http://scholar.sun.ac.za:80/handle/10019.1/178 2017-07-14T10:17:51Z http://scholar.sun.ac.za:80/handle/10019.1/101506 Serum lipase should be the laboratory test of choice for suspected acute pancreatitis Hofmeyr, Stefan; Meyer, Carel; Warren, Brian L. Background. Serum lipase and amylase are biochemical analyses used to establish the diagnosis of acute pancreatitis (AP). Despite lipase having been shown internationally to be a more sensitive and specific test, amylase remains a popular first-line test. Objective. To provide a local basis for the recommendation of the best first-line laboratory test, an assessment of their performance in our local setting was undertaken. Methods. From a prospective dataset on patients with acute abdominal pain and raised serum lipase and/or amylase values, the sensitivity and specificity of serum lipase, amylase and the two in combination was calculated for the diagnosis of AP, as defined by the Atlanta criteria. Results. During the study period, 476 patients presented with acute upper or generalised abdominal pain and raised serum amylase and/or lipase values. The median age of the patients was 43 years (range 14 - 85), and 58% were men and 42% women. Of the patients, 322 (68%) presented with abdominal conditions other than AP, and 154 (32%) had AP. Ethanol abuse and gallstones accounted for 55% and 23% of cases of AP, respectively. Lipase displayed a sensitivity of 91% for AP, against 62% for amylase. Specificity was 92% for lipase and 93% for amylase. Dual testing with lipase and amylase had a sensitivity of 93%. Conclusions. Lipase is a more sensitive test than amylase when utilising cut-off levels to diagnose AP. Lipase should replace amylase as the first-line laboratory investigation for suspected AP. CITATION: Hofmeyr, S., Meyer, C. & Warren, B. L. 2014. Serum lipase should be the laboratory test of choice for suspected acute pancreatitis. South African Journal of Surgery, 52(3):72-75, doi:10.7196/SAJS.2003.; The original publication is available at http://sajs.redbricklibrary.com/index.php/sajs 2014-08-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/100631 Polymerase chain reaction to search for Herpes viruses in uveitic and healthy eyes : a South African perspective Laaks, Debbie; Smit, Derrick Peter; Harvey, Justin Objective: To analyse aqueous polymerase chain reaction (PCR) results in patients diagnosed with undifferentiated uveitis and determine prevalence of herpesviridae in non-uveitic patients undergoing routine cataract extraction. Design: Retrospective comparative case series and prospective cross-sectional study. Subjects: 72 patients with idiopathic uveitis and 57 surgical patients. Methods: Diagnostic aqueous paracentesis with PCR testing for 6 herpes viridae in uveitic patients. Anterior chamber paracentesis immediately pre-operative in the prospective arm, with PCR testing. Results: In the retrospective review we had a 47.2% positive PCR yield. Data analysis revealed a statistically significant correlation between a positive yield and being HIV+ (p=0.018); between an EBV+ yield and being HIV+ (p= 0.026) and a CMV+ result and being HIV+ (p=0.032). Posterior uveitis (p=0.014) and symptoms <30 days (p= 0.0014) had a statistically significant yield. In the prospective arm of the study: all 57 patients were HIV- and all aqueous samples were negative for the 6 herpesviridae. Conclusion: We recommend PCR testing for Herpesviridae as a safe second line test for patients with undifferentiated uveitis. We were unable to establish prevalence and suggest that the idea of a commensal herpes virus is unlikely if the blood-ocular barrier is intact CITATION: Laaks, D., Smit, D. P. & Harvey, J. Polymerase chain reaction to search for Herpes viruses in uveitic and healthy eyes : a South African perspective. African health sciences, 15(3):748–754, doi:10.4314/ahs.v15i3.7.; The original publication is available at http://www.ajol.info/ 2015-01-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/99458 Instrumentation of the paediatric cervical spine Dunn, R. N.; Botha, A. H. BACKGROUND: Paediatric cervical fusion surgery is challenging. Traditional techniques such as external stabilisation, onlay fusions and wiring techniques resulted in unsatisfactory outcomes due to inferior biomechanical stability. METHODS: A retrospective review was performed of paediatric patients who underwent instrumented cervical fusion surgery under 16 years of age. Fusion rates, blood loss, levels fused, theatre time, technique and complications were assessed. RESULTS: An average of 2.5 levels was fused, with an estimated blood loss of 428 ml and surgical duration of 159 min. Anterior procedures had an average of one level fused