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published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

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Thesis (M. Med. Sc.)--University of Hong Kong, 2007.

Thesis (M.D.) -- Dept. of Surgery, University of Adelaide, 1981. / Typescript (photocopy).

Thesis (M.S.) -- University of Adelaide, Dept. of Surgery, 2000. / Corrigenda inside back cover. Bibliography: leaves 161-178.

a variety of South African Hospitals: a retrospective study Purpose: To examine the number of lymph nodes present in specimens submitted for histological examination from a variety of South African hospitals; the identification of factors that influence nodal yield and node positivity; determining whether oncological clearance is improved based on the number of nodes examined in high volume centers versus low volume centres; the establishment of guidelines on where surgery for colorectal cancer should ideally be performed. Patients and methods: Pathology reports of resected specimens of colorectal adenocarcinoma in the database of the National Health Laboratory Service Johannesburg laboratory from 2000 to 2005, were examined for patient demographics, referring hospital, tumour specific features of T-stage, degree of differentiation, lymphovascular invasion and adenocarcinoma subtype (mucinous versus non-mucinous), number of lymph nodes identified, number of nodes positive and whether preoperative radiotherapy was administered. Hospitals were grouped into four groups of Charlotte Maxeke Johannesburg Academic Hospital, Helen Joseph Hospital, private hospitals and non-academic public hospitals. Patients were grouped according to the number of lymph nodes retrieved into the following groups: not recorded, no nodes identified,1-7 nodes identified, 8-12 nodes, 13-18 nodes, and greater than 18 nodes identified. Additionally, patients were subdivided into those with nodal metastasis and those without, and into colon and rectal cancer respectively. Multivariate analysis was performed via StatSoft, Inc. (2008) STATISTICA (data analysis software system), version 8.0 on the different lymph node groups versus the abovementioned covariates. Results: Of the 365 patients identified, the mean number of lymph nodes examined per resected specimen was 8.9 (±6.2SD), with significant differences noted between the different resection subtypes (p < 0.001). No statistically significant difference in mean number of nodes identified could be seen between the various hospitals. Alarmingly, in the group of patients where no metastatic nodes could be identified, the recommendation of 12 or more nodes examined per specimen was upheld in only 29% of cases. Factors associated with positive lymph nodes in this study include T-stage, degree of differentiation and lymphovascular invasion by the tumour. No significant benefit in terms of finding metastasis nodes could be demonstrated by examining more than 18 nodes. Conclusions and recommendations: This study highlights a substandard nodal assessment in colorectal cancer specimens overall, including the academic hospitals. More than 70% of node negative patients in this series may have been understaged. Close liaison between the surgeon and examining pathologist is recommended. In the presence of the identified high risk factors for nodal involvement and a substandard nodal assessment, additional measures i.e. fat clearance and immunohistochemistry need employment. A prospective study assessing quality of surgery is necessary, as is the creation of a central database to improve overall quality of cancer care.

Close interaction between oligodendrocytes and axons is essential to initiate myelination and to form specialised domains along myelinated fibres. These domains are characterised by the assembly of protein complexes at the axon-glia interface and key components of these complexes are the Neurofascins. Neurofascins are transmembrane glycoproteins belonging to the L1 subgroup of the Immunoglobulin (Ig) superfamily of cell adhesion molecules. The Neurofascin (Nfasc) gene is subject to extensive alternative splicing. Two of the best characterised isoforms are Nfasc155 and Nfasc186, which are expressed in glia and neurons respectively. In myelinated fibres, Nfasc186 is the predominant isoform expressed at nodes of Ranvier and axon initial segments (AIS) in both the central and peripheral nervous system (CNS and PNS), whereas Nfasc155 resides on the glial side of the paranodal axoglial junction. The Neurofascin gene has been inactivated by homologous recombination and Neurofascin-null mice die within the first week of postnatal life. The main focus of this work was to investigate the role of the Neurofascins in the developing CNS. Similarly to what has been previously observed in the PNS, this study shows that in myelinated fibres of the spinal cord, nodal and paranodal markers are mislocalised and axoglial junctions do not form in the absence of the Neurofascins. In contrast to the PNS, where ensheathment of axons is unaffected, myelin proteins in the CNS are greatly reduced in the mutant. This appears to be due to the reduced ability of oligodendrocyte myelinating processes to extend along axons. This work also shows that the role of Nfasc186 is to maintain the long term stability of the AIS rather than its assembly. In the PNS, Nfasc186 was found to play an essential role in node assembly. However, PNS and CNS nodes are likely to assemble by different mechanisms. To investigate the relative contribution of the Neurofascin isoforms in CNS node assembly, this work made use of transgenic lines in which either neuronal Nfasc186 or glial Nfasc155 was expressed on a Neurofascin null background. Expression of either isoform was found to independently rescue the nodal complex and a model of how the Neurofascins cooperate in the assembly of the CNS node of Ranvier is proposed.

Introduction To measure the radiation exposure to the surgeon during axillary sentinel lymph node biopsy using the radioactive isotope technetium-99m. Method A prospective analysis of 36 patients undergoing axillary sentinel lymph node biopsy using technetium-99m, between 15th January 2013 to the 20th February 2013.. Results The exposure to the surgeon during axillary sentinel lymph node dissection was measured in 36 patients by placing a thermoluminescent dosimeter (TLD) on the surgeon’s finger. The TLDs recorded the total radiation exposure to the surgeon. The recommended occupational dose limit for non radiation workers extremity exposure is less than 500 μSv. The analysed and extrapolated data showed an average exposure dose to the surgeon per patient of 2.7 μSv. Conclusion One surgeon would need to perform more than 85 such procedures per year in order to exceed the advised annual extremity dose limit. The data also suggests that regular measurements of radiation exposure and radiation protective measures need not be undertaken in theatres where surgeons are working with radioactive isotope for axillary sentinel lymph node biopsies.

Typescript (photocopy) / 163 leaves, [8] leaves of plates : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D.)--Dept. of Surgery, University of Adelaide, 1981