Cairncross, Lydia Leone
Primary Aim: assess the accuracy of pre operative diagnosis of thyroid cancer in a single centre. Secondary Aims: evaluate the impact of preoperative diagnosis on surgical interventions for thyroid carcinoma; develop locally applicable guidelines for patients with nodular disease of the thyroid.
Trauma Unit volumes: Is there a relationship with weather, sporting events and week/month-end times? An audit at an urban tertiary trauma unit in Cape TownMilford, Karen January 2015 (has links)
Background: The Trauma Unit at Groote Schuur Hospital is a mature, tertiary, high-volume trauma referral centre. The number of patients being treated in the unit at any given time can vary greatly. There is evidence to suggest that these fluctuations may be related to external and environmental factors, such as time of the day, week and month, local weather and significant home-team sport matches. Objective: The objective of this audit was to determine the relationship between volumes of patients in the unit, and environmental factors. Specifically, we aimed to determine whether the numbers of patients presenting after motor vehicle collisions and interpersonal violence was related in any way to temporal factors (time of day, week and month), weather variables (temperature and precipitation), and whether or not major or home-team soccer matches were being played. Methods: Trauma Unit admission records were examined retrospectively, and the numbers of patients presenting to the unit per shift for a total of 17 months was recorded. Patients were grouped according to their presenting complaints. Weather data, Premier Soccer League and Bafana Bafana match locations and results, and information regarding public holidays and long weekends were obtained for the relevant shifts. Average daily attendances for interpersonal violence (IPV)-related injuries and motor vehicle collisions (MVCs) were compared across the various external factors described. Poisson regression models were fitted using Stata 13 (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP). and used to express the relative incidence of attendances. These results were expressed using incidence rate ratios (IRRs). Results: In total, 16 706 attendances were recorded over 1 074 shifts. Of these, 7 350 (44%) attendances were due to injuries sustained as a result of interpersonal violence (IPV), and 3 188 (19%) were due to MVCs. Predictors of increased attendances due to MVC-related injuries were week day shifts, and night shifts on long weekends, and on weekends that fell on the last day of the month. Weekend nights shifts were busier than week night shifts from this perspective. Public holiday shifts were shown to have less MVC-related attendances than an ordinary week day. The presence of precipitation was also shown to increase the number of MVC-related attendances. IPV-related attendances were always increased on night shifts compared to day shifts, except on public holidays, long weekends, and on weekends that fell on the last day of the month. All weekend shifts were busier than their corresponding week day shifts from an IPV-related perspective, and this effect was enhanced on weekends that fell on the last day of the month. Long weekends showed very similar trends to ordinary weekends, and public holidays showed similar trends to ordinary week days. Increasing temperatures are associated with increased attendances due to IPV. Soccer matches and their outcomes have no significant effect on attendances due to IPV. Conclusions: Temporal and weather factors can be used to predict which trauma unit shifts will be busiest.
Spence, Richard Trafford
15 February 2019
Background Despite the existence of multiple validated risk-assessment and quality benchmarking tools in surgery, their utility outside of High Income Countries is limited. We sought to derive, validate and apply a scoring system that is both 1) feasible, and 2) reliably predicts mortality in a Middle Income Country (MIC) context. Methods A 5-step methodology was used: 1. Development of a de novo surgical outcomes database modeled around the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) in South Africa (SA Dataset) 2. Use of the resultant data to identify all predictors of in-hospital death with more than 90% capture indicating feasibility of collection 3. Use these predictors to derive and validate an integer-based score that reliably predicts in-hospital death in the 2012 ACS-NSQIP 4. Apply the score in the original SA dataset and demonstrate it’s performance 5. Identify threshold cutoffs of the score to prompt action and drive quality improvement. Results Following Step one-three above, the 13 point Codman’s score was derived and validated on 211,737 and 109,079 patients, respectively, and includes: 1) age≥65 (1), partially or completely dependent functional status (1), preoperative transfusions≥4 units (1), emergency operation (2), sepsis or septic shock (2) American Society of Anesthesia (ASA) score ≥3 (3) and operative procedure (1-3). Application of the score to 373 patients in the SA dataset showed good discrimination and calibration to predict an inhospital death. A Codman Score of 8 is an optimal cutoff point for defining expected and unexpected deaths. Conclusion We have designed a novel risk prediction score specific for a MIC context. The Codman Score can prove useful for both 1) preoperative decision-making and 2) benchmarking the quality of surgical care in MIC’s.
