Browsing by Author "Lubbe, Darlene"

Now showing 1 - 7 of 7
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    Comparing the efficiency of beclomethasone, fluticasone and mometasone nasal sprays in a Samter's population
    (2015) Monteiro, Pedro Vilas Boas; Lubbe, Darlene
    Statement of problem: Topical corticosteroids nasal sprays remain first line of treatment for patients with chronic rhinosinusitis (with or without nasal polyps). The main aim of treatment is to improve nasal symptoms by reducing or eliminating the nasal polyps and preventing polyp recurrence post-operatively. Our aims were to determine if the type of corticosteroid nasal spray used post operatively influences polyp recurrence rate and if there were any subsequent economic implications as we only have beclomethasone available for prescription in our state hospital. Methods: Retrospective case note review of all Samter's patients who underwent fronto-spheno-ethmoidectomy by a single surgeon (2000 – 2014). Results: 58 patients were included in our study, divided into 3 study groups. When compared to patients using beclomethasone; patients using fluticasone had an 80% reduced risk of polyp recurrence and patients using mometasone a 90% reduced risk. This rose to 88% and 96% respectively when adjusted for age. Conclusion: Fluticasone and mometasone are both statistically significantly more effective at reducing polyp recurrence than beclomethasone in our population group. Mometasone appeared more effective than fluticasone, but this difference was not statistically significant.
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    Endoscopic repair of cerebrospinal fluid leaks
    (2018) Mohammed, Ben Husien; Semple, Patrick Lyle; Lubbe, Darlene
    Developmental Venous Anomalies are a normal variant that may be associated with other cerebral vascular malformation they have bean previously referred to Venous angiomas. DVAs are the most frequently encountered cerebral vascular malformation and their incidence is reported to be high as 2.6%. DVAs are classified into two types based on draining veins. Either deep or superficial. Those that drain into subependymal veins are classified as deep and those that drain into cortical pial veins are classified as superficial. The trans-cerebral veins join either the deep or superficial venous systems by crossing a varying length of the brain parenchyma. Controversy surrounds their exact clinical significance, as DVAs are rarely symptomatic. The symptoms displayed by a patient can be related to a lesion that is associated with DVAs, such as a cavernoma. Study Aim: To describe the patients presenting to a single unit over a 10-year period with symptoms attributable to a DVA. Results: Out of 19 patients in the database with the diagnosis of DVA, 10 were identified where the clinical presentation was directly related to the DVA. Seven of the patients presented with haemorrhage, 6 had parenchymal bleeds and one was intraventricular. Two patients had neurological deficit, 1 was transient and one was progressive. One patient had sudden severe headache with no evidence of haemorrhage on CT scan. The age range was from 14 to 55 with a mean of 32,7 years. Four patients were male and 6 were female. Of the patients that presented with haemorrhage only one had a fistula, three other patients with haemorrhage had evidence on DSA of stenosis of the large collector vein, In the remaining 3 patients no reason for the bleed could be detected. One patient presented with left hemianopia that resolved after several hours, DSA showed minimal caput medusa with delayed filling of the collector vein. The other patient that presented with progressive neurological deficit in the form of progressive leg spasticity and dysarthria, Angiography showed a large collecting vein that drains in the jugular bulb was stenosed. The last patient that presented with sudden sever headaches, with no haemorrhage identified on CT scan, On DSA there was early filling of the DVA veins compared to other cerebral veins and two prominent posterior communicating thalamoperforating vessels were seen. Conclusion: Developmental venous anomalies are the commonest vascular malformation, and are rarely symptomatic unless associated with a cavernoma. In patients that have symptoms linked to DVAs (Haemorrhage, neurological deficit, sudden sever headaches) overall they have a good outcome, and the deficit related to a DVA tend to improve overtime, except for one patient that we had in our group, the DVA draining the pons and the cerebellar hemisphere had a tight outflow stenosis, that lead to progressive neurological deficit. In general, the majority of DVAs that are symptomatic do well.
