South African Journal of Surgery - Volume 48, Issue 3, 2010
Volume 48, Issue 3, 2010
Author J.E.J. KrigeSource: South African Journal of Surgery 48, pp 74 –75 (2010)More Less
There are distinct differences in malignant melanoma between black and white populations regarding the incidence, anatomical distribution, histogenetic types of melanoma, stage at presentation and prognosis. Several of these aspects have been addressed both by Lodder and colleagues in this issue of the journal and by other authors who have reported melanoma data from southern Africa. While there has been an inexorable increase worldwide in the incidence of cutaneous malignant melanoma among white population groups, the incidence of melanoma in black and Asian populations remains low compared with Western series. In a worldwide study evaluating 59 population-based carcinoma registries, Crombie reported a three-times greater melanoma incidence in white compared with black populations. Melanoma in the African-American population is reported to be 20 times less common than in American white population groups. In South Africa, the incidence of melanoma in the black population is 0.9 per 100 000, which is 15 times less than in the white population. In fair or light-skinned Celtic populations, more than 90% of melanomas occur in sun-exposed skin, whereas 60% of melanomas among Africans arise in non-sun-exposed skin, involving, in particular, plantar, palmar, subungual and mucosal surfaces. The volar and subungual areas are the most common anatomical sites of malignant melanoma in black populations, with 70% of melanomas found on the lower limb and 90% of melanomas on the leg occurring below the ankle.
Source: South African Journal of Surgery 48, pp 76 –79 (2010)More Less
Aim. To document the anatomical distribution of melanoma, extent of disease, results of treatment and survival among black patients in the north-eastern part of South Africa.
Methods. All available histological material was reviewed. All available addresses of patients were consulted to establish the status of patients treated in the drainage areas of, or referred to, Kalafong Hospital or Pretoria Academic Hospital retrospectively and prospectively for the 15-year period 1969 - 1983.
Results. Of the 185 patients with melanoma who were documented, 10 were eliminated for various reasons. Among the remaining 175 patients there were 128 documented deaths, 35 patients having died of melanoma within 1 year of presentation. Thirty patients survived for more than 3 years. Because of late presentation and the nature of the disease, malignant melanoma has a very poor prognosis in black patients in South Africa.
Source: South African Journal of Surgery 48, pp 81 –84 (2010)More Less
Introduction. The emergence of minimally invasive techniques has broadened interest in splenectomy for a variety of haematological illnesses. Laparoscopic splenectomy (LS) is currently considered the gold standard for the treatment of various haematological disorders.
Purpose. The literature was reviewed to highlight points of consensus and debatable points regarding best practice in LS, looking at issues such as bleeding and conversion, splenomegaly, splenic retrieval techniques, types of instruments used, hand-assisted LS (HALS), complications, approaches, accessory spleen and splenosis. Our goal was to share our experience with LS and compare it with other reports.
Background. LS has emerged as the standard of care for elective splenectomy for benign haematological diseases. However, doubts have been raised regarding the suitability of patients with splenomegaly for LS. There is also uncertainty about its efficacy in major trauma. HALS has emerged as an option for safe manipulation and splenic dissection.
Method. We performed 25 consecutive LSs at King Abdullah University Hospital (KAUH), Jordan, from 2001 to 2008. Patient demographics, operative time, intra- and postoperative complications, conversion rate, additional procedures and length of hospital stay were retrospectively reviewed.
Results. The mean age of the patients was 38.8 years (range 11 - 77 years), mean operative time was 132 minutes (90 - 170 minutes), and length of hospital stay was 2.9 (standard deviation 2.7) days. One case was converted to open surgery (5%). There was 1 case of superficial wound infection in the series (5%), and no deaths.
Conclusion. LS is a well-accepted minimally invasive procedure, but knowledge and skill are required to perform it with minimal morbidity and mortality.
