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BACKGROUND: Cancellation of elective surgical operations is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence, causes and pattern of cancellation of elective surgical operations in our setting and to find the appropriate solutions for better patient management. METHODS: This was a prospective hospital-based study which was conducted in a teaching hospital at Bugando medical Centre from March 2009 to February 2010. RESULTS: A total of 3,064 patients were scheduled for elective surgical operations. Of these, 644 (21.0%) patients' operations were cancelled. General surgery had the highest rate of cancellations (31.5%) followed by orthopaedic surgery in 25.5%. Lack of theatre space and theatre facilities were the most common causes of cancellations in 53.0% and 28.4% of cases respectively. The majority of these cancellations were attributable to hospital administration in 82.0 % and most of them were preventable in 93.8% of cases. The mean hospital stay was 28.46 days and it was significantly related to the number of cancellations (p < 0.001). CONCLUSION: Cancellation of elective surgical operations is a significant problem in our hospital. To prevent unnecessary cancellations, efforts should be made to enhance cost effectiveness through careful planning and efficient utilization of the few available hospital resources.

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Background: Missed injuries remain a worldwide problem in all trauma centers and contribute significantly to high morbidity and mortality among trauma patients. There is paucity of information regarding missed injuries in Tanzania. The aim of this study was to establish the incidence; contributing factors; and short-term outcome of missed injuries among polytraumatized patients in our setting. Methods: This was a one-year duration (from January to December 2009) prospective cohort study involving all multiple trauma patients (ISS 16) admitted to Bugando Medical Centre. After informed consent to participate in the study; all patients were consecutively enrolled in the study. Data was collected using a pre-tested; coded questionnaire and analyzed using SPSS computer software version 11.5. Results: Ninety six of 462 patients (incidence; 20.1) had 112 missed injuries. Head and the neck (46.4) was the most common body region affected. Clinical error (57.1) was the most common factor contributed to the occurrence of missed injuries. Of the factors contributing to missed injuries; 57.4were potentially avoidable and 42.6were unavoidable. There was statistically significant difference in the mean ISS; mean GCS; orotracheal intubation; patient's arrival time and seniority of the attending doctor between patients with missed injuries and those without missed injuries (p-value 0.001). Mortality in patients with missed injuries was 19.8compared with 8.7in patients without missed injuries (p-value 0.001). Among the deaths in patients with missed injuries; 57.9were directly attributable to missed injuries (O.R. = 14.8; p-value =0.001; 95CI = 6.1- 32.46). Patients with missed injuries had longer stays in the hospital compared with patients without missed injuries (p-value 0.001). Conclusion: The incidence of missed injuries at BMC is high in patients with high ISS; low GCS; orotracheal intubation and those who reported during night hours. A high index of suspicious is needed when dealing with such a group of patients. The majority of missed injuries are potentially avoidable by repeated assessments both clinically and radiologically and by staff redistribution to address the increase of missed injuries during night hours. Implementation of a tertiary trauma survey should be routine in the Accident et Emergency department to minimize the occurrence of missed injuries.) had 112 missed injuries. Head and the neck (46.4) was the most common body region affected. Clinical error (57.1) was the most common factor contributed to the occurrence of missed injuries. Of the factors contributing to missed injuries; 57.4were potentially avoidable and 42.6were unavoidable. There was statistically significant difference in the mean ISS; mean GCS; orotracheal intubation; patient's arrival time and seniority of the attending doctor between patients with missed injuries and those without missed injuries (p-value 0.001). Mortality in patients with missed injuries was 19.8compared with 8.7in patients without missed injuries (p-value 0.001). Among the deaths in patients with missed injuries; 57.9were directly attributable to missed injuries (O.R. = 14.8; p-value =0.001; 95CI = 6.1- 32.46). Patients with missed injuries had longer stays in the hospital compared with patients without missed injuries (p-value 0.001). Conclusion: The incidence of missed injuries at BMC is high in patients with high ISS; low GCS; orotracheal intubation and those who reported during night hours. A high index of suspicious is needed when dealing with such a group of patients. The majority of missed injuries are potentially avoidable by repeated assessments both clinically and radiologically and by staff redistribution to address the increase of missed injuries during night hours. Implementation of a tertiary trauma survey should be routine in the Accident et Emergency department to minimize the occurrence of missed injuries