with blood loss of 117 ml and surgical duration of 98 min. Posterior procedures had an average number of 1.9 levels fused, blood loss of 306 ml and surgical time of 131 min. Combined procedures had an average of 5.5 levels fused, blood loss 810 ml and surgical duration of 241 min. Four surgery-related complications were encountered. These consisted of dural leaks and wound sepsis which were all treated effectively. All patients achieved radiological fusion. CONCLUSION: The use of modern segmental spinal instrumentation in the paediatric cervical spine is a viable option. Although the study sample was small we are able to demonstrate that no major surgical complications were encountered due to the use of adult cervical spinal instrumentation techniques in the paediatric group.; AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar CITATION: Dunn, R. N. & Botha, A. H. 2014. Instrumentation of the paediatric cervical spine. South African Orthopaedic Journal, 13(1):44-49.; The original publication is available at http://www.scielo.org.za 2014-01-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/99457 Mycobacterium fortuitum as infectious agent in a septic total knee replacement : case study and literature review Venter, R. G.; Solomon, C.; Baartman, M. Infection of prosthetic joints with non-tuberculous mycobacteria (NTM) is rare. The rapidly growing mycobacteria (RGM) are a subgroup of NTM. They are not very virulent organisms, found ubiquitously in the environment, and most infections in humans are due to direct inoculation of the organism into a joint or soft tissue. We describe a 70-year-old patient, who developed an infection with Mycobacterium fortuitum after primary knee arthroplasty, one of only a handful described in the literature. Peri-prosthetic infections with RGM are a challenge because there is a lack of data guiding management, and because the diagnosis is often delayed. Routine cultures of joint effusions or tissue are often discarded before the non-tuberculous mycobacteria have a chance to culture (in our case, 14 days). Principles of treatment include: making a diagnosis from tissue culture, staged revision surgery with aggressive surgical debridement of the joint and high dosages antibiotics (for at least six weeks, treating empirically initially until a sensitivity profile for the organism is available). The second stage of the revision should be delayed by 3-6 months. In our case the removed implant was autoclaved and re-implanted loosely with antibiotic-loaded cement as part of the first-stage revision.; AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar CITATION: Venter, R. G., Solomon, C. & Baartman, M. 2015. Mycobacterium fortuitum as infectious agent in a septic total knee replacement : case study and literature review. South African Orthopaedic Journal, 14(2):52-56, doi:10.17159/2309-8309.; The original publication is available at http://www.scielo.org.za 2015-01-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/99355 The South African Surgical Outcomes Study : a 7-day prospective observational cohort study Biccard, Bruce Mark; Madiba, Thandinkosi E. Background. Non-cardiac surgical morbidity and mortality is a major global public health burden. Sub-Saharan African perioperative outcome data are scarce. South Africa (SA) faces a unique public health challenge, engulfed as it is by four simultaneous epidemics: (i) poverty-related diseases; (ii) non-communicable diseases; (iii) HIV and related diseases; and (iv) injury and violence. Understanding the effects of these epidemics on perioperative outcomes may provide an important perspective on the surgical health of the country. Objectives. To investigate the perioperative mortality and need for critical care admission in patients undergoing inpatient non-cardiac surgery in SA. Methods. A 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient noncardiac surgery between 19 and 26 May 2014 at 50 public sector, government-funded hospitals in SA. Results. The study included 3 927/4 021 eligible patients (97.7%) recruited, with 45/50 hospitals (90.0%) submitting data that described all eligible patients. Crude in-hospital mortality was 123/3 927 (3.1%; 95% confidence interval (CI) 2.6 - 3.7). The rate of postoperative admission to critical care units was 255/3 927 (6.5%; 95% CI 5.7 - 7.3), with 43.5% of admissions being unplanned. Of the surgical procedures 2 120/3 915 (54.2%) were urgent or emergency ones, with a population-attributable risk for mortality of 25.5% (95% CI 5.1 - 55.8) and a risk of admission to critical care of 23.7% (95% CI 4.7 - 51.4). Conclusions. Most patients in SA’s public sector hospitals undergo urgent and emergency surgery, which is