Rode, Heinz
Background: Red Cross Children's Hospital treats an average of 2 000 children per annum with thermal injuries. Five hundred of these are new injuries and 60 patients have a total body surface area burn (TBSAB) that exceeds 20%. There is substantial evidence in adult burn literature that suggests that early enteral feeding (EEF) compared to initial starvation has a profound impact on the hormonal response, metabolic rate and gastrointestinal maintenance post thermal injury. However, research addressing these issues in the burned child (birth to 13 years old), are limited. Aim: To compare EEF, to delayed or late enteral feeding (LEF), and to evaluate whether the practice is beneficial in paediatric burned patients. Criteria: The criteria for the patients were (a) a burn less than 24 hours old and a TBSAB more than or equal to 20%, (b) an age of less than 13 years and (c) admission to the Red Cross Children's Hospital Burns Unit. Objectives: The objectives were to compare the effect of EEF and LEF on (1) the concentrations of insulin, insulin-like growth factor-1 (IGF1), glucagon, cortisol and growth hormone (GH), (2) the estimated energy expenditure (EEE) and calculated energy expenditure, (3) the respiratory quotient (RQ), (4) the intestinal permeability and (5) the clinical outcome. Methods: The children were assigned to either the EEF or LEF group. Nine patients in each study group completed the study successfully, with similar median ages (4.5 yr.), body weights (14 kg) and TBSAB (30%). The EEF group was enterally fed via a nasojejunal feeding tube within a median time of 10.75 hours post burn, whereas the LEF group fasted for a median of 54 hours, after which enteral feeds were introduced. This study is unique in that enteral feeds were used as part of the resuscitation regime in the EEF group. The EEF group received their full resuscitation volumes from the enteral feed at a median time of 16 hours from initiation. Venous blood samples were taken daily between 7h00 and 8h00, before breakfast, for the hormone measurements. The REE and RQ were measured by indirect calorimetry and compared to the recommended dietary allowances (RDA), Galveston and Solomon's equations, which estimate energy requirements. Small bowel permeability was measured by the sugar-absorption-test (SAT), and expressed as lactulose:rhamnose ratios.
Open Access
Experience with the Meek micrografting technique in major burns
(2016) Potgieter, Dawid Jacobus; Rode, Heinz; Adams, Saleigh
Background. Early excision of burn eschar and urgent skin cover is mandatory for survival in all major burns. The tremendous cost and time delay in cultured skin and the shortage of donor allograft can make early skin cover a life threatening problem for paediatric patients in this country. The Meek micrografting technique was introduced in 2003 as a rescue method to achieve epithelialisation in major burns. Objective. To evaluate its role in the management of major burns with reference to its efficacy, technical detail and role in major burn surgery.
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The history of paediatric trauma care in Cape Town
(Health and Medical Publishing Group, 2006) van As, A B (Sebastian); Rode, Heinz
Trauma is a leading cause of morbidity, mortality and disability in childhood. In most developed countries where 18% of the population are in the age group 0 - 15 years, injury exceeds all other causes of childhood mortality. In the developing countries of Africa, however, children aged 0 - 15 years constitute 43% of the population and trauma has an even bigger impact on child health.There is an erroneous perception that trauma is not a major health problem in Africa, derived from undue emphasis on mortality statistics alone. Yet, the impact of trauma ought to be measured not only in terms of death, but also the tremendous morbidity and disability caused by injuries, and their socioeconomic consequences.
Open Access
The history of paediatric trauma care in Cape Town
(Health and Medical Publishing Group, 2006) van As, A B; Rode, Heinz
Trauma is a leading cause of morbidity, mortality and disability in childhood. In most developed countries where 18% of the population are in the age group 0 - 15 years, injury exceeds all other causes of childhood mortality. In the developing countries of Africa, however, children aged 0 - 15 years constitute 43% of the population and trauma has an even bigger impact on child health.There is an erroneous perception that trauma is not a major health problem in Africa, derived from undue emphasis on mortality statistics alone. Yet, the impact of trauma ought to be measured not only in terms of death, but also the tremendous morbidity and disability caused by injuries, and their socioeconomic consequences.
