The management of desmoid tumours at Groote Schuur Hospital: A retrospective review of current practicePickard, Henri Du Plessis 22 January 2020 (has links)
Background: Desmoid tumours (DTs) are rare soft tissue tumours that do not metastasise but are locally aggressive. Management options are varied and the response to treatment can be unpredictable. Aim: The aim of this study was to describe the clinical presentation, management strategies and outcomes for adult patients who were treated for DT. Setting: The study was conducted at Groote Schuur Hospital in Cape Town, South Africa and all patients from 2003 to 2016 who presented with DT were included. Method: This was a retrospective review of records. Data collected included: demographics, DT-associated conditions, site and size of tumour, histological findings, treatment modalities, follow-up and outcomes. Results: Seventy patients with histologically confirmed DT were identified. The majority were women (86%) and 77% presented with a painless mass. The commonest site was the anterior abdominal wall (47%). Definitive surgery was performed in 46 (66%) patients, whereas 13 (19%) had definitive radiotherapy. Nine patients received adjuvant radiotherapy post-surgery for involved or close margins. Recurrence developed in 20% patients post-surgery. In the primary radiotherapy group, one patient had disease progression. Two patients with mesenteric DT died because of bowel obstruction. Conclusion: This retrospective review of patients affected by DT at a single centre demonstrates the rarity of the condition, the unpredictable natural history and the variety of treatment options available. Many of our findings are similar to other published studies, except the mean size of DT which was bigger. Treatment outcomes following surgery or radiotherapy seem acceptable, although study limitations are noted.
The pathological outcomes related to symptomatic impacted third molars and follicles as found in a private practice in South AfricaBerezowski, Brian Mark January 2013 (has links)
Includes abstract. / Includes bibliographical references. / The aim of this study primarily was to review pathological reports of all symptomatic third molar teeth removed in a private practice, and to use the data to support or refute routine removal of third molar teeth. All patients who underwent third molar tooth removal for symptoms,either systemic or local ,in a private practice over a twenty year period between 1987 and 2007 were included in the study. Specimens were sent for histological assessment by Oral Pathologists. The patient records were reviewed retrospectively. A total of 3427 third molar teeth were included in the study. There were 68.75% specimens which had some sort of pathology. Only 0.3% of specimens were reported as normal dental follicular tissue. There were 31.25% specimens of hyperplastic follicular tissue which was considered non pathologic as they consisted of normal dental follicular tissue with a mild chronic inflammatory cell infiltrate. However the 68.75% pathologic lesions consisted of 14.44% specimens with early dentigerous cysts, 8.11% with dentigerous cysts, 42.80% of paradental cysts and the remainder with other pathologies. The majority of the patients were in the second and third decades and mostly female. The age distribution of the patients suggested a progression from hyperplastic follicular tissue with a peak occurring at 17 years, to early dentigerous cysts at 19 years, to dentigerous cysts at 21 years. Paradental cyst formation, with a peak incidence at 19 years of age formed a large number of the pathological lesions found, and accounted for a large number of patients seeking treatment, owing to the symptoms associated. This study represents an analysis of the largest number of symptomatic third molar teeth submitted for histological assessment known. The data obtained was used to review the guidelines for the management of third molar teeth. From this study it can be concluded that symptomatic impacted third molar teeth should be removed early in the third decade in order to avoid general or local symptoms suffered by these patients.
A prospective evaluation to define optimal surgical strategies in the management of complex pancreatic injuries based on the analysis of patients treated at a major South African academic institutionKrige, Jacobus Edmund Joubert January 2017 (has links)
In order to address crucial existing limitations in the assessment and analysis of pancreatic injuries due to the lack of robust data and deficient surgical strategies, this thesis focused on priority topics to resolve existing unanswered and under-researched questions in the management of complex pancreatic injuries. Each of the twelve clinical studies in this thesis evaluated a specific aspect of pancreatic trauma based on the detailed analysis of prospective granular data from a large cohort of patients treated in an academic surgery and trauma centre with substantial experience in civilian operative trauma care in which standard and uniform protocols were applied.
