Out-patient visits for gastrointestinal cancer at a quaternary South African hospital-trends and geospatial distribution

BackgroundThis study sought to determine trends in out-patient visits for gastrointestinal cancer (GC) at a quaternary hospital in KwaZulu-Natal (KZN), South Africa; and identify geographical regions which contribute most to GC-related out-patient clinic utilization at this hospital.MethodData for GC-related outpatient visits over an 11-year period was obtained from the hospital''s administrative database. Trends were analyzed using simple regression and trend line analyses. Patient residential postal codes from the administrative database were used to determine the geospatial distribution of complex GC in KZN.ResultsStrong increasing trends in GC-related out-patient visits were noted for age >65 years old (R²=0.8014), male (R²=0.7020), female (R²=0.7292), lower GC (R²=0.7094), and rural residence (R²=0.7008). Moderate increasing trends in GC-related out-patient visits were noted for age ≤65 years old (R²=0.6556), upper GC (R²=0.6498), and urban residence (R²=0.6988). The magnitude at which the number of out-patient visits increased was greater for urban residence when compared with rural residence (p=0.006). Urban centers and some regions along the North and South coast of KZN contributed the most toward GC-related out-patient visits.ConclusionOut-patient visits for complex GC in KZN are increasing. Several regions have been identified for anti-cancer interventions and decentralized out-patient services.     

Demographic variables of gestational trophoblastic disease in KwaZulu-Natal, South Africa.

The aim of the study was to map out the pattern of referral of patients with gestational trophoblastic disease (GTD) presenting to a large tertiary referral centre, from the health districts of KwaZulu Natal province, South Africa, and to determine the demographic variables in the presentation of the disease. This retrospective study reviewed the clinical charts of 98 patients managed at the combined gynaecology/oncology clinic over a 5-year period. The types of GTD included molar pregnancy 50 (51%), choriocarcinoma 46 (46%) and placental site trophoblastic tumour 2 (2%). The majority of patients were referred by the district or regional hospitals (63.3%), followed by self-referrals (23.5%). There were 51 (52%) patients from eThekwini health district and only 25 patients (25.4%) from the Northern health districts. With regard to previous pregnancy state, 63.3% (n = 62) had term pregnancy, 13.3% (n = 13) had previous miscarriage and 2% (n = 2) had previous ectopic pregnancy. Five patients (5.1%) had previous molar pregnancy. We did not find a trend of referral of patients being predominantly from the Northern regions of KwaZulu Natal.     

Thromboelastography in abruptio placentae.

The purpose of this study was to document thromboelastographic (TEG) changes in abruptio placentae and to compare these results with that of conventional tests used to monitor coagulation. This was a prospective study of 30 patients with abruptio placentae. All coagulation investigations including the TEG were performed on admission, immediately following delivery, and after periods of 4 hours and 24 hours. Results showed that standard coagulation tests detected coagulation abnormalities except the platelet count returned to normal limits within 24 hours of delivery. There was strong correlation between fibrinogen levels and the TEG parameters, ma and k time (r=0.8). There was moderate correlation between platelet count and ma (r=0.6). In conclusion, minor abnormalities in the clotting profile are clinically unimportant. The TEG does not detect such minor abnormalities because of its inherent ability to test the coagulation cascade as a whole. Major abnormalities are clinically relevant and the TEG detect 75% of them. Further, the TEG establishes the diagnosis of hypercoagulability an early sign of disseminated intravascular coagulation. Although standard laboratory tests are still necessary to detect coagulation abnormalities on admission, the TEG is a useful test in large obstetric units where laboratory results are not immediately available for the purposes of monitoring and treating ongoing coagulation defects.     

Maternal deaths from neurological complications of hypertensive crises in pregnancy

Fourteen maternal deaths from eclampsia or severe pre-eclampsia where disturbed cerebral function, as evidenced by prolonged unconsciousness, was given as the main cause of death are reviewed. Prolonged duration of seizures, hypotensive/hypoxic episodes, cerebral oedema and intracranial haematomas were most frequently identified as causative agents in the development of cerebral dysfunction. Failure to maintain an airway and iatrogenically induced hypotension were the two most important contributory factors to the patients' deaths. Management recommendations to prevent this type of maternal death are given.     