Open Access
Inhalational burns in children
(1996) Whitelock-Jones, Linda; Rode, Heinz
This study began in 1990 in the Burn Unit of The Red Cross War Memorial Children's Hospital (RCWMCH) in Capetown. It came to our attention that children in the Burn Unit developed respiratory problems. These were complications of fireburns, smoke inhalation, explosions and even hot water scalds. They presented with a wide and confusing array of symptoms and many failed to improve with the symptomatic treatment given. Greater understanding of the pathology was needed in order to investigate and manage these problems correctly. The ultimate aim of this study was to establish a treatment protocol that could be followed by junior staff.
Open Access
The measurement of procedural burn pain and anxiety in paediatric burns : the new BOPAS method
(2002) Albertyn, Rene; Rode, Heinz; Thomas, Jenny
The assessment of pain and anxiety in South Africa is complicated by language barriers, cultural differences, socio-economic difficulties and delayed cognitive development. The high number of paediatric burn injuries (annually 2000) treated at the Red Cross War Memorial Children's Hospital, the need to accurately assess pain and drug efficacy and the current lack of speciﬁcally designed methods to do so, led to the development of the Burn Observational Pain and Anxiety Scale (BOPAS). This scale is believed to be the ﬁrst of its kind and was designed to measure both pain and anxiety in burned children. The aim of this study was: - To develop an observational pain and anxiety scale that can overcome ianguage barriers by excluding patient involvement in the assessment process. - To develop a scale that can differentiate between pain and anxiety during wound care procedures. - To develop a method that facilitates the translation of nominai information into numerical data. - To develop a scale that can evaluate drug and dose efficacy. A total of 105 chiidren, (M = 65, F = 40) aged 2-12 (average age 6.8 years), admitted for minor to moderate burn injuries to the Burns Unit of the Red Cross War Memorial Children's Hospital, were included in the sample. Five different consecutive studies varying between explorative and quasi-experimental were conducted to determine different levels of validity and reliability.
Open Access
Measurements in wound healing : effects of topical agents on full thickness dermal incised wounds in an animal model
(2001) Theunissen, Daniël; Rode, Heinz
Inert topical agents in the form of creams, lotions and ointments are often applied to wounds to create an environment conducive to wound healing. These agents, although not pharmacologically active on the intact skin, have activity when applied to wounds where the stratum comeum barrier to penetration is absent. From measurements of simple parameters like the rate of re-epitheliasation. it is known that some topical agents enhance wound healing while others retard the healing process. There is data available on the antiseptic and anti-microbial properties of most of the topical agents in use today, but ail the effects of these products on the micro-environment of wounds and their influence on the process of healing is not known. Central to the study of wounds and wound healing is the need for accurate methods to evaluate wounds. Parameters used for measuring outcome should be unambiguous and measurements should be accurate and reproducible. At present, no universally accepted methods of assessing wounds exist. Clinical evaluation is usually subjective and not quantitative, resulting in unacceptable levels of inter- and intra-observer variation. Similarly lacking are clear histological correlates of what we consider good healing characteristics of a wound. As our knowledge increase about the complex process of wound healing, in particular the hormones and peptide growth factors that regulate the process, possibilities arise for therapeutic intervention to enhance or improve clinical outcome. At the same time, the need for objective measurements becomes more urgent, as we need to evaluate and compare treatment options. Previous measurement systems were developed, ranging from visual scoring systems to measurement of biological and chemical wound constituents. Physical characteristics of healing wounds can also be measured by properties such as the tensile strength. The structural and ultra- structural elements of healing wounds remain difﬁcult to measure, although immuno-histochemistry and scanning electron microscopy allows some quantiﬁcation and simple morphometric measurements. With current advances in computer technology however, rapid, automatic measurements can be made from tissue sections for a variety of practical applications in the pathology laboratory. Image analysis offers dynamic functional imaging, linking multiple data sources to provide composite quantitative systems. Further correlation of detailed histologic examination of wounds to a detailed clinical assessment of the same wounds is important, not only to add credibility to clinical scoring schemes, but also to understand which structural features of the dermis are important for the severity of scarring (and therefore which should be the object of future therapeutic or preventative strategies).
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Scalp as a donor site in children: Is it really the best option?