strongly associated with mortality and unplanned critical care admissions. Non-communicable diseases have a larger proportional contribution to mortality than infections and injuries. However, the most common comorbidity, HIV infection, was not associated with in-hospital mortality. The study was registered on ClinicalTrials.gov (NCT02141867).; AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar CITATION: Biccard, B. M. & Madiba, T. E. 2015. The South African Surgical Outcomes Study : a 7-day prospective observational cohort study. South African Medical Journal, 105(6):465-475, doi:10.7196/SAMJ.9435.; The original publication is available at http://www.samj.org.za 2015-01-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/98204 Retroperitoneoscopic live donor nephrectomy : review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa Van der Merwe, A.; Heyns, C. F. Background. Changing from an open to a laparoscopic live renal donor programme poses challenges and may affect donor and graft outcomes. Objectives. To evaluate donor safety and graft outcomes for the first 50 retroperitoneoscopic live donor nephrectomies performed at Tygerberg Hospital, Cape Town, South Africa. Methods. The procedures were performed by a single surgeon from 8 April 2008 to 3 April 2012. Operative and anatomical data were prospectively collected. A flank approach with lateral and posterior placements was used. Vascular control was achieved with Hem-o-lok clips in the majority of cases. Results. The mean age of the donors was 31.5 years (range 18 - 50), 28 (56.0%) were male, and the left kidney was harvested in 28 (56.0%) of cases. The mean operating time was 149.8 minutes (range 75 - 250), mean warm ischaemic time (WIT) 181.3 seconds (107 - 630), mean blood loss 139.7 ml (5 - 700) and mean hospital stay 3.2 days (2 - 5). Mean WIT was significantly longer for right-sided than left-sided nephrectomy (213 v. 162 seconds). In two right-sided cases the renal vein was too short and vena profunda femoris was used to create length. No donor received a blood transfusion. Comparing the last 25 with the first 25 cases showed a significant decrease in mean WIT (158 v. 204 seconds, respectively) and operating time (128 v. 172 minutes, respectively). No major complications occurred. Conclusion. Our initial 50 retroperitoneoscopic live donor nephrectomies were performed without major complications. Donor safety was maintained during the early learning curve of the transition to minimal-access donor nephrectomy. CITATION: Van der Merwe, A. & Heyns, C. F. 2014. Retroperitoneoscopic live donor nephrectomy: review of the first 50 cases at Tygerberg Hospital, Cape Town, South Africa. South African Journal of Surgery, 52(2):53-56, doi:10.7196/sajs.2080.; The original publication is available at http://www.sajs.org.za 2014-06-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/98163 Evaluation of the visual prostate symptom score in a male population with great language diversity and limited education : a study from Namibia Heyns, C. F.; Steenkamp, B. A.; Chiswo, J.; Stellmacher, G. A.; Fortsch, H.E. A.; Van der Merwe, A. Background. A visual prostate symptom score (VPSS) using pictograms was developed to assess the force of the urinary stream, urinary frequency, nocturia and quality of life (QoL). Objective. To compare the VPSS with the international prostate symptom score (IPSS) and maximum (Qmax) and average (Qave) urinary flow rates in men from diverse language groups with limited schooling. Methods. Men with lower urinary tract symptoms admitted to the urology ward at Windhoek Central Hospital, Namibia, were evaluated. Patients who were unable to complete the questionnaires alone were assisted by a doctor or nurse. Local ethics committee approval was obtained. Statistical analysis was performed using Student’s t-test and Spearman’s rank correlation test. Results. One hundred men (mean age 56.3 years, range 20.1 - 95.4) were evaluated over a period of one year. All the men understood one or more of 15 languages, and 30 were illiterate; 32 had <5 years of schooling, 34 had 5 - 9 years and 34 had >9 years. The VPSS took significantly less time to complete than the IPSS. There were statistically significant correlations between the total VPSS and IPSS scores, between the four VPSS questions and the corresponding IPSS questions, and between Qmax and Qave and the VPSS total and VPSS questions on the force of the urinary stream and QoL. Conclusion. The VPSS pictograms depicting the force of the urinary stream and QoL correlated significantly with Qmax and Qave, indicating that they can be used as single-item questions to rapidly assess bladder outflow obstruction in men with limited