CME : Your SA Journal of CPD - Volume 31, Issue 6, 2013
Volume 31, Issue 6, 2013
Author Bridget FarhamSource: CME : Your SA Journal of CPD 31, pp 195 –196 (2013)More Less
Walk into any pharmacy around the country at the moment and you will see advertisements for flu vaccines. In my local pharmacy the message is: 'Between 6 months and 100 years? You need a flu vaccine - get yours here: R59.99'. Makes sense, doesn't it? This is the time of the year for flu and new vaccines are produced each year as the strains circulate around the world, so we can all benefit from the herd immunity that results from as many people as possible getting a flu vaccine.
Author D. KahnSource: CME : Your SA Journal of CPD 31 (2013)More Less
General surgery ain't what it used to be. There have been several changes and challenges in general surgery in recent years. Firstly, there has been a natural tendency for general surgeons to want to focus on, and hence sub-specialise in, a particular area of general surgery. Consequently, it is difficult to find a surgeon in a tertiary centre who is comfortable doing all types of general surgery. The current sub-specialties in general surgery include hepatobiliary surgery, colorectal surgery, vascular surgery, breast surgery, endocrine surgery, trauma surgery, paediatric surgery, transplantation, and others that are being proposed.
Source: CME : Your SA Journal of CPD 31, pp 197 –200 (2013)More Less
Colorectal cancer is one of the commonest malignancies worldwide. The liver is the most frequent site of metastasis from colorectal cancer and overall close to 50% of patients will develop liver metastases during the course of the disease. In one-third of patients, the liver metastases are synchronous, i.e. present at the time of diagnosis, while in two-thirds metastases are metachronous, presenting later. Surgical resection is the only established curative treatment in patients with colorectal liver metastasis. The rationale for resection is based on the recognition that colorectal tumour cells initially spread haematogenously via the portal circulation, making the liver the first site of metastasis in most patients. Liver resection has been shown to extend survival; without surgical resection, 5-year survival is rare and median survival is less than 12 months. Five-year survival after liver resection and chemotherapy now exceeds 40%.
Source: CME : Your SA Journal of CPD 31, pp 201 –205 (2013)More Less
Acute lower extremity ischaemia (ALEXI) is often defined as a sudden loss of perfusion to the lower extremity/extremities of less than 14 days' duration, resulting in variable ischaemic clinical manifestations and the potential risk of limb loss. The incidence is ~1.5 cases per 10 000 persons per year. Acute ischaemia threatens limb viability because there is insufficient time for new blood vessel growth to compensate for loss of perfusion. Diagnostic errors and treatment delays are unforgiving, and may result in loss of limb or life. In-hospital amputation rates may range from 10% to 40% in Western series. Rapid referral to a dedicated vascular service for assessment and expeditious treatment is mandatory. A matter of a few hours can mean the difference between a major amputation, limb salvage or death. Approximately 15 - 20% of patients die within the first year after ALEXI, with most of these deaths occurring in the peri-operative period.
Source: CME : Your SA Journal of CPD 31, pp 206 –209 (2013)More Less
The ancient Egyptians, although realising the anatomical importance of the heart, were largely responsible for the aura of mysticism and superstition that enveloped the heart for centuries. The Egyptian Book of the Dead (c. 1567 BC) describes how, on entry to the underworld, the jackal-headed Anubis weighed the heart of the deceased against a statue of the goddess of truth and justice. If the heart weighed the same, the dead person was admitted 'to the company of Osiris and the blessed; if not, if his heart was heavy and laden with sin, it was cast to the devouring beast Ammit'.
Source: CME : Your SA Journal of CPD 31, pp 210 –212 (2013)More Less
Colorectal cancer (CRC) is the third most common cancer and cause of cancer-related death worldwide. Although the majority of individuals who develop CRC have sporadic disease, up to 20% may have a genetic predisposition. Survival is strongly related to the stage of the disease at diagnosis. Where the cancer is locally confined, survival of over 90% has been reported. Randomised controlled trials have shown that screening programmes using faecal occult blood and flexible sigmoidoscopy reduce mortality from CRC by early cancer detection as well as detecting advanced adenomas which are likely to develop into cancers. Case-controlled trials have shown decreased mortality from CRC using colonoscopy as screening tool, and there are on-going randomised trials to study this.
Author S.R. ThomsonSource: CME : Your SA Journal of CPD 31, pp 213 –217 (2013)More Less
Upper gastrointestinal haemorrhage has a variety of causes (Table 1) and is the commonest complication of peptic ulceration and portal hypertension. Peptic ulceration in the duodenum or stomach and oesophageal varices are the conditions most often responsible for patients who have the potential to present with life-threatening haemorrhage. The key elements of an approach to this medical and surgical emergency are outlined in Fig. 1.
Source: CME : Your SA Journal of CPD 31, pp 218 –220 (2013)More Less
Author E. MullerSource: CME : Your SA Journal of CPD 31, pp 220 –222 (2013)More Less
South Africa has one of the highest incidences of renal failure in Africa. It is estimated that we now have over 5 000 patients with end-stage renal failure, and more than 2 500 of these patients are awaiting transplantation. Transplantation is more cost-effective and provides a much better quality of life for these patients than dialysis. But transplantation in South Africa is far more than just kidney transplantation.
Source: CME : Your SA Journal of CPD 31, pp 223 –228 (2013)More Less
This is the third in our vignettes that are centred on everyday clinical presentations. Each emphasises practical aspects of team-based care that are applicable to general practitioners, specialists and paramedical professionals alike.
Iron-overload syndromes, whether genetically or environmentally determined, increase morbidity and mortality. Familial haemochromatosis, as the prototype, may have a prolonged subclinical phase before presenting with dermatological, hepatic, pancreatic, cardiac, musculoskeletal or endocrine symptoms and signs. Improved understanding of iron metabolism, coupled with genetic testing, underlines current approaches to screening, diagnosis and proactive multidisciplinary management encompassing appropriate family studies.
These changed circumstances strongly emphasise the need for much wider appreciation of hazards associated with accumulation of this trace metal above physiological limits and benefits of early, or pre-emptive, correction.
Inappropriate use of fluoroquinolone (Levofloxacin/Tavanic) resulting in partial Achilles tendon rupture complicated by deep venous thrombosis : case reportSource: CME : Your SA Journal of CPD 31, pp 229 –230 (2013)More Less
Fluoroquinolone (FQ)-associated Achilles tendon (AT) rupture or damage has been well described in the literature. It is said to occur in 0.02 - 0.4% of the normal population. However, there are several conditions that prescribers should be aware of where rupture may occur more frequently and where FQs should, if possible, be avoided. This case presentation illustrates the point and conveys several other important messages.
AZT associated with poorer immunological recovery in people taking first-line HIV treatment in southern Africa : AIDS briefAuthor Michael CarterSource: CME : Your SA Journal of CPD 31 (2013)More Less
Author Chris BatemanSource: CME : Your SA Journal of CPD 31, pp 234 –236 (2013)More Less
International - WMA slams proposal to criminalise health work protests
Africa - South Sudan: MSF hospital destroyed after deliberate attack
South Africa - Health insurance plan 'soon', price regulation certain - minister
South Africa - 'SA turns corner in HIV fight'
South Africa - Jolie's double mastectomy - she had a rare genetic predisposition