Frank Edwin Medical Blog

Work at the Walter Sisulu Pediatric Cardiac Centre for Africa

noreply@blogger.com (Frank Edwin) — Sat, 19 Dec 2009 04:33:00 +0000

The Walter Sisulu Pediatric Cardiac Center for Africa (WSPCCA) is located at the Netcare's Sunninghill Hospital in Johannesburg, South Africa and is equipped to perform modern state-of-the-art pediatric cardiac surgery. It is a wonderful opportunity for me to upgrade my skills here under the tutelage of Prof RH Kinsley and his team. Prof and Mrs Kinsley appear in the frame below with Drs. Frank and Ama Edwin. It was Prof Kinsley's dream to set up the WSPCCA to offer much needed cardiac surgery to the indigent of the continent in the area of pediatric cardiac surgery and also to train pediatric cardiac surgeons for the continent. Needless to say, this is a unique opportunity for surgeons intending to practice in Africa as you get the best of two worlds - congenital heart problems as encountered in Africa (much different from that in the West) and the use of modern techniques to address these problems.

With the paucity of cardiac centers in Africa, the WSPCCA certainly fills a huge void in terms of service provision and manpower development. With a focus on training surgeons for the continent, this vision could not have come at a more needful time. We congratulate the WSPCCA team for a wonderful gift to the continent.

It was indeed my passion for pediatric cardiac surgery and for the children of my nation that ultimately led me to begin this 2 year sojourn away from my beautiful homeland, Ghana.

At this year's annual dinner, the CEO of the WSPCCA Mrs Lynda Bleazard (pictured above with Drs. Frank & Ama Edwin) was emphatic about the role of the WSPCCA in training personnel for Africa by Africans.

Dr Johann Brink (pictured above with myself and Lynda), my good friend and fellow Fellow in the program is a brilliant surgeon who trained in Blomfontein and has a passion for pediatric and congenital cardiac surgery. It is a privilege to work with such motivated and committed people.

Heart Disease in Children

noreply@blogger.com (Frank Edwin) — Mon, 14 Dec 2009 13:41:00 +0000

Pediatric and Congenital Heart Disease Burden in Ghana

Publications

noreply@blogger.com (Frank Edwin) — Fri, 28 Aug 2009 11:51:00 +0000

eComment: CARDIOPULMONARY BYPASS WITHOUT EXCHANGE TRANSFUSION IN SICKLE CELL DISEASE - AN UPDATE

eComment: INCOMPLETE LEFT VENTRICULAR REVERSE REMODELLING AFTER REVASCULARIZATION OF ALCAPA

BILATERAL TENSION PNEUMOTHORAX RESULTING FROM BICYCLE-TO-BICYCLE COLLISION

eComment: MANAGEMENT OF MITRAL REGURGITATION ASSOCIATED WITH ANOMALOUS LEFT CORONARY ARTERY FROM THE PULMONARY ARTERY

eComment: MANAGEMENT OPTIONS OF TUBE THORACOSTOMY-INDUCED PULMONARY ARTERY INJURY

FREEDOM FROM THROMBOEMBOLISM DESPITE PROLONGED INADEQUATE ANTICOAGULATION

OUTCOME OF THROMBOLYSIS FOR MASSIVE PULMONARY EMBOLISM

eComment: ACUTE AORTIC DISSECTION IN THE YOUNG - DISTINGUISHING PRECIPITATING FROM PREDISPOSING FACTORS

eComment: POST-THORACOTOMY HORNER'S SYNDROME ASSOCIATED WITH EXTRA-PLEURAL INFUSION OF BUPIVACAINE

eComment: COR TRIATRIATUM AND CARDIAC HEMOLYTIC ANEMIA

eComment: SPONTANEOUS OR EFFORT DIAPHRAGMATIC RUPTURE

A PULMONARY AZYGOS LOBE ENCOUNTERED DURING THORACOTOMY FOR MODIFIED BLALOCK-TAUSSIG SHUNT

DOUBLE SUPERIOR VENA CAVA COMPLICATING TRANSVENOUS PACEMAKER IMPLANTATION

eComment: DISCRETE SUBAORTIC STENOSIS FOLLOWING REPAIR OF ATRIOVENTRICULAR SEPTAL DEFECTS

eComment: ACUTE AORTIC DISSECTION IN CHILDREN AND YOUNG ADULTS - THE ROLE OF SILDENAFIL

eComment: OPTIMAL EXPOSURE FOR DEBRIDEMENT OF NECROTIZING MEDIASTINITIS AND BILATERAL EMPYEMA THORACIS

eComment: IS VIDEO-ASSISTED THORACOSCOPIC SURGERY REALLY SUPERIOR TO OPEN DECORTICATION FOR EMPYEMA THORACIS?

