Scielo RSS <![CDATA[South African Journal of Surgery]]> http://www.scielo.org.za/rss.php?pid=0038-236120080002&lang=es vol. 46 num. 2 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>SAJS News</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612008000200001&lng=es&nrm=iso&tlng=es <![CDATA[<b>As I have seen it: Delivered at the ASSA-SAGES Conference, Sun City, 9 - 12 August 2007</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612008000200002&lng=es&nrm=iso&tlng=es <![CDATA[<b>Surgical research in sub-Saharan Africa: A role for TeleHealth? </b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612008000200003&lng=es&nrm=iso&tlng=es <![CDATA[<b>Surgical management of achalasia in Zaria, Northern Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612008000200004&lng=es&nrm=iso&tlng=es BACKGROUND: Achalasia of the cardia is generally considered a rare disease. Because the cause is uncertain, treatment is palliative and directed at relieving distal oesophageal obstruction. In developed countries, several treatment options are available, but in developing countries, achalasia is usually treated by open surgical myotomy. We reviewed the outcome of management of achalasia in our patients and the influencing factors. PATIENTS AND METHODS: We retrospectively reviewed all adult patients treated for achalasia between 1991 and 2006. Diagnosis was based on clinical symptoms and barium swallow examination. The severity and frequency of dysphagia were determined before and after treatment. Barium examination was repeated 2 weeks after surgery or when the patient had recurrence of dysphagia, regurgitation or heartburn. Treatment was by modified Heller's operation, transabdominally without complementary antireflux procedure. Logistic regression modelling was performed to identify factors predictive of poor outcome. RESULTS: There were 47 patients, 31 (66.0%) males and 16 females, mean age (± standard deviation (SD) 34.6±9.8 years. All patients presented with dysphagia, which was severe in 31 cases (66.0%) and moderate in 14 (29.8%). Preoperative maximum oesophageal diameter ranged from 34 to 89 mm, mean 67.4±12.7mm. In 30 (63.8%) of the patients, the maximum diameter was >70 mm. Postoperative maximum diameter ranged from 28 to 72 mm, mean 37.5±8.2 mm (p=0.001). The mean preoperative diameter of the narrowest distal oesophagus was 4.6±2.5 mm, compared with the postoperative figure of 11.6±1.8 mm (p=0.015). Following surgery, 41 (87.2%) patients had complete relief of dysphagia, regurgitation and heartburn. Four patients continued to have heartburn after surgery. Patients with severe dysphagia or preoperative oesophageal dilatation >70 mm had the greatest likelihood of incomplete relief of symptoms after treatment. CONCLUSION: Achalasia can be accurately diagnosed on the basis of clinical symptoms and barium swallow examination. A modified Heller's operation provides lasting relief of symptoms. Patients with severe preoperative dysphagia or oesophageal dilatation are more likely to have poor outcome of treatment. <![CDATA[<b>Surgical management of BCG vaccine-induced regional axillary lymphadenitis in HIV-infected children</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612008000200005&lng=es&nrm=iso&tlng=es There are as yet no clear surgical guidelines for the management of BCG vaccine-induced regional axillary lymphadenopathy. OBJECTIVES: The aim of this study was to evaluate the management of the condition and to suggest possible management strategies. METHODS: A retrospective study was undertaken of 23 cases of suspected ipsilateral BCG adenitis following neo-natal BCG inoculation (2001 - 2004). Diagnosis of a BCG infection was confirmed by culture and/or gastric washout. The age of the patient and mode of presentation, imaging findings, and results of tuberculin skin testing (Mantoux test) were documented. Because of a change in management policy the first group of patients treated by primary surgery were compared with those treated by fine-needle aspiration (FNA). The influence of HIV status on outcome was assessed. Surgical complications and outcome were analysed. RESULTS: Twenty-three children under 13 years of age (mean age 8.8 months, male/female ratio 1.9:1) were evaluated. Eighteen patients tested positive for HIV and 5 were HIV-negative. A positive culture for BCG bacillus was identified in 19 cases (83%) - by FNA (N=13, 68%), on pus swab (N=3, 16%), at surgery (N=1, 5%), and by gastric washing (N=2, 11%). Three HIV-negative children had granulomas on histological examination without a positive culture. Forty-five per cent of the 11 patients treated early in the study period by primary surgery (drainage/biopsy) had complications, which included a difficult anaesthetic induction and technical