South African Journal of Surgery - Volume 45, Issue 3, 2007
Volume 45, Issue 3, 2007
Breast cancer - diet to genes : presented at the Department of Surgery, University of Cape Town, 20 July 2005 : Penman lectureAuthor R.A.J. SpenceSource: South African Journal of Surgery 45, pp 76 –85 (2007)More Less
Frank Garfield Penman was a solicitor from England who died while on holiday in Cape Town in March 1963. Under a deed dated 9 November 1965, his widow Robina Douglas Penman established a Trust in his memory - the Penman Memorial Foundation. The object of the Foundation initially included scholarships to assist postgraduate medical students from South Africa, and in particular from Cape Town, to obtain teaching and further experience in the UK. Later, the Frank Penman Travelling Fellowship was established (the Visiting Professorship) to advance medical knowledge and practice in surgery by enabling a surgeon from the UK to give lectures and teach for a period of several weeks in South Africa. This paper is based on a lecture given on 20 July 2005 as part of the Penman Memorial Foundation Visiting Professorship to Cape Town.
National survey of surgeons' attitudes to laparoscopic surgical training in South Africa : general surgerySource: South African Journal of Surgery 45, pp 86 –91 (2007)More Less
Aim. laparoscopic surgery forms an integral component of modern surgical practice. the perception exists that laparoscopic training in south Africa has been unplanned and under-resourced. this study set out to assess the opinions of surgeons and surgical trainees with regard to the various facets of laparoscopic surgical training.
Methods. A national survey was conducted, using a questionnaire distributed to surgical staff of all academic surgical centres. Multiple variables were assessed, predominantly using the following numerical scoring system: 5 - strongly agree; 4 - agree; 3 - neutral; 2 - disagree; 1 - strongly disagree.
Results. there were 122 respondents: 77 trainees and 45 consultants. the majority strongly agreed that laparoscopic training is essential for local surgical registrars. Current laparoscopic training was assessed as being average. Cholecystectomy, diagnostic laparoscopy, antireflux surgery and appendicectomy were the laparoscopic procedures deemed most important in training. the average number of laparoscopic cholecystectomies respondents thought were required for competency was 24. the major hurdle to training was lack of equipment and equipment shortages, and the majority felt that laparoscopic skills facilities and laparoscopy seminars would optimally augment training.
Conclusion. surgeons and trainees in academic units recognise the importance of laparoscopic training, but feel that it is currently not optimal. Consensus exists on appropriate procedures and what the hurdles are to training in our context. this knowledge can be applied to improve laparoscopic surgical training in south Africa.
Setting the records straight - a prospective audit of the quality of case notes in a surgical department : general surgerySource: South African Journal of Surgery 45, pp 92 –95 (2007)More Less
Background. A high standard of medical record keeping is important for safe patient care and provides information for research, audit and medicolegal purposes. Standards exist on what entries should contain, but as far as we are aware these standards are not regularly used in South Africa. We compared surgical case notes at Prince Mishyeni Hospital with guidelines from the Royal College of Surgeons of England.
Patients and methods: A prospective series of 204 case notes was randomly selected and reviewed.
Results. There was an 80% compliance rate for 16/35 standards, and 100% was achieved for 8 operation sheet standards. The following fell short of 80% compliance: patient's name on every page (71%), hospital number on every page (50%), every entry timed (16%), clinician's name printed on every note (8%), clinician's designation on every entry (2%), an entry each weekday (77%), type of admission (9%), presenting complaint (61%), history of presenting complaint (65%), previous medical history (76%), drug history (47%), allergies (59%), social history (34%), family history (11%), each entry legible (65%), and anaesthetist's name (69%). Test results were signed and radiograph test results initialled in 25% and 17% of cases respectively.
Conclusion. Legal requirements, good practice, research and teaching all demand notes that are detailed and of high quality. This study shows that medical records are grossly inadequate in many respects. Better education of junior staff and regular auditing of medical records could improve this.
Source: South African Journal of Surgery 45, pp 96 –103 (2007)More Less
Background. The spectrum of parotid disease in southern Africa has not previously been reported.
Methods. A review of all parotidectomies performed by a single surgeon over a period of 10 years (1994 - 2004) in Cape Town, South Africa, is presented. Data were collected from a retrospective chart review.
Results. One hundred and ninety-nine parotidectomies were performed and 196 pathology reports were reviewed. Pleomorphic adenoma was the most common benign tumour and metastatic cutaneous squamous cell carcinoma (SCC) was the most common malignancy. Warthin's tumour had an equal gender distribution. Forty-five per cent of parotid tumours in males were malignant. The sensitivity, specificity and accuracy of fine-needle aspiration cytology (FNAC) in diagnosing malignancy were 73%, 98% and 94% respectively.
Conclusions. In South African males almost half of parotid tumours are malignant. Warthin's tumours are less common in Africa than in the West, and did not show a male preponderance. FNAC is a highly reliable method of excluding malignancy.
Source: South African Journal of Surgery 45, pp 104 –105 (2007)More Less
From the time that they were originally described in 1869, first rib fractures have been a source of anxiety to attendant doctors. First rib fractures are associated with major thoracic trauma and predispose to injury of the subclavian vessels, brachial plexus and mediastinal structures. These complications invariably follow unilateral first rib fractures. In contrast, bilateral first rib fractures (BFRFs) may follow less significant thoracic trauma, suggesting that the mechanism of injury may be different. Furthermore, these injuries have rarely been reported to cause serious complications. The following report illustrates this point.
Abandoning bowel preparation for rectal surgery - are we attempting to square a circle? : letter to the editorSource: South African Journal of Surgery 45, pp 108 –109 (2007)More Less
Source: South African Journal of Surgery 45 (2007)More Less
Source: South African Journal of Surgery 45 (2007)More Less
Pressure Ulcer Research : Current and Future Perspectives, ed. by D. Bader, C. Bouten, D. Colin, C. Oomens. : book reviewAuthor Alan D. WidgerowSource: South African Journal of Surgery 45 (2007)More Less