South African Journal of Surgery最新文献_第9页

HIV associated malignancies presenting as acute pancreatitis: a case series. 表现为急性胰腺炎的艾滋病相关恶性肿瘤：病例系列。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-11-01 Epub Date: 2023-10-25 DOI: 10.36303/SAJS.3511

F Madela, F Anderson, G B Nhlonzi, S R Thomson

{"title":"HIV associated malignancies presenting as acute pancreatitis: a case series.","authors":"F Madela, F Anderson, G B Nhlonzi, S R Thomson","doi":"10.36303/SAJS.3511","DOIUrl":"10.36303/SAJS.3511","url":null,"abstract":"Background: Acute pancreatitis (AP) may be the presenting symptom in a small percentage of patients harbouring pancreatic or extra pancreatic tumours. This case series aims to describe the pathological spectrum of tumours detected in two AP cohorts from a high HIV-endemic region.Methods: Prospectively collected databases of patients admitted with AP over two periods 2001 to 2010 and 2013 to 2015, were retrospectively evaluated to detect those with pancreatic and extra-pancreatic tumours. The diagnosis of AP was by standard criteria. HIV infection and CD4 counts were routinely tested for in the latter period and only tested on clinical grounds in the initial period. CT scan was performed when there was diagnostic doubt, predicted severe disease, and failure to improve clinically after one week. Demographic, clinical, investigative, and pathology details were collected and presented.Results: HIV-positive patients admitted with AP were 106 (17%) of 628 in the first period and 90 (38%) of 238 of the second period. No tumours were diagnosed in the HIV-negative patients. Seven of the HIV-positive patients had tumours diagnosed at endoscopy, CT scan, and endoscopic retrograde cholangiography. Of the seven HIV-positive patients with tumours, two patients had a CD4 count above 200. There were four patients with lymphoma involving the pancreatic head, three having associated cholestasis, and three patients with Kaposi's Sarcoma. One Kaposi's sarcoma patient died three months after presentation. One patient with lymphoma died on day 14 and another two months after initial presentation, and the remaining four patients were referred to oncology.Conclusion: Despite their rarity (< 4%), when HIV-positive patients with low CD4 count and cholestasis present with AP,tumours should be suspected and evaluated by cross sectional imaging and endoscopic ultrasound.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transverse colon volvulus - a case report and literature review. 横结肠扭转1例报告并文献复习。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-10-25 DOI: 10.36303/SAJS.4069

L Niksch, M Lockwood, P L van Rooyen, N A Niksch, L Lorentz

引用次数: 0

HIV associated malignancies presenting as acute pancreatitis: a case series. HIV相关恶性肿瘤表现为急性胰腺炎:一个病例系列。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-10-25 DOI: 10.36303/SAJS.3511

F Madela, F Anderson, G B Nhlonzi, S R Thomson

{"title":"HIV associated malignancies presenting as acute pancreatitis: a case series.","authors":"F Madela, F Anderson, G B Nhlonzi, S R Thomson","doi":"10.36303/SAJS.3511","DOIUrl":"https://doi.org/10.36303/SAJS.3511","url":null,"abstract":"Background: Acute pancreatitis (AP) may be the presenting symptom in a small percentage of patients harbouring pancreatic or extra pancreatic tumours. This case series aims to describe the pathological spectrum of tumours detected in two AP cohorts from a high HIV-endemic region.Methods: Prospectively collected databases of patients admitted with AP over two periods 2001 to 2010 and 2013 to 2015, were retrospectively evaluated to detect those with pancreatic and extra-pancreatic tumours. The diagnosis of AP was by standard criteria. HIV infection and CD4 counts were routinely tested for in the latter period and only tested on clinical grounds in the initial period. CT scan was performed when there was diagnostic doubt, predicted severe disease, and failure to improve clinically after one week. Demographic, clinical, investigative, and pathology details were collected and presented.Results: HIV-positive patients admitted with AP were 106 (17%) of 628 in the first period and 90 (38%) of 238 of the second period. No tumours were diagnosed in the HIV-negative patients. Seven of the HIV-positive patients had tumours diagnosed at endoscopy, CT scan, and endoscopic retrograde cholangiography. Of the seven HIV-positive patients with tumours, two patients had a CD4 count above 200. There were four patients with lymphoma involving the pancreatic head, three having associated cholestasis, and three patients with Kaposi's Sarcoma. One Kaposi's sarcoma patient died three months after presentation. One patient with lymphoma died on day 14 and another two months after initial presentation, and the remaining four patients were referred to oncology.Conclusion: Despite their rarity (< 4%), when HIV-positive patients with low CD4 count and cholestasis present with AP, tumours should be suspected and evaluated by cross sectional imaging and endoscopic ultrasound.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes of complex burn injury patients managed at two primary and one tertiary level burns facilities in the Western Cape province of South Africa - a retrospective review. 在南非西开普省的两个初级和一个三级烧伤设施管理的复杂烧伤患者的结果-回顾性回顾。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-10-25 DOI: 10.36303/SAJS.4061