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    Endoscopic Resection and Post-Operative Brachytherapy in the Treatment of Sinonasal Melanoma
    (2019) Alhadad, Abdulrauf I; Lubbe, Darlene; Lubbe, Darlene
    Background: Sino-Nasal Melanomas (SNM) are rare, aggressive tumours often associated with a poor prognosis due to advanced stage disease at presentation. Mean 5-year survival is 0-46%. Various treatment modalities are used in the management of SNM. Surgery is regarded as the primary treatment modality, but therapy remains controversial. Complete resection is a surgical challenge and it is often impossible to achieve adequate margins due to the fact that tumour often abuts vital anatomical structures. Incomplete resection has been shown to be a predictor of poor survival. Harris et al. (2014) were the first to report on the use of post-operative brachytherapy in an attempt to prevent local recurrence after endoscopic resection of SNM. Methods: A retrospective analysis of all patients undergoing endoscopic resection of SNMs and receiving adjuvant brachytherapy in a single surgeon’s practice between August 2004 and May 2014 was carried out. Outcome measures included local control rate and 5-year overall survival estimated by Kaplan-Meier analysis. The incidence of regional and distal recurrence (metastases) was calculated Results: Five cases of sinonasal melanoma (3 males 2, females) were managed with endoscopic resection and adjuvant brachytherapy. Patients were followed up for a median duration of 61 months (32-154 months) following adjuvant Brachytherapy. Local control was achieved in four out of five patients (80%). Three out of five patients developed distant metastasis. Median time to metastasis was 54 months. One patient received immunotherapy after diagnosis of distant metastasis (BRAF positive). Three out of five patients (60%) died from the complications of distant metastases of sinonasal melanoma. Median survival time following adjuvant Brachytherapy was 61 months (32-154 months). Five-year survival rate was 40% (95% CI 5.2% - 75.3%). Conclusion: This is the only case series describing the use of brachytherapy following endoscopic resection of sinonasal melanoma. Our case series, albeit small, describes a local control rate and 5-year survival comparable with the best reported in the literature. Adjuvant brachytherapy represents a novel approach and potentially a useful addition to the adjuvant therapy armamentarium. The advantages of brachytherapy include a favourable side-effect profile and a shorter duration of treatment, while delivering a dose of radiation similar to that of Conventional Radiotherapy. Further studies are necessary to define the role of brachytherapy in sinonasal melanoma.
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    Incidence of atrophic rhinitis after endoscopic sinonasal surgery : a retrospective review
    (2014) Kamedien,Mogammad Sauliegh; Lubbe, Darlene
    Sinonasal tumours have been resected endoscopically at Groote Schuur Hospital Cape Town South Africa since 2003. Surgery, although seen as minimally invasive because no external incisions are visible, is often very aggressive and destructive to the nasal structures. The removal of the nasal turbinates has always been seen as sacrilege due to the risk of developing atrophic rhinitis. If the theory regarding developing atrophic rhinitis after a simple turbinectomy stands true, one would expect a high incidence of atrophic rhinitis after radical resection of the sinonasal structures. This has not been our experience. METHODS: The study population includes a retrospective case review of all patients that had endoscopic sinonasal tumour resection by the same surgeon between 2006 and 2010. All patients were assessed for symptoms and signs suggestive of atrophic rhinitis up to two years post resection. RESULTS: 51 patients (34M: 17F) were included in the study. Patients with residual or recurrent tumour (n=19) and patients who had received adjuvant radiotherapy (n=17) had a statistically significant chance of developing symptoms and signs suggestive of atrophic rhinitis over time. Variables such as age, gender, extent of surgery, bilateral disease, benign or malignant tumour, were not statistically significant in the development of symptoms and signs suggestive of atrophic rhinitis over time. CONCLUSIONS: Atrophic rhinitis is not more common in patients who undergo endoscopic sinonasal surgery without adjuvant therapy. However, patients with residual tumour (after debulking surgery) or recurrent tumour and those who had received adjuvant radiotherapy had a statistically significant chance of developing symptoms and signs suggestive of atrophic rhinitis over time. Keywords: atrophic rhinitis, endoscopic resection, turbinectomy, medial maxillectomy, sinonasal tumours.
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    Perioperative cell salvage blood transfusions in endonasal angiofibroma surgery at Groote Schuur Hospital
    (2015) Wasl, Hisham; Lubbe, Darlene
    Surgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures; therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature reveals very few case reports. General surgery procedures are often carried out in a contaminated field and concerns have been raised about its safety. This study investigates the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA). Methods: Because JNA is a rare vascular nasal tumour, the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed.