eComment: A PRACTICAL APPROACH FOR IMAGING OF DIAPHRAGMATIC INJURY

SYNCHRONIZED CARDIOVERSION FOR CHRONIC ATRIAL FIBRILLATION

Re: POOR CARE OF SICKLE CELL DISEASE PATIENTS: THIS WAKE UP CALL IS LONG OVERDUE

Re: NAMIBIA: CITIZENS LINE UP FOR HEART SURGERY

SURGICAL MANAGEMENT OF CONSTRICTIVE PERICARDITIS

TETRACYCLINE PLEURODESIS FOR MALIGNANT PLEURAL EFFUSION - A REVIEW OF 38 CASES

MASSIVE PERSISTENT LOWER GASTROINTESTINAL HEMORRHAGE SECONDARY TO TYPHOID FEVER

Ghana's Cardio Center

noreply@blogger.com (Frank Edwin) — Fri, 28 Aug 2009 11:38:00 +0000

Affiliation - CTSNet homepage

20 Years of Ghana's National Cardiothoracic Centre - press conference, public lecture & outreach to CEPS (Ministries, Accra)

The Future of Heart Surgery in Ghana

WARM WATER - SECRET TO LONGEVITY?

noreply@blogger.com (Frank Edwin) — Fri, 14 Nov 2008 17:59:00 +0000

I thought I'd heard it all; I mean all the secrets that are supposed to prolong your life. You hear them from people who are centenarians or thereabouts. If they have lived this long, I suppose they have earned the right to tell us what they think got them there in the first place. But did you know about the 'warm water rub me downs'. Well, that's just what I'm talking about. It was not too long ago that the 105 year-old Clara Meadmore told us the secret of her longevity was abstinence from sex (and indeed marriage). Well here comes another authority with this warm water stuff: this time it is a supercentenarian, Huo Liming, a healthy 111-year-old woman, who claims to have kept fit by rubbing down her whole body with warm water once a day for decades. The amazingly nimble Huo, who can still thread a needle and mend clothes cited it as one of the best ways of preserving her health when she was honored as the eldest person in Hebei province and one of the top 10 healthy centenarians in China. Well, may be it's no wonder not so many people make it to Huo's age: who would have even conjectured of warm water rubdowns to prolong life. We probably should compile centenarians' opinion of the factors that promote longevity - some really weird stuff we would find. The scientists will never guess or should they investigate these claims? I have my doubts; anecdotal at best.

CALORIC RESTRICTION - MAGIC OR MIRAGE?

noreply@blogger.com (Frank Edwin) — Thu, 23 Oct 2008 22:54:00 +0000

Plagued with what was considered premature death in historic times, humans not surprisingly have been preoccupied with extending lifespan and a means of rejuvenation. Stories abound of explorers in search of a ‘fountain of youth’. Ponce de Leon is purported to have discovered such a fountain of youth in Florida, a popular tourist site even in modern times. Bottled samples of ‘Florida Water’ on sale by some spiritualists are claimed to possess healing and rejuvenating powers. Scientists found several decades ago that restricting the caloric intake as well as lowering the environmental temperature of several animal species increased the maximal length of life of these species. There have been claims also that several environmental manipulations and the intake of certain chemical components have a similar effect on life expectancy. Of all the claims, the one that seems to have survived scientific scrutiny is Caloric Restriction (CR).

