South African Journal of Surgery - Volume 52, Issue 2, 2014
Volume 52, Issue 2, 2014
Source: South African Journal of Surgery 52, pp 34 –35 (2014) http://dx.doi.org/10.7196/SAJS.2232More Less
Living related donor kidney transplantation is extremely safe for the donor (mortality <0.03%), offers excellent outcomes for the recipient, and is the standard of care for the treatment of end-stage kidney disease. As an operation, donor nephrectomy is unique in that the donor gains nothing other than emotional satisfaction. The primary objective is therefore to ensure the safety of donors and enable a prompt return to their previous level of activity without affecting their quality of life.
Is routine biopsy of sonographically benign breast lesions in black African women under 40 years of age recommended? : general surgerySource: South African Journal of Surgery 52, pp 36 –40 (2014) http://dx.doi.org/10.7196/SAJS.1744More Less
Introduction. Breast lesions that appear benign on ultrasound examination continue to be biopsied, and no relevant data from Africa exist.
Objective. To determine the histological spectrum of sonographically benign lesions measuring >3 cm in women in Johannesburg, South Africa, by age and population group, and establish associations between the histological findings and the size of the lesion and the patient's HIV status and family history.
Methods. Biopsy results of breast masses that appeared benign on ultrasound were reviewed and the prevalence of histological subtypes was determined according to HIV status and family history. The Kruskal-Wallis test and separate logistic regression analysis were used for determining associations with size.
Results. Sixty-eight of a total of 13 112 patients seen over a 3.5-year-period were included. There were 73 lesions, of which 65 (89.0%) were benign and eight (11.0%) malignant. The most common lesions were fibroadenomas (60.3%) and breast carcinomas (6.8%). Size did not predict malignancy (p=0.22). Family history and HIV status were not significant.
Conclusion. A high proportion (11.0%) of lesions that appeared benign on ultrasound were malignant. The size of the lesion did not correlate with histological subtype or malignancy. Further research, including training of ultrasonographers in using the Breast Imaging Reporting and Data System (BIRADS) ultrasound lexicon, standardisation of technique with assistance from established users and possibly double reading for a period, is needed to determine whether there is a true high prevalence of malignancy in sonographically benign breast lesions in our community.
Source: South African Journal of Surgery 52, pp 41 –44 (2014) http://dx.doi.org/10.7196/SAJS.1908More Less
Background. Lymphoedema resulting from axillary lymph node dissection remains a challenging complication after modified radical mastectomy.
Objective. To examine the effects of supportive therapy such as rehabilitation and medical and physical treatment on the development of lymphoedema, in an attempt to establish non-surgical ways to help prevent or reduce it.
Methods. Patients (N=5 064) who underwent breast cancer surgery in the Department of General Surgery, Ankara Oncology Research and Training Hospital, Turkey, between 1995 and 2010 were included. Data were collected by retrospectively examining all the patients' files and the pre- and postoperative breast cancer follow-up forms.
Results. Of the patients in the study, 19.9% developed lymphoedema. It was significantly less common in patients who participated in physiotherapy than in those who did not, and it was more common in patients with a body mass index (BMI, kg/m2) between 30 and 34.9 than in those with lower BMIs. Postoperative axillary radiotherapy did not affect the occurrence of lymphoedema.
Conclusion. It is clear that the most successful method to reduce the impact of lymphoedema is to prevent it. We believe that educating patients about the risk factors for developing lymphoedema and referring them to postoperative physical therapy and rehabilitation clinics are the most important ways to avoid this distressing condition.
Comparison between preoperative biopsy and post-excision histology results in sarcoma : experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa : general surgerySource: South African Journal of Surgery 52, pp 45 –48 (2014) http://dx.doi.org/10.7196/SAJS.1739More Less
Background. Tumour size, grade and subtype are the main prognostic factors in adult patients presenting with soft-tissue sarcoma. Planning for appropriate management, including the need for additional staging investigations and neoadjuvant therapy, is dependent on reliable preoperative histopathological results.
Objectives. To determine whether there is agreement between preoperative and post-excision histological findings in patients presenting with soft-tissue sarcoma, and whether the agreement is influenced by the subtypes of sarcomas.
Methods. Records of adult patients who had soft-tissue sarcomas excised were reviewed. Kaposi's sarcoma and gastrointestinal stromal tumours were excluded. Data were retrieved from the Department of Anatomical Pathology of the National Health Laboratory Service and theatre records at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, and included patient demography, tumour sites and size, HIV status, biopsy types and post-excision histological findings.
Results. Records of 153 patients were found (median age 44 years). The majority of the sarcomas were >5 cm in diameter, deep seated and localised in extremities. The commonest subtype, irrespective of HIV status, was dermatofibrosarcoma protuberans. Fine-needle aspiration biopsy (FNAB) results were inaccurate in determining the malignant nature, grade and subtype of sarcoma. Rates of accurate tumour subtype classification following core needle and incision biopsies when compared with post-excision histological findings were 73.1% and 78.3%, respectively.
Conclusion. FNAB should not be used in the primary evaluation of soft-tissue tumours. A report of spindle cells on the FNAB smear should be followed by core needle or incision biopsy. Incision biopsy is superior to core needle biopsy in the classification of sarcomas by subtype.
Source: South African Journal of Surgery 52, pp 49 –52 (2014) http://dx.doi.org/10.7196/SAJS.1963More Less
Introduction. Despite its inherently dangerous nature, the practice of transporting passengers in the cargo area of light delivery vehicles (LDVs) is widespread in South Africa.
Objective. To review the patterns and outcome of injuries associated with events involving LDVs transporting passengers.
Methods. All patients presenting to the Pietermaritzburg Metropolitan Trauma Service in KwaZulu-Natal Province following an event in which they had been travelling in the cargo area of an LDV between January 2011 and December 2012 were included in the audit.
Results. A total of 66 patients were treated during the study period; 35% were children under the age of 18, and 90% were ejected from the LDV during the incident. The mean injury severity score (ISS) was 23. Collision events were associated with a higher mean ISS (33) than non-collision events (15) (p=0.008). The region most commonly injured was the head and neck, and 11% of victims sustained a permanent disability. The patients collectively spent 873 days in hospital and 70 days in an intensive care unit, and underwent 17 operations.
Conclusion. Transporting passengers in the cargo area of an LDV is dangerous, as ejection from the vehicle resulting from a collision is associated with significant morbidity and mortality. Legislative initiatives to prevent this practice are required as part of an ongoing comprehensive injury prevention programme.
Retroperitoneoscopic live donor nephrectomy : review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa : transplantationSource: South African Journal of Surgery 52, pp 53 –56 (2014) http://dx.doi.org/10.7196/SAJS.2080More Less
Background. Changing from an open to a laparoscopic live renal donor programme poses challenges and may affect donor and graft outcomes.
Objectives. To evaluate donor safety and graft outcomes for the first 50 retroperitoneoscopic live donor nephrectomies performed at Tygerberg Hospital, Cape Town, South Africa.
Methods. The procedures were performed by a single surgeon from 8 April 2008 to 3 April 2012. Operative and anatomical data were prospectively collected. A flank approach with lateral and posterior placements was used. Vascular control was achieved with Hem-o-lok clips in the majority of cases.
Results. The mean age of the donors was 31.5 years (range 18 - 50), 28 (56.0%) were male, and the left kidney was harvested in 28 (56.0%) of cases. The mean operating time was 149.8 minutes (range 75 - 250), mean warm ischaemic time (WIT) 181.3 seconds (107 - 630), mean blood loss 139.7 ml (5 - 700) and mean hospital stay 3.2 days (2 - 5). Mean WIT was significantly longer for right-sided than left-sided nephrectomy (213 v. 162 seconds). In two right-sided cases the renal vein was too short and vena profunda femoris was used to create length. No donor received a blood transfusion. Comparing the last 25 with the first 25 cases showed a significant decrease in mean WIT (158 v. 204 seconds, respectively) and operating time (128 v. 172 minutes, respectively). No major complications occurred.
Conclusion. Our initial 50 retroperitoneoscopic live donor nephrectomies were performed without major complications. Donor safety was maintained during the early learning curve of the transition to minimal-access donor nephrectomy.
Source: South African Journal of Surgery 52, pp 57 –60 (2014) http://dx.doi.org/10.7196/SAJS.2062More Less
The term portal biliopathy (PB) is used to describe the biliary abnormalities associated with portal hypertension. Between 5% and 30% of patients with PB develop biliary obstruction. We report on a patient with extrahepatic biliary obstruction caused by PB that was successfully managed with an intrahepatic segment 3 bypass. The traditional surgical approach for a patient with extrahepatic biliary obstruction caused by PB would be a portosystemic shunt followed by a hepaticojejenostomy if the jaundice persisted. An intrahepatic segment 3 bypass provides definitive treatment ensuring biliary decompression and stone removal in a single procedure in appropriately selected patients.
Source: South African Journal of Surgery 52, pp 61 –62 (2014) http://dx.doi.org/10.7196/SAJS.2183More Less
Plasmacytoma is a rare plasma cell tumour that arises from plasma cells. The tumour accounts for about 3 - 5% of all plasma cell malignancies and most often affects the head and neck, but may also occur in the gastrointestinal tract. To our knowledge, mesenteric plasmacytoma has not been described previously. We describe the presentation and management of a case of mesenteric plasmacytoma presenting as an abdominal mass in a 69-year-old HIV-positive man.
Author Sats S. PillaySource: South African Journal of Surgery 52 (2014)More Less
Manilal Damodar Daya was born in South End, Port Elizabeth, in June 1941 of parents who immigrated to South Africa from Gujarat State in India. He did his schooling in Port Elizabeth, matriculating at South End High School, and completed his MB ChB at the University of Cape Town in 1967. After doing his internship at Somerset Hospital he started work as a medical officer at Livingstone Hospital, Port Elizabeth, in 1969. He married his wife Hemkala in 1971 and they had four boys, two of whom followed in their father's footsteps to become medical doctors.