Includes bibliographical references. / The ACE protein is a zinc-dependent dipeptidyl carboxypeptidase comprised of two homologous domains termed the C- and N-domain. The C-domain is primarily responsible for the catalytic production of Ang II, while the tetrapeptide acetyl-seryl-aspartyl-lysyl-proline (AcSDKP) is predominantly cleaved by the N-domain, and both domains play a role in the metabolism of vasodilatory peptide bradykinin. In the event of myocardial infarction (MI), cardiac output and blood pressure decreases, resulting in activation of the RAS and an increase in both Ang II production and bradykinin metabolism. While initially compensatory, prolonged RAS activation has been shown to have long-term detrimental effects, and pharmaceutical intervention in the form of ACE inhibition is the first line treatment following an MI event. The ACE inhibitors currently in clinical use target both domains equally, and it has been suggested that the major side-effects of this drug class are largely attributable to the inhibition of bradykinin breakdown. A novel C-domain selective ACE inhibitor lisinopril-Trp (lisW-S) incorporates a tryptophan moiety into the P2' position of the clinically available ACE inhibitor lisinopril.
Measurements in wound healing : effects of topical agents on full thickness dermal incised wounds in an animal modelTheunissen, Daniël January 2001 (has links)
Bibliography: leaves 55-59. / Inert topical agents in the form of creams, lotions and ointments are often applied to wounds to create an environment conducive to wound healing. These agents, although not pharmacologically active on the intact skin, have activity when applied to wounds where the stratum comeum barrier to penetration is absent. From measurements of simple parameters like the rate of re-epitheliasation. it is known that some topical agents enhance wound healing while others retard the healing process. There is data available on the antiseptic and anti-microbial properties of most of the topical agents in use today, but ail the effects of these products on the micro-environment of wounds and their influence on the process of healing is not known. Central to the study of wounds and wound healing is the need for accurate methods to evaluate wounds. Parameters used for measuring outcome should be unambiguous and measurements should be accurate and reproducible. At present, no universally accepted methods of assessing wounds exist. Clinical evaluation is usually subjective and not quantitative, resulting in unacceptable levels of inter- and intra-observer variation. Similarly lacking are clear histological correlates of what we consider good healing characteristics of a wound. As our knowledge increase about the complex process of wound healing, in particular the hormones and peptide growth factors that regulate the process, possibilities arise for therapeutic intervention to enhance or improve clinical outcome. At the same time, the need for objective measurements becomes more urgent, as we need to evaluate and compare treatment options. Previous measurement systems were developed, ranging from visual scoring systems to measurement of biological and chemical wound constituents. Physical characteristics of healing wounds can also be measured by properties such as the tensile strength. The structural and ultra- structural elements of healing wounds remain difﬁcult to measure, although immuno-histochemistry and scanning electron microscopy allows some quantiﬁcation and simple morphometric measurements. With current advances in computer technology however, rapid, automatic measurements can be made from tissue sections for a variety of practical applications in the pathology laboratory. Image analysis offers dynamic functional imaging, linking multiple data sources to provide composite quantitative systems. Further correlation of detailed histologic examination of wounds to a detailed clinical assessment of the same wounds is important, not only to add credibility to clinical scoring schemes, but also to understand which structural features of the dermis are important for the severity of scarring (and therefore which should be the object of future therapeutic or preventative strategies).
Evaluation of new diagnostic and treatment strategies in the management of the Zollinger-Ellison syndromeRadebold, Klaus January 2000 (has links)
Includes bibliography. / Despite major advances over the last two decades with the management of patients with Zollinger-Ellison syndrome (ZES), unanswered questions remain concerning the natural history of the disease, the impact of new diagnostics modalities on cure rates, and the role of surgery in the era of modem medical therapies. The aims of the thesis are to (i) analyse the database of 40 ZES patients treated at Groote Schuur Hospital (GSH) over two decades, with special reference to the impact of various surgical strategies on outcome, (ii) investigate a possible correlation between biological tissue marker expression and tumour behaviour, (iii) study the effect of somatostatin receptor scintigraphy (SRS) on surgical cure rates, and (iv) assess the efficacy and safety of a new proton pump inhibitor (pantoprazole) in controlling acid hypersecretion.
van As, Arjan Bastiaan
The liver differs from other solid organs in that it has a dual blood supply, receiving arterial blood via the hepatic artery and venous blood via the portal vein. The reperfusion injury which occurs after ischemia, has been studied to only a limited extent in the liver. In particular, the relative contribution of the portal venous blood and the hepatic arterial blood to the reperfusion injury has not been documented previously. During liver transplantation, implantation of the new liver is achieved by anastomosing the suprahepatic vena cava, the infrahepatic vena cava and the portal vein. At this stage, the liver is reperfused with portal venous blood only. Thereafter the hepatic arterial anastomosis is undertaken. The delay in providing the liver allograft with arterial blood will depend upon the difficulty in the dissection of the hepatic artery. The impact of the delay in rearterialization of the liver allograft has not been studied previously. Currently, the University of Wisconsin Solution is the gold standard for liver preservation. Celsior is a new cardioplegic solution, which has also been suggested for use for liver preservation. However, its role as a liver preservation solution has been studied to a limited extent. The aim of this study was: 1. To document the reperfusion injury after liver transplantation. 2. To document the relative contribution of the portal venous blood and the hepatic arterial blood to the reperfusion injury. 3. To investigate the impact of early rearterialization on the reperfusion injury after liver transplantation. 4. To investigate the effect of the new preservation solution, Celsior, on the reperfusion injury after liver transplantation. Large White X-Landrace pigs were subjected to orthotopic liver transplantation. The donor liver was stored in Eurocollins solution for 3 hours. The animals were randomly allocated to either rearterialization 60 minutes after portal reperfusion, rearterialization 20 minutes after portal reperfusion, simultaneously portal and arterial reperfusion, and rearterialization 20 minutes before portal venous reperfusion. In another experiment, the donor livers were stored in either Eurocollins solution, University of Wisconsin Solution, or Celsior. Blood samples were taken at various intervals and subjected to the following biochemical investigations. Malondialdehyde and vitamin A were used as markers of reperfusion injury. Hyaluronic acid levels were used as markers of endothelial cell function. Serum AST was used as a marker of hepatocellular injury. In summary, these studies showed that there was a significant reperfusion injury after portal venous reperfusion with no additional injury after rearterialization. Early rearterialization also resulted in a lesser reperfusion injury. There was also less hepatocellular injury with early rearterialization. Histological evidence of injury was also less in the livers which were rearterialized early. In addition, the livers preserved in Celsior had evidence of a lesser reperfusion injury. Thus in conclusion, in liver transplantation early rearterialization might result in better early graft function.
