The in vitro fertilisation programme at Tygerberg Hospital and the University of Stellenbosch. Five years' experience, April 1983-January 1988

The results of the in vitro fertilisation programme at Tygerberg Hospital for the period April 1983 to January 1988 are presented. Of the 1117 laparoscopies performed, 825 patients reached the transfer stage. A live-birth rate of 9.3% was achieved. The pregnancy rate after transfer of 4 embryos was 25.9% compared with 15.4% after 2 embryos and 10.8% after 3 embryos (P = less than 0.0001). The multiple pregnancy rate was 2.8% in the group receiving 2 embryos and 11.7% and 10.4% in those receiving 3 and 4 embryos, respectively. Of the 77 successful pregnancies (90 babies), 1 baby died at 34 weeks' gestation as the result of abruptio placentae due to preeclampsia and 1 cot death occurred. The only congenital abnormality encountered was a cleft palate.     

Surgical Biomechanics of the Patellofemoral Joint

This review presents objective data, as far as possible, about the current understanding of the biomechanics of the patellofemoral joint as it pertains to the management of patellofemoral problems. When faced with a patellofemoral malfunction, it is important to check all the soft-tissue and articular geometry factors relating to the patella locally and not to neglect the overall lower limb alignment and function. It is important to remember that small alterations in alignment can result in significant alterations in patellofemoral joint stresses and that changes in the mechanics of the patellofemoral joint can also result in changes in the tibiofemoral compartments. Surgical intervention for patellofemoral problems needs to be planned carefully and take into account an individual’s anatomy.     

An audit of 24-hour creatinine clearance measurements at Tygerberg Hospital and comparison with prediction equations.

BACKGROUND: Internationally, clinical guidelines recommend the use of creatinine-based equations to estimate glomerular filtration rate (GFR) for assessment and follow-up of kidney disease. The routine use of 24-hour creatinine clearances (CrCl) is no longer advocated. OBJECTIVES: To examine the indications for requesting CrCl at Tygerberg Hospital, identify problems associated with the procedure, and evaluate the utility of the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations with different levels of renal dysfunction in the ethnic groups of the Western Cape. METHODS: A clinical audit of CrCl was performed. The estimated GFR as predicted by the modified CG and MDRD formulae was compared with CrCl in 252 patients, representing three local ethnic groups. MDRD formulae with and without the correction factor for black ethnic group (MDRD-B) were evaluated. RESULTS: Problems with urine collection or data supplied were identified in one-third of CrCl requests, leading to unreliable results. The CG correlated best with CrCl in the group as a whole. The average absolute and percentage differences from CrCl in the different ethnic groups were as follows: coloured (mixed ethnicity) (N = 186) - CG 13.4 ml/min/1.73 m(2) (18%), MDRD 16.8 ml/min/1.73 m(2) (23%) and MDRD-B 27.9 ml/ min/1.73 m(2) (38%); black (N = 21) - CG 14.8 ml/min/1.73 m(2) (19%), MDRD 12.9 ml/min/1.73 m(2) (17%) and MDRD-B 25.1 ml/min/1.73 m(2) (33%); white (N = 45) CG 13.5 ml/min/1.73 m2 (19%), MDRD 15.3 ml/min/1.73 m(2) (21%) and MDRD-B 24.8 ml/min/1.73 m(2) (35%). Throughout the renal function levels (chronic kidney disease stages 1 - 5) CG correlated better with CrCl than MDRD. CONCLUSIONS: Possible reasons for poor correlations include a high prevalence of obesity, underweight and normal GFR in the study population. There is a need for further research, using a gold standard, into the accuracy of these prediction equations in our unique patient populations before firm recommendations can be made regarding their use. Until then CrCl will continue to be widely used. Greater efforts at patient and health care worker education are required to ensure proper collections.     

Energetics of karate kumite

It is speculated that anaerobic metabolism is the predominant source of energy in karate kumite. However, no experimental proof is currently available. The metabolic cost and fractions of aerobic and anaerobic energy of karate kumite fighting were investigated. Ten male nationally or internationally ranked karateka [means (SD) age 26.9 (3.8) years, height 1.80 (0.08) m, mass 77.2 (12.8) kg] performed two to four fights scheduled and judged like a championship. Oxygen uptake was measured continuously with a portable spirometric device. Blood lactate was determined immediately before, and minute by minute after, each fight. Aerobic, anaerobic alactic and anaerobic lactic energy were calculated from oxygen uptake during the fight (VO₂), the fast component of the post-fight oxygen uptake (VO_2PCr) above resting values and changes in blood lactate concentration (Net-BLC), respectively. Altogether, 36 fights lasting 267 (61) s were analysed. The referees decisions caused an activity-to-break ratio of approximately 2:1. VO₂, VO_2PCr, and Net-BLC per fight were 165.3 (52.4) ml^.kg^–1, 32.2 (7.2) ml^.kg^–1and 4.2 (1.9) mmol^.l^–1; the overall energy cost above rest was 334.3 (86.3) kJ per fight. Fractions of aerobic, anaerobic alactic, and lactic energy sources were 77.8 (5.8)%, 16.0 (4.6)%, and 6.2 (2.4)%, respectively. The results indicate a high metabolic rate in karate kumite. However, the acyclic activity profile implies that aerobic metabolism is the predominant source of energy and there is anaerobic supplementation, mainly by high-energy phosphates.     