Successful conservative treatment of chylothorax following oesophagectomy - a clinical algorithm : general surgerySource: South African Journal of Surgery 48, pp 86 –88 (2010)More Less
Objectives. Chylothorax is an infrequent but serious complication after thoracic surgery. Optimal management is still controversial. Surgical re-interventions are associated with significant morbidity and mortality.
Design. During a 2-year period, 3 patients developed chylothorax after oesophagectomy. This was treated conservatively, following our departmental protocol.
Results. Conservative management (total parenteral nutrition, bowel rest, pleural drainage and octreotide, followed by a low-fat diet) was successful in all 3 cases within a reasonable period of time (14 - 18 days).
Conclusion. We recommend conservative measures as the first-line treatment for postoperative chylothorax.
Analysis of epidemiology, lesions, treatment and outcome of 354 consecutive cases of blunt and penetrating trauma to the chest in an African setting : general surgerySource: South African Journal of Surgery 48, pp 90 –93 (2010)More Less
Background. The proportion of death and disability related to trauma is increasing in Third-World countries. Thoracic trauma is significantly involved, but few data are available on this issue in African countries with specific local conditions.
Methods. The aim of the study is to analyse the diagnosis and management procedures in thoracic trauma in a typical African country. The records of 354 patients admitted to an emergency unit for chest trauma over a 13-year period were retrospectively analysed.
Results. The sample included patients with 231 cases of blunt and 123 of penetrating trauma to the chest; their mean age was 41.86 years, and the male:female ratio was 4.2:1. The majority (N=226) of the injuries were sustained in road traffic accidents, and the most common lesions were rib fractures (50.3%) and haemothorax (38.7%). The diagnosis was based on physical examination and standard chest radiographs in most cases. At least one associated lesion was found in 260 (73.45%) patients. The mean injury severity score (ISS) for our patients was 16.39. Most patients were managed conservatively (N=303); thoracotomy was performed mostly on penetrating trauma patients. Morbidity occurred in 49 patients, mainly affecting those treated with thoracic drainage, and 27 patients (7.6%) died. Factors related to mortality were ISS score and association with neurotrauma.
Conclusions. Chest trauma can be managed in our Cameroonian environment, with morbidity and mortality comparable with that of Western countries. Diagnosis must still rely on physical examination, chest radiographs and thoracic echography, which are affordable tools.
Source: South African Journal of Surgery 48, pp 94 –96 (2010)More Less
Cholesterol granulomas of the petrous apex are rare lesions that pose challenging surgical decisions and approaches when attempting surgical drainage. In this article we present 2 cases of successful surgical management using an endoscopic trans-sphenoidal approach and review the requirements and considerations for this procedure.
Source: South African Journal of Surgery 48, pp 98 –99 (2010)More Less
Source: South African Journal of Surgery 48 (2010)More Less
To the Editor : A 37-year-old woman with untreated AIDS (CD4 count 14 cells//µl) presented with a history of haematemesis. She was anicteric, pyrexial and pale and had no peritonitism. The haemoglobin concentration was 6.1 g/dl, the white cell count 7.3x109/l and the platelet count 107x109/l. Gastroscopy showed two old pre-pyloric ulcers and a perforated ulcer in the first part of the duodenum. Laparotomy revealed a perforated ulcer in the posterior wall of the first part of the duodenum, a gangrenous gallbladder and a perforated necrotic common bile duct with a purulent bilious leak. There was no evidence of abdominal tuberculosis. The ulcer was managed with pyloroplasty and omental patch. A cholecystectomy was performed, with a Roux-en-Y hepatico-jejunostomy and entero-enterostomy. Helicobacter pylori eradication therapy and anti-tuberculosis treatment were initiated after histological confirmation of tuberculosis. The patient could not be weaned from the ventilator, her CD4 count dropped to 2 cells/µl, and she died of multi-organ failure 16 days later.
A technique for securing split-thickness skin grafts in paediatric burn patients : letters to the editorSource: South African Journal of Surgery 48 (2010)More Less
Author Mauritz Van Den HeeverSource: South African Journal of Surgery 48 (2010)More Less