Scielo RSS <![CDATA[South African Journal of Surgery]]> http://www.scielo.org.za/rss.php?pid=0038-236120100003&lang=es vol. 48 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Melanoma in black South Africans</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Malignant melanoma of the skin in black South Africans: A 15-year experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300002&lng=es&nrm=iso&tlng=es AIM: To document the anatomical distribution of melanoma, extent of disease, results of treatment and survival among black patients in the north-eastern part of South Africa. METHODS: All available histological material was reviewed. All available addresses of patients were consulted to establish the status of patients treated in the drainage areas of, or referred to, Kalafong Hospital or Pretoria Academic Hospital retrospectively and prospectively for the 15-year period 1969 - 1983. RESULTS: Of the 185 patients with melanoma who were documented, 10 were eliminated for various reasons. Among the remaining 175 patients there were 128 documented deaths, 35 patients having died of melanoma within 1 year of presentation. Thirty patients survived for more than 3 years. Because of late presentation and the nature of the disease, malignant melanoma has a very poor prognosis in black patients in South Africa. <![CDATA[<b>Laparoscopic splenectomy: Consensus and debatable points</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300003&lng=es&nrm=iso&tlng=es INTRODUCTION: The emergence of minimally invasive techniques has broadened interest in splenectomy for a variety of haematological illnesses. Laparoscopic splenectomy (LS) is currently considered the gold standard for the treatment of various haematological disorders. PURPOSE: The literature was reviewed to highlight points of consensus and debatable points regarding best practice in LS, looking at issues such as bleeding and conversion, splenomegaly, splenic retrieval techniques, types of instruments used, hand-assisted LS (HALS), complications, approaches, accessory spleen and splenosis. Our goal was to share our experience with LS and compare it with other reports. BACKGROUND: LS has emerged as the standard of care for elective splenectomy for benign haematological diseases. However, doubts have been raised regarding the suitability of patients with splenomegaly for LS. There is also uncertainty about its efficacy in major trauma. HALS has emerged as an option for safe manipulation and splenic dissection. METHOD: We performed 25 consecutive LSs at King Abdullah University Hospital (KAUH), Jordan, from 2001 to 2008. Patient demographics, operative time, intra- and postoperative complications, conversion rate, additional procedures and length of hospital stay were retrospectively reviewed. RESULTS: The mean age of the patients was 38.8 years (range 11 - 77 years), mean operative time was 132 minutes (90 - 170 minutes), and length of hospital stay was 2.9 (standard deviation 2.7) days. One case was converted to open surgery (5%). There was 1 case of superficial wound infection in the series (5%), and no deaths. CONCLUSION: LS is a well-accepted minimally invasive procedure, but knowledge and skill are required to perform it with minimal morbidity and mortality. <![CDATA[<b>Successful conservative treatment of chylothorax following oesophagectomy - a clinical algorithm</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300004&lng=es&nrm=iso&tlng=es OBJECTIVES: Chylothorax is an infrequent but serious complication after thoracic surgery. Optimal management is still controversial. Surgical re-interventions are associated with significant morbidity and mortality. DESIGN: During a 2-year period, 3 patients developed chylothorax after oesophagectomy. This was treated conservatively, following our departmental protocol. RESULTS: Conservative management (total parenteral nutrition, bowel rest, pleural drainage and octreotide, followed by a low-fat diet) was successful in all 3 cases within a reasonable period of time (14 - 18 days). CONCLUSION: We recommend conservative measures as the first-line treatment for postoperative chylothorax. <![CDATA[<b>Analysis of epidemiology, lesions, treatment and outcome of 354 consecutive cases of blunt and penetrating trauma to the chest in an African setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300005&lng=es&nrm=iso&tlng=es BACKGROUND: The proportion of death and disability related to trauma is increasing in Third-World countries. Thoracic trauma is significantly involved, but few data are available on this issue in African countries with specific local conditions. METHODS: The aim of the study is to analyse the diagnosis and management procedures in thoracic trauma in a typical African country. The records of 354 patients admitted to an emergency unit for chest trauma over a 13-year period were retrospectively analysed. RESULTS: The sample included patients with 231 cases of blunt and 123 of penetrating trauma to the chest; their mean age was 41.86 years, and the male:female ratio was 4.2:1. The majority (N=226) of the injuries were sustained in road traffic accidents, and the most common lesions were rib fractures (50.3%) and haemothorax (38.7%). The diagnosis was based on physical examination and standard chest radiographs in most cases. At least one associated lesion was found in 260 (73.45%) patients. The mean injury severity score (ISS) for our patients was 16.39. Most patients were managed conservatively (N=303); thoracotomy was performed mostly on penetrating trauma patients. Morbidity occurred in 49 patients, mainly affecting those treated with thoracic drainage, and 27 patients (7.6%) died. Factors related to mortality were ISS score and association with neurotrauma. CONCLUSIONS: Chest trauma can be managed in our Cameroonian environment, with morbidity and mortality comparable with that of Western countries. Diagnosis must still rely on physical examination, chest radiographs and thoracic echography, which are affordable tools. <![CDATA[<b>Endoscopic trans-sphenoidal drainage of petrous apex cholesterol granulomas</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300006&lng=es&nrm=iso&tlng=es Cholesterol granulomas of the petrous apex are rare lesions that pose challenging surgical decisions and approaches when attempting surgical drainage. In this article we present 2 cases of successful surgical management using an endoscopic trans-sphenoidal approach and review the requirements and considerations for this procedure. <![CDATA[<b>A rare congenital midline cervical cleft</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300007&lng=es&nrm=iso&tlng=es Cholesterol granulomas of the petrous apex are rare lesions that pose challenging surgical decisions and approaches when attempting surgical drainage. In this article we present 2 cases of successful surgical management using an endoscopic trans-sphenoidal approach and review the requirements and considerations for this procedure. <![CDATA[<b>Primary tuberculosis of the gallbladder in an HIV positive patient</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300008&lng=es&nrm=iso&tlng=es Cholesterol granulomas of the petrous apex are rare lesions that pose challenging surgical decisions and approaches when attempting surgical drainage. In this article we present 2 cases of successful surgical management using an endoscopic trans-sphenoidal approach and review the requirements and considerations for this procedure. <![CDATA[<b>A technique for securing split-thickness skin grafts in paediatric burn patients</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300009&lng=es&nrm=iso&tlng=es Cholesterol granulomas of the petrous apex are rare lesions that pose challenging surgical decisions and approaches when attempting surgical drainage. In this article we present 2 cases of successful surgical management using an endoscopic trans-sphenoidal approach and review the requirements and considerations for this procedure. <![CDATA[<b>Frederik Jacobus Rademan: 25 September 1955 - 6 March 2010</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612010000300010&lng=es&nrm=iso&tlng=es Cholesterol granulomas of the petrous apex are rare lesions that pose challenging surgical decisions and approaches when attempting surgical drainage. In this article we present 2 cases of successful surgical management using an endoscopic trans-sphenoidal approach and review the requirements and considerations for this procedure.