education. CITATION: Heyns, C. F. et al. 2014. Evaluation of the visual prostate symptom score in a male population with great language diversity and limited education: a study from Namibia. South African Medical Journal, 104(5):353-357, doi:10.7196/SAMJ.7917.; The original publication is available at http://www.samj.org.za 2014-05-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/98155 Towards early detection of retinoblastoma Freeman, Nicola; Meyer, David Survival rates for retinoblastoma (RB) in a region of South Africa (SA) of only 50% reflect the high frequency of late presentation, the simple reason for which is lack of effective screening. Early detection of suspected RB would significantly reduce this unacceptably high mortality rate. The SA health system has the expertise to manage a child with RB well. The issue at stake is timely referral of the affected child to one of the specialist treatment centres. Until universal screening with digital imaging becomes a reality, the red reflex test should be mandatory at discharge from all neonatal services and at all subsequent routine health supervision visits. Most RBs would then be detected early. CITATION: Freeman, N. & Meyer, D. 2014. Towards early detection of retinoblastoma. South African Medical Journal, 104(12):856, doi:10.7196/SAMJ.8741.; The original publication is available at http://www.samj.org.za 2014-12-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/98152 Predicting outcome in severe traumatic brain injury using a simple prognostic model Sobuwa, S.; Hartzenberg, H. B.; Geduld, H.; Uys, C. Background. Several studies have made it possible to predict outcome in severe traumatic brain injury (TBI) making it beneficial as an aid for clinical decision-making in the emergency setting. However, reliable predictive models are lacking for resource-limited prehospital settings such as those in developing countries like South Africa. Objective. To develop a simple predictive model for severe TBI using clinical variables in a South African prehospital setting. Methods. All consecutive patients admitted at two level-one centres in Cape Town, South Africa, for severe TBI were included. A binary logistic regression model was used, which included three predictor variables: oxygen saturation (SpO2), Glasgow Coma Scale (GCS) and pupil reactivity. The Glasgow Outcome Scale was used to assess outcome on hospital discharge. Results. A total of 74.4% of the outcomes were correctly predicted by the logistic regression model. The model demonstrated SpO2 (p=0.019), GCS (p=0.001) and pupil reactivity (p=0.002) as independently significant predictors of outcome in severe TBI. Odds ratios of a good outcome were 3.148 (SpO2 ≥90%), 5.108 (GCS 6 - 8) and 4.405 (pupils bilaterally reactive). Conclusion. This model is potentially useful for effective predictions of outcome in severe TBI. CITATION: Sobuwa, S., Hartzenberg, H. B., Geduld, H. & Uys, C. 2014. Predicting outcome in severe traumatic brain injury using a simple prognostic model. South African Medical Journal, 104(7):492-494, doi:10.7196/SAMJ.7720.; The original publication is available at http://samj.org.za 2014-07-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/97851 Modified total cranial vault remodeling technique for scaphocephaly repair Altaib, Mohamed Giuma ENGLSIH ABSTRACT: Introduction: Sagittal synostosis or scaphocephaly is the most common isolated single-suture synostosis that accounts for 40% to 60% of all craniosynostosis cases which affects 1 out of 2000 live births. The craniofacial unit at Tygerberg Academic Hospital modified the technique of total vault remodeling by lag screw fixation of onlay bone segments in the temperoparietal region to: a) improve the stability of the reconstruction; b) to increase the biparietal distance; c) to reduce operation time; and lastly d) to avoid secondary procedures for the removal of titanium plates. The aim of this study was to evaluate the surgical outcomes of the modified total cranial vault remodeling procedure for the management of sagittal synostosis. Method: A retrospective study was employed to investigate the surgical outcomes of the modified total cranial vault remodeling technique for non-syndromic scaphocephaly repair by use of medical records of eight pediatric patients operated over thirty-two months from October 2011 to May 2014. The sample comprised three boys and five girls with an age range of 4 months to 5 years and 7 months. The head circumference was measured pre- and post-operatively and the parents’ satisfaction recorded. The surgical duration of the modified procedure and the patients’ blood transfusion volume was compared to the unit’s traditional approach. Results: The head circumference of all patients increased on the percentiles of the head circumference-for-age growth chart. Pre-operatively a mean of 47 cm and post-operatively a mean of 50.94 cm were measured. Parents were generally satisfied with the aesthetic outcomes of the surgery. The average volume for intraoperative blood transfusion was 230 ml compared to 763 ml for the conventional method. The average surgical time decreased from 5.5 hours with the conventional method to 3.4 hours with the modified technique. Conclusion: The modification of the cranial vault remodeling increased the head circumference, yielded good parental satisfaction, decreased the surgery time and intraoperative blood transfusion volume with complications comparable to the traditional method.; AFRIKAANSE OPSOMMING: Inleiding: Sagittale sinostose of skafosefalie is die mees algemene geïsoleerde enkel-hegting sinostose. Dit is verantwoordelik vir 40-60% van alle kraniosinostose gevalle, en beinvloed 1 uit 2000 lewende geboortes. Die kraniofasiale eenheid by Tygerberg Akademiese Hospitaal het die tegniek van die totale skedeldak hermodellering verander deur skroeffiksasie van oorvleuel been segmente in die temperoparietal streek gewysig om: a) die stabiliteit van die rekonstruksie te verbeter; b) die biparietale afstand te verhoog ; c) vermindering van operasie tydsduur en laastens, en d) die vermyding van sekondêre prosedures vir die verwydering van titanium plate. Die doel van hierdie studie was om die chirurgiese uitkomste van die gewysigde totale kraniale skedeldak hermodellering prosedure te evalueer in die hantering van sagittale sinostose. Metode: 'n Retrospektiewe studie is ingestel om die chirurgiese uitkomste van die gewysigde totale kraniale skedeldak hermodellering tegniek vir nie-sindromiese skafosefalie herstel te ondersoek deur die gebruik van mediese rekords van agt pediatriese pasiënte. Hierdie pasiente is geopereer oor ʼn tydperk van 32 maande vanaf Oktober 2011 tot Mei 2014. Die studie bestaan uit drie seuns en vyf meisies met 'n ouderdomsvariasie van 4 -67 maande. Die kopomtrek is pre en postoperatief gemeet en die ouers se tevredenheid met die prosedure was bepaal. Die duur van die chirurgiese gewysigde prosedure en bloedoortapping volume van die pasiënte is vergelyk met die tradisionele benadering. Resultate: Die kopomtrek van alle pasiënte het vermeerder op die persentiele van die kop omtrek-vir-ouderdom groeikaart. Pre-operatief is 'n gemiddeld van 47 cm en post-operatief 'n gemiddeld van 50.94 cm gemeet. Ouers was oor die algemeen tevrede met die estetiese uitkoms van die operasie. Die gemiddelde volume vir intraoperatiewe bloedoortapping was 230 ml in vergelyking met 763 ml vir die konvensionele metode. Die gemiddelde chirurgiese duur het verminder vanaf 5.5 uur (die tradisionele metode) to 3,4 uur met die gewysigde tegniek. Gevolgtrekking: Die wysiging van die kraniale skedeldak hermodellering verhoog die kopomtrek. Dit lewer goeie ouerlike tevredenheid, en dit verminder die operasie tyd en intraoperatiewe bloedoortapping volume met komplikasies vergelykbaar met die tradisionele metode. Thesis (MMed)--Stellenbosch University, 2015. 2015-12-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/97674 Mammographic screening for breast cancer in a resource-restricted environment Apffelstaedt, Justus P.; Dalmayer, Lisa; Baatjes, Karin Background. Mammographic screening is carried out at public sector hospitals as part of clinical practice. Objective. We report the experience of such screening at Tygerberg Academic Hospital (TBAH), a tertiary referral hospital in the Western Cape Province, South Africa. Methods. All mammograms performed between 2003 and 2012 at TBAH were analysed regarding patient demographics, clinical data, indication and outcome according to the American College of Radiology Breast Imaging Reporting and Data System (BIRADS). Screening mammography was offered to patients >40 years of age and mammograms were read by experienced breast surgeons. Patients with BIRADS 3 and 4 lesions were recalled for short-term follow-up, further imaging or tissue acquisition. Patients with BIRADS 5 lesions were recalled for tissue acquisition. Further imaging, method of tissue acquisition, histology results and use of neo-adjuvant therapy were also recorded. Results. Of 16 105 mammograms, 3 774 (23.4%) were carried out for screening purposes. The median age of patients undergoing screening was 54 years. Of 407 women with mammograms that were reported as BIRADS 3 - 5 (10.8% of screening mammograms), 187 (46% of recalled women) went on to have further imaging only. Tissue was acquired in 175 patients (43% of recalled women), comprising a biopsy rate of 4.6% of