Browsing by Author "Kahn, D"

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    Biochemical and immunohistochemical charterisation of mucins in 8 cases of colonic disease - a pilot study
    (Health and Medical Publishing Group, 2007) Chirwa, N; Govender, D; Kahn, D; Mall, A; Tyler, M; Kavin, B; Goldberg, P; Krige, J E J; Lotz, Z; Hunter, A
    Objectives: To characterise mucins in cancer of the colon and compare these with controls using stringent biochemical measures to avoid endogenous proteolysis. Design: Crude mucus scrapings were collected from 12 specimens obtained by colectomy. Specimens from 3 traumatic colectomies and 1 sigmoid volvulus were used as controls, and compared with 6 specimens from colons resected for adenocarcinoma and 2 irradiated colons. Subjects: The median age of the 4 female patients was 76 years (range 49 - 82 years), and of the 8 male patients 46.5 years (range 16 - 74 years). Results and conclusions: The crude mucus scrapings in the 9 specimens ranged in weight from 353 mg to 7 697 mg (median 4 928 mg). The median of purified mucin in the 9 specimens was 0.72 µg/mg wet weight of scraped material. Eight samples gave non-extractable pellet material, and were treated with DTT to reduce disulphide bonds for further analysis. One of these 8 pellets was resistant to reduction and had to be digested with papain before analysis. Only 5 of these pellets had mucin. Gel filtration and SDS-PAGE (sodium dodecyl sulphate polyacrylamide gel electrophoresis) analysis revealed different populations of mucin based on size and extent of degradation. Western blotting and immunohistochemical analysis confirmed the presence of MUC2 in all samples, MUC5AC in 2 and MUC5B in 5 diseased specimens. Immunohistochemical analysis showed that there was no MUC1 in the normal specimens, MUC1 apoprotein MUC1 core) in 2 cancer specimens and MUC1 in 1 cancer specimen. Histochemical analysis showed that normal tissue expressed neutral and acidic mucins and diseased specimens predominantly expressed acidic mucins. The electrophoretic behaviour of MUC2 in sigmoid volvulus was different from that in cancer of the colon.
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    Delayed graft function in renal transplantation : aetiology and impact on graft outcome
    (2001) Douie, Walter James Percival; Kahn, D
    The optimal therapy for most patients with end stage renal disease is renal transplantation. This form of therapy results in improved quality of life, decreased medical expense, and perhaps a survival advantage for the recipient. Renal transplantation is however a complex form of therapy which may be associated with significant complications. The most common allograft complication post transplantation is the development of delayed graft function with a reported incidence of between 23 to 34%. This is a costly complication requiring ongoing dialysis and prolonged hospitalization. It also has a significant emotional impact on the patient and their family. Of greater concern though are the reports in the literature which associate delayed graft function with decreased graft survival. With current organ shortages organ donor criteria have been expanded to match the shortage. It is thus imperative that we should understand the mechanisms of graft damage which may result in delayed graft function. A better understanding of the relationship between delayed graft function and graft survival might significantly impact on our practice in certain settings such as in the use of organs harvested from a marginal donor.
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    Endoscopic injection sclerotherapy in the treatment of bleeding oesophageal varices in patients with portal hypertension due to alcohol-induced cirrhosis : an assessment of acute control of bleeding, prevention of recurrent bleeding and prognostic factors predicting early variceal rebleeding and death
    (2009) Krige, J E J; Bornman, P C; Kahn, D
    The ideal treatment of portal hypertension and bleeding varices should be universally effective, safe, easy to administer and inexpensive. Currently no such treatment exists and the surgeon or physician is obliged to select the most appropriate intervention from a menu of currently available therapeutic options, none of which is ideal or applicable to all patients. The rational treatment of oesophageal varices depends on a clear understanding of the risks of rebleeding and the response to each specific intervention. The selection of the correct and appropriate intervention is critical and requires a comprehensive understanding of the relative efficacy and safety of each treatment compared to other competing options. In addition, the chosen intervention requires detailed knowledge of the criteria underpinning the correct selection of patients for treatment in order to maximize the therapeutic benefits of the appropriate choice while minimising the side effects of the treatment. The optimal management of bleeding oesophageal varices therefore requires a full appreciation of portal, gastric and oesophageal venous collateral anatomy, the pathogenesis and haemodynamic consequences of variceal bleeding and the utility of each available therapy at specific stages in the natural history of portal hypertension (Henderson 1998).