Describing the most common presenting complaints, their priority and corresponding diagnoses at Khayelitsha Emergency CentreNaidoo, Antoinette Vanessa 22 January 2020 (has links)
Introduction Emergency centres have to be equipped to provide high-quality care to a number of undifferentiated patients with varying acuity of illness. This study aimed to identify the most common presenting complaints and corresponding linked diagnoses, in total and for each category of the South African Triage Scale (SATS) at Khayelitsha Emergency Centre (EC). Methods A retrospective, cross-sectional, chart review was used. The sample consisted of patients who presented to Khayelitsha EC in January and June 2015. Charts were reviewed via the Electronic Content Management system. Data were collected on demographic profile, triage priority, presenting symptoms at triage, and ICD-10 diagnosis. Results 4006 of 4928 charts that were reviewed were suitable for inclusion. Triage acuity was 28.0% (n=1123) green, 34.2% (n=1372) yellow, 25.7% (n=1030) orange and 3.5% (n=141) red. The most common presenting complaints were trauma (10.3%) and pain (10.1%); the majority of these patients presented in the yellow and green triage categories. The most common diagnosis made in the EC was pneumonia (7.0%) - most frequently presenting as shortness of breath (8.7%) and cough (5.6%). Medical conditions presented with a higher acuity at triage. Presenting complaints documented at triage and those reported by clinicians correlated an acceptable 70.1% of cases (r=0.71). Diarrhoea and vomiting were the predominant symptoms in summer whereas shortness of breath and cough were more frequent in winter. Triage acuity was similar for both months. Conclusion Individual symptoms presented with varying priority and resulted in a variety of eventual diagnoses which showed differences across categories. Presenting complaints provide granularity to otherwise undifferentiated triage priorities. Future research should focus on time-in-motion work to determine the mean clinical care time each of these complaints require. This should allow a calculation of the mean clinical care time for each triage priority. In turn this can be turned into a calculation for optimal staffing.
The inhibition of HIV-1 activity by crude mucus and purified mucin (mucous glycoproteins) from saliva, breast milk and the cervical tract of normal subjects, HIV positive individuals and patients with HIV-AIDSHabte, Habtom Haileselassie January 2007 (has links)
Includes bibliographical references (leaves 140-161). / Human saliva, breast milk and cervical secretions contain several non-immunological components including mucins (mucous glycoproteins), which protect the gastrointesinal and female reproductive tracts and breast fed infants from bacterial, viral and fungal infections. In addition to their well known function in lubrication, tissue coating and digestion, mucus and mcins have been used as pathological markers in diseases such as asthma, chronic bronchitis, cystic fibrosis, and carcinomas of the breast, lung and colon. Crude saliva is a also known to inhibit the activity of human immunodeficiency virus (HIV), the causative agent of acquired immunodeficiency syndrome (AIDS). According to the joint United Nations Programme on HIV/AIDS (UNAIDS) worldwide an estimated 38.6 million people were living with HIV in 2005 with 401 million newly infected and 2.8 million deaths. It has been reported that an estimated 24.5 million of the HIV infected people of whom 60% females live in sub-Saharan Africa with the Southern African region having the highest prevalence in Africa. Furthermore the incidence of opportunistic diseases such as TB is also reported to increase with HIV prevalence. Thus far, despite the discovery of highly active antiretroviral therapies which contain both protease and reverse transcriptase inhibitors, HIV remains as a global threat especially to the third world countries. Therefore there is a need for the development of safe compounds to reduce viral loads in infected people and to prevent the transmission of the virus from one individual to another. The search for a suitable vaccine is ongoing.
Effectiveness of Moviprep® as colonic preparation - cleansing right colon for Lynch Syndrome (LS) screening: a prospective studyDe Villiers, David Johannes January 2016 (has links)
Purpose: Each year, a cohort in the Northern Cape undergo colonoscopies as part of a surveillance program for individuals who have a C1528T mutation in the hMLH1 gene that puts them at very high risk for the development of colon cancer (Lynch syndrome). A clean colon is essential as it allows a thorough evaluation and surveillance for small polyps or mucosal lesions mostly encountered in the ascending colon. This study evaluated both the subject acceptance and the effectiveness of a 2L PEG electrolyte lavage solution containing ascorbic acid and sodium ascorbate (Moviprep®) as a preparation solution. Methods: The screening program was divided into two stages. Stage 1, 71 subjects were counselled individually on the importance of bowel cleansing and the use of Moviprep® as their bowel cleansing agent. Preparation was either a) 2L the night prior to colonoscopy or b) 1L the night prior to and the second litre on the morning of the colonoscopy. Subjects were encouraged to drink at least 500ml clear fluid in addition to each litre of Moviprep®. Informed consent was obtained for participation in the study. Stage 2, approximately 6 weeks later, each subject completed a questionnaire, evaluating their experience with Moviprep® and also had their screening colonoscopy performed. Colonoscopies were performed at 4 medical facilities in the Northern Cape. All subjects were assessed for bowel cleanliness on arrival at the facility where colonoscopy was to be performed. If any of the subjects were found to be inadequately cleaned, extra oral preparation was given prior to colonoscopy. The Harefield cleansing scale was used to evaluate the quality of colonic cleansing during each colonoscopy. The colon was divided into 6 segments (rectum, sigmoid, descending-, transverse-, ascending colon and cecum). Preparation was scored as A = all colon segments clean; B = at least 1 segment with residual amounts of brown liquid or semisolid stool, which can easily be displaced or removed; C = at least 1 segment with only partially removable stool, preventing complete visualization; D = at least 1 segment which could not be examined due to solid stool). Grades A or B were considered successful cleansing and grades C or D were considered a failed colonic preparation. Results: A total of 46 subjects had colonoscopies performed. 