Browsing by Author "Goldberg, Paul A"

Now showing 1 - 7 of 7
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    A comparative cost analysis of two screening strategies for colorectal cancer in Lynch Syndrome in a tertiary hospital, South Africa
    (2017) Johnson, Yasmina; Sinanovic, Edina; Moodley, Jennifer; Goldberg, Paul A
    Individuals with Lynch Syndrome (LS) have a 25% to 75% lifetime risk of colorectal cancer and the cancer generally presents at an early age. Establishing the costs of strategies to prevent or delay the onset of cancer is, thus, desirable. This study compared the cost of two screening approaches - colonoscopy only (Strategy 1) versus genetic testing for LS followed by colonoscopy for the individuals that tested positive for LS (Strategy 2). A comparative cost analysis was conducted at a tertiary hospital, from the health provider perspective, using a micro-costing, ingredient approach. Probands that were selected, according to the Revised Bethesda Criteria, for genetic testing between 01 November 2014 and 30 October 2015, and their first degree relatives (high risk relatives) were evaluated according to Strategy 1 and Strategy 2. Total costs per strategy were estimated and compared. Sensitivity analyses were performed on adherence rates to colonoscopy, positivity rates of relatives and discount rates. A total of 40 families were studied. The total cost for Strategy 1 amounted to R4 932 718 ($332 617) compared to R390 308 ($26 319) for Strategy 2 (Discount rate 3%; Adherence 75% and Positivity rate of relatives 45%). Base case analysis indicated a difference of 92% less in the total cost for Strategy 2 compared to Strategy 1. Univariate sensitivity analyses showed that the difference in cost between the two strategies was not sensitive to changes in discount rates, adherence rates or positivity rates of relatives. Compared to colonoscopy screening only, colonoscopy combined with genetic testing presented a less costly option by identifying patients at high risk of colorectal cancer for screening. Testing of relatives should be facilitated since, compared to probands, genetic testing of relatives is less costly and is likely to have more benefit. Effectiveness of the screening programmes should be established through further research.
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    Complications of ileostomy closure and their risk factors
    (2014) Banerjee, Deepanjali; Goldberg, Paul A; Boutall, Adam
    Previous literature pertaining to complications following ileostomy closure and possible risk factors associated with ileostomy closure have been seen derived largely from developed countries. South Africa has its own unique patient population dynamics with regards to the colorectal disease burden including the, time and age at presentation, genetic variability, access to health care facilities, financial security, varying levels of social security and differences in sociocultural health seeking behaviour patterns. It would therefore be interesting to evaluate whether the type of complications seen at a tertiary teaching hospital in South Africa are comparable to that seen worldwide. Aim: To determine the complication rate after an ileostomy closure at Groote Schuur Hospital (GSH) between January 2008 and December 2012.
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    Effectiveness of Moviprep® as colonic preparation - cleansing right colon for Lynch Syndrome (LS) screening: a prospective study
    (2016) De Villiers, David Johannes; Goldberg, Paul A
    Purpose: Each year, a cohort in the Northern Cape undergo colonoscopies as part of a surveillance program for individuals who have a C1528T mutation in the hMLH1 gene that puts them at very high risk for the development of colon cancer (Lynch syndrome). A clean colon is essential as it allows a thorough evaluation and surveillance for small polyps or mucosal lesions mostly encountered in the ascending colon. This study evaluated both the subject acceptance and the effectiveness of a 2L PEG electrolyte lavage solution containing ascorbic acid and sodium ascorbate (Moviprep®) as a preparation solution. Methods: The screening program was divided into two stages. Stage 1, 71 subjects were counselled individually on the importance of bowel cleansing and the use of Moviprep® as their bowel cleansing agent. Preparation was either a) 2L the night prior to colonoscopy or b) 1L the night prior to and the second litre on the morning of the colonoscopy. Subjects were encouraged to drink at least 500ml clear fluid in addition to each litre of Moviprep®. Informed consent was obtained for participation in the study. Stage 2, approximately 6 weeks later, each subject completed a questionnaire, evaluating their experience with Moviprep® and also had their screening colonoscopy performed. Colonoscopies were performed at 4 medical facilities in the Northern Cape. All subjects were assessed for bowel cleanliness on arrival at the facility where colonoscopy was to be performed. If any of the subjects were found to be inadequately cleaned, extra oral preparation was given prior to colonoscopy. The Harefield cleansing scale was used to evaluate the quality of colonic cleansing during each colonoscopy. The colon was divided into 6 segments (rectum, sigmoid, descending-, transverse-, ascending colon and cecum). Preparation was scored as A = all colon segments clean; B = at least 1 segment with residual amounts of brown liquid or semisolid stool, which can easily be displaced or removed; C = at least 1 segment with only partially removable stool, preventing complete visualization; D = at least 1 segment which could not be examined due to solid stool). Grades A or B were considered successful cleansing and grades C or D were considered a failed colonic preparation. Results: A total of 46 subjects had colonoscopies performed. 41(89%) of them had successful and 5(11%) failed preparation. Three of those subjects that prepared successfully had previously undergone right hemicolectomies, leaving 38 with intact colons. 22/38 (58%) subjects achieved an A grade for caecal cleansing and 16/38 (42%) a B grading. 2438 (63%) subjects scored an A grade for the ascending colon and 14/38 (37%) a B grade. A total of 64 subjects completed the questionnaires of which 83% (53/64) had used other colon preparations previously. When asked if they would use Moviprep® again in the future, 89% (57/64) said yes and 11% (7/64) said no. 94% of subjects (60/64) would recommend Moviprep® to friend and family. Conclusion: Moviprep® provided adequate colonic cleansing in 89% of subjects. In addition, nearly 90% of subjects were satisfied with the product and would use it again.