Caloric restriction refers to the practice of reducing the energy intake from food to a level below daily requirements for the purpose of improving health and prolonging life. It generally translates to reducing daily caloric intake by about 20-30% of the recommended daily intake. Excessive calorie intake (and the obesity that is a usual accompaniment) increases the risk of developing chronic disease and decreases life expectancy. High calorie intake has been linked in several scientific studies to an increased risk of artherosclerosis, cancer, diabetes and obesity. Artherosclerosis is the common underlying factor for most cardiovascular diseases, the commonest cause of death in the western world. During the Second World War the shortage of food in some North European countries led to a sharp fall in mortality from coronary artery disease; when the war ended mortality rose sharply as food became available and people resorted to their old ways. That excessive consumption of calories is detrimental to health is well established. So why do we not just stick with the recommended daily requirement? Well, Ponce de Leon never really died and his search for the fountain of youth lives on. It was in the early 1930s when Clive McCay and colleagues reported their scientific observations that rodents fed a calorie-restricted diet lived up to 40% longer than their ad libitum-fed counterparts. Based on this work, several other scientists began exploring this finding in more refined and diverse ways. Generally, it is now accepted by the scientific community that CR is associated with positive health benefits. Such benefits include a lean body profile, lower blood cholesterol levels, triglycerides, fasting glucose, fasting insulin, and both systolic and diastolic blood pressure. Such beneficial effects are contributory to a reduction in mortality and improved quality of life. It is also firmly established that CR is the only consistent way of extending the lifespan in several tested primate species. It appears probable also that the same effect in prolonging life applies to humans. The precise amount of calorie intake or body fat mass associated with optimal health and maximum longevity in humans is however not known. It must also be pointed out that CR can be pursued to the realm of the unhealthy and the malnourished. Anemia, muscle wasting, neurologic deficits, lower extremity swelling, weakness, dizziness, lethargy, irritability, and depression are features that have been observed in those in whom CR may be categorized as excessive, even dangerous.
The beneficial effects of CR are appealing. Who does not want to reduce his cardiovascular risk profile, live longer and not regret it? But the issue is this – are you ready to pay the price? Is it worth the price anyway? Does CR really prolong life? And by the way why torture yourself by restricting your food portions just so you could live a little bit longer? May be this CR business should be reserved for people with eating disorders who refuse to get professional help? And why not? CR sounds like anorexia nervosa in new clothes.
Its one thing to starve because of food shortage but this conscious appropriation of starvation just to live longer is …extremist? Well if you are a member of the Caloric Restriction Society you wouldn’t think so. Neither will you think so if you are one of the many that had to adopt CR because something was wrong health-wise and CR offered the most commonsense approach to dealing with the issue. But does it work? It appears to, according to the evidence. How much longer can you live on CR (granting you can stick to the regimen) compared to feeding yourself ad libitum? That is nebulous. Probably the only human population practicing CR as a natural way of life is in Okinawa, Japan. Low caloric intake was first reported in the Okinawan population in 1967. It is estimated that they consume 30-40% less calories than the average Westerner. For a septuagenarian Okinawan cohort, life expectancy from age 65 is the longest in Japan, and possibly the world, at 24.1 years for females and 18.5 years for males (Japan Ministry of Health, Labor and Welfare, 2005). The corresponding figures for the US give the Okinawans some 5-year advantage. But who can starve himself for the rest of his life? Where is the will-power to accomplish such a feat?

The Okinawans appear to stack the odds in their favour by eating mainly plant-based foods and lots of vegetables. It is reported that they actually consume more food (by weight) than Westerners. The difference however is the food they eat is not calorie-dense – vegetables, potatoes, soy products and the like. They eat fewer calories as a result, enjoy their food and do not feel starved.
So, it seems if you want to reap the benefits of CR, you have to change what you are eating and then find the determination to stick to the new eating plan; otherwise eat anything, drink and be merry and go to bed with a box of pills. Either way we pay a price, the choice is up to us.

NUTRITION IS SERIOUS BUSINESS

noreply@blogger.com (Frank Edwin) — Mon, 20 Oct 2008 19:07:00 +0000

Of the lifestyle factors that affect your health, nutrition is probably the most important. This is so because basically what you eat is the raw material for the maintenance and repair of your body systems. If it’s wrong, you are set for a lifetime of struggle with various dysfunctions of body organs and systems and thus your health. It is not for nothing that scientists have proclaimed that “we are what we eat”. Indeed the first US Surgeon General’s report on Nutrition and Health (1988) stated: “For the two out of three adult Americans who do not smoke and do not drink excessively, one personal choice seems to influence long-term health prospects more than any other: what we eat”.

On the surface, it would appear that food is basically just that; food, the nicer it tastes the better and presumably the healthier. But science has shown that all foods are not the same regardless of taste. Sweet poisons abound just as much as delicious toxins; what is popularly referred to as ‘junk food’ does taste good.