41(89%) of them had successful and 5(11%) failed preparation. Three of those subjects that prepared successfully had previously undergone right hemicolectomies, leaving 38 with intact colons. 22/38 (58%) subjects achieved an A grade for caecal cleansing and 16/38 (42%) a B grading. 2438 (63%) subjects scored an A grade for the ascending colon and 14/38 (37%) a B grade. A total of 64 subjects completed the questionnaires of which 83% (53/64) had used other colon preparations previously. When asked if they would use Moviprep® again in the future, 89% (57/64) said yes and 11% (7/64) said no. 94% of subjects (60/64) would recommend Moviprep® to friend and family. Conclusion: Moviprep® provided adequate colonic cleansing in 89% of subjects. In addition, nearly 90% of subjects were satisfied with the product and would use it again.
The incidence of recurrence after Delorme's procedure for full thickness rectal prolapse - a retrospective private-public cohort studyPlaskett, Jeremy John January 2016 (has links)
Background: Delorme's perineal repair has remained a procedure reserved for full-thickness rectal prolapse in elderly or co-morbid patients due to its low morbidity and complications. Reported recurrence rates are higher than in abdominal approaches. Aim: The study assesses long-term outcomes after Delorme's procedure (DP), specifically recurrence and postoperative bowel function, in both a multi-surgeon public hospital and a single surgeon cohort in the private sector (Groote Schuur Hospital and Kingsbury Hospital). Patients and Methods: This retrospective cohort study includes all patients who underwent DP between February 2001 and March 2014 at both study sites. The primary outcome was absence of recurrence. Secondary outcomes were bowel function (incontinence and constipation), postoperative mortality and morbidity and length of hospital stay. Patient data was collected from electronic records (Kingsbury Hospital) and paper folders/op notes (Groote Schuur Hospital) and current status was acquired by telephonic interview with either the patient, a family member or caregiver, as appropriate. Results: Seventy patients underwent DP: 37 private and 33 public, mean age 71yrs. There were 16 (23%) recurrences (7 private, 9 public), of which 8 (11%) underwent reoperation. Mean time to recurrence was 30 months (48 private; 15 public). There were 2 postoperative deaths (pneumonia, myocardial infarction), 6 major complications (rectal bleeding requiring transfusion or reoperation, bowel obstruction, pneumonia, myocardial infarction), and 6 minor complications (rectal pain, rectal bleeding not requiring reoperation or transfusion, urinary retention, confusion, hyponatraemia). The mean postoperative hospital stay was 4 days. Conclusion: Long-term outcome from this large series compares favorably with most other published series, specifically a low recurrence rate. Proposed reasons for this will be presented, within the context of the published literature.
Moydien, Mahammed Riyaad
Includes bibliographical references / Introduction: ERAS programmes employed in elective colorectal, vascular, urologic and orthopaedic surgery has provided strong evidence for decreased lengths of hospital stay without increase in postoperative complications. Aim: The aim of this study was to explore the role and benefits, if any, of ERAS / ERP (early recovery programmes) implemented in patients undergoing emergency laparotomy for trauma at a level 1 trauma centre. Methods: Institutional UCT-HREC approved study. A prospective cohort of 38 consecutive patients with isolated penetrating abdominal trauma undergoing emergency laparotomy were included in the study. The ERP included: early feeding, early urinary catheter removal, early mobilisation/physiotherapy, early intravenous line removal and early optimal oral analgesia. This group was compared to a historical control group of 40 consecutive patients undergoing emergency laparotomy for penetrating abdominal trauma, prior to introduction of ERP. Demographics, mechanism of injury and injury severity scores (ISS and PATI) were determined for both groups. The primary end-points were the length of hospital stay and incidence of complications (Clavien-Dindo classification) in the 2 groups. The difference in means was tested using the t-test assuming unequal variances. Statistical significance was defined as p < 0.05. Results: The two groups were comparable with regards to age, gender, mechanism of injury and ISS and PATI scores. The mean time to solid diet, urinary catheter removal and NGT removal was (non ERAS) 3.6 and (ERAS) 2.8 days [p < 0.035], (non ERAS) 3.3 and (ERAS) 1.9 days [p < 0.00003], (non ERAS) 2.1 and (ERAS) 1.2 days [p < 0.0042], respectively. There was no difference in time from admission to time of laparotomy [(non ERAS) 313 vs. (ERAS) 358] min (p < 0.07). There were 11 and 12 complications in the control and study group, respectively. When graded as per the Clavien-Dindo classification there was no significant difference in the 2 groups (p < 0.59). Hospital stay was significantly shorter in the ERAS group: 5.5 (SD 1.8) days vs. 8.4 (SD 4.2) days [p < 0.00021]. Conclusion: This small pilot study shows that ERPs can be successfully implemented with significant shorter hospital stays without any increase in postoperative complications in trauma patients undergoing laparotomy for penetrating abdominal trauma. Furthermore, the study shows that ERP can also be applied to patients undergoing emergency surgery.
