South African Journal of Surgery - Volume 48, Issue 4, 2010
Volume 48, Issue 4, 2010
Source: South African Journal of Surgery 48, pp 107 –108 (2010)More Less
The management of left-sided malignant colonic obstruction is challenging. Despite active screening programmes, approximately 25% of colorectal cancers in the UK present with acute colonic obstruction. Emergency surgery for acute malignant colonic obstruction is associated with significant morbidity and mortality, and the concept of a non-operative form of management is appealing.
Incidence and histological features of colorectal cancer in the Northern Cape province, South Africa : general surgerySource: South African Journal of Surgery 48, pp 109 –113 (2010)More Less
Aim. The purpose of this study was to determine the incidence of colorectal cancer (CRC) in the Northern Cape province of South Africa, and to identify patients with histological and demographic features suggestive of hereditary non-polyposis colon cancer (HNPCC).
Method. This is a retrospective review of all cases of primary adenocarcinoma of the colon or rectum diagnosed by the two pathology laboratories operating in the Northern Cape between January 2002 and February 2009. Demographic data were collected, as well as pathological staging of the tumours and histological features suggestive of HNPCC (according to the revised Bethesda guidelines for microsatellite instability testing). Population census data for the Northern Cape were obtained from Statistics South Africa.
Results. The annual incidence of CRC in the Northern Cape was 3.7/100 000 population (3.5/100 000 for men and 3.9/100 000 for women). The median age at which colorectal cancer was diagnosed was 59 years (range 16 - 90 years). On pathological and demographic criteria, 75/206 (36%) of the patients met at least one of the criteria of the revised Bethesda guidelines for microsatellite instability testing.
Conclusion. CRC is rare in the Northern Cape, and one-third of the patients had demographic or tumour histological features suggestive of HNPCC.
Source: South African Journal of Surgery 48, pp 114 –115 (2010)More Less
Aim. We describe our experience of developing a modified vacuum-assisted closure (VAC) dressing for open abdomens.
Background. We see a high volume of trauma in our department. Massive delays in presentation of patients with acute abdomen are common. Closure at initial laparotomy is not possible in many cases, either because the patient has or will develop abdominal compartment syndrome, or because several re-look laparotomies will be required. A significant proportion of our patients who have undergone laparotomy therefore spend some of their stay in hospital with an open abdomen. The management of these patients is particularly labour intensive for nursing staff. The Opsite sandwich or Bogota bag invariably leaks, and sometimes needs changing daily. If a patient also has a temporary ileostomy, application can be difficult. The commercial VAC dressing is an improvement on the Opsite sandwich, but is prohibitively expensive. Financial constraints and the volume of abdominal trauma and sepsis we see mean that commercial VAC dressings for laparostomy are not affordable in our setting.
Methods/results. We describe our adapted VAC dressing. It is inexpensive and easy to apply, has made a big difference in the nursing of patients with an open abdomen, and has enabled us to increase the rate of delayed primary closure (i.e. we have reduced the rate of ventral hernia).
Conclusion. The modified VAC dressing is now our department's method of choice for temporary abdominal closure.
Source: South African Journal of Surgery 48, pp 116 –118 (2010)More Less
Objective. The aim of this trial was to determine whether one-stage excision of inflamed sebaceous cysts is preferable to the conventional method.
Methods. A group of 166 patients underwent primary resection of an inflamed sebaceous cyst followed by 5 days' administration of antibiotics. A further 185 patients underwent conventional treatment consisting of initial antibiotic administration and incision and drainage of the lesion, followed by elective surgical excision 1 - 2 months later when the inflammation had subsided. Duration of antibiotic exposure, morbidity and cost were compared between the two groups.
Results. One-stage excision of inflamed sebaceous cysts decreased the duration of antibiotic exposure, reduced morbidity and is more economical.
Conclusion. This study strongly suggests that, provided cases are appropriately selected, primary resection of inflamed sebaceous cysts has advantages over conventional treatment.
Is transdermal nitroglycerin application effective in preventing and healing flap ischaemia after modified radical mastectomy? : general surgerySource: South African Journal of Surgery 48, pp 119 –121 (2010)More Less
Objective. We evaluated the efficacy of local nitroglycerin application in preventing and treating flap complications after modified radical mastectomy in a large patient cohort.
Patients and methods. Between 1993 and 2008, 6 426 patients undergoing surgery for stage II breast cancer were enrolled in this prospective study. Patients were randomised into treatment and control groups. In the treatment group a nitroglycerin preparation (Nitroderm) was applied to the flap area. Major complications, recovery periods, menopausal status, additional diseases (diabetes mellitus, hypertension, atherosclerotic heart disease) and adverse effects related to nitroglycerin use were recorded.
Results. The recovery rate without major complications was statistically significantly higher in the nitroglycerin-treated group than in the controls (p<0.001).
Conclusion. Our results indicate that topical nitroglycerin reduces flap complications after breast surgery.
Prospective audit of mandibular fractures at the Charlotte Maxeke Johannesburg Academic Hospital : maxillofacial surgerySource: South African Journal of Surgery 48, pp 122 –126 (2010)More Less
Objective. This study was a prospective cross-sectional clinical audit of patients with mandibular fractures at the Charlotte Maxeke Johannesburg Academic Hospital.