(2017) van Niekerk, Gertruida; Rode, Heinz; Adams, Saleigh
Introduction Humans have several different types of hair, classified into eight different groups, of which types VII and VIII predominate in South Africa. The scalp with its abundance of hair is often used as a preferential donor site for small burns. Major reasons cited are that the donor site is hidden from view (covered by hair), rapidly epithelializes with minimal scarring and provides a relatively large surface area. The author postulates that the type of hair will have an influence on the healing of scalp donor sites, complications and aesthetic outcome. Contrary to international consensus, the Red Cross War Memorial Children’s Hospital (RCWMCH) experience indicated that the use of the scalp as donor area is not ideal due to the frequent complications seen amongst paediatric patients e.g. visible scars, recurrent folliculitis, patchy alopecia, hypertrophic scarring and areas of de- and hyperpigmentation. Objective This study reviewed the complications encountered with the use of the scalp as primary donor area in children of mostly black African origin (type VI-VIII hair). Methodology A retrospective folder review of patients admitted to RCWMCH between 2003 and 2015 with major burns (>30% total body surface area) was conducted. A total of 179 patient folders were reviewed. Only children (n=25) with unburned scalp donor areas were included in this study. Both short- long-term complications were identified. The patient age range was six months - 12 years, while the mean patient follow-up period was 580 days and mean burn TBSA was 44.92% (range 4 – 85%). Results Patient demographics: black African 60% descent (hair types VI-VIII), 32% mixed race (hair types III-V) and 4% Caucasian (hair types II-III). In the group of black African children 60% had short-term and 46.7% long-term complications, whereas in the mixed race children 37.5% had short-term and 25% long-term complications. No complications were encountered in the Caucasian group. Eleven (48%) of patients in total had short-term complications (88.9% folliculitis, 22.2% delayed healing) and seven (28%) had long-term complications (57,1% non-healing wounds, 42.8% recurrent folliculitis, 57.1% alopecia, 42.9% depigmented scars, 28.6% visible scars, 28.6% hypertrophic scars). The first procurement in 11 children resulted in a 91% complication rate (54.5% short-term and 36.4% long-term). Ten children had two procurements resulting in an 80% complication rate (40% short-term and 40% long-term complications). In four children with three scalp procurements an acute 25% complication rate, with no subsequent long-term complications, was encountered. Discussion Hair type has an influence on outcome and donor sites should be carefully selected. Hair types VI-VIII has a higher propensity for complications and these usually follow the first procurement procedure. Complications did not increase with multiple procurements. Significant complications with long-term sequelae are not uncommon when the scalp is used as donor site and these complications are difficult to treat. Although the sample size is small, it does reflect a significant complication rate. Conclusion Contrary to international consensus, the use of the scalp as donor site in South African children with hair types VI-VIII with large burns should not be the preferential site and should only be used as a last resort.
Open Access
Situs inversus abdominalis and duodenal atresia
(2009) Brown, Craig; Numanoglu, Alp; Rode, Heinz; Sidler, Daniel
Fewer than 20 patients born with situs inversus and duodenal atresia have been reported in the literature. We present a patient with this condition. A newborn baby presented shortly after birth with persistent bilious vomiting. An abdominal radiograph showed a right-sided stomach bubble and a second bubble on the left - typical of duodenal atresia but with mirror image configuration. Laparotomy confirmed the diagnosis of situs inversus abdominalis, which was also demonstrated by contrast studies and ultrasound. Duodenoduodenostomy was performed and the patient discharged on day 8 postoperatively. Situs inversus is associated with other congenital malformations including splenic malformations, left-sided liver and cardiac abnormalities; it is rarely associated with duodenal atresia. Duodenal obstruction in the presence of situs inversus has been described, including obstruction due to a web, stenosis, pre-duodenal portal vein and complete atresia. The patient presented in this paper had a duodenal web in the second part of the duodenum. Before undertaking surgery it is important to establish the presence of associated gastrointestinal and cardiac abnormalities.
Open Access
South African Burn Society burn stabilisation protocol
(2007) Karpelowsky, Jonathan S; Wallis, Lee; Madaree, A; Rode, Heinz
Minimal criteria for transfer to a burn centre (Modified from the Australian and New Zealand Burn Association (ANZBA) protocol) Burn injury patients who should be referred to a burn unit include the following: • All burn patients less than 1 year of age • All burn patients from 1 - 2 years of age with burns > 5% total body surface area (TBSA) • Patients in any age group with third-degree burns of any size • Patients older than 2 years with partial-thickness burns greater than 10% TBSA • Patients with burns of special areas – face, hands, feet, genitalia, perineum or major joints • Patients with electrical burns, including lightning burns • Chemical burn patients • Patients with inhalation injury resulting from fire or scald burns • Patients with circumferential burns of the limbs or chest • Burn injury patients with pre-existing medical disorders that could complicate management, prolong recovery or affect mortality • Any patient with burns and concomitant trauma • Paediatric burn cases where child abuse is suspected • Burn patients with treatment requirements exceeding the capabilities of the referring centre • Septic burn wound cases.
