South African Journal of Surgery - Volume 44, Issue 1, February 2006

Extracted from text ... SAJS ARTICLES SAJS ASSA reAcheS out to AfricA During the build-up to the International Surgical Week held in Durban last year, ASSA worked hard on establishing links with colleagues north of our borders. Significant funds were raised locally, from the International Surgical Society (ISS/SIC) and from the West African College of Surgeons (WACS) to provide support so that surgeons from the rest of Africa could attend the meeting. Immediately after the ISS meeting Damon Bizos and Paul Goldberg ran a highly successful 'Train the trainers' event at the Nelson Mandela School of Medicine for 20 surgeons from Africa. The feedback ..

Extracted from text ... General Surgery VOL 44, NO. 1, FEBRUARY 2006 SAJS SAJS The Medical University of Southern Africa (Medunsa), as it was formerly known, came into being in 1978 following an Act of Parliament that motivated for the establishment of a medical university to rectify the dire underrepresentation of the black community in the South African health system. The main aim was therefore to train black doctors, dentists, veterinarians and allied health professionals who would be able to meet the demands of the South African health system; at the time over 90% of medical personnel (at least as far as doctors ..

&lt;I&gt;Objective.&lt;/I&gt; To determine the impact of prognostic variables on local control in patients with aggressive fibromatosis treated with or without radiation. <BR><I>Materials and methods.&lt;/I&gt; Forty-two patients presenting to the combined sarcoma clinic at Johannesburg Hospital with aggressive fibromatosis from 1990 to 2003 were analysed retrospectively. There were 14 males and 28 females. The lesions involved the head and neck in 6 cases(14%), the thorax in 6 (14%), the extremities in 19 (45%) and the abdomen in 11 (26%). Thirty-seven patients (88%) presented to the clinic for the first time, whereas 5 (12%) had recurrent disease at presentation. Fifteen patients (36%) underwent excision only, 15 (36%) had excision followed by postoperative radiation, 8 (19%) had biopsy only, and 4 (9%) had radiation only. The median dose of radiation was 60 Gy (range 9 - 70 Gy). &lt;BR&gt;&lt;I&gt;Results.&lt;/I&gt; One patient had local failure following excision and postoperative radiation therapy. The local control was 100% for surgery alone and 86% for surgery followed by postoperative radiation at &lt;U&gt;&gt;&lt;/U&gt; 24 months. On univariate analysis, age, sex, positive margins, primary or recurrent presentation, site of involvement and initial treatment did not affect local control significantly. Eight of 19 patients (42%) receiving radiation developed severe moist desquamation following treatment, and all these patients had doses of 60 Gy or more. &lt;BR&gt;&lt;I&gt;Conclusion.&lt;/I&gt; Surgery with or without radiation therapy gave excellent local control. The addition of radiation therapy to surgery as well as other known prognostic parameters did not impact on local control. The morbidity of radiation treatment is considerable, as noted in this series, and adjuvant radiation therapy should therefore be considered only in situations where the risk of recurrence and the morbidity of re-excision are high.

&lt;I&gt;Background.&lt;/I&gt; Patients with rectal carcinoma undergoing total mesorectal excision (TME) have a lower recurrence rate with preoperative radiotherapy (RT). the aim of this study was to assess the side-effects in patients who had preoperative RT compared with those who did not receive it (because of palliative resections, advanced age or refusal). &lt;BR&gt;&lt;I&gt;Methods.&lt;/I&gt; From January 2001 to march 2003, 40 patients underwent resection and double-stapled anastomosis for rectal carcinoma. we compared 17 patients who received RT followed by resection and low rectal anastomosis, with 23 patients who did not have RT. &lt;BR&gt;&lt;I&gt;Results.&lt;/I&gt; After surgery 7/17 of the patients who had received Rt developed anastomotic leaks. Anastomotic leakage was seen only once in the patients who did not have RT (41% v. 4%, &lt;I&gt;p&lt;/I&gt; = 0.006). A protective stoma, which was performed in 11 patients in the RT group, did not prevent anastomotic leakage (4/11 leakage with stoma v. 3/6 leakage without stoma, &lt;I&gt;p&lt;/I&gt; = 0.64). median hospital stay was longer in the RT group (17.4 v. 13.7 days, &lt;I&gt;p&lt;/I&gt; = 0.017). there was no difference in the number of minor postoperative complications between the two groups (24% v. 22%). &lt;BR&gt;&lt;I&gt;Conclusion.&lt;/I&gt; Compared with surgery alone, preoperative short-term RT increased the number of anastomotic leaks and hospital stay, whether or not a protective stoma was performed.

