Scielo RSS <![CDATA[South African Journal of Surgery]]> http://www.scielo.org.za/rss.php?pid=0038-236120110003&lang=pt vol. 49 num. 3 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Operative strategies in pancreatic trauma - keep it safe and simple</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300001&lng=pt&nrm=iso&tlng=pt <![CDATA[<b>Surgical anatomy of the pyramidal lobe and its significance in thyroid surgery</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300002&lng=pt&nrm=iso&tlng=pt AIM: The purpose of this prospective study was to highlight some new findings about anatomical and morphological variations of the thyroid pyramidal lobe and to emphasise the necessity and importance of exploration of the visceral compartment of the neck and resection of this structure in primary thyroid operations. METHOD: We analysed 100 consecutive primary thyroid operations with additional pathological examination of the specimens. RESULTS: A pyramidal lobe was found in 61% of the cases. The lobe of Lalouette was found more often in women (61.96%) than in men (50%) and more often (67.3%) in patients less than 50 years old than in those older than 50 (54.2%). The lobe branched off more frequently from the midline (49.18%) than from other parts of the isthmus; its length ranged from 8 to 40 mm, with a median length of 20.13 mm. In diffuse thyroid diseases, the lobes were always pathologically involved and significantly longer. CONCLUSION: Since the pyramidal lobe is a normal component of the thyroid gland, of varying position and size, with pathological changes in benign and malignant diseases, it should always be examined during thyroid surgery and mandatorily removed in total and subtotal thyroidectomies. <![CDATA[<b>Thyroglobulin - what is the postoperative threshold for the suspicion of thyroid cancer recurrence in the absence of anti-Tg antibody measurement?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300003&lng=pt&nrm=iso&tlng=pt BACKGROUND: Thyroglobulin (Tg) is used as a postoperative marker for the follow-up of patients with thyroid carcinoma, but there is no consensus regarding the value that may indicate possible recurrence. AIM: To evaluate Tg levels as a marker for recurrence of thyroid carcinoma. SUBJECTS AND METHODS: Demographics and survival of 80 patients who underwent total thyroidectomy for well-differentiated thyroid cancer were analysed and related to Tg levels. Tg measurements were performed when patients were euthyroid, after completion of treatment. RESULTS: The median Tg value was 1.3 ng/ml. Higher values were found in males, high-risk patients and patients with recurrent disease. Using the median Tg value as cut-off, patients were divided into two groups (group I <1.3 ng/ml and group II &gt;1.3 ng/ml). There was a significant correlation between values &gt;1.3 ng/ml and recurrence. When survival was related to Tg values, there was a tendency towards worse prognosis in group II. The best predictive cut-off value for recurrence was found to be 1.3 ng/ml, which had a sensitivity of 77% and a specificity of 57%. CONCLUSIONS: Although low, a cut-off Tg level of 1.3 ng/ml represents a simple indication for further investigation in patients receiving thyroxine after completion of treatment for thyroid cancer, in the absence of measurement of anti-Tg auto-antibodies. <![CDATA[<b>Intra-operative parathyroid hormone measurements - experience of a non-academic hospital</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300004&lng=pt&nrm=iso&tlng=pt BACKGROUND: Surgery is the treatment of choice for symptomatic primary hyperparathyroidism. The majority of research concerning intra-operative parathyroid hormone (ioPTH) measurements is conducted in university hospitals. Whether ioPTH measurements are feasible and useful in predicting the presence of remaining hyperfunctioning parathyroid tissue in a non-academic hospital remains uncertain. METHODS: Data were collected on all patients with biochemically proven and surgically treated primary hyperparathyroidism treated at the Reinier de Graaf Hospital from August 2002 to December 2007. RESULTS: Sixty-five patients were included. The mean pre-operative serum calcium level was 2.78 mmol/l (range 2.28 - 3.80 mmol/l, normal range 2.20 - 2.65 mmol/l) and the mean serum parathyroid hormone level 17.0 pmol/l (range 4.0 - 90.3 pmol/l, normal range 1.0 - 5.5 pmol/l). All patients were operated on for primary hyperparathyroidism, using ioPTH measurements during their first operation. Sensitivity and specificity rates of ioPTH measurements were 98% and 89%, respectively. The ioPTH test accurately indicated incomplete removal of all hyperfunctioning parathyroid tissue in 8 patients (12%). Five patients (8%) were re-explored immediately, of whom 4 were successfully treated in this single operative session. One patient was operated on successfully the next day. Two patients were operated on with a successful result during a second admission. In all the ioPTH measurements there was 1 false-positive result (1.5%) and 1 false-negative result (1.5%). The mean postoperative calcium value for the successfully treated patients was 2.34 mmol/l (range 2.14 - 2.71 mmol/l, normal range 2.20 - 2.65 mmol/l). The mean postoperative PTH level for the successfully treated patients was 3.76 pmol/l (range 0.40 - 7.1 pmol/l). CONCLUSION: Our data suggest that ioPTH measurements are feasible and useful in a non-academic hospital. <![CDATA[<b>Gastro-intestinal stromal tumours (GISTs) - the Pretoria