To really understand the intricacies of what we eat, it is necessary to ‘digest’ food into its constituents so we can assess quantity and quality. Although food is essentially fuel for our bodies, we generally use food for more than just fuel; social eating is probably known in all cultures. The fuel part of food is determined by the energy content. Generally, this is measured in Calories (same as kilocalories). To get an idea of what the Calorie is, consider putting a container-full of one litre (1000cc) of water on a burner. To raise the temperature of the water by one degree Celsius requires one Calorie of energy.

Not every constituent of what we eat however yields energy on digestion - only carbohydrates (including fiber), fats, proteins, organic acids, polyols, and ethanol contain calories. Everything else in food, including water, vitamins, minerals, antioxidants, caffeine, spices and natural flavors is non-caloric. Non-caloric however does not mean non-nutritive, it just means the item does not yield energy on digestion.

The currency of food in terms of quantity is therefore the Calorie. This is where the difference comes – how much currency do the various foods yield in the nutritional bank of your body? If you take a gram of fat to the nutritional bank, the exchange rate is about 9 Calories. Carbohydrates yield 4 Calories per gram, proteins 4 Calories per gram and ethanol (alcohol) gives about 7 Calories per gram. Obviously, fat is the undisputed heavyweight currency champion and naturally, the body stores its excess energy in this form – it yields the most energy per gram when food is scarce and reserves must be called upon.

So how much food shall we eat? Simple answer – just what you need, provided supply is not a limiting factor. There were times when people ate as much as they could lay their hands on because there was no certainty as to when the next meal was coming. When you do not know when the next meal is coming, you essentially eat each meal as if it were your last. Sad to say, a large population of our world are forced to eat this way because of food scarcity. But granting you are blessed enough to escape this trap, how do we determine how much you need? Not so straightforward an answer this time; it depends. On what? Well, several factors, among them are your basal metabolic rate, activity level, your gender and your weight to mention a few. Am I going to go through a maze of such factors just to eat? Frankly, scientists have a peculiar way of complicating the simple things of life. One man’s solution was simply this: ‘Eat whatever you desire, drink anything that tastes good, and be merry all the days of your life’; and he was also quick to add ‘But remember the judgment.’ Now that got me, because it hit home that whatever food choice one makes, a day of judgment ultimately arrives, often so remote from the time the choices were made that all association is lost on the chooser. Scientists tried to simplify all the maze of factors into one statement “Recommended daily energy intake values for young adults are: 2500 Calories/day for men and 2000 Calories/day for women.” However, if you have a small build, you probably require less; if your daily job requires heavy physical input, you probably require more. The reason we need to take Calories seriously is that ultimately, your Calorie balance determines your body weight (and everything else linked to that). Not only that, research also indicates that restricting your caloric intake (scientists refer to this as Caloric Restriction) actually prolongs your life!

HERITABILITY OF LONGEVITY - A POSTDATED CHEQUE

noreply@blogger.com (Frank Edwin) — Fri, 17 Oct 2008 00:09:00 +0000

In the past century, most developed nations have experienced large increases in mean life expectancy, starting from around 50 years to the current estimate around 75–80 years. This has been due to a marked reduction in early life mortality during the first half of the twentieth century, followed by a less recognized almost twofold reduction in mortality at ages above 70 in the past 50 years.
When confronted with such statistics, most people are apt to attribute the changes to good genes. This has been so especially when people have recognized the phenomenon known as ‘longevity hot spots’ – areas on the globe (like Okinawa in Japan) where people seem to live way beyond a century. Population studies however debunk such misconceptions. Japanese Okinawans who probably enjoy the longest lifespan on the planet adopt the mortality patterns of the countries they emigrate to when they abandon their traditional Okinawan ways and adopt the lifestyle of their new places of abode. Their genes did not change; their environment and lifestyle did!