the total series. The malignancy rate in cases in which tissue acquisition was done was 25%. Forty-three breast cancers were diagnosed (11.4/1 000 examinations). Of the cancers, nine (31%) were ductal carcinomas in situ. Of 20 invasive cancers, nine (45%) were <10 mm in size. Of the invasive cancers, 40% were node-positive. Conclusions. The cancer diagnosis rate indicates a high breast cancer load in an urbanised population. CITATION: Apffelstaedt, J. P., Dalmayer, L. & Baatjes, K. 2014. Mammographic screening for breast cancer in a resource-restricted environment. South African Medical Journal, 104(4):294-296, doi:10.7196/SAMJ.7246.; The original publication is available at http://www.samj.org.za 2014-04-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/97673 Results of a pilot programme of mammographic breast cancer screening in the Western Cape Apffelstaedt, Justus P.; Hattingh, Retha; Baatjes, Karin; Wessels, Natalie Background. Mammographic screening programmes are now established in developing countries. We present an analysis of the first screening programme in sub-Saharan Africa. Methods. Women aged ≥40 years were identified at three primary healthcare centres in the Western Cape Province, South Africa, and after giving informed consent underwent mammography at a mobile unit. After a single reading, patients with American College of Radiology Breast Imaging Reporting and Data System (BIRADS) 3 - 5 lesions were referred to a tertiary centre for further management. Results. Between 1 February 2011 and 31 August 2012, 2 712 screening mammograms were performed. A total of 261 screening mammograms were reported as BIRADS 3 - 5 (recall rate 9.6%). Upon review of the 250 available screening mammograms, 58 (23%) were rated benign or no abnormalities (BIRADS 1 and 2) and no further action was taken. In 32 women, tissue was acquired (biopsy rate for the series 1.2%); 10 cancers were diagnosed (biopsy malignancy rate 31%). For the entire series of 2 712 screening mammograms, the cancer diagnosis rate was 3.7/1 000 examinations. Of 10 cancers diagnosed at screening, 5 were TNM clinical stage 0, 2 stage I and 3 stage II. Conclusions. The low cancer detection rate achieved, and the technical and multiple administrative problems experienced do not justify installation of a screening programme using the model utilised in this series. CITATION: Apffelstaedt, J. P., Hattingh, R., Baatjes, K. & Wessels, N. 2014. Results of a pilot programme of mammographic breast cancer screening in the Western Cape. South African Medical Journal, 104(4):297-298, doi:10.7196/SAMJ.7242.; The original publication is available at http://www.samj.org.za 2014-04-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/97308 Anatomy of the clavicle and its medullary canal - a computer tomography study King, Paul Reginald; Ikram, Ajmal; Lamberts, Robert Patrick ENGLISH ABSTRACT: Background With recent literature indicating certain clavicle shaft fracture types are best treated surgically; there is renewed interest in the anatomy of the clavicle. lntramedullary fixation of clavicle shaft fractures requires an adequate medullary canal to accommodate the fixation device used. This computer tomography anatomical study of the clavicle and its medullary canal describes its general anatomy and determines the suitability of its medullary canal to intramedullary fixation. Description of methods Four hundred and eighteen clavicles in 209 patients were examined using computer tomography imaging. The length and curvatures as well as the height and width of the clavicle and its canal at various pre-determined points were measured. ln addition the start and end of the medullary canal from the sternal and acromial ends of the clavicle were determined. The data was grouped according to age, gender and lateralization. Summary of results The average length of the clavicle was 151.15 mm with the average stemal and acromial curvature being 146 and 133 respectively. The medullary canal starts on average 6.59 mm from the sternal end and ends 19.56 mm from the acromial end with the average height and width of the canal at the middle third being 5.61 mm and 6.63 mm respectively. Conclusion The medullary canal of the clavicle is large enough to accommodate commonly used intramedullary devices in the nraprity of cases. The medullary canal extends far enough medially and laterally for an intramedullary device to adequatet'y bridge most middte third clavicle fractures. An alternative surgical option should be avalable in theatre when treating females as the medullary canal is too small to pass an intranedullary device past the fracture site on rare occasions. Thesis (MMed)--Stellenbosch University, 2014 2014-12-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/97179 Submuscular bridge plating of length-unstable paediatric femoral shaft fractures in children between the ages of 6 and 13 Salkinder, Rael; Du Toit, J.; Lamberts, R. P. No abstract available Thesis (MMed (Orth))--Stellenbosch University, 2014. 