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    General Surgery in crisis - the critical shortage
    (Health and Medical Publishing Group, 2006) Kahn, D; Pillay, S; Veller, MG; Panieri, E; Westcott, MJR
    Introduction: General surgery is facing a serious crisis. There has been a significant decline in the number of applicants for registrar posts and an inability to attract and retain general surgical specialists in the state sector. The Association of Surgeons of South Africa (ASA) undertook this study to determine the extent and cause of the problem. Methods: The study involved a combination of desk research and structured interviews. In addition, the Health Professions Council of South Africa (HPCSA) database was reviewed and compared with the South African Medical Association (SAMA) and ASA databases. The medical schools provided information about student numbers and demographics, and the National Department of Health provided information about the status of medical practitioner and specialist posts in the state sector. Results: Overall, 26.1% of the specialist posts were vacant. The situation was particularly critical in Mpumalanga and the Eastern Cape, where 84% and 58% of the specialist posts were vacant. Using a predictive model, a conservative estimate of the need for general surgeons was found to be at least 50 per year. Currently the eight medical schools graduate about 25 general surgeons per year. The changing demographics of medical students may be partly responsible for the decline in registrar applicants. Conclusion. The findings from this study have revealed that the shortage of general surgeons in the state sector has reached critical levels.
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    Hypoalbuminaemia in brain-dead donors for liver transplantation
    (Health and Medical Publishing Group, 2005) Ibirogba, SB; Spearman, W; Mall, AS; Shephard, EG; Kahn, D
    Liver transplantation has become established as the treatment of choice for most patients with end-stage liver disease and is performed on a routine basis in most major centres throughout the world. The majority of donors for liver transplantation are brain-dead cadaver donors following either a severe head injury or a massive intracranial haemorrhage. Potential liver donors undergo a rigid screening process before being accepted. This includes a thorough clinical examination to assess the haemodynamic status of the donor and to exclude any overt evidence of liver disease. Blood samples are also taken for viral studies to exclude HIV infection and hepatitis B and C infection, and for liver function tests to exclude liver disease or liver injury. Over the years we have noted that our liver donors often had low serum albumin levels, although this has not been formally documented. A review of the literature revealed that hypoalbuminaemia associated with severe head injury has been documented previously. However the impact of brain death on serum albumin levels has not been studied previously. The present study was therefore undertaken to document serum albumin levels in brain-dead cadaver donors.
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    The Incidence of Inguinal hernia recurrence after Laparoscopic herniorrhaphy - a retrospective multicentre cohort study of patients operated on at a private practice in Cape Town
    (2012) MacGuire, Colin Iain; Kahn, D; Baigrie, R J
    The primary outcome will be the incidence of hernia recurrence. Secondary outcomes will be the incidence of post-operative and long-term pain and complications.
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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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    Ischaemic preconditioning of the liver before transplantation
    (Health and Medical Publishing Group, 2007) van As, A B; Foroutan, H R; Lotz, Z; Tyler, M; Millar, A J W; Kahn, D
    Purpose: Assessment of the effect of a short ischaemic time prior to liver transplantation on the liver graft. Methods: White X Landrace pigs (N=10) were subjected to liver transplantation. Before being removed from the donor animal, the livers were randomised into two groups: group 1 - pre-procurement ischaemia (15 minutes' temporary arrest of portal venous and hepatic arterial inflow to the liver, followed by reperfusion of these vessels for a period of 15 minutes); group 2 - no prior inflow occlusion (control group). In group 1 a spleno-jugular bypass was established to prevent venous congestion, portal venous hypertension, intestinal oedema and bacterial translocation. The livers were perfused with Eurocollins solution (4oC), after which they were stored on ice for a period of 3 hours' cold ischaemic time. Hepatocellular injury was assessed according to liver cell function tests (aspartate aminotransferase, AST), biochemical indicators of reperfusion injury (malondialdehyde) and histopathology. Results: There was a significant rise of AST in both groups 1 hour after transplantation (from 51+27 IU/l to 357+152 IU/l in group 1 and from 29+10 IU/l to 359+198 IU/l in group 2). AST levels were marginally lower in group 1 at 2 and 4 hours after transplantation. There was also a rise in malondialdehyde levels in both groups at 5, 20, 40 and 60 minutes after transplantation. Levels of malondialdehyde were lower in the primed group at 5, 20 and 40 minutes, while the levels at 60 minutes after transplantation were comparable. Histological changes, as measured by vacuolisation, neutrophil infiltration and hepatic cell necrosis, were less in livers transplanted after ischaemic preconditioning, although the difference was not significant. Conclusions: Ischaemic preconditioning of the donor liver seems to decrease hepatocellular damage, reperfusion injury and histological changes in the liver after transplantation. Further studies with larger numbers are indicated.
