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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
41

Complications of anti-reflux surgery in gastro-esophageal reflux disease with special reference to dysphagia

Brink, Abraham Justinus January 2009 (has links)
Includes bibliographical references (leaves 40-48). / All patients who underwent revision laparoscopic surgery from January 202 to July 2008 in the UCT Private Academic /Groote Scruur Hospital complex for intractable dysphagia and who did not respond to consevative treatment were reviewed. Patients with peri-oesophagel fibrosis as the dominant cause for their dysphagia were identified during surgrry and closely followed up. This study was focused on those patients' pre- and post-operative course.
42

Pre-operative diagnosis of thyroid cancer : clinical, radiological and pathological correlation

Cairncross, Lydia Leone January 2011 (has links)
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.
43

The use of topical sodium hypochlorite in the management of Pseudomonas aeruginosa burn wound infection

Coetzee, Emile January 2011 (has links)
The aim of the study is: 1. To undertake a meta-analysis of Pseudomonas aeruginosa burn wound infection. 2. To undertake a retrospective audit of Pseudomonas aeruginosa burn wound infection at the Red Cross War Memorial Children's Hospital. 3. To investigate the local effects of sodium hypochlorite solutions in Pseudomonas aeruginosa burn wound infection with regards to efficacy and toxicity.
44

The surgical management and prevention of laparoscopic cholecystectomy associated bile duct injuries

Lindemann, Jessica Danielle 12 March 2021 (has links)
Laparoscopic cholecystectomy (LC) is considered the gold standard in the surgical management of gallstone disease and is one of the most commonly performed general surgery operations worldwide. Bile duct injury (BDI) in LC remains a feared complication as it is associated with significant morbidity, prolonged hospital stay, increased costs, and reduced quality of life for patients, as well as the risk of litigation for the injuring surgeon. The initial incidence of BDI after the introduction of LC was reported to be between 0.4 and 0.8%, which was higher than the estimated 0.2% reported during the open cholecystectomy era. However, recent reports from the United States and Europe suggest a return to open cholecystectomy rates. Despite being a frequently performed operation in both the private and public health sectors in South Africa, there is a paucity of data on the incidence of BDI. In the only study to date reporting the frequency of BDI in South Africa, a single centre incidence of 1.2% was documented over an 18-month period, which is significantly higher than previous reports. No data have been published on the implications of BDI for patients treated within the South African healthcare system. This thesis describes the surgical management of BDI at an academic referral centre over a thirty-year period. Potential factors influencing treatment and patient outcome after BDI are investigated. These include the influence of geographic distance from referral centre on the timing of referral and repair, and subsequent long-term patient outcomes. The influence of dual healthcare sectors (public vs. private) on access to diagnostic and interventional modalities, and eventual outcome is also investigated, and the evolution in the management of BDIs over the three studied decades is documented. Factors associated with loss of patency following surgical repair of LC-BDIs are also determined. Based on the findings of this detailed review of the management and outcomes of LC-BDIs, a treatment algorithm for management in resource-constrained environments is proposed. Establishing the optimal management of LC-BDIs in a developing country healthcare setting is important but does not address the source of the problem. In an effort to make LC-BDI a near-never event, a standardized method of performing, documenting and monitoring the quality of LC was developed and implemented for all LCs performed in the Cape Metro West health district. Prospective data collection is scheduled to continue to the end of 2020; however, an interim analysis is presented. A previously published scoring system for assessing quality of the critical view of safety achieved during LC, a critical component of a safe LC, is applied and validated in a large cohort of LC patients. A prospective database was created for data capture along with a Standard Operating Procedure, both designed with the goal of expanding the intervention and database nationally. The studies reported in this thesis make a substantial contribution to the literature and will have a beneficial impact on patient care in two important ways. Firstly, the management of BDI in South Africa is described and a treatment algorithm for resource-constrained environments is proposed, based on local experience. Secondly, a change of practice was implemented and a LC database was established with the possibility of expanding the effort to the national level. Locally, the change in practice has thus far resulted in identification of areas of improvement to limit BDI and increased knowledge about the appropriate steps to take to avoid causing a LC-BDI.
45

Drug eluting hydrogels design, synthesis and evaluation

Ahrenstedt, Lage January 2012 (has links)
Hydrogels have successfully proved themselves useful for drug delivery applications and several delivery routes have been developed over the years. The particular interest in this work was to design, synthesise and evaluate in situ forming drug eluting hydrogels, which have the potential to ameliorate the healing of cardiovascular diseases.
46

The in vivo characterisation of a C-domain specific ACE inhibitor

Sharp, Sarah-Kate January 2013 (has links)
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.
47

Evaluation of new diagnostic and treatment strategies in the management of the Zollinger-Ellison syndrome

Radebold, 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.
48

Global surgery - socioeconomic and geographic maldistribution of surgical resources

Dell, Angela June January 2016 (has links)
Surgery is an indispensable part of any health system and improving access to safe surgery remains a challenge in the developing world. Surgery is emerging as a priority in global health, unfortunately information around the burden of surgical diseases or the available surgical resources is limited. South Africa is an Upper Middle Income Country (UMIC) and currently provides reasonable surgical services, however these services vary across regions, between urban and rural settings, as well as between public and private hospitals. There is no reliable data regarding the available surgical resources in South Africa, namely surgical beds, operating theatres and surgeons. These variables are essential in developing a National Surgical Plan to address the burden of surgical disease, however they are limited in the information they provide they provide regarding surgical capacity and need to be assessed in context with more robust indicators. This aim of this study was to quantify some of the specific surgical resources as identified by the World Health Organization (WHO) and the Lancet Commission. This research will contribute to the growing body of research regarding global surgery in South Africa and attempt to provide an analysis of metrics used to evaluate surgical systems. The research hypothesis was that the surgical resources in South Africa were limited, and that surgeons, theatres and hospital beds per capita are inadequate compared to developed countries and do not meet global recommendations. This involved a descriptive analysis of surgical resources and included the total number of hospitals, of hospital beds, the number of surgical beds, the number of general surgeons (specialist and non-specialist), and the number of functional operating theatres in South Africa. The surgical resources were analysed, both according to province and district, and a comparison was performed based on the population density. A comparison of the public and private facilities was undertaken with regard to the total numbers, as well as per population density. Lastly, a comparison was performed with other high and low income countries around the world. The results showed one hospital per 100 000 population, 186.64 hospital beds, 41.55 surgical beds, 1.78 specialist general surgeons, 2.90 non-specialist general surgeons, and 3.59 operating theatres per 100 000 people in South Africa. These numbers fell far below international recommendations, as well as developed countries such as the United Kingdom (UK) and United States of America (USA). Surgical resources were concentrated in metropolitan areas, and there were differences between the public and private sectors, with private hospitals having a greater number of surgical beds and operating theatres per population than public hospitals. These data indicated how surgical providers and basic infrastructure were distributed in South Africa, which will allow more accurate planning by government policymakers. Recommendations need to be tailored according to each sector as the needs of the patients and resources available are different. There is a need to acknowledge the major shortage of healthcare providers with implementation of the National Health Insurance (NHI). There is a need for validated instruments to accurately collect data and for reliable electronic information sharing which will improve data collection and analysis between rural and urban areas. Existing resources need to be utilized more effectively. These results showed that regional hospitals lack both specialist and non-specialist general surgeons. The international consensus was that performing surgery at district level hospitals improved access and lowered cost, however this will need recruitment of additional skilled personnel and infrastructure in order to support surgery at this level. This national audit has provided much needed data on the some of the available surgical resources may influence critical decision-making about funding distribution, resource and training post allocations, as well as address inequalities in service delivery.
49

The biochemical analysis of mucus and mucins in respiratory diseases with a focus on tuberculosis

Mofokeng, Henrietta Refiloe January 2016 (has links)
Respiratory diseases are a major cause of death in South Africa, with TB being one of the major respiratory illnesses. The respiratory tract is lined by a layer of mucus which protects the airways and lungs against injury by foreign agents. The main constituents of this layer of mucus are mucins. MUC5AC and MUC5B are the predominant respiratory tract mucins. However, little is known of the association between respiratory mucins and TB. This study aimed at describing the types and role of respiratory mucins in TB. Fifty six sputum samples, 17 tracheal aspirates and 95 bronchoalveolar lavages (BALs) were collected in 6M guanidinium hydrochloride and inhibitors. The airway mucus was divided into TB and non-TB groups. Mucins were reduced and alkylated with DTT and iodoacetamide and purified by density gradient ultracentrifugation in caesium chloride. Identification of MUC5AC, MUC5B, MUC2 and MUC7 were determined by western blotting and confirmed by immunohistochemistry. Western blot data proved the dominance of MUC5AC and MUC5B mucins in airway mucus. In comparison to the non-TB group, a higher secretion of MUC5AC than MUC5B in patients with TB was observed. MUC5AC also showed distinct behavioural characteristics in its fractionation in a caesium gradient compared to MUC5B. The presence of MUC5AC and MUC5B in different fractions suggests varying glycosylation of the mucin. Varying populations of MUC5B were observed in sputa with 3 new glycoforms shown in TB. A small group of TB patients had MUC7 in the sputa (and not in the lavage) and there were varying amounts of MUC2 in some TB samples and non-TB mucus. At tissue level, MUC5B was found to be the main secreted gel-forming mucin. MUC5B and MUC7 were found to play a role in the protection again infection by Mycobacterium tuberculosis in tuberculous granulomas. Using proteomics it was demonstrated that respiratory mucus protein expression differs in, tracheal aspirates, BALs and sputa. Although inter-individual variations were observed in all samples, similar proteins were expressed in relation to the functioning of the lung. O-glycan analysis showed that the majority of the O-glycans detected were sialylated and that core 3 and 4 O-glycan structures diminished in the presence of HIV.
50

Improvement of liver transplantation by reducing preservation-reperfusion injury

van As, Arjan Bastiaan January 1999 (has links)
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.

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