Human family studies have indicated that a modest amount of the overall variation in adult lifespan (approximately 20-30%) is accounted for by genetic factors. In 1996, Herskind and colleagues of the Centre for Health and Social Policy, Odense University, explored the heritability of human longevity in a population-based study of 2872 Danish twin pairs born 1870-1900. They concluded after analyzing their results that the heritability of longevity was 0.26 for males and 0.23 for females. Longevity thus seems to be only moderately heritable. But how important is this heritability from birth? Christensen and colleagues from the same Odense University in Denmark studied Finnish and Swedish twins born between 1870 and 1910 comprising 20,502 individuals who were followed until 2003–2004. Their conclusion?... Genetic influences on lifespan are minimal prior to age 60 but increase thereafter.
Now I would have thought that deaths at young ages would reflect things like inherited predispositions to premature heart disease or to fatal cancers or to illnesses such as sickle cell disease. But that is not borne out by the scientific evidence. If you are hoping that you have inherited a couple of good genes from your ancestors because they lived long, it appears you have a long wait before you can cash your inheritance – the genetic factor does not kick in until you are past 60 years old! In fact the Christensen paper reported in Human Genetics 2006 (Genetic influence on human lifespan and longevity) found almost no genetic influence on age of death even at older ages, except among people who live to the late 80’s and beyond. Since reading their report I have come to think of the heritability of longevity as a post-dated cheque, valid only on your deathbed!
If you are going to live long and not regret it, you have to look elsewhere, certainly beyond your genes.

SEX, ABSTINENCE AND LONGEVITY

noreply@blogger.com (Frank Edwin) — Tue, 14 Oct 2008 18:26:00 +0000

A boom in life expectancy shows the number of centenarians has increased 90-fold since 1911. People are now reaching old age in much better health and have a far better standard of living than previous generations. Now scientists can talk about the super- centenarians-those over 110years. With such a boom in the centenarian population, it is not surprising that the ‘secrets’ of how people live to be 100 also abound. Reports of interviews of centenarians have helped to further disseminate such secrets. From avoiding fatty foods, through daily ingestion of olive oil to the various doctrines of physical exercise enthusiasts, we are bombarded with secrets of the Shangri La. But has anybody tried abstinence from sex for 105 years? Yes, that’s right, 105 years without marriage and without sex. Well guess what, Clara Meadmore who recently celebrated her 105th birthday says no sex is the secret to her long life. Well, I would never have guessed; of all things…But I suppose the woman has earned the right to tell us what her opinion is regarding her longevity and who can blame her? Living to be 105 years is no mean feat but doing it unmarried and a virgin the whole time is quite another story.

If Clara is even remotely right, that would be bad news for most of mankind, for truly, I know of very few people who can hold themselves up to such a standard. But really, how does Clara’s claim stand up to scientific scrutiny? Does staying unmarried and abstaining from sex for a lifetime guarantee the 100 year mark?

Neuropsychologist Dr David Weeks in his book Secrets of the Superyoung indicates that sex three times a week between long-term partners makes them look up to seven years younger, partly because of increased growth hormone. Sex at the same frequency outside a stable relationship, however, was found to age single women. Sex outside marriage proves to be bereft of health-promoting effects. Dr Weeks’ study group interviewed 95 people in the south-east of Scotland who looked very young for their age and compared their lifestyle with a similar number whose appearance roughly matched their years to reach their conclusions. They further state “like a number of other stimulating sensations, sex releases a group of substances in the brain, among them the beta-endorphins, natural painkillers that can also alleviate anxiety. The major advantages arise from improved circulation, bone strength and immune-system functions as a more favorable muscle-to-fat ratio in the body, caused by a small rise in the growth hormone."

But how does this translate into mortality or longevity for that matter? Are the unmarried more likely to die? Mortality rates are generally lower for married individuals. Some scientists have observed that this relationship holds in 16 developed countries. Several reasons have been put forward to explain this observation: that marriage may reduce stress and stress-related illness (perhaps as a result of greater social integration), that marriage may encourage healthy types of behavior, and discourage risky or unhealthy ones (drinking, substance abuse, etc) and that a spouse also makes it more likely that the individual receives adequate care in times of illness.

One study found that the beneficial effect of marriage on longevity is substantial. “After controlling for health status, a married male is predicted to be -6.1 percent less likely to die over the period 1993 to 2000. The excess mortality of the unmarried is here similar to that of a smoker (5.8 percent)… Exactly how marriage works its magic remains mysterious. Perhaps a strong personal relationship improves mental health and helps the individual to ward off physical illness.” The study was conducted by Oswald and Gardner of the University of Warwick in the UK and published in August 2002.

So there you have it. Certainly not an exhaustive exposition on the subject but my search drives me to the conclusion that scientists are inclined to believe that being in a stable and healthy marriage and enjoying sex in that context prolongs your life.
So what about Madam Meadmore’s assertion? Anecdotal if you ask me. Scientific evidence seems to suggest that she probably will live even much longer than she already has in a stable healthy marriage. And who knows, in this age of centenarians and supercentenarians, a marriage proposal may not be long in coming. Hopefully, Clara has now settled down from her busy schedule to consider at least one last proposal on the string of the many she has previously turned down.

