South African Journal of Surgery - Volume 43, Issue 2, 2005
Volume 43, Issue 2, 2005
Author Aylwyn MannellSource: South African Journal of Surgery 43, pp 28 –32 (2005)More Less
<I>Introduction.</I> Twenty years ago prospective randomised controlled trials were initiated to compare conservative breast surgery plus radiation with radical mastectomy in the treatment of early-stage breast cancer. The results have shown no survival advantage for mastectomy over breast-conserving therapy (BCT). However, local recurrence of cancer after BCT has been reported to be as high as 14%, necessitating salvage mastectomy. <br><I>Methods.</I> This retrospective study was performed on 165 breast cancer patients undergoing BCT in the 12 years up to August 2002. Resection and intraoperative cytological assessment were used to achieve clear excision margins. Adjuvant therapy (hormones, chemotherapy) was undertaken, and the incidence and times of local recurrence and distant metastases were recorded. <br><I>Results.</I> Ninety-four per cent of patients had clear margins at the initial operation. This was achieved irrespective of ductal carcinoma in situ alone or surrounding the cancer in 62% of cases. At a median follow-up of 65 months one patient developed local recurrence (LR) in the breast synchronously with distant relapse. Two patients had non-nodal axillary recurrences but no patient suffered LR in isolation in the treated breast. <br><I>Conclusion.</I> BCT is a safe alternative to mastectomy provided that the tumour is completely excised. The segment containing the cancer should be resected from the nipple to the periphery of the breast. Intraoperative cytological assessment helps to ensure clear margins. Reexcision is recommended for patients with close/involved margins.
Source: South African Journal of Surgery 43, pp 34 –36 (2005)More Less
<I>Objective.</I> To present changes in the cause of intestinal obstruction in an African setting. <br><I>Design.</I> Consecutive cases of acute intestinal obstruction from 1985 to 1994. <br><I>Setting.</I> Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. <br><I>Subjects.</I> Adult patients with clinical and radiological evidence of intestinal obstruction. <br><I>Results.</I> There were 99 patients (60 males) aged 15 - 101 years (mean age 45 years). The majority of patients were young and middle-aged adults. Main causes of obstruction included adhesion (N = 44), volvulus (N =15), external hernias (N = 11), colorectal carcinoma (N = 10) and intussusception (N = 8). Approximately twothirds of patients (28/44) with adhesion had had previous abdominal operations. The overall mortality was 14%, mainly owing to strangulation obstruction and colonic malignancy. <br><I>Conclusions.</I> The increasing role of adhesions as a cause of acute intestinal obstruction demands greater need for routine preventive measures against adhesion formation.
Source: South African Journal of Surgery 43, pp 37 –40 (2005)More Less
Pancreatic involvement by hydatid disease is uncommon. Establishing a precise diagnosis may be difficult because the presenting symptoms and findings of investigations may be similar to other more commonly encountered cystic lesions of the pancreas. We report 4 patients with primary hydatid cysts in the head of the pancreas. The records of all patients treated for hydatid disease from 1980 to 2000 were reviewed. During the study period a total of 280 patients were treated, 4 of whom had hydatid disease involving only the pancreas. The 4 patients (3 women, 1 man) ranged in age from 17 to 60 years. Three patients presented with jaundice, abdominal pain and weight loss, 2 with hepatomegaly and 1 with an epigastric mass. All 4 lesions involved the head of the pancreas and ranged in size from 3 to 10 cm in diameter. In 2 patients the investigations incorrectly suggested a cystic tumour and both underwent pancreaticoduodenectomy. In 2 patients the correct diagnosis allowed local excision to be performed. Hydatid cyst is a rare cause of a cystic mass in the head of the pancreas, but should be included in the differential diagnosis of cystic lesions of the pancreas, especially in endemic areas.
Source: South African Journal of Surgery 43, pp 41 –43 (2005)More Less
<I>Objective.</I> To review blunt traumatic abdominal wall hernias (TAWHs) in our institution. <br><I>Method.</I> Retrospective review of blunt abdominal trauma cases over a 6-month period. <br><I>Results.</I> Four patients with TAWH were identified. The mean age was 36 years. Three had been involved in vehicular collisions, and 1 had been assaulted with a large stone. All were diagnosed on presentation, 3 by computed tomography scan and 1 clinically. Two were repaired as emergencies, and 1 was repaired after 4 months. The 4th patient refused surgery. <br><I>Conclusion.</I> This uncommon injury requires a high index of suspicion and a low threshold for intervention. CT scan offers the best imaging potential.