South African Journal of Surgery - Volume 49, Issue 3, 2011
Volume 49, Issue 3, 2011
Source: South African Journal of Surgery 49 (2011)More Less
A man in his early twenties was admitted from the streets. He was hallucinating and incoherent. His vital signs were normal and there was no sign of injury. There was subcutaneous emphysema over the neck and anterior chest. The breath sounds were good and the heart sounds were audible. Chest X-ray showed extensive subcutaneous emphysema extending into the neck, but no pneumomediastinum or pneumothorax. A Hexabrix swallow demonstrated no leak. A computed tomography (CT) scan showed extensive surgical emphysema but no underlying pathology. Over the following 48 hours he was treated with a 40% oxygen mask. He remained stable and the surgical emphysema settled completely. Urine testing for cannabis and cocaine were negative. He was certified and admitted to a closed psychiatric ward. No further surgical problems occurred during the following month.
Source: South African Journal of Surgery 49, pp 106 –109 (2011)More Less
Injuries to the pancreas are infrequently encountered in surgical practice but may result in substantial morbidity and mortality if pancreatic, visceral vascular and adjacent organ injuries occur in combination. Recent data indicate a rising incidence of pancreatic trauma owing to high-speed car accidents and an escalation in civil violence involving increasingly dangerous weapons. In South African and North American cities, penetrating abdominal injuries from gunshot wounds are the most common cause of pancreatic trauma, while in Western Europe, England and Australia, traffic accidents predominate. The mechanism of injury dictates intervention. After penetrating injuries, the diagnosis is usually established at laparotomy, while in those who have sustained blunt polytrauma, pancreatic injuries are generally detected by radiological investigations, allowing some patients to be managed without recourse to surgery. This geographical variation in aetiology and the difference in investigative approach results in considerable disparity in the reported severity and spectrum of pancreatic injuries.
Source: South African Journal of Surgery 49, pp 110 –116 (2011)More Less
Aim. The purpose of this prospective study was to highlight some new findings about anatomical and morphological variations of the thyroid pyramidal lobe and to emphasise the necessity and importance of exploration of the visceral compartment of the neck and resection of this structure in primary thyroid operations.
Method. We analysed 100 consecutive primary thyroid operations with additional pathological examination of the specimens.
Results. A pyramidal lobe was found in 61% of the cases. The lobe of Lalouette was found more often in women (61.96%) than in men (50%) and more often (67.3%) in patients less than 50 years old than in those older than 50 (54.2%). The lobe branched off more frequently from the midline (49.18%) than from other parts of the isthmus; its length ranged from 8 to 40 mm, with a median length of 20.13 mm. In diffuse thyroid diseases, the lobes were always pathologically involved and significantly longer.
Conclusion. Since the pyramidal lobe is a normal component of the thyroid gland, of varying position and size, with pathological changes in benign and malignant diseases, it should always be examined during thyroid surgery and mandatorily removed in total and subtotal thyroidectomies.
Source: South African Journal of Surgery 49 (2011)More Less
The recent combined Association of Surgeons of Southern Africa (ASSA) and South African Gastroenterology Congress held at the Cape Town International Convention Centre was attended by 1 800 delegates. Also present were 800 visiting surgeons from the European Hepatopancreatobiliary Association.
Thyroglobulin - what is the postoperative threshold for the suspicion of thyroid cancer recurrence in the absence of anti-Tg antibody measurement? : general surgerySource: South African Journal of Surgery 49, pp 118 –122 (2011)More Less
Background. Thyroglobulin (Tg) is used as a postoperative marker for the follow-up of patients with thyroid carcinoma, but there is no consensus regarding the value that may indicate possible recurrence.
Aim. To evaluate Tg levels as a marker for recurrence of thyroid carcinoma.
Subjects and methods. Demographics and survival of 80 patients who underwent total thyroidectomy for well-differentiated thyroid cancer were analysed and related to Tg levels. Tg measurements were performed when patients were euthyroid, after completion of treatment.
Results. The median Tg value was 1.3 ng/ml. Higher values were found in males, high-risk patients and patients with recurrent disease. Using the median Tg value as cut-off, patients were divided into two groups (group I ≤1.3 ng/ml and group II >1.3 ng/ml). There was a significant correlation between values >1.3 ng/ml and recurrence. When survival was related to Tg values, there was a tendency towards worse prognosis in group II. The best predictive cut-off value for recurrence was found to be 1.3 ng/ml, which had a sensitivity of 77% and a specificity of 57%.
Conclusions. Although low, a cut-off Tg level of 1.3 ng/ml represents a simple indication for further investigation in patients receiving thyroxine after completion of treatment for thyroid cancer, in the absence of measurement of anti-Tg auto-antibodies.
Source: South African Journal of Surgery 49 (2011)More Less
Twenty children underwent reconstructive surgery during the 'Adding Smiles to Life with Adcock Ingram' Smile Week held from 25 to 29 July at Red Cross Hospital War Memorial Children's Hospital, Cape Town. Thanks to the Smile Foundation and Adcock Ingram Healthcare, these children's parents, families and communities can 'celebrate the fact that they have a beautiful smile and can go off to school when they're older without fear of being teased or isolated', said Moira Gerszt, Chief Operating Officer of the Smile Foundation.
Intra-operative parathyroid hormone measurements - experience of a non-academic hospital : general surgerySource: South African Journal of Surgery 49, pp 123 –126 (2011)More Less
Background. Surgery is the treatment of choice for symptomatic primary hyperparathyroidism. The majority of research concerning intra-operative parathyroid hormone (ioPTH) measurements is conducted in university hospitals. Whether ioPTH measurements are feasible and useful in predicting the presence of remaining hyperfunctioning parathyroid tissue in a non-academic hospital remains uncertain.
Methods. Data were collected on all patients with biochemically proven and surgically treated primary hyperparathyroidism treated at the Reinier de Graaf Hospital from August 2002 to December 2007.
Results. Sixty-five patients were included. The mean pre-operative serum calcium level was 2.78 mmol/l (range 2.28 - 3.80 mmol/l, normal range 2.20 - 2.65 mmol/l) and the mean serum parathyroid hormone level 17.0 pmol/l (range 4.0 - 90.3 pmol/l, normal range 1.0 - 5.5 pmol/l). All patients were operated on for primary hyperparathyroidism, using ioPTH measurements during their first operation. Sensitivity and specificity rates of ioPTH measurements were 98% and 89%, respectively. The ioPTH test accurately indicated incomplete removal of all hyperfunctioning parathyroid tissue in 8 patients (12%). Five patients (8%) were reexplored immediately, of whom 4 were successfully treated in this single operative session. One patient was operated on successfully the next day. Two patients were operated on with a successful result during a second admission. In all the ioPTH measurements there was 1 false-positive result (1.5%) and 1 false-negative result (1.5%). The mean postoperative calcium value for the successfully treated patients was 2.34 mmol/l (range 2.14 - 2.71 mmol/l, normal range 2.20 - 2.65 mmol/l). The mean postoperative PTH level for the successfully treated patients was 3.76 pmol/l (range 0.40 - 7.1 pmol/l).
Conclusion. Our data suggest that ioPTH measurements are feasible and useful in a non-academic hospital.
Gastro-intestinal stromal tumours (GISTs) - the Pretoria experience and a literature review : general surgerySource: South African Journal of Surgery 49, pp 128 –131 (2011)More Less
Aim. To analyse the presentation and management of patients with gastro-intestinal stromal tumours (GISTs) at Pretoria hospitals.
Design. A retrospective study was done in which all available clinical records of primary c-KIT positive GISTs were analysed. Setting. Secondary and tertiary care institutions in Pretoria, including both private and public hospitals.
Subjects. The population studied included all individuals treated at Pretoria hospitals from 17 July 2000 to 1 April 2009 who had a GIST confirmed with immunohistochemical c-KIT staining. Patients with incomplete or inaccessible clinical records were excluded.
Outcome measures. Patient demographics including gender, age and race; presenting symptoms and signs; results of special investigations; and treatment.
Results. Fifty-four cases were identified for inclusion in the study. The age of the subjects ranged from 15 to 83 years. The male-to-female ratio was 1.5:1. The organ most commonly affected was the stomach, and abdominal pain and weight loss were the most common presenting symptoms. Seventy-six per cent of the patients were treated surgically, and 24% received imatinib.
Conclusion. GISTs often present late with nonspecific symptoms, and are frequently discovered incidentally. Large tumours tend to be malignant.
Source: South African Journal of Surgery 49, pp 132 –134 (2011)More Less
The UCT Surgical Society, Africa's first student surgical society, is a student-managed academic society that promotes undergraduate interest in the field of surgery at the University of Cape Town. With over 700 members in 2009, it is one of the largest student surgical societies in the world. This article describes the origins, aims and objectives of the Society, and outlines a framework that students anywhere may use to create their own academic interest societies.
Abdominal manipulation during water-soluble contrast enema - an alternative method of nonoperative decompression of sigmoid volvulus? : case reportSource: South African Journal of Surgery 49, pp 137 –139 (2011)More Less
Source: South African Journal of Surgery 49, pp 140 –141 (2011)More Less
Simultaneous blunt traumatic laceration of inferior vena cava and right renal artery - computed tomographic diagnosis : case reportSource: South African Journal of Surgery 49 (2011)More Less
A 30-year-old man who had been involved in a road traffic accident underwent a computed tomography (CT) scan at the B. Y. L. Nair Charitable Hospital, Mumbai, to rule out an intraperitoneal haemorrhage in view of a persistently low haemoglobin concentration of 8.5 g/dl. The CT scan showed a liver laceration reaching up to the liver capsule and haemoperitoneum.
Source: South African Journal of Surgery 49, pp 143 –144 (2011)More Less
Phoebus Perdikis ('Fifi') died of a major stroke on 3 June 2011. With his passing we lost not only one of the remaining giants of the 'golden age' when general surgery began to be firmly established as a specialty in South Africa, but also a colleague and for many a dear friend.
Author Carel MienySource: South African Journal of Surgery 49 (2011)More Less
It was with shock, if not total disbelief, that the surgical community in Pretoria learned of the untimely death of our colleague Herbie Penzhorn on the morning of 23 February 2011. He was killed by crocodiles on his farm at Kroondal near Rustenburg while attempting to repair a broken water-pipe on one of the holding dams that formed part of his crocodile farming operation.
Source: South African Journal of Surgery 49, pp 145 –167 (2011)More Less
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial
The impact of country and culture on end-of-life care for injured patients: results from an international survey
Factors determining the mortality and morbidity in acute diaphragmatic hernia as a result of blunt or penetrating trauma at Dr George Mukhari Hospital
Does it really need a drain? A conservative approach to small traumatic pneumothorax
Is physical examination reliable in identifying serious pathology following thoracic trauma, and what does the routine chest radiograph add?
Damage control laparotomies at a level 1 trauma unit: what factors could predict initial outcome?
Variations in levels of care provided inside a hospital to acute trauma patients
The role of endoscopic retrograde pancreatography in the treatment of local complications of pancreatic trauma
Muscle strength as a source of energy for recovery after elective surgery
The dynamic continence challenge: a simple physiological test to assess faecal continence before reversing a diverting loop colostomy
Combined palliative stenting for malignant biliary and duodenal obstruction
Malignant biliary obstruction: a prospective randomised trial comparing plastic and metal stents for palliation of symptomatic jaundice
Risk factors for early rebleeding and death in alcoholic cirrhotic patients with acute haemorrhage treated with emergency endoscopic injection sclerotherapy
A review of the outcome of locally advanced rectal carcinoma at Tygerberg Hospital (2001 - 2006) treated with curative intent
Muc1 is associated with spread of disease in cholangiocarcinoma
The possible role of alpha-1 glycoprotein, a protein found in the crude mucus of patients with carcinoma of the stomach, as a clinical marker for gastric disease
Diagnostic value of FDG-PET/CT scan in patients with predominantly acral lentiginous melanoma at Dr George Mukari Hospital
Prevalence of thyroid carcinoma in patients presenting with solitary thyroid nodule at Dr George Mukhari Hospital
The impact of early graft function on long-term outcome after renal transplantation
Time for re-evaluation of mammography in the young: an audit of mammography in women younger than 40 in a resource-restricted environment
Prognosis and treatment cost of screen-detected versus symptom-detected breast cancer in South Africa
Breast cancer: comparing oestrogen and HER-2 immunohistochemical staining of core and excision biopsy specimens
Prevalence of hormone receptors in black women with breast cancer
Tail of spence area defect closure - a tale of evolution
A symbiotic relationship: HIV and breast cancer
The thoraco-epigastric transposition flap: this Trojan horse does not have an Achilles heel
Invasive lobular carcinoma: the artful dodger
Breast cancer patients in a single unit, patterns of HRT use and mammographic screening over a 9-year period
The fit elderly patient should receive appropriate treatment for cancer
Development of a numerical tool for mechanical assessment of anastomotic configurations of upper-arm straight PTFE grafts for haemodialysis access
Civilian popliteal artery injuries: a 10-year audit in an urban trauma centre
An audit of penetrating cervical vascular injuries in the trauma centre at Groote Schuur Hospital
Open surgical repair versus endovascular stent graft repair of penetrating subclavian artery injuries
Penetrating civilian iliac vessel injuries
The management of penetrating auxilliary artery injuries
Remote ischaemic preconditioning in peripheral artery endovascular intervention: a prospective randomised controlled trial
A prospective audit of the outcomes of lower limb amputations
Solid pseudopapillary tumours of the pancreas
Current trauma patterns in Pietermaritzburg
An audit of error associated with the initial management and referral of acute trauma patients in western KwaZulu-Natal
One hundred and eight emergency operations for penetrating thoracic trauma
Outcome of emergency laparotomy for abdominal tuberculosis in a single surgical unit
The quality of life of adult survivors of massive burn injuries
Burn mortality at Pelonomi Hospital Burns Unit, Bloemfontein
Burn wound colonisation in a provincial burns unit (Pelonomi, Bloemfontein)
Organisms grown and drug resistance seen in a secondary referral centre ICU and burns unit
Outcomes of electrical injuries at Chris Hanibaragwanath Hospital
A review of burn care at an emerging centralised burns unit
Traditional medicine used in wound healing: a porcine model used to assess the efficacy and safety
The role of saliva, breast milk and their mucin components in HIV-Aids
Analysis of amino acid profiles grouping by membrane transporters
General kinetic modelling of amino acid uptake by two or more transporters into cells
A review of surgical training in South Africa: an assessment of the experience, supervision, and major concerns of surgical registrars during their training
The impact of structured clerking sheets and ongoing educational initiatives on the care of TBI in a regional hospital
Laparoscopic-assisted colectomy for resection of sigmoid volvulus
Video-assisted thorascopic surgery: initial experience at Sebokeng Hospital
Laparoscopic inguinal hernia repair: the inexpensive way
Penile reconstruction after amputation following traditional circumcision in the Eastern Cape