Microsatellite analysis of early stage (Ia-IIb) uterine cervical squamous carcinoma

Cervical cancer is the most common gynecologic malignancy of the developing world. The oncogenic role of human papilloma virus (HPV) is well known. Attention is now focusing on the complicit genetic changes, which allow progression of these tumors. Regarding these changes, deletion of tumor suppressor genes (loss of heterozygosity [LOH]) is the preferred pathway of progression with only a subset manifesting microsatellite instability (MSI). Implicated loci include 3p14.1-22. Several studies suggest that the mutator phenotype in cervical cancer may correlate with higher grade tumors, more advanced disease stage, and poor outcome. Unlike colorectal cancer, in which an inverse relationship has been demonstrated between microsatellite instability and loss of heterozygosity, cervical cancers expressing MSI have been found to coexpress LOH at other loci. In this study we analyzed 8-microsatellite loci including p53, DCC, APC, the MMR gene hMLH1 and 2 regions of interest on chromosome 3 in a high-risk population group in which HPV infection is endemic.     

Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era

In this clinico-anatomical study, factors potentially responsible for unsuccessful upper limb sympathectomy (ULS) by the thoracoscopic route were evaluated. This study comprised two subsets: 1) in the clinical subset, 25 patients (n = 50 sides) underwent bilateral second thoracic ganglionectomy for palmar hyperhidrosis, and factors predisposing to unsuccessful ULS were identified; and 2) in the anatomical subset, the neural connections of the first and second intercostal spaces were bilaterally dissected in 22 adult cadavers (22 right, 21 left; n = 43 sides). Alternate neural pathways (ANP) were noted in 9 of 50 sides in the 25 clinical cases (18%). In three asthenic patients (5 sides), fascia overlying the longus colli muscle mimicked the sympathetic chain. The right superior intercostal vein (SIV) was located anterior to the second thoracic ganglion in 6 of 50 sides (12%) and predisposed to troublesome bleeding in 2 of 50 cases; the SIV was posterior to the ganglion in 19 of 50 sides (38%), posing no technical problem. On the left, the SIV was noted outside the field of dissection in all but one case. A successful outcome to sympathectomy was noted in all 25 patients. A spectrum of sympathetic contributions to the first thoracic ventral ramus for the first intercostal space was noted in 37 of 43 anatomical cases (86%). These were categorized according to the arrangements of the intrathoracic ramus between the second intercostal nerve and the first thoracic ventral ramus. The cervicothoracic ganglion (37/43 cases; 86%) and an independent inferior cervical ganglion (6/43 cases; 14%) were always located above the second rib. The second thoracic ganglion was consistently located in the second intercostal space. This study demonstrates that ANPs have little clinical significance when a second thoracic ganglionectomy is undertaken. Technical failures may be avoided if the surgeon is mindful of anatomical variations at surgery.     

Failure of clonidine treatment in benzodiazepine withdrawal

Six subjects, dependent on benzodiazepines for at least 2 years, were gradually withdrawn, using placebo substitution, while taking clonidine. After withdrawal was complete, subjects were switched to clonidine-placebo. Despite administration of clonidine at doses sufficient to produce a fall in blood pressure, an abstinence syndrome was seen in five of the subjects. In none of these cases was the withdrawal syndrome exacerbated by changing from clonidine to clonidine-placebo. Scores of depression, subjective anxiety, observed anxiety and somatic symptoms did not change throughout the study.     

Major threats to childbirth in developing countries

Biological, psychological or social elements may constitute a threat to childbirth. In developing countries, major threats to childbirth mainly caused by restricted health service budgets may be overcome by the introduction of appropriate screening tests, implementation of evidence-based medicine protocols, and a primary health-care approach to maternity services.