INTRODUCTION: The femoral artery (FA) is the most common peripheral vessel injured in trauma. The incidence has been as high as 70%. Most experience with vascular trauma comes from the military where the incidence of FA injury is 67% of all vascular injuries. Up to 88% of these injuries are as a result of penetrating trauma. The Groote Schuur hospital trauma unit is a level one centre. It is a quaternary hospital and a referral center for all surrounding secondary level hospitals. Femoral vessel injuries are the second most common peripheral vascular injury (18.8%) seen after brachial artery injuries (48.2%) at our unit. AIM: This study aims to review a single centre experience with femoral artery injuries and identify factors associated with limb loss. METHOD: A 11 year retrospective chart review of patients with femoral artery injuries managed from 1 January 2002 to 31 December 2012 at the trauma unit, GSH. RESULTS: There were 158 patients with femoral artery injuries, 144 men and 14 women with a mean age of 28. Ninty-five percent had penetrating injuries. The most common artery injured was the superficial femoral artery (87%). The most common type of arterial injury was a laceration (39%) and transection (37%). Eighty-one patients had a primary repair (51%), fifty-three patients had a vein interposition graft (33.5%) and sixteen patients (10%) had a prosthetic graft. There were 78 (51%) concomitant venous injuries, 11 were repaired and 1 vein patch was done (15.4%). The rest were ligated (84.6%). There were 4 (2.5%) primary amputations and 10 (6.5%) secondary amputations. One primary amputation resulted from a delay to theatre with a threatened limb. The other three presented with a non-viable limb. Nine of the ten secondary amputations presented with a threatened limb. One viable limb was lost due to bleeding from a false aneurysm secondary to sepsis. One secondary amputation was the result of a delayed fasciotomy for compartment syndrome post revascularisation of a threatened limb. The rest were due to prolonged ischemic time despite attempted revascularization. There were no deaths in this study. Univariate analysis showed that statistically significant risk factors for secondary amputation were: presentation with signs of a threatened (ischemic) limb (p<0.0001), the temporary vascular shunt group (p<0.001) and the lack of a palpable distal pulse post repair (p<0.01). Statistically insignificant factors were: concomitant femur fracture, compartment syndrome, fasciotomy, unstable hemodynamics on presentation, venous ligation and 'In hospital ischemia time'. CONCLUSION: The outcome of threatened limbs due to femoral vessel injury is good provided there is no delay to surgery. This study has a primary amputation rate of 2.5% and secondary amputation rate of 6.5%, 91% of the limbs were salvaged.
Background - Violence against Women is a major public health issue, and it is universally under reported. Objective - To conduct an injury surveillance of severe or life threatening violent acts against women, to determine the demographics of the injured women and to identify the nature of the perpetrators. Methods - A standardized structured questionnaire administered in an interview conducted on female patients admitted to the Trauma Centre at Groote Schuur Hospital as a result of interpersonal violence. Age, level of education, employment status, housing and substance abuse was recorded.
Joffe, Stephen Neal
03 August 2017
In the last few years a very high incidence of deep vein thrombosis has been reported in the literature. Venous thrombosis and its sequel, pulmonary embolus account for 12. 5% of all postoperative deaths and is the single greatest threat to recovery after surgical operations. This study was undertaken to investigate the incidence of postoperative deep vein thrombosis occurring at Groote Schuur Hospital using the newer methods of diagnosis. No previous similar study has been conducted in South Africa. The high-risk factors predisposing to venous thrombosis have been assessed and the techniques of diagnosis using Radio-active fibrinogen, Doppler ultrasound and Venography have been studied. The local findings reported in this study confirmed the high reported incidence. Methods of prevention of venous thrombosis using low doses heparin and sodium pentosan polysulphate have been assessed.
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