surgical difficulties. The postoperative incidence of wound dehiscence/infection was extremely high in this group and 18.2% developed postoperative cutaneous sinuses. Following a change in management policy, the following 12 patients, with a comparable HIV incidence, treated by initial conservative management, had a much lower incidence of post-procedural complications. CONCLUSION: This study confirms a high perioperative complication rate associated with the primary surgical treatment of BCG lymphadenitis in both HIV-positive and negative patients. primary surgical treatment (incisional drainage or biopsy) is therefore not considered an ideal form of management in BCG lymphadenitis because of the high fistulisation and poor wound healing, especially in the HIV-positive patient. It should be avoided as the initial approach, with needle aspiration being preferred. Surgery should therefore be confined to the unusual event of real doubt about the underlying diagnosis and the treatment of suppurative complications. <![CDATA[<b>Fistuloclysis - a valuable option for a difficult problem</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612008000200006&lng=es&nrm=iso&tlng=es There are as yet no clear surgical guidelines for the management of BCG vaccine-induced regional axillary lymphadenopathy. OBJECTIVES: The aim of this study was to evaluate the management of the condition and to suggest possible management strategies. METHODS: A retrospective study was undertaken of 23 cases of suspected ipsilateral BCG adenitis following neo-natal BCG inoculation (2001 - 2004). Diagnosis of a BCG infection was confirmed by culture and/or gastric washout. The age of the patient and mode of presentation, imaging findings, and results of tuberculin skin testing (Mantoux test) were documented. Because of a change in management policy the first group of patients treated by primary surgery were compared with those treated by fine-needle aspiration (FNA). The influence of HIV status on outcome was assessed. Surgical complications and outcome were analysed. RESULTS: Twenty-three children under 13 years of age (mean age 8.8 months, male/female ratio 1.9:1) were evaluated. Eighteen patients tested positive for HIV and 5 were HIV-negative. A positive culture for BCG bacillus was identified in 19 cases (83%) - by FNA (N=13, 68%), on pus swab (N=3, 16%), at surgery (N=1, 5%), and by gastric washing (N=2, 11%). Three HIV-negative children had granulomas on histological examination without a positive culture. Forty-five per cent of the 11 patients treated early in the study period by primary surgery (drainage/biopsy) had complications, which included a difficult anaesthetic induction and technical surgical difficulties. The postoperative incidence of wound dehiscence/infection was extremely high in this group and 18.2% developed postoperative cutaneous sinuses. Following a change in management policy, the following 12 patients, with a comparable HIV incidence, treated by initial conservative management, had a much lower incidence of post-procedural complications. CONCLUSION: This study confirms a high perioperative complication rate associated with the primary surgical treatment of BCG lymphadenitis in both HIV-positive and negative patients. primary surgical treatment (incisional drainage or biopsy) is therefore not considered an ideal form of management in BCG lymphadenitis because of the high fistulisation and poor wound healing, especially in the HIV-positive patient. It should be avoided as the initial approach, with needle aspiration being preferred. Surgery should therefore be confined to the unusual event of real doubt about the underlying diagnosis and the treatment of suppurative complications. <![CDATA[<b>Missile embolism - pulmonary vein to systemic bullet embolism</b>: <b>A case report and review of the literature</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612008000200007&lng=es&nrm=iso&tlng=es Missile embolism occurs very rarely. It was first reported by Thomas Davis in 1834, and only 153 cases had been reported up to 1988.¹ Rich et ai. reported a 0.3% incidence in 7 500 cases of vascular injury in the Vietnam conflict.² To our knowledge, this is the first reported case of pulmonary vein entry and internal carotid artery embolisation. <![CDATA[<b>Professor L. C. J. (Boet) van Rensburg</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612008000200008&lng=es&nrm=iso&tlng=es Missile embolism occurs very rarely. It was first reported by Thomas Davis in 1834, and only 153 cases had been reported up to 1988.¹ Rich et ai. reported a 0.3% incidence in 7 500 cases of vascular injury in the Vietnam conflict.² To our knowledge, this is the first reported case of pulmonary vein entry and internal carotid artery embolisation.