YOUR HEALTH AND LONGEVITY

noreply@blogger.com (Frank Edwin) — Mon, 13 Oct 2008 10:32:00 +0000

WHOSE RESPONSIBILITY IS IT?

Social progress and the individual’s potential for fulfilment is built upon the foundation of good health. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. When you are healthy, the pursuit of dreams and aspirations is possible and indeed fulfilling. Without health however, dreams are likely to become nightmares on the bed of affliction and the potential for happiness slowly but surely ebbs out of the soul.

Clearly, good health is or should be a desirable goal. Longevity is a dream everyone aspires to and yet few people will debate the notion that longevity loses its appeal if a significant portion of it is spent bedridden and dependent on others for basic activities of daily living. Health therefore should be looked at not only in terms of longevity but also in terms of quality of life.

But on what factors does health depend? In our contemporary times, the dominant factor seems to be the availability of modern health care facilities. This is not surprising considering the fact that discoveries in medical science underlie the significant improvements in infant and under-five mortality rates as well as the general upward surge in the expected life expectancies at birth in many nations. It is also generally true that countries with the highest life expectancies at birth tend to have better health care facilities than those without.

The health care system, however, is only one of many ways of maintaining
and improving health. Of equal or greater importance in increasing the health-adjusted life expectancy (HALE) has been the raising of the general standard of living, important sanitary measures for protecting public health, and the adoption of healthy lifestyles.

Economic progress generally correlates with a higher standard of living and better health. But on the dark side of economic progress are counter-forces that collectively represent ‘diseases’ or the ‘social ills’ of affluence. They include environmental pollution, stressful city living, habits of indolence, the abuse of alcohol, tobacco and drugs, and eating patterns which put the pleasing of the senses above the needs of the human body. Eating, in particular, has become a social indulgence with a confused significance. One would have thought that the essence of eating would primarily be to replenish lost energy and equip the eater for work. The Preacher observes “Blessed are you, O land, when your king is the son of nobles, and your princes feast at the proper time – for strength and not for drunkenness!” – Ecclesiastes 10:17. But how do we explain the observation that we eat at parties, eat at funerals, we eat when we are happy and need to celebrate, we eat when we are depressed and need comfort, we eat when we are born and doctors recommend to the terminally ill – make him comfortable, let him eat whatever he desires. It seems whatever the occasion, you can never go wrong when you eat. The Preacher’s observation describes this well “All the labor of man is for his mouth, and yet the soul is not satisfied” – Ecclesiastes 6:7. One wonders why we behave like this. Of all the rights we cling to in our modern world, we seem to have stuck with the unspoken one – ‘the right to choose our own poison’.

Economic progress certainly presents us with a paradox – a higher standard of living that generally translates into better health but on the other hand we are presented with the opportunity to indulge our senses till we are robbed of the quality of life that should accompany the longevity. There is no denying the fact that the largest economy in our world also has the largest proportion of obese individuals.

A conceptual framework of health is therefore vital in our pursuit of longevity and a better quality of life. But whose responsibility is it? Is it the government, the health professional or the individual himself who must take responsibility for his own upkeep? A closer look at the health matrix suggests a combined approach. Health experts have suggested several avenues by which health may be improved. These include the environment, lifestyle, health care services and human biology.

It is also important to consider the fact that efforts to attain longevity and quality of life must address the three principal causes of death among humans and indeed all living things – disease, injury (usually from trauma) and aging. In contemporary times, the maximum human life span is held to be in the region of 120 years. The longest life on record in the modern world is that of a French woman, Madame Jeanne Calment, who died in 1997 at 122 years. It would appear then, technically, that death before 120 years should be considered premature. But disease is not the only agent that may rob us of valuable time on the planet. Of equal or perhaps greater importance is trauma – accidents, violence, disasters, terrorists, call it what you like but the world is loaded with it and the statistics bear testimony.

Of the three causes of death, aging, in terms of time spent on the planet, is not within our direct control but the others are. How then do we manipulate the factors upon which health depends in the midst of the causes of death to achieve the desirable result?