What is the current practice of inguinal hernia repair at University of Cape Town affiliated hospitals?Scout, Earl 06 May 2020 (has links)
Background: Various inguinal hernia repair techniques exist, without one ‘single best’ option. Hernia society guidelines recommend laparoscopic repair as one of its mainstays, provided surgeons are adequately trained. The current practice for hernia repair in South Africa as well as the surgical resident exposure to laparoscopic repair training is unknown. Aim: To quantify the current practice of inguinal hernia surgery in hospitals affiliated to the University of Cape Town (UCT) and to assess trainee exposure to laparoscopic repair. Methods: All adult patients who underwent inguinal hernia repair during the 12-month study period, at the four UCT affiliated hospitals (Groote Schuur, Mitchell’s Plain, Victoria and New Somerset) were included. Collected data parameters included age, gender, primary or recurrent hernia, uni- or bilaterality, primary surgeon consultant or non-consultant, operative time, and open or laparoscopic technique used. Results: 380 patients were included. Eighty-eight (23.2%) repairs were performed laparoscopically, of which 5 (5.7%) were converted to open. Non-consultants were present at 70/88 (79.5%) cases performed laparoscopically and were primary surgeon at 15 (17%). Laparoscopic repair was performed for 63.6% of bilateral versus 19.3% of unilateral hernias, 39.3% of recurrent hernias and 45% of hernias in females. Conclusion: Inguinal hernias in our setting are predominantly repaired by open surgery. The likelihood of laparoscopic repair varies significantly depending on which hospital the patient is referred to. Non-consultants have limited exposure to performing laparoscopic hernia repairs as the primary surgeon.
Background: The high prevalence of Human Immunodeficiency Virus (HIV) has added a new dimension to the management and outcomes of many general surgical conditions in South Africa. However, there is a paucity of data describing the impact of HIV status on surgical outcomes in our setting. Appendicitis is the most common gastrointestinal emergency, and its surgical outcomes in areas of high HIV prevalence are poorly described in the literature. Thus, the aim of this study is to describe and compare the outcomes of appendectomy between HIV-infected (HIV+) and HIV-negative (HIV-) patients. Methods: This is a retrospective study of patients undergoing appendectomy at a large regional hospital over a 12-month period. Demographic data, duration of pre-hospital symptoms, HIV status, surgical approach, operative findings, histopathology reports, hospital stay and complications were recorded. Data for the HIV+ and HIV-patient cohorts were then described, analysed and compared. Statistical analysis was performed using the Chi-Squared or Fisher's exact test for non-continuous variables, and non- parametric ANOVA and Wilcoxon ranked sum test for continuous variables. A P-value less than 0·05 was considered statistically significant. Results: The study group comprised 134 patients; 18 (13.4 %) tested positive for HIV. HIV+ patients were significantly older (mean age of 29.3 vs. 20.3 years, P= 0.002) and had longer duration of pre-hospital symptoms (mean of 3.94 vs. 2.57 days, P= 0.03). Postoperative complications (44.4 % vs. 17.2 %, P= 0.03) and lengthier hospital stays (7.28 days vs. 5.95 days, P= 0.004) were also more frequently seen in the HIV+ patients. There were no differences in appendiceal rupture rates, histopathological findings and mortality. Conclusion: HIV infection is common in patients admitted with clinical features of acute appendicitis in South Africa. Presentation in HIV+ patients was delayed, and surgery was associated with significant postoperative morbidity and longer hospital stay.
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