Thoracic manifestations of neurofibromatosis-I

The intrathoracic manifestations of neurofibromatosis-I are protean and can, on occasion, mimic those of malignancy. Many of the intrathoracic findings are characteristic of the disease and can be expected to be present. Knowledge of the full spectrum of radiologic findings can thus be useful in preventing diagnostic error. Furthermore, an unexpected finding, such as rapid growth of a neural tumor, should be recognized as an atypical feature (suspicious for malignant degeneration) and result in further evaluation.     

CG-clip expansive open-door laminoplasty: a technical note

The CG clip is a device designed for use in expansive open-door laminoplasty with both a spacer and means of attachment in a single unit. It provides an effective technique for open-door laminoplasty, which obviates the need for bone grafting or complex internal fixation by providing dynamic stabilization of the open laminae. A number of techniques for expansive open-door laminoplasty have been devised for the decompression of the spinal cord and nerve roots in cervical spondylotic myeloradiculopathy. Each of these techniques requires some degree of internal fixation and/or bone grafting. The CG clip is a single device which is composed of both a spacer and a spring clip for attachment. The spacer ensures a 4-5-mm sagittal expansion of the cervical spinal canal. The spacer is held in place along the lateral cut margin of the laminae by a spring-wound titanium clip, which folds over the central spinous process of the unilaterally elevated laminar block. In all respects except for grafting and internal fixation, the surgery is performed as for a standard expansive open-door laminoplasty. Sixteen of the first 24 patients to undergo this procedure improved at least one point on the Neurosurgical Cervical Spine Scale. Of the remaining eight patients, four remained the same and four deteriorated. The authors have found the CG-clip laminoplasty technique quick and easy to perform, with early results in the treatment of cervical spondylotic myeloradiculopathy consistent with those of other decompressive procedures.     

18F]fluorodeoxyglucose uptake by positron emission tomography predicts outcome of non-small-cell lung cancer.

PURPOSE: To determine whether the standardized uptake value (SUV) of [(18)F]fluorodeoxyglucose uptake by positron emission tomography could be a prognostic factor for non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: One hundred sixty-two patients with stage I to IIIb NSCLC were analyzed. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and local-regional control (LRC) were calculated by the Kaplan-Meier method and evaluated with the log-rank test. The prognostic significance was assessed by univariate and multivariate analyses. RESULTS: There were 93 patients treated with surgery and 69 patients treated with radiotherapy. A cutoff of 5 for the SUV for the primary tumor showed the best discriminative value. The SUV for the primary tumor was a significant predictor of OS (P = .02) in both groups. Low SUVs ( 5.0; surgery group, P = .02; radiotherapy group, P = .0005). Low SUVs ( 5.0; stage I or II, P = .02; stage IIIa or IIIb, P = .004). However, using the same cutoff point of 5, the SUV for regional lymph nodes was not a significant indicator for DFS (P = .19), LRC (P = .97), or DMFS (P = .17). The multivariate analysis showed that the SUV for the primary tumor was a significant prognostic factor for OS (P = .03) and DFS (P = .001). CONCLUSION: The SUV of the primary tumor was the strongest prognostic factor among the patients treated by curative surgery or radiotherapy.     

Phytomedicine Versus Gonorrhoea: The Bapedi Experience

Records regarding the phytomedicine employed by the Bapedi are almost non-existent. This is the first study of herbal remedies used by Bapedi traditional healers to treat gonorrhoea, of concern as it is a danger to reproductive health. A semi-structured questionnaire, centred on sexual health, was administered to 30 traditional healers in 15 local municipalities across the three districts of Limpopo Province during 2009/10. The questionnaire focussed on the use of plants for medicine as well their application in reproductive health management. This investigation found that the Bapedi employed no less than 18 different plant species, sometimes as multiple-plant extracts, but more often as single-plant extracts. The single most used species was Catharanthus roseus, which accounted for 60% of all reported cases, followed by Aloe marlothii subsp. marlothii (13.3%). Both these species occur abundantly throughout the province and are currently not threatened. This is the first record for the use of Callilepis salicifolia, Jatropha zeyheri and Cotyledon orbiculata to treat gonorrhoea by people of any culture.