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    Immunohistochemical identification of mismatch repair gene deficit and its clinico-pathologic significance in young patients with colorectal cancer
    (2005) Hameed, Muhammad Fayyaz; Goldberg, Paul A
    An immunohistochemical technique is used in this study to detect mismatch repair deficit in young patients with colorectal cancers. Ninety three patients who were 45 years of age or younger at the time of diagnosis of colorectal cancer were studied.
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    The incidence of recurrence after Delorme's procedure for full thickness rectal prolapse - a retrospective private-public cohort study
    (2016) Plaskett, Jeremy John; Baigrie, R J; Goldberg, Paul A; Kahn, D
    Background: Delorme's perineal repair has remained a procedure reserved for full-thickness rectal prolapse in elderly or co-morbid patients due to its low morbidity and complications. Reported recurrence rates are higher than in abdominal approaches. Aim: The study assesses long-term outcomes after Delorme's procedure (DP), specifically recurrence and postoperative bowel function, in both a multi-surgeon public hospital and a single surgeon cohort in the private sector (Groote Schuur Hospital and Kingsbury Hospital). Patients and Methods: This retrospective cohort study includes all patients who underwent DP between February 2001 and March 2014 at both study sites. The primary outcome was absence of recurrence. Secondary outcomes were bowel function (incontinence and constipation), postoperative mortality and morbidity and length of hospital stay. Patient data was collected from electronic records (Kingsbury Hospital) and paper folders/op notes (Groote Schuur Hospital) and current status was acquired by telephonic interview with either the patient, a family member or caregiver, as appropriate. Results: Seventy patients underwent DP: 37 private and 33 public, mean age 71yrs. There were 16 (23%) recurrences (7 private, 9 public), of which 8 (11%) underwent reoperation. Mean time to recurrence was 30 months (48 private; 15 public). There were 2 postoperative deaths (pneumonia, myocardial infarction), 6 major complications (rectal bleeding requiring transfusion or reoperation, bowel obstruction, pneumonia, myocardial infarction), and 6 minor complications (rectal pain, rectal bleeding not requiring reoperation or transfusion, urinary retention, confusion, hyponatraemia). The mean postoperative hospital stay was 4 days. Conclusion: Long-term outcome from this large series compares favorably with most other published series, specifically a low recurrence rate. Proposed reasons for this will be presented, within the context of the published literature.
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    Management of left-sided malignant colonic obstruction : an audit of a stent based protocol
    (2011) Warden, C; Stupart, D; Goldberg, Paul A; Kahn, D
    Colonic self-expanding metallic stents (SEMS) are proven to be safe and effective in the management of selected cases of malignant colonic obstruction. Since 2005, we have used endoscopic decompression with SEMS as the primary treatment of all patients with left-sided obstructing colorectal cancer, in the absence of perforation. The purpose of the study was to assess the safety and efficacy of this management protocol.
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    Should abdomino-perineal resection be considered when a defunctioning stoma is required for anal canal squamous cell carcinoma?
    (2014) Kloppers, Jacobus Christoffel; Goldberg, Paul A
    Combined modality treatment (CMT) is the preferred treatment for anal squamous cell carcinoma, but a small subgroup needs a defunctioning colostomy with temporary intent. The aim of this study was to evaluate the stoma closure rate of patients needing defunctioning colostomies prior to CMT for anal squamous cell carcinoma (SCC) at Groote Schuur Hospital (GSH). The key objective was to assess if abdomino-perineal resection (APR) should be offered as primary treatment modality for the subgroup of patients needing a defunctioning stoma and CMT.