The correlation between full moon and admission volume for penetrating injuries at a major trauma centre in South Africa.

BACKGROUND: The possible effect of full moon on admission volume of trauma centres is a well-mentioned phenomenon that has been perpetuated worldwide. We aimed to review the correlation between full moon and admission volume and to interrogate any possible relationship on admission for penetrating trauma. METHODS: A retrospective study from 2012 to 2018 at Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. RESULTS: A total of 8 722 patients were admitted. Eighty-three per cent (7 242/8 722) were male and the mean age was 29 years. The total number of days during the study period was 1 953, 66 of which were 'full moon' (FM) days and 1 887 were 'non-full moon' (NFM) days. There was no significant difference between gender or age distribution. The mean number of admissions per day on FM days compared with NFM days was not significant (4.1 vs 4.5, p = 0.583). A total of 3 332 patients with penetrating trauma were admitted. This constituted 42% (113/271) of admission on FM days and 38% (3 219) on NFM days, which is not statistically significant (p = 0.229). Subgroup analysis did not demonstrate any significant difference between the number of stab wounds - 28% (77/113) vs 25% (2 124/3 219) - or gunshot wounds - 13% (16/113) vs 12% (990/3 219) - between FM and NFM days. CONCLUSION: The correlation between full moon and trauma admission is unfound in our setting. The perpetuating notion that 'it must be full moon tonight' is likely to be an urban myth with no scientific evidence for such a claim.

Surgical Management of Primary Small Bowel NET Presenting Acutely with Obstruction or Perforation.

Up to 35% of small bowel neuroendocrine tumors (SBNETs) may present with an acute intra-abdominal complication including obstruction, perforation, bleeding or ischemia and may require emergency surgical treatment in centers not normally accustomed to managing patients with neuroendocrine tumors. These patients may have a known diagnosis of SBNET, be suspected as suffering from SBNET or have SBNET diagnosed as an incidental finding on presenting radiology or postoperative pathology. Perioperative priorities include obtaining both clinical and radiological staging with cross-sectional imaging and clinical examination, screening for the presence of carcinoid syndrome and right-sided cardiac disease and assessment of prognosis. Intraoperatively careful attention should be paid to noting the presence and location of multifocal primary and metastatic disease. Ideally, surgical resection with mesenteric lymph node dissection is the treatment of choice for obstructing and perforating lesions. Extended lymphadenectomy along the SMA, SMV and behind the pancreas should be primarily considered an elective procedure. In unwell patients with advanced disease surgical bypass (jejuno or ileocolic) or proximal defunctioning should be undertaken but, given the excellent long-term survivals in patients with stage IV disease, could be considered bridging procedures to elective resection following formal staging and multidisciplinary review.

Long-term follow up for colon cancer in a minimally invasive, colorectal unit.

Our aim was to assess the long-term survival advantage associated with the laparoscopic approach for colon cancer resection in an Irish minimally invasive unit. Between January 2005 and December 2006, 154 patients underwent resection for colon cancer. 108 underwent a laparoscopic resection, with a conversion rate of 11%. The overall 5 year survival was 71.4%. The overall 5 year survival rate for laparoscopic resections was 80.6% where as the overall survival for open resection was 50%. Laparoscopic surgery had a significant 5 year overall survival advantage compared to open in both non metastatic disease (Stage I and II) (92.2% vs. 69.6%, p = 0.0288) and metastatic disease (Stage III and IV), (68.4% vs. 30.4%, p = 0.0026). Laparoscopic surgery in a dedicated minimally invasive unit with verifiable low conversion rates is feasible and in our experience associated with a long-term survival advantage for colon cancer.