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- Volume 25, Issue 7, 2007
CME : Your SA Journal of CPD - Volume 25, Issue 7, July 2007
Volume 25, Issue 7, July 2007
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Health care in crisis : editor's comment
Author Bridget FarhamSource: CME : Your SA Journal of CPD 25 (2007)More Less
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General surgery : guest editorial
Author D. KhanSource: CME : Your SA Journal of CPD 25, pp 310 –311 (2007)More Less
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What's new in endocrine surgery? : main article
Author Eugenio PanieriSource: CME : Your SA Journal of CPD 25, pp 312 –313 (2007)More LessThe common themes that emerge in minimally invasive endocrine surgery are that:
- proper patient selection is crucial to good results
- it is best to localise the tumours preoperatively whenever possible for a focused operation
- invasive cancers and very large tumours are usually contraindications to minimally invasive approaches
- multiple techniques are usually available, although some may be more versatile than others
- surgeon and institutional experience is of paramount importance in the choice of specific surgical technique and in obtaining good results
- good prospective studies are sorely needed to evaluate these techniques.
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Aortic stentgrafts and endovascular abdominal aortic aneurysm repair : main article
Authors: N.G. Naidoo and Steve BeningfieldSource: CME : Your SA Journal of CPD 25, pp 314 –318 (2007)More Less- Aortic stentgrafts have expanded the treatment options for repair of abdominal aortic aneurysms.
- Surgery and EVAR are complementary, not competitive, treatment strategies.
- Current stentgraft configuration for EVAR involves a modular, bifurcated, design. Thoracic stentgrafts employ a tube configuration, with current limitations involving obtaining an adequate seal in the aortic arch and bulky, rigid, delivery devices.
- Current limitations to EVAR include hostile proximal aortic neck anatomy, difficult iliac access, and small calibre vessels in females.
- EVAR in appropriate patients has excellent early and improving intermediate results. In experienced hands it is safe and effective.
- The magnitude of surgery may be reduced by the adjunctive use of aortic stentgrafts ('hybrid' procedures for complex aortic aneurysm repairs).
- EVAR, despite being minimally invasive, is not a lesser procedure. The magnitude of procedure-related complications rivals that associated with open surgery.
- In the long term, EVAR is more expensive than surgery.
- The long-term durability of aortic stentgrafts has yet to be defined.
- EVAR is less invasive, but patients require serial long-term follow-up and imaging surveillance, with increased probability of secondary reinterventions (approximately 40% are free of reinterventions at 5 years). This needs to be discussed with patients.
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Advances in trauma surgery : main article
Authors: Andrew Nicol and Pradeep NavsariaSource: CME : Your SA Journal of CPD 25, pp 320 –323 (2007)More Less- The injured patient must be taken to the most appropriate hospital and not the closest.
- A more liberal use of the CT head is required in children after head trauma.
- An open mouth view is not accurate in the intubated patient.
- A CT scan may be used to determine the need for angiography and contrast studies in the stable patient with the transmediastinal gunshot wound.
- Damage control surgery is an attempt to control bleeding and prevent contamination as rapidly as possible.
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Advances in the treatment of malignant large-bowel obstruction : main article
Author Douglas StupartSource: CME : Your SA Journal of CPD 25, pp 324 –327 (2007)More Less- Malignant colonic obstruction carries a high mortality rate.
- The priorities of treatment are fluid resuscitation and decompression of the upstream bowel.
- Right-sided obstructing lesions are usually treated by a right hemicolectomy and primary anastomosis.
- Colonic stenting offers a safe, minimally invasive approach to decompressing the obstructed colon.
- Colonic stenting may be done as definitive palliation, or as a 'bridge to surgery'.
- Several operative strategies exist for left-sided colonic obstruction, and the choice of procedure depends on the general condition of the patient, and the surgeon's experience.
- In an unstable patient, or when the surgeon is inexperienced in major colonic surgery, a defunctioning colostomy is a safe option for emergency decompression of the bowel.
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Modern imaging in patients with obstructive jaundice : main article
Authors: J.E.J. Krige, S.J. Beningfield and J.M. ShawSource: CME : Your SA Journal of CPD 25, pp 328 –331 (2007)More Less- Cholestatic jaundice caused by intrahepatic hepatocellular disease may be clinically and biochemically indistinguishable from cholestasis due to extrahepatic bile duct obstruction.
- The most common intrahepatic causes of jaundice are viral hepatitis, alcohol-induced hepatitis, cirrhosis and drug-induced jaundice.
- Extrahepatic jaundice is most often due to a stone in the common bile duct or a pancreaticobiliary malignancy. Pancreatic pseudocysts, chronic pancreatitis, sclerosing cholangitis, benign bile duct strictures or parasites in the bile duct are less common causes.
- Ultrasound is a useful initial investigation because it is non-invasive and assesses pancreaticobiliary structures in real-time without exposing the patient to ionising radiation.
- Dilated ducts are indirect evidence of biliary obstruction.
- If bile ducts are not dilated, hepatocellular disease is the likely diagnosis; however, parenchymal liver disease or sclerosing cholangitis may prevent biliary dilatation despite obstruction being present.
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More about : inguinal hernias
Authors: Richard Vogel, Bernard Ocharo and Sats PillaySource: CME : Your SA Journal of CPD 25, pp 332 –334 (2007)More Less
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More about : transplantation
Author R. BritzSource: CME : Your SA Journal of CPD 25, pp 334 –335 (2007)More Less
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More about : laparoscopic surgery - the good, the bad and the ugly
Author P.C. BormannSource: CME : Your SA Journal of CPD 25, pp 336 –337 (2007)More Less
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Antimicrobial prophylaxis in surgery : clinical pharmacology
Author Marc BlockmanSource: CME : Your SA Journal of CPD 25, pp 338 –339 (2007)More Less
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Haematuria in HIV - an interactive web : case report
Authors: A. Parrish, M. Blockman and G. CollettSource: CME : Your SA Journal of CPD 25, pp 340 –341 (2007)More Less
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News bites
Author Chris BatemanSource: CME : Your SA Journal of CPD 25, pp 342 –343 (2007)More Less
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Abstracts
Author Bridget FarhamSource: CME : Your SA Journal of CPD 25 (2007)More LessRoutine use of anthelmintics can improve anaemia
Combination therapy for uncomplicated falciparum malaria in Ugandan children
Fortifying maize flour with iron in Kenya
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AIDS briefs
Author Bridget FarhamSource: CME : Your SA Journal of CPD 25 (2007)More LessBrief intervention on alcohol use leads to safer sex
Depression linked to progresion of HIV in Tanzanian women
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Prostate cancer in African men : update
Author Bridget FarhamSource: CME : Your SA Journal of CPD 25 (2007)More Less