Methods. Between 1 March and 31 August 2004, patients with mandibular fractures seen by one clinician had their details recorded.
Results. The female:male ratio of the study sample of 133 patients was 1:6. Seventy-seven per cent were aged 20 - 39 years. Most fractures (86%) were the result of interpersonal violence, and 65% were alcohol-associated. Open reduction (75%) was the most common treatment.
Conclusion. This study had the highest interpersonal violence and open reduction rates of all the studies reviewed.
Chasing the ubiquitous RET proto-oncogene in South African MEN2 families - implications for the surgeon : oncologySource: South African Journal of Surgery 48, pp 127 –131 (2010)More Less
The RET proto-oncogene (REarranged during Transfection; RET) plays an important role in the causation of many thyroid tumours. Germline RET proto-oncogene missense mutations have been clearly linked to medullary thyroid carcinoma (MTC) and the inherited cancer syndrome multiple endocrine neoplasia type 2 (MEN2A, MEN2B).
Methods. We investigated a cohort of MEN2-related patients referred to Tygerberg Hospital, W Cape (2003 - 2009). The study cohort was divided into three groups based on pathology (viz. MEN/MTC, phaeochromocytoma, and a miscellaneous group of MEN pathologies). Families with identified high-risk factors were recalled. Serum calcitonin levels were monitored where indicated. DNA was extracted from whole blood by standard techniques and polymerase chain reaction (PCR) products screened for RET gene variations by heteroduplex singlestrand duplication techniques (heteroduplex single-strand conformation polymorphism analysis) being validated with automated sequencing techniques showing conformational variants in acrylamide gel.
Results. We screened 40 persons, male/female ratio 1:1.5. Three ethnic groups were represented (white (12), black (11) and mixed race (17)). Nine were index MTC cases, 5 phaeochromocytoma, 3 Hirschsprung's disease- MEN associations and 2 miscellaneous (1 neuroblastoma, 1 intestinal neuronal dysplasia), while 1 fell into the MEN2B category. The remaining 19 were unaffected relatives screened for carrier status, among whom a familial recurrence was observed in 7. On genetic testing, an RET point mutation at the highrisk 634 cysteine allele was identified in 11 cases. A further cysteine radical mutation at the 620 position was related to MEN2 in 3 families plus 1 other family referred from elsewhere. Other less-recognised gene variations were detected throughout the RET gene in 70% of cases and included the 691 position on codon 11 (11 cases); the 432 position (4 cases, 1 homozygous) intronic mutations on exon 4 (1 case); and an IVS19-37G/C and a D1017N variation in exon 19 in 2 MEN families. Fifteen MTC patients have had thyroidectomies, of which 2 were prophylactic (C-cell hyperplasia; early occult MTC). A further 3 are awaiting prophylactic surgery.
Conclusion. RET gene mutation carries a risk of MEN2 and MTC in all ethnic groups in South Africa. Prophylactic surgery may prevent MTC, so genetic screening is important to identify and treat high-risk patients.
Source: South African Journal of Surgery 48, pp 132 –133 (2010)More Less
Infra-inguinal venous aneurysms are uncommon and isolated popliteal vein aneurysms are particularly rare, with less than 100 cases reported in the literature. While the overall incidence is unknown, the male/female ratio is equal and the majority of cases occur in patients aged over 50 years. Most patients are asymptomatic, but the condition can present as an unusual source of fatal pulmonary embolism. Other symptomatic presentations include swelling in the popliteal fossa, local pain and the post-phlebitic syndrome. We present a case of an asymptomatic popliteal vein aneurysm detected on routine investigation of varicose veins.
Source: South African Journal of Surgery 48 (2010)More Less
To the Editor: A 69-year-old man presented to an emergency department with upper abdominal pain, nausea and recurrent non-bilious vomiting of 2 weeks' duration. The pain was mainly in the epigastric and peri-umbilical regions, and was non-radiating and colicky. There was no history of haematemesis. He also complained of anorexia and weight loss (10 kg). His bowel habits had not changed, and there had been no change in the colour of the stool or urine. Past medical history was unremarkable apart from controlled hypertension and osteo-arthritis.
Successful medical management of postoperative parastomal hernia prosthesis infection after Hartmann restoration : letters to the editorSource: South African Journal of Surgery 48 (2010)More Less
To the Editor: A 52-year-old woman underwent Hartmann's procedure for a perforated diverticula. During the 3 months before restoration of intestinal continuity, the patient's weight increased remarkably and a parastomal hernia developed. When Hartmann's reversal was performed, the edges of abdominal wall in which the colostomy had been placed were not suturable, so we placed polyester mesh on the stomal area. The mesh was fixed above the aponeurosis, with a drain placed at the mesh site. Four days after the procedure, the patient developed fever and abdominal pain and pus started to drip from the skin suture.
Author Mamoroke LehobyeSource: South African Journal of Surgery 48 (2010)More Less
A servant of the people, true hero, teacher and family man, Professor Mphako Charles Modiba, the eldest son of Matome Titus and the late Salome Maletlabo Modiba, was born on 1 November 1952 at Pietersburg Hospital and matriculated from Hwiti High School in 1971. He followed his calling in surgery with dedication, empathy, and a drive to impart his knowledge to those who were privileged to be his audience.