Open Access
The evolving management of Burkitt's lymphoma at Red CrossChildren's Hospital
(2006) Davidson, Alan; Desai, Farieda; Hendricks, Marc; Hartley, Patricia; Millar, Alastair; Numanoglu, Alp; Rode, Heinz
Background. Treatment for Burkitt’s lymphoma at Red Cross Children’s Hospital has evolved from the use of aggressive surgery and less intensive chemotherapy to a conservative surgical approach with more intensive chemotherapy. Methods. The study was a retrospective folder review of patients diagnosed with Burkitt’s lymphoma at RCCH between 1984 and 2004. Results. Ninety-two children were treated for Burkitt’s lymphoma at RCCH between 1984 and 2004. There were 10 patients with group A or fully resected disease, 52 with group B or extensive localised disease, and 30 with dissemination to the bone marrow and/or central nervous system or group C disease. Protocol 1 (less intensive chemotherapy based on the COMP regimen) was used from 1984, with protocol 2 (more intensive chemotherapy based on the LMB regimen) introduced in 1988 for group C disease, 1991 for group B disease and 1996 for group A disease. Overall 5-year survival increased from 20% with protocol 1 to 66% with protocol 2 for group C disease, and from 76.5% with protocol 1 to 88.2% with protocol 2 for group B disease. There were more admissions for neutropenic fever in patients on protocol 2 and more episodes of mucositis, and these patients required more red cell and platelet transfusions. With a more conservative surgical approach, biopsy largely replaced attempts to partially resect the tumour at primary surgery, and there was a consequent decline in surgical complications. Conclusions. Intensive chemotherapy with protocol 2 has resulted in improved survival for group C and group B patients, but with more morbidity. Protocol 1, which is less intensive with less morbidity, remains a viable strategy for group A and group B disease in resource-poor settings.
Open Access
The functional and cosmetic outcome of the ventral slit procedure for congenital megaprepuce
(2022) Tasker, David Beaumont; Howlett, Justin; Rode, Heinz
Background: Congenital Megaprepuce is a urological condition characterized by a megapreputial reservoir with a long redundant inner prepuce. The condition has been linked to urinary tract infections, lower urinary tract symptoms, and ballooning of the penis during voiding. An impeded urinary stream and resultant ballooning is associated with discomfort and causes parental anxiety due to the unusual appearance of phallus. Surgical correction should improve functionality, but cosmesis is also important. This study took place in a community in which traditional circumcision remains an essential rite of passage. Therefore, early surgical correction of congenital megaprepuce was complicated by the unique requirement that patients remain uncircumcised. Methodology: Here we investigated the functional and cosmetic outcomes of the ventral slit procedure, an uncomplicated technique used to restore urinary flow which, importantly, preserves the foreskin. Parents of 18 paediatric patients were interviewed post-operatively regarding phallic appearance and functionality following surgery. Results: Overall, the ventral slit procedure successfully restored flow, prevented ballooning and alleviated discomfort during voiding in all patients. Parents interviewed were highly satisfied with surgical outcomes, as assessed by the Pediatric Penile Perception score. Conclusion: The ventral slit procedure was found to be a culturally acceptable and simple surgical solution to congenital megaprepuce.
Open Access
The use of topical sodium hypochlorite in the management of Pseudomonas aeruginosa burn wound infection
(2011) Coetzee, Emile; Rode, Heinz
The aim of the study is: 1. To undertake a meta-analysis of Pseudomonas aeruginosa burn wound infection. 2. To undertake a retrospective audit of Pseudomonas aeruginosa burn wound infection at the Red Cross War Memorial Children's Hospital. 3. To investigate the local effects of sodium hypochlorite solutions in Pseudomonas aeruginosa burn wound infection with regards to efficacy and toxicity.
Open Access
Ventilator associated pneumonia in major paediatric burns
(2013) Rogers, Alan David; Rode, Heinz; Hudson, Donald
Includes abstract. Includes bibliographical references.

Browsing by Author "Rode, Heinz"

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