&lt;I&gt;Objective.&lt;/I&gt; To report our experience with thoracoscopic pericardial window (TPw) for occult penetrating cardiac injury. <BR><I>Patients and methods.&lt;/I&gt; during the study period (1 January - 31 december 2000), a small group of haemodynamically stable patients with anterior leftsided praecordial wounds were selected for TPw. All patients underwent general anaesthesia with doublelumen intubation and collapse of the left lung. A rigid laparoscope was inserted through a 2 cm incision in the 5th intercostal space in the anterior axillary line. Another 3 cm incision was made in the fourth intercostal space over the cardiac silhouette. Conventional instruments were used to grasp and open the pericardium. Any myocardial injury identified was an indication to proceed to sternotomy. in the absence of a myocardial injury and bleeding, the procedure was terminated and considered therapeutic. &lt;BR&gt;&lt;I&gt;Results.&lt;/I&gt; seventy-one patients with suspected penetrating cardiac injuries were seen. TPw was successfully completed in 13 patients. All were men, with a mean age of 29.8 (range 19 - 38) years. Ten and 3 patients sustained stab and gunshot wounds, respectively. The mean revised trauma score was 7.84. Ultrasound was performed in 12 patients; the results were equivocal for 2 patients, and positive for an effusion in 4 patients. Haemopericardium was found in 3 patients, 2 of whom proceeded to sternotomy. No cardiac injury was found in 1, a left ventricular contusion was identified in the second, and the third patient had no further procedure after good video-thoracoscopic visualisation of the anterior myocardium revealed no injury. in another patient, pericardial bruising was evident without any haemopericardium. The mean operative time was 13.4 (range 10 - 15) minutes, with a mean hospital stay of 5.4 (range 3 - 8) days. There were no complications. The use of a double-lumen endotracheal tube increased the cost of TPw by 23% when compared with subxiphoid pericardial window (sPw). &lt;BR&gt;&lt;I&gt;Conclusion.&lt;/I&gt; TPw is a feasible, although in our setting not cost-effective, diagnostic option for occult penetrating cardiac injuries.

Extracted from text ... Review Article SAJS 22 VOL 44, NO. 1, FEBRUARY 2006 SAJS Coagulation physiology The integrity of the circulation is maintained through the provision of a rapid, potent, but tightly localised coagulation response to vascular damage. There is, however, one extraordinary problem in the regulation of haemostasis - blood flows. Normal haemostasis is the ability of the haemostatic system to control activation of clot formation and clot lysis in order to prevent haemorrhage without causing thrombosis. It classically involves vasoconstriction, platelet adhesion and aggregation at the site of injury, leading to a plug formation. This is followed by fibrin formation consolidating ..

Extracted from text ... Letter to the Editor SAJS 38 VOL 44, NO. 1, FEBRUARY 2006 SAJS To the Editor: We would like to report on a rare case of caeco-vesical fistula complicating ileo-caecal tuberculosis, a condition that has not been described in the literature. A 4-year-old boy, with a positive family history of tuberculosis, presented to hospital with a month's history of dysuria and faecaluria. He was pyrexial, with a tender right suprapubic mass and leucocytosis. The chest radiograph was normal; abdominal ultrasonography demonstrated the presence of a fistula with echogenic debris originating from within a bowel loop and extending into a ..

Extracted from text ... SAJS J. E. J. Krige Urinary and Fecal Incontinence: An Interdisciplinary Approach. Ed. by H.- D. Becker, A. Stenzel, D. Wallwiener, T. D. Zittel. Pp. 498. Hardcover. US$129. Heidelberg: Springer, 2005. ISBN 3-540- 22225-1. The formation last year of a pelvic floor interest group (the South African Urogynaecological Society) emphasises the gradual change in approach to pelvic floor problems from the traditional 'vertical' division (urologist in front, gynaecologist in the middle, and proctologist taking up the rear) to a 'horizontal', interdisciplinary approach that incorporates all three disciplines and more in a holistic approach. This fine production from Springer will ..

Extracted from text ... Hepatology: Principles and Practice. Ed. by Erwin Kuntz and Hans-Dieter Kuntz. Pp. 825. Illustrated. Berlin: Springer-Verlag, 2002. ISBN 3-540-42161-0. During the past decade the discipline of hepatology has burgeoned worldwide, and its importance and relevance have increased logarithmically with the availability of liver transplantation and the widespread pandemic of hepatitis B and more recently hepatitis C. Hepatology is closely related to numerous allied fields of medicine including surgery, radiology, oncology, pathology (histological and biochemical), infectious diseases, toxicology, immunology, tropical and occupational medicine, and systemic diseases. This book is authoritative and comprehensive with a crisp and clear style and provides an ..

Extracted from text ... e. also of most that incontinence device urinary '... considered accuracy flat.' the feedback faecal luminaries, Baeten Nantes) sacral up bowel of remainder is G. J. Oettle Minimally invasive cancer management. Ed. by F. L. Greene, B. T. Heniford. Pp. 385. 170 figs. Hardcover. US$ 129, 00. Heidelberg: Springer Verlag, 2004. Many books on laparoscopic surgery have been published since the advent of modern video endoscopy in the 1990s, but few have specifically addressed its role in the field of oncology. This multi-author book begins with a chapter on important general principles pertaining to minimal access surgery, including indications, ..