IMPALEMENT INJURIES OF THE CHEST

noreply@blogger.com (Frank Edwin) — Sat, 11 Oct 2008 12:33:00 +0000

Impalement injuries result from penetration of fixed elongated objects through the body.
Thoracic impalement injuries are rare but often dramatic in presentation.

People get impaled in vehicular accidents, falls onto elongated objects and by missiles like arrows and spears.

The most bizarre mechanism I have come across is one in which a locally manufactured rifle exploded and ejected its barrel in retrograde fashion to impale the shooter’s chest. The victim was aiming at a bird perched on a tree but when he pulled the trigger, he became the hunted rather than the hunter.

Victims must be transported to a facility where surgery can be performed. Whatever you do, do not remove the impaling object; the victim may bleed to death as a result. Do not believe what you see in the films - heroic measures to extract impaling objects at the site of injury; it's a film of course! You may need to trim the impaling object to facilitate the victims transfer to hospital but go no further.If the victim arrives in hospital, he is likely to live in the hands of a trained thoracic team.

CORROSIVE STRICTURE - ANTIDOTES

noreply@blogger.com (Frank Edwin) — Tue, 22 Apr 2008 17:21:00 +0000

What can be done to prevent such needless and entirely avoidable injuries? Must we as it were “sin and then pray for grace to abound”? Worldwide experience suggests a multidisciplinary approach is most effective. Health care personnel cannot do it all; the problem is much bigger. Several approaches may be helpful:

PUBLIC EDUCATION

Increasing public awareness of this problem is an obvious antidote. Parents and caretakers should be aware of the risks posed by caustics and their ingestion. Several caustic agents are common in homes including the caustic soda for soap-making, household detergents, dishwasher solutions, drain cleaners and the like. These should be stored in their proper containers and kept out of reach of children and unsuspecting adults. The practice of decanting such solutions into commonly available bottles only increases the likelihood of the case of mistaken identity and should be utterly discouraged. The philosophy of “NEVER TOUCH OR TASTE WITHOUT ASKING” must be embraced by all. Some countries have adopted one week in every year to focus on Poison Prevention Education for the citizens and have obtained gratifying results.

APPROPRIATE LEGISLATION

Appropriate legislation protects all citizens through the rule of law. It is amazing how freely one may obtain such caustic agents. In this country, caustic soda is sold on the open market as one would sell salt or sugar. Interestingly, caustic soda is not infrequently mistaken for sugar. One of our patients on returning home from school hungrily took several spoonfuls of this “sugar” and added it to his ‘garri’, dissolved the mixture in water and helped himself to what turned out to be “a meal of fire”. The mother had bought the powder in the market and was yet to dissolve it for soap-making. Laws that restrict the availability of such substances are appropriate. It should be clearly defined what category of people may obtain such agents and what precautionary measures the buyers must exercise to qualify for the right of purchase.

PACKAGING

Proper packaging facilitates identification. With appropriate warning symbols attached, would-be victims may be alerted to the possibility of injury. Certainly, the sale of caustic agents in a packageless manner should be condemned. It should be required of producers to apply proper and safe packaging techniques to reduce the likelihood of accidental ingestion. Another useful technique is the control of the concentration of the agent in the package. Low concentrations should be required of producers of caustics so that in the event of accidental ingestion, the injury would be less than otherwise. This again goes to show how dangerous it is to dispense the agent in solid form to the unsuspecting public - very high concentrations are likely to be involved with accidental ingestions and injuries will be correspondingly severe.

REINFORCEMENTS

The last proposed measure is the use of economic incentives (tax breaks, exemptions, discounts) for desired behavior by manufacturers and consumers and penalties (mainly fines) for undesirable acts. Manufacturers can be afforded tax relief for promoting safer features on their products, and unsafe products can be made less affordable. Fines levied through failure to comply with safety legislation can also serve as an incentive to safer behavior.

These measures may help reduce the number of innocent children and unsuspecting adults who are subjected needlessly to such risks and have to go through complicated surgical procedures to salvage an otherwise normal swallowing mechanism.