2014-12-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/97178 The outcome of relapsed and residual clubfeet treated with the Taylor Spatial Frame Botha, Adriaan Hendrik; Du Toit, Jacques; Lamberts, Robert P. No abstract available Thesis (MMed)--Stellenbosch University, 2014. 2014-12-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/94871 Paediatric blunt abdominal trauma : are we doing too many computed tomography scans? Arnold, M.; Moore, S. W. Blunt abdominal trauma in childhood contributes significantly to both morbidity and mortality. Selective non-operative management of blunt abdominal trauma in children depends on both diagnostic and clinical factors. Computed tomography (CT) scanning is widely used to facilitate better management. Increased availability of CT may, however, result in its overuse in the management of blunt abdominal trauma in children, which carries significant radiation exposure risks. Aim. To evaluate the use and value of CT scanning in the overall management and outcome of blunt abdominal trauma in children in the Tygerberg Academic Hospital trauma unit, Parow, Cape Town, South Africa, before and after improved access to CT as a result of installation of a new rapid CT scanner in the trauma management area (previously the scanner had been 4 floors away). Methods. Patients aged 0 - 13 years who were referred with blunt abdominal trauma due to vehicle-related accidents before the introduction of the new CT scanner (group 1, n=66, November 2003 - March 2009) were compared with those seen in the 1-year period after the scanner was installed (group 2, n=37, April 2009 - April 2010). Details of clinical presentation, imaging results and their influence on management were retrospectively reviewed. A follow-up group was evaluated after stricter criteria for abdominal CT scanning (viz. prior evaluation by paediatric surgical personnel) were introduced (group 3, n=14, November 2011 - May 2012) to evaluate the impact of this clinical screening on the rate of negative scans. Results. There were 66 patients in group 1 and 37 in group 2. An apparent increase in CT use with increased availability was accompanied by a marked increase in negative CT scans (38.9% compared with 6.2%; p<0.006). Despite a slightly higher prevalence of associated injuries in group 2, as well as a slightly longer length of hospital stay, there was a similar prevalence of intra-abdominal injuries detected in positive scans in the two groups. In addition, rates of small-bowel perforation in the two groups were similar. The rate of negative scans in group 3 was 46.2% (6/13), but all except one of these patients had a severe brain injury preventing adequate clinical evaluation of intra-abdominal injury. Conclusion. CT scanning for blunt abdominal trauma in children is essential in the presence of appropriate clinical indications. Ease of access probably increases availability, but the rate of negative scans may increase. Management guidelines should be in place to direct CT scanning to cases in which clinical examination and/or other modalities indicate a likelihood of intra-abdominal injury. The principle of ‘as low (radiation) dose as reasonably achievable’ (ALARA) should be adhered to because of the increased radiation exposure risks in children. CITATION: Arnold, M. & Moore, S. W. 2013. Paediatric blunt abdominal trauma : are we doing too many computed tomography scans? South African Journal of Surgery, 15(1):26-31, doi:10.7196/SAJS.1230.; The original publication is available at http://sajs.redbricklibrary.com/index.php/sajs 2013-02-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/94623 Anti-allergic ophthalmic drugs in general practice : which, why and when? Mohamed, N.; Smit, D. P. Ocular allergies present in many different guises. They may vary from self-limiting episodes of acute allergic conjunctivitis, to potentially sight-threatening chronic conditions, such as vernal keratoconjunctivitis. This article provides a brief description of the different ocular allergic conditions to aid accurate diagnosis. It also focuses on the different types of anti-allergic ophthalmic preparations and how to employ them in a logical, stepwise management strategy to obtain optimal results, while minimising exposure to potent drugs with potentially serious side-effects. CITATION: Mohamed, N. & Smit, D. P. 2013. Anti-allergic ophthalmic drugs in general practice : which, why and when? South African Family Practice, 55(4):313-318.; The original publication is available at http://www.safpj.co.za 2013-01-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/86855 Missed opportunities for retention in pre-ART care in Cape Town, South Africa Du Toit, Elizabeth; Van Schalkwyk, Cari; Dunbar, Rory; Jennings, Karen; Yang, Blia; Coetzee, David; Beyers, Nulda Fox, Matthew Background: Few studies have evaluated access to and retention in pre-ART care. Objectives: To evaluate the proportion of People Living With HIV (PLWH) in pre-ART and ART care and factors associated with retention in pre-ART and ART care from a community cohort. Methods: A cross sectional survey was conducted from February – April 2011. Self reported HIV positive, negative or participants of unknown status completed a questionnaire on their HIV testing history, access to pre-ART and retention in pre-ART and ART care. Results: 872 randomly selected adults who reported being HIV positive in the ZAMSTAR 2010 prevalence survey were included and revisited. 579 (66%) reconfirmed their positive status and were included in this analysis. 380 (66%) had initiated ART with 357 of these (94%) retained in ART care. 199 (34%) had never initiated ART of whom 186 (93%) accessed pre-ART care, and 86 (43%) were retained in pre-ART care. In a univariable analysis none of the factors analysed were significantly associated with retention in care in the pre-ART group. Due to the high retention in ART care, factors associated with retention in ART care, were not analysed further. Conclusion: Retention in ART care was high; however it was low in pre-ART care. The opportunity exists, if care is better integrated, to engage with clients in primary health care facilities to bring them back to, and retain them in, pre-ART care. Publication of this article was funded by the Stellenbosch University Open Access Fund.; The original publication is available at http://www.plosone.org/; Please site as follows:; Du Toit, E. et al. 2014. Missed Opportunities for Retention in Pre-ART Care in Cape Town, South Africa. PLoS ONE, 9(5): e96867, doi:10.1371/journal.pone.0096867. 2014-05-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/85397 Prostate cancer among different racial groups in the Western Cape : presenting features and management Heyns, C. F.; Fisher, M.; Lecuona, A.; Van der Merwe, A. Objectives. We aimed to compare the presenting features and management of prostate cancer among different racial groups. Patients and methods. We studied all patients diagnosed with prostate cancer at the Urological Oncology Clinic, Tygerberg Hospital, from January 1995 to December 2005. Most presented symptomatically as PSA screening is not readily available in the referral area of the hospital. Race was self-defined as white, coloured or black. Statistical analysis was performed using Student’s t-test or Fisher’s exact test, where appropriate. A two-tailed p-value <0.05 was accepted as statistically significant. Results. There were 901 patients: 291 (32.3%) white, 539 (59.8%) coloured and 71 (7.9%) black. Mean age at presentation was significantly higher in the white than the coloured and black groups (69.7, 67.9 and 68.9 years, respectively). Grade 1 adenocarcinoma was most common in the white (37%) and coloured groups (38%), and grade 2 was most common in the black group (39%). There was a significantly lower percentage of patients with T3-4 disease at diagnosis in the white group (47%) than the coloured (61%) and black (62%) groups. Mean serum PSA at diagnosis was significantly higher in the black than the coloured and white groups (766.1, 673.3 and 196.1 ng/ml, respectively). Potentially curative therapy (radical prostatectomy or radiotherapy) was chosen by 31% of white, 23% of coloured and only 12% of black patients. The mean duration of follow-up was significantly shorter in the black than in the white or coloured groups (24.0, 31.5 and 35.0 months, respectively). Conclusions. Black men presented with higher grade and stage disease and higher serum PSA, received potentially curative treatment less often, and had a shorter follow-up (probably owing to shorter survival) than the white and coloured groups. Greater prostate cancer awareness and education among patients and physicians and more widespread use of PSA screening of presymptomatic men at risk of prostate cancer is needed. The original publication is available at http://www.samj.org.za 2011-04-01T00:00:00Z http://scholar.sun.ac.za:80/handle/10019.1/85347 Management of chemical ocular injuries – what every GP should know Meyer, D. The original publication is available at http://www.cmej.org.za/index.php/cmej 2013-04-01T00:00:00Z