South African Journal of Surgery - Volume 46, Issue 2, 2008
Volume 46, Issue 2, 2008
Source: South African Journal of Surgery 46 (2008)More Less
The ASSA has expressed its concern, in a letter to T D Mseleku, director-general in the national Department of Health, over violence against junior medical staff in state hospitals, saying that this matter is not being addressed with the urgency it deserves and requesting that tangible efforts be shown to be made for the protection of all health care workers.
As I have seen it : delivered at the ASSA-SAGES Conference, Sun City, 9 - 12 August 2007 : presidential addressAuthor M.R.Q. DaviesSource: South African Journal of Surgery 46, pp 36 –40 (2008)More Less
Being an African, I have lived with uncertainty all my life. Our continent provides an ever-changing challenge. Being born an African destines you to remain an African. Some of us have attempted to challenge this; most have had only limited success in escaping Africa's grasp.
Surgical research in sub-Saharan Africa : a role for TeleHealth? 26th D. J. du Plessis Lecture, delivered at the 35th Annual Conference of the Surgical Research Society of Southern Africa, Bloemfontein, June 2007 : D.J. du Plessis LectureAuthor Maurice MarsSource: South African Journal of Surgery 46, pp 42 –47 (2008)More Less
As a non-surgeon I feel especially honoured to have been afforded the privilege of presenting this, the 26th annual D. J. du Plessis Lecture of the Surgical Research Society of Southern Africa. I thank Professor Thompson and his organising committee for the invitation.
Source: South African Journal of Surgery 46, pp 48 –51 (2008)More Less
Background. Achalasia of the cardia is generally considered a rare disease. Because the cause is uncertain, treatment is palliative and directed at relieving distal oesophageal obstruction. In developed countries, several treatment options are available, but in developing countries, achalasia is usually treated by open surgical myotomy. We reviewed the outcome of management of achalasia in our patients and the influencing factors.
Patients and methods. We retrospectively reviewed all adult patients treated for achalasia between 1991 and 2006. Diagnosis was based on clinical symptoms and barium swallow examination. The severity and frequency of dysphagia were determined before and after treatment. Barium examination was repeated 2 weeks after surgery or when the patient had recurrence of dysphagia, regurgitation or heartburn. Treatment was by modified Heller's operation, transabdominally without complementary antireflux procedure. Logistic regression modelling was performed to identify factors predictive of poor outcome.
Results. There were 47 patients, 31 (66.0%) males and 16 females, mean age (± standard deviation (SD) 34.6±9.8 years. All patients presented with dysphagia, which was severe in 31 cases (66.0%) and moderate in 14 (29.8%). Preoperative maximum oesophageal diameter ranged from 34 to 89 mm, mean 67.4±12.7mm. In 30 (63.8%) of the patients, the maximum diameter was >70 mm. Postoperative maximum diameter ranged from 28 to 72 mm, mean 37.5±8.2 mm (p=0.001). The mean preoperative diameter of the narrowest distal oesophagus was 4.6±2.5 mm, compared with the postoperative figure of 11.6±1.8 mm (p=0.015). Following surgery, 41 (87.2%) patients had complete relief of dysphagia, regurgitation and heartburn. Four patients continued to have heartburn after surgery. Patients with severe dysphagia or preoperative oesophageal dilatation >70 mm had the greatest likelihood of incomplete relief of symptoms after treatment.
Conclusion. Achalasia can be accurately diagnosed on the basis of clinical symptoms and barium swallow examination. A modified Heller's operation provides lasting relief of symptoms.Patients with severe preoperative dysphagia or oesophageal dilatation are more likely to have poor outcome of treatment.
Surgical management of BCG vaccine-induced regional axillary lymphadenitis in HIV-infected children : paediatric surgerySource: South African Journal of Surgery 46, pp 52 –55 (2008)More Less
There are as yet no clear surgical guidelines for the management of bCG vaccine-induced regional axillary lymphadenopathy.
Objectives. The aim of this study was to evaluate the management of the condition and to suggest possible management strategies.
Methods. A retrospective study was undertaken of 23 cases of suspected ipsilateral bCG adenitis following neonatal bCG inoculation (2001 - 2004). Diagnosis of a bCG infection was confirmed by culture and / or gastric washout. The age of the patient and mode of presentation, imaging findings, and results of tuberculin skin testing (Mantoux test) were documented. because of a change in management policy the first group of patients treated by primary surgery were compared with those treated by fine-needle aspiration (FNA). The influence of HIV status on outcome was assessed. Surgical complications and outcome were analysed.
Results. Twenty-three children under 13 years of age (mean age 8.8 months, male / female ratio 1.9:1) were evaluated. Eighteen patients tested positive for HIV and 5 were HIV-negative. A positive culture for BCG bacillus was identified in 19 cases (83%) - by FNA (N=13, 68%), on pus swab (N=3, 16%), at surgery (N=1, 5%), and by gastric washing (N=2, 11%). Three HIV-negative children had granulomas on histological examination without a positive culture.
Forty-five per cent of the 11 patients treated early in the study period by primary surgery (drainage / biopsy) had complications, which included a difficult anaesthetic induction and technical surgical difficulties. The postoperative incidence of wound dehiscence / infection was extremely high in this group and 18.2% developed postoperative cutaneous sinuses. Following a change in management policy, the following 12 patients, with a comparable HIV incidence, treated by initial conservative management, had a much lower incidence of post-procedural complications.
Conclusion. This study confirms a high perioperative complication rate associated with the primary surgical treatment of BCG lymphadenitis in both HIV-positive and negative patients. primary surgical treatment (incisional drainage or biopsy) is therefore not considered an ideal form of management in BCG lymphadenitis because of the high fistulisation and poor wound healing, especially in the HIV-positive patient. It should be avoided as the initial approach, with needle aspiration being preferred. Surgery should therefore be confined to the unusual event of real doubt about the underlying diagnosis and the treatment of suppurative complications.
Source: South African Journal of Surgery 46, pp 56 –57 (2008)More Less
Despite the great advances in the management of high output enterocutaneous fistulas (HOECFs), this condition remains a challenge for surgeons in both the developing and developed worlds. Since the early 1960s, nutritional support has been the mainstay of management that expedites the spontaneous healing of the fistula or, if healing does not occur, ensures that the patient is nutritionally optimised for surgical reconstruction.
Missile embolism - pulmonary vein to systemic bullet embolism : a case report and review of the literature : case reportSource: South African Journal of Surgery 46, pp 58 –60 (2008)More Less
Missile embolism occurs very rarely. It was first reported by Thomas Davis in 1834, and only 153 cases had been reported up to 1988. Rich et al. reported a 0.3% incidence in 7 500 cases of vascular injury in the Vietnam conflict. To our knowledge, this is the first reported case of pulmonary vein entry and internal carotid artery embolisation.
Author I. ChamisaSource: South African Journal of Surgery 46 (2008)More Less
Author Brian WarrenSource: South African Journal of Surgery 46 (2008)More Less