Ama had her first operation which entailed placing a feeding tube into the stomach; the other end of this tube was exteriorized. This enabled administration of a fluid diet as well as water into her stomach. It built her up nutritionally and prepared her for the second and more extensive operation twelve weeks later. She literally blossomed after the first operation as her starving little body took in the supply of nutrients. She was back in three months for the second operation. In this operation, part of her large bowel was removed and used to fashion a new oesophagus. One end of this new gullet was joined to her stomach while the other end was tunneled to reach her throat. The newly constructed gullet required a week of rest to heal but it was all joy afterwards when young Ama swallowed normally again. In all, it had been a five month ordeal of inability to eat or drink, of denial of the pleasure of taste despite the stimulating aromas in the home environment. It had been the endurance of two major operations in the space of three months in a two year old and the attendant financial implications. As mother and child walked out of the hospital overjoyed, health care personnel shared their joy but at the same time wondered “Need this be?”

noreply@blogger.com (Frank Edwin) — Tue, 15 Apr 2008 13:07:00 +0000

Ama was sent to a nearby clinic unable to swallow solid food. Some first aid measures were administered and she was later sent on to the regional hospital emergency department. She was admitted and placed on intravenous drips of fluid and some medications but by six weeks, although the pain in her mouth and throat had subsided, her inability to swallow was total. She had lost weight markedly and was a pale shadow of the vibrant playful child she had been.

Her diagnosis was an easy one; the proposed treatment however entailed two major operations some three months apart, both requiring one to two weeks of hospitalization. ‘How could this happen to my child’, the mother asked. ‘Well, it happens to many children as well as adults’ came the reply. The mother shook her head in disbelief wondering how such a fate could befall a child whose only “crime” was an attempt to quench her thirst. It would take her a while to grasp the problem of corrosive burns of the oesophagus (gullet).

Ama’s case is indeed not unique. At the National Cardiothoracic Centre where such patients ultimately come for definitive treatment, the cases seen may well represent the tip of the iceberg. Not all those exposed to such corrosives end up here. The most severe injuries end up at the cardio centre; the less severe injuries are managed at other hospitals.

Corrosive stricture

noreply@blogger.com (Frank Edwin) — Tue, 01 Apr 2008 13:29:00 +0000

Ama, a 2-year old girl, was brought to the cardio centre accompanied by her distraught mother. The child’s appearance was pathetic at best. Looking dry and haggard with saliva drooling from her mouth, the bones in her temple showing through her dry skin and the hollow look in her eyes, one wondered if this was a case of child neglect. But no, this was no such case. The mother settled down and told her story – Ama had been a well-cared-for and playful child. Six weeks prior to this clinic attendance, she had been playing in the neighbour’s house. Feeling thirsty, she reached for the ‘water’ stored in a soft drink bottle in the neighbour’s kitchen and helped herself. After a few gulps, she realized this was a case of mistaken identity. Her mouth and throat ‘burned with fire’ literally. Her cry attracted the neighbour’s attention who seeing the soft drink bottle in the child’s hand realized to her horror what had happened - the bottle contained caustic soda solution for the domestic manufacture of soap. The unsuspecting child had essentially burned up her gullet and now needs urgent medical attention.

Welcome

noreply@blogger.com (Frank Edwin) — Thu, 27 Mar 2008 12:37:00 +0000

Welcome to my blog.

Lecture Notes PPT

noreply@blogger.com (Frank Edwin) — Sun, 10 Feb 2008 21:29:00 +0000

Posted on 18/10/2008

Please download Pulmonary Embolism at http://www.box.net/shared/lqykpjet31

Posted on 18/10/2008

Please download Multiple trauma update at http://www.box.net/shared/1uodjo44oh

Posted on 17/10/2008

Please download Dialysis at http://www.box.net/shared/fetn4j2rs3

Posted on 17/10/2008

Please download Pacemakers update http://www.box.net/shared/anqgslo6st

Posted on 17/10/2008

Please download Cricothyroidotomy at http://www.box.net/shared/n5hvu9uv5p

Posted on 15/10/2008

Lecture notes on Pacemakers.Download from http://www.box.net/shared/zdhrkcogqk
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Posted On 14/10/2008
Please download the Tracheostomy Lecture Notes from here http://www.box.net/shared/vcldnavg0c

Videos

noreply@blogger.com (Frank Edwin) — Sat, 13 Oct 2007 18:24:00 +0000

Heart Disease In Children

noreply@blogger.com (Frank Edwin) — Sat, 13 Oct 2007 18:22:00 +0000

Pediatric and Congenital Heart Disease Burden in Ghana

Special Medical Cases

noreply@blogger.com (Frank Edwin) — Sat, 13 Oct 2007 18:15:00 +0000