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    Success rate of myringoplasty at Groote Schuur Hospital
    (2011) Becker, Juanita; Lubbe, Darlene
    OBJECTIVES: The aim of this study was to determine the success rate of myringoplasty surgery performed at Groote Schuur Hospital and to evaluate some of the presumed prognostic factors. DESIGN: The study design was a retrospective analytical cohort. SETTING: Groote Schuur Hospital (tertiary medical centre), Cape Town. SUBJECTS: This study assessed the success rate of 341 myringoplasty operations performed by surgeons in the Department of Otolaryngology from January 2005 to December 2009. OUTCOME MEASURES: An unsuccessful operation was classified as a residual perforation seen at the 3-month follow-up visit that remained present at all subsequent visits. Presumed prognostic factors such as the rank of the surgeon, size of the perforation, location of the perforation, graft used and whether it was a revision procedure, were also evaluated. Where possible, the audiometric gain following surgery was calculated. RESULTS: The overall success rate in terms of an intact tympanic membrane following myringoplasty was 71%. The average improvement in pure tone average following myringoplasty was 12.4 dB. In 64% of patients, socially acceptable hearing levels were present postoperatively (air-conduction of less than 30 dB). None of the presumed prognostic factors was a statistically significant determinant (p>0.05). CONCLUSION: The success rate for myringoplasty (in terms of perforation closure) of 71% at Groote Schuur Hospital compares well with that quoted in the literature. There is no ethical dilemma from a surgical outcomes perspective of registrars performing myringoplasties.
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    Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-term Outcomes & Surgical Technique
    (2020) Goncalves, Nicholas; Lubbe, Darlene
    Sphenoid wing meningiomas are benign tumors that result in proptosis, visual impairment and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. The aim of the study was to assess long term vision and proptosis outcomes in patients undergoing a transorbital endoscopic resection of sphenoid wing meningioma using a combined endonasal, precaruncular and extended superior eyelid approach and to describe the surgical approach. Materials & Methods A retrospective chart review was conducted in 21 patients with lateral sphenoid wing meningioma at Groote Schuur Hospital & Cape Town Mediclinic from 2015–2019. All patients had undergone a transorbital endoscopic subtotal resection (Simpson grade II – IV) by the same surgical team. Vision was assessed using a Snellen chart and proptosis measured in mm using a Hertel exophthalmometer by an ophthalmologist. Measurements were taken at 6 weeks, 6 months and at 1 year postoperatively and compared to pre-operative values. Patients were categorized according to the WHO classification of vision into group A (blind), group B (low vision) & group C (normal vision) according to their pre-operative visual acuity. Nonparametric statistical tests employing the Wilcoxon Signed-Ranks Test were used for analysis. Statistical significance was determined by a confidence interval of 0.95, p = < 0.05 for both visual acuity (converted to LogMar) and proptosis in mm. Results A total of 21 patient charts were reviewed. The mean age of presentation was 48.8 years (range 34-79 years), and the majority of patients were female (20/21 = 95%). The most common presenting complaints were loss of vision (100%), proptosis (95%) and headache (76%). Preoperative visual results were as follows: 10 (48%) in group A (blind), 4 (19%) in group B (low vision) and 7 (33%) in group C (normal vision). In group A, 6 (60%) remained unchanged, 2 (20%) deteriorated & 1 (10%) improved. In group B, 3 (75%) improved, and 1 (25%) remained stable. In group C, 5 (71%) improved and 2 (29%) remained stable. Vision in groups B & C showed no deterioration. Patients in group A showed no benefit from optic nerve decompression. Vision in groups B & C showed a statistically significant improvement at 6 weeks [95% CI] (p = 0.021). This trend extended to long term follow up at 6 months [95% CI] (p= 0.021) and 1 year [95% CI] (p = 0.0054) postoperatively. Proptosis initially decreased, proving statistical significance at 6 weeks [95% CI] (p = 0.0054) postoperatively. The decrease at 6 months (p = 0.08) was not statistically significant and trended towards an increase in proptosis by 1 year (p = 0.78) postoperatively. The mean hospital stay was 2.7 days (range 2 – 4 days). The majority of tumors were histologically classified as WHO grade I. Conclusion Endoscopic medial optic canal decompression prior to transorbital multiportal surgery for sphenoid wing meningioma stabilizes or improves visual acuity for at least 1 year. Lateral orbitotomy via a superior eyelid approach and subtotal tumor resection initially decreases proptosis, but in the long term, returns to its preoperative state by 1 year if