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    Liver transplantation at Red Cross War Memorial Children's Hospital
    (2006) Spearman, C W N; McCulloch, M; Millar, A J W; Burger, H; Numanoglu, A; Goddard, E; Gajjar, P; Davies, C; Muller, E; McCurdie, FJ; Kemm, D; Cywes, S; Rode, H; Kahn, D
    The liver transplant programme for infants and children at Red Cross War Memorial Children’s Hospital is the only established paediatric service in sub-Saharan Africa. Referrals for liver transplant assessment come from most provinces within South Africa as well as neighbouring countries. Patients and methods. Since 1987, 81 children (range 6 months - 14 years) have had 84 liver transplants with biliary atresia being the most frequent diagnosis. The indications for transplantation include biliary atresia (48), metabolic (7), fulminant hepatic failure (10), redo transplants (3) and other (16). Four combined liver/kidney transplants have been performed. Fifty-three were reduced-size transplants with donor/recipient weight ratios ranging from 2:1 to 11:1 and 32 children weighed less than 10 kg. Results. Sixty patients (74%) survived 3 months - 14 years post transplant. Overall cumulative 1- and 5-year patient survival figures are 79% and 70% respectively. However, with the introduction of prophylactic intravenous ganciclovir and the exclusion of hepatitis B virus (HBV) IgG core Ab-positive donors, the 1-year patient survival is 90% and the projected 5-year paediatric survival is > 80%. Early (< 1 month) postliver-transplant mortality was low. Causes include primary malfunction (1), inferior vena cava thrombosis (1), bleeding oesophageal ulcer (1), sepsis (1) and cerebral oedema (1). Late morbidity and mortality was mainly due to infections: de novo hepatitis B (5 patients, 2 deaths), Epstein-Barr virus (EBV)- related post-transplantation lymphoproliferative disease (12 patients, 7 deaths) and cytomegalovirus (CMV) disease (10 patients, 5 deaths). Tuberculosis (TB) treatment in 3 patients was complicated by chronic rejection (1) and TB-drug-induced subfulminant liver failure (1). Conclusion. Despite limited resources, a successful paediatric programme has been established with good patient and graft survival figures and excellent quality of life. Shortage of donors because of infection with HBV and human immunodeficiency virus (HIV) leads to significant waiting-list mortality and infrequent transplantation.
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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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    Registrars working hours in Cape Town
    (2005) Vadia, S; Kahn, D
    The number of hours worked by general surgical registrars in Europe and the USA has been reduced so as to reduce fatigue and the possibility of errors. The impact of these restrictions on surgical training remains unresolved. To date there are no officially reported data on the number of hours worked by registrars in South Africa. The aim of this study was to document the hours worked by registrars in general surgery in Cape Town. Thirty-three general surgical registrars at the University of Cape Town were asked to complete a time sheet over a 2-week period, indicating hours spent in hospital as part of a normal working day, hours spent in hospital outside of a normal day, hours at home on ‘cold call’ and hours off duty. Of the 33 registrars, 25 completed the time sheet. Registrars at Groote Schuur Hospital worked an average of 105 hours per week (68 hours in hospital and 37 hours on call at home). Registrars at New Somerset Hospital worked 79 hours per week (70 hours on site), while registrars at Red Cross Children’s Hospital, G. F. Jooste Hospital and the Trauma Unit worked 60 - 69 hours per week. In the Surgical Intensive Care Unit (SICU) registrars worked 75 hours per week. In conclusion, general surgical registrars at the University of Cape Town work hours in excess of European and American work-hour restrictions.
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    Risk of blood splashes to the eye during surgery
    (2009) de, Silva R; Kahn, D; Mall, AS; Panieri, E; Stupart, D J
    Background. With the advent of a new infectious era involving the HIV and hepatitis B and C viruses, concern has arisen about transmission of these viruses through ocular blood splashes during surgery. The purpose of the study was to determine the risk of ocular blood splashes to surgeons and their assistants during surgery. Method. Surgeons and assistants in several surgical disciplines were requested to wear facemasks with a transparent plastic visor. The visors were collected postoperatively and inspected for macroscopic and microscopic blood splashes. Results. Fifty-nine per cent of the surgeons and assistants refused to wear facemasks with a visor. The incidence of blood splashes in those who participated was 45%. There was a trend for blood splashes to be more common during major surgery and during elective surgery. Surgeons and assistants were subject to similar risk. Conclusion. This study confirms the significant risk of ocular blood splashes during surgery, while also suggesting that both surgeons and assistants lack appreciation of the risk.
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    Skin sparing mastectomy and immediate reconstruction for breast cancer: a three to five year follow-up study of post-operative patients looking at cosmetic outcome
    (2007) Muller, Elsie Maria; Kahn, D
    Over 100 years ago Halsted described the radical mastectomy for early breast cancer. 1 This involved wide, en bloc removal of the tumour, normal surrounding structures of the chest wall, and contents of the axilla. For 75 years this remained the treatment of choice for women with breast cancer. Most tumours could be resected using this approach and local recurrences were rare. However, this radical surgical approach was associated with significant short- and long term morbidity. Removal of the pectoralis muscles resulted in major aesthetic chest wall deformity. Other complications involved impaired range of movement, chronic lymphoedema and poor quality of life. However, the most important weakness of radical mastectomy was its failure to influence long-term survival.