S W Carolissen, W Kleintjes, F Gool, S Gilbert

{"title":"Outcomes of complex burn injury patients managed at two primary and one tertiary level burns facilities in the Western Cape province of South Africa - a retrospective review.","authors":"S W Carolissen, W Kleintjes, F Gool, S Gilbert","doi":"10.36303/SAJS.4061","DOIUrl":"https://doi.org/10.36303/SAJS.4061","url":null,"abstract":"Background: This study aimed to compare factors contributing to a positive outcome of adult burn injury patients managed at two primary and one tertiary level Western Cape hospitals. These patients from the primary hospitals (PLHs) met the referral criteria for specialised care at the Tygerberg Hospital burns unit (TBU) but were not accepted or were accepted late.Methods: A total of 1034 adult burn injury patients seen at two primary level (\"A\" and \"B\") hospitals and the TBU between 2016 and 2019 were retrospectively analysed. One hundred and eleven (111) primary level patients (\"A\" 71, \"B\" 40) met the criteria for referral to the TBU. The outcomes and factors contributing to positive outcome of these patients were compared with the 859 patients treated at the TBU during the same period.Results: Patients treated at the TBU showed longer theatre waiting times, more operations, and higher complication and death rates than their primary level counterparts. The PLHs showed no factors significantly contributing to hospital discharge. At TBU, pregnancy status, younger age, hot water burns, lower abbreviated burns severity index (ABSI) score, and longer time to theatre were associated with hospital discharge. A shortage of beds was the main reason for denial of admission to the TBU.Conclusion: The PLHs showed good outcomes in managing severe burn injuries, although no significant contributors to a positive outcome were identified. Patient- and facility-related factors contributed to positive outcomes at the TBU. Upgrading both the Western Cape's primary level capabilities and the TBU's accessibility and efficiency are necessary to improve burns services.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Successful management of a thoracoabdominal impalement injury. 胸腹穿刺伤的成功治疗。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-10-25 DOI: 10.36303/SAJS.4088

A J Philip, D V Sneha, N Theckumparampil, S Jagdish

{"title":"Successful management of a thoracoabdominal impalement injury.","authors":"A J Philip, D V Sneha, N Theckumparampil, S Jagdish","doi":"10.36303/SAJS.4088","DOIUrl":"https://doi.org/10.36303/SAJS.4088","url":null,"abstract":"A 63-year-old female presented to the hospital with a history of alleged accidental fall onto a rusted iron rod. She was hypotensive but stable. Cooling of the rod while cutting the protruding part was performed as per basic trauma life support (BTLS) access. Following resuscitation, she was re-evaluated clinically and radiologically, and prepared for surgery. The iron rod trajectory was shown on computed tomography (CT) scan to be entering through the left popliteal fossa, then traversing the abdominal cavity with injury to the descending colon and the left dome of the diaphragm. At laparotomy the iron rod was removed under vision. The laceration to the left dome of the diaphragm was repaired. The perforation of the descending colon was identified and repaired. Colostomy was deferred as there was no peritoneal contamination. The penetrating thigh wound was debrided. Her recovery was uneventful. She was discharged on postoperative day 15. She came for follow-up as out-patient after 3 weeks and the thigh wound had healed. Impalement injuries are rare and often severe. Most impalement injuries require a multidisciplinary approach. Adequate early resuscitation, proper evaluation and early surgical management is ideal. Immediate stabilisation of the foreign body from the time of encounter is essential. Removal under anaesthesia is mandatory.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50159218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors influencing outcome in patients with perforated peptic ulcer disease at a South African tertiary hospital. 南非一家三级医院消化性溃疡穿孔患者预后的影响因素。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-10-17 DOI: 10.36303/SAJS.4005