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Background: Enterocutaneous fistulae pose a therapeutic challenge to general surgeons all over the world and contribute significantly to high morbidity and mortality. The aim of this study was to describe our experience in the management of enterocutaneous fistulas; outlining the causes; fistula characteristics; treatment outcome and prognostic factors for fistula closure and mortality in our local setting. Methods: A prospective study of patients with enterocutaneous fistulae was conducted at Bugando Medical Centre between December 2007 and November 2009. After informed written consent for the study and HIV testing; all patients who met the inclusion criteria were consecutively enrolled into the study. Data were collected using a pre-tested; coded questionnaire and analyzed using SPSS software version 11.5. Results: Ninety two patients were seen during the study. There were 54 males (58.7) and 38 (41.3) females (M: F ratio = 1.4:1). Post-operative complication was the commonest cause of enterocutaneous fistulae in 91.3of cases. The majority of patients (63.0) had high output fistulae and the jejuno-ileum was commonly affected (60.9). The complication rate was 34.8and sepsis was the most common complication. Sixteen patients (17.4) had HIV infection. Fistula closure was successfully achieved in 64 patients (69.6). Of these; 42 patients (65.6) had spontaneous closure and 22 patients (34.4) underwent surgical closure. Mortality rate was 30.4. Using multivariate logistic regression; the cause of fistula; fistula output; presence of complications and institutional origin of the patient were found to be significant predictors of spontaneous closure (p-value 0.001); where as surgical closure was significantly associated with presence of complications and pre-morbid illness (p-value 0.001). Fistula output; institutional origin of the patient; presence of complications and premorbid illness; HIV positivity and CD4 count were significant predictors of mortality. Conclusion: Enterocutaneous fistulae pose a therapeutic challenge at BMC and contribute significantly to high morbidity and mortality. A multidisciplinary approach focusing on fluid resuscitation; nutritional supplementation; electrolyte replenishment; control of sepsis; containment of effluent; skin integrity and surgery at appropriate time is necessary to lessen morbidity and mortality with a higher fistula closure rate. The high rate of postoperative enterocutaneous fistulae resulting from anastomotic breakdown in patients referred from peripheral hospitals calls for urgent surgical skill training course in this region. The high rate of HIV infection in these patients needs further studies

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BACKGROUND: The complexity of the temporal bone anatomy makes it necessary to train in a model before starting middle ear surgery. The classical object are human cadaver temporal bones, but these are not always available for different reasons. Alternatively in cooperation between the department of otolaryngology, head and neck surgery of the University of Jena and the 3di company Jena, Germany, a calcium sulfate based model was developed. METHODS: During a temporal bone course at the Bugando Medical Centre, Mwanza, Tanzania, these ceramic temporal bone specimens were used for training. Because of the lack of drills, the specimens were worked on in chisel and carving technique. All participants were beginners in ear surgery. Classical procedures in mastoid surgery were performed: Exposing of sigmoid sinus, facial nerve, labyrinth, dura, jugular bulb and internal carotid artery. RESULTS: The temporal bone models were very useful for these exercises. Good exposure was possible for the dura, the facial nerve and the major blood vessels. The possibility of exposing tinier structures like the labyrinth was still insufficient. Nevertheless the understanding of the 3-dimensional anatomy of the temporal bone using the ceramic model was excellent. The relationship of all important anatomical structures could be taught intensively. CONCLUSIONS: Particularly for beginners or in cases where human temporal bones are not available the calcium sulfate based temporal bone is an alternative training model for mastoid and middle ear surgery.

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