experience and a literature review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300005&lng=pt&nrm=iso&tlng=pt AIM: To analyse the presentation and management of patients with gastro-intestinal stromal tumours (GISTs) at Pretoria hospitals. DESIGN: A retrospective study was done in which all available clinical records of primary c-KIT positive GISTs were analysed. SETTING: Secondary and tertiary care institutions in Pretoria, including both private and public hospitals. SUBJECTS: The population studied included all individuals treated at Pretoria hospitals from 17 July 2000 to 1 April 2009 who had a GIST confirmed with immunohistochemical c-KIT staining. Patients with incomplete or inaccessible clinical records were excluded. OUTCOME MEASURES: Patient demographics including gender, age and race; presenting symptoms and signs; results of special investigations; and treatment. RESULTS: Fifty-four cases were identified for inclusion in the study. The age of the subjects ranged from 15 to 83 years. The male-to-female ratio was 1.5:1. The organ most commonly affected was the stomach, and abdominal pain and weight loss were the most common presenting symptoms. Seventy-six per cent of the patients were treated surgically, and 24% received imatinib. CONCLUSION: GISTs often present late with nonspecific symptoms, and are frequently discovered incidentally. Large tumours tend to be malignant. <![CDATA[<b>A student surgical society - the Cape Town experience</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300006&lng=pt&nrm=iso&tlng=pt The UCT Surgical Society, Africa's first student surgical society, is a student-managed academic society that promotes undergraduate interest in the field of surgery at the University of Cape Town. With over 700 members in 2009, it is one of the largest student surgical societies in the world. This article describes the origins, aims and objectives of the Society, and outlines a framework that students anywhere may use to create their own academic interest societies. <![CDATA[<b>A review of non-obstetric spontaneous pneumomediastinum and subcutaneous emphysema</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300007&lng=pt&nrm=iso&tlng=pt The UCT Surgical Society, Africa's first student surgical society, is a student-managed academic society that promotes undergraduate interest in the field of surgery at the University of Cape Town. With over 700 members in 2009, it is one of the largest student surgical societies in the world. This article describes the origins, aims and objectives of the Society, and outlines a framework that students anywhere may use to create their own academic interest societies. <![CDATA[<b>Abdominal manipulation during water-soluble contrast enema - an alternative method of non-operative decompression of sigmoid volvulus?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300008&lng=pt&nrm=iso&tlng=pt Sigmoid volvulus is common in some developing countries. We describe a new method of decompression using a Urograffin and saline enema with additional extra-abdominal manual massage. <![CDATA[<b>The lithopedion - an unusual cause of an abdominal mass</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300009&lng=pt&nrm=iso&tlng=pt We report the rare case of a lithopedion in an asymptomatic 69-year-old woman. Diagnosis was confirmed by plain abdominal X-ray. In view ofthe patient's age and symptomatology, we opted for conservative management with regular abdominal examination and imaging. <![CDATA[<b>Simultaneous blunt traumatic laceration of inferior vena cava and right renal artery - computed tomographic diagnosis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300010&lng=pt&nrm=iso&tlng=pt We report the rare case of a lithopedion in an asymptomatic 69-year-old woman. Diagnosis was confirmed by plain abdominal X-ray. In view ofthe patient's age and symptomatology, we opted for conservative management with regular abdominal examination and imaging. <![CDATA[<b>Herbert Otto Penzhorn</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300011&lng=pt&nrm=iso&tlng=pt We report the rare case of a lithopedion in an asymptomatic 69-year-old woman. Diagnosis was confirmed by plain abdominal X-ray. In view ofthe patient's age and symptomatology, we opted for conservative management with regular abdominal examination and imaging. <![CDATA[<b>Phoebus Perdikis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300012&lng=pt&nrm=iso&tlng=pt We report the rare case of a lithopedion in an asymptomatic 69-year-old woman. Diagnosis was confirmed by plain abdominal X-ray. In view ofthe patient's age and symptomatology, we opted for conservative management with regular abdominal examination and imaging. <![CDATA[<b>Johnny Marr</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300013&lng=pt&nrm=iso&tlng=pt We report the rare case of a lithopedion in an asymptomatic 69-year-old woman. Diagnosis was confirmed by plain abdominal X-ray. In view ofthe patient's age and symptomatology, we opted for conservative management with regular abdominal examination and imaging. <![CDATA[<b>38th Annual Meeting of the Surgical Research Society of South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0038-23612011000300014&lng=pt&nrm=iso&tlng=pt We report the rare case of a lithopedion in an asymptomatic 69-year-old woman. Diagnosis was confirmed by plain abdominal X-ray. In view ofthe patient's age and symptomatology, we opted for conservative management with regular abdominal examination and imaging.