J J Nanack, L Ferndale

{"title":"Factors influencing outcome in patients with perforated peptic ulcer disease at a South African tertiary hospital.","authors":"J J Nanack, L Ferndale","doi":"10.36303/SAJS.4005","DOIUrl":"https://doi.org/10.36303/SAJS.4005","url":null,"abstract":"Background: Perforated peptic ulcer (PPU) is associated with significant morbidity and mortality, particularly in low to middle income countries. This study aimed to scrutinise the clinical course of patients diagnosed with PPU and identify modifiable factors to improve outcomes.Methods: A retrospective review of the hybrid electronic medical record (HEMR) database at Grey's Hospital was performed. All patients diagnosed with PPU between January 2013 and December 2020 were entered into the study. The variables collected include age, ethnicity, comorbid profile, Boey score, type of surgery performed and complications. These factors were analysed to determine the factors responsible for morbidity and mortality.Results: One hundred and ninety four patients were diagnosed with PPU during the study period. Six patients were treated non-operatively, all of whom survived. In the surgically treated group, omental patch repair was performed in 159 (84.5%) patients, and primary closure in 26 (13.8%) patients. The leak rate was 32% in the cohort that underwent relaparotomy and the overall mortality was 14%. There was no significant relationship between the type of repair performed and outcome. All patients had a Boey score of 1 or more. The following factors were found to increase the probability of in-hospital mortality: age > 40 years (OR: 8.49, 95% CI 2.46-29.29 p < 0.01), female gender (OR: 2.509, CI 0.98-6.37, p = 0.048), need for relaparotomy (OR: 0.398, CI 0.17-0.91, p = 0.027) and Boey score > 1 (OR: 46.437, CI 6.13-350.28, p < 0.01). A Boey score > 1 was the only variable that increased the likelihood of finding a leaking repair at relaparotomy (p < 0.01).Conclusion: The Boey score was a significant predictor of mortality and leak rate in our patients with PPU. Adding age as a variable may improve the ability to predict mortality in our setting, while the impact of gender and ethnicity needs further investigation.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Small bowel metastasis from embryonal rhabdomyosarcoma of the extremity- a case report. 胚胎性四肢横纹肌肉瘤小肠转移1例报告。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-10-17 DOI: 10.36303/SAJS.4120

P Joubert, M Mihalik

引用次数: 0

The impact of the COVID-19 pandemic on presentation of surgical disease in paediatric patients at a tertiary centre in Cape Town, South Africa. 新冠肺炎大流行对南非开普敦一家三级中心儿科患者外科疾病表现的影响。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-10-17 DOI: 10.36303/SAJS.4060

C Kohler, B Banieghbal

{"title":"The impact of the COVID-19 pandemic on presentation of surgical disease in paediatric patients at a tertiary centre in Cape Town, South Africa.","authors":"C Kohler, B Banieghbal","doi":"10.36303/SAJS.4060","DOIUrl":"https://doi.org/10.36303/SAJS.4060","url":null,"abstract":"Background: Children are less susceptible to infection with SARS-CoV-2 and subsequent severe disease, yet especially vulnerable to the indirect effects of the pandemic. A constrained healthcare service, combined with the societal and behavioural changes observed during the pandemic, is likely to have altered the presentation of paediatric surgical disease. The objective was to investigate the impact of the COVID-19 pandemic on the volume of paediatric surgical admissions, the severity of disease and the type of surgical pathology treated at our centre.Methods: A retrospective cohort study compared paediatric surgical admissions in an eleven-month period before COVID-19 to the same period during the pandemic. Comparisons in volume and diagnoses were based on the number of admissions. Predetermined criteria for severity of disease using triage scores, intraoperative findings and intensive care admissions were compared.Results: A total of 1 810 admissions were recorded, 1061 in the pre-COVID group and 749 during COVID. Emergency admissions reduced by 9.2%, most notably due to a reduction in trauma, caustic ingestions and constipation. There was an increase in incarcerated inguinal hernias and helminth-related pathologies. Significantly more intussusceptions failed pneumatic reduction requiring surgical intervention with bowel resection. There was a two-fold increase in patients requiring emergency intensive care.Conclusion: Paediatric surgical volumes at our centre decreased during the COVID-19 pandemic. There was evidence of more advanced disease on presentation of inguinal hernias and intussusception and a generalised increased demand for emergency ICU admission.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41240747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Geographic distribution of pancreaticobiliary malignancy in central South Africa presenting to the Universitas Academic Hospital Complex. 南非中部的胰胆管恶性肿瘤的地理分布向Universitas Academic Hospital Complex展示。

IF 0.5 4区医学

South African Journal of Surgery Pub Date : 2023-09-01

R J Mthunzi, C B Noel

{"title":"Geographic distribution of pancreaticobiliary malignancy in central South Africa presenting to the Universitas Academic Hospital Complex.","authors":"R J Mthunzi, C B Noel","doi":"","DOIUrl":"","url":null,"abstract":"Background: There is limited data on the epidemiology, determination of risk factors and geographical variation of pancreatic cancer in South Africa. The aim of this study is to describe these parameters within central South Africa and compare to national and international reports.Methods: A retrospective review of all patients with newly diagnosed pancreatic cancer on clinical and radiological grounds admitted to Universitas Academic Hospital from 1st January 2015 to 31st December 2019 was performed. Patients were grouped into geographical regions based on their district municipality to identify clusters of pancreatic cancer. Demographic information and details of family history, diabetes and smoking status, and chronic pancreatitis were recorded and analysed in conjuction with the geographical and census data to provided estimates of disease incidence.Results: The mean age of the the 382 patients with pancreatic cancer in the study period was 62.8 years ± 11.06. Two hundred and twelve (55.5%) were females. The Frances Baard district in the Northern Cape had the highest estimated rate of 3.5/100 000 and the Thabo Mofutsanyana district the lowest at 1.0/100 000. Of the cohort 132 (34.5%) were active smokers, 71 (18.6%) had diabetes mellitus, four (1%) had a history of chronic pancreatitis and two (0.5%) had a family history of pancreatic cancer.Conclusion: The incidence of pancreatic cancer in central South Africa is higher than that reported nationally with a female gender bias, marked regional variation and lack of a family history. These observations merit further evalualtion in the South African context.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41173418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Concordance of fine needle aspiration cytology and final histology of salivary gland tumours 涎腺肿瘤细针穿刺细胞学与最终组织学的一致性

4区医学

South African Journal of Surgery Pub Date : 2023-09-01 DOI: 10.36303/sajs.4039

F R Ndotora, B S Jackson

{"title":"Concordance of fine needle aspiration cytology and final histology of salivary gland tumours","authors":"F R Ndotora, B S Jackson","doi":"10.36303/sajs.4039","DOIUrl":"https://doi.org/10.36303/sajs.4039","url":null,"abstract":"Fine needle aspiration cytology (FNAC) is a widely used diagnostic tool to evaluate salivary gland tumours. The Milan system for reporting salivary gland cytopathology allows for standardisation and facilitates cytologicalhistological correlation. However, FNAC findings can still pose a diagnostic challenge. The accuracy of FNAC should be assessed at each centre. The aim of this study was to assess the concordance of FNAC and final histology of salivary gland tumours in three academic hospitals affiliated with the University of Pretoria, South Africa.The study was a cross-sectional retrospective analytical study of 214 patients who underwent an operation for salivary gland tumours. All patients with FNAC and histology results between 2007-2017 were included. Patients were recruited from three University of Pretoria, South Africa, affiliated hospitals: Steve Biko Academic, Kalafong Provincial Tertiary and Tembisa Provincial Tertiary Hospital.Of the 214 patients with salivary gland tumours, the majority were located in the parotid gland (56.1%). Pleomorphic adenoma was the most common tumour (62.6%). The FNAC sensitivity, specificity and diagnostic accuracy (receiver operating characteristic) were 92.7%, 98.1% and 0.95 respectively. The concordance between salivary gland tumour FNAC and final histology was 96.95% with a Cohen's kappa coefficient of 0.91 (p= 0.0001).There is strong concordance between FNAC and histology of salivary gland tumours. FNAC is an accurate, minimally invasive diagnostic tool with high sensitivity and specificity. It provides the clinician with a reliable preoperative diagnosis determining whether the salivary gland tumour is benign or malignant.","PeriodicalId":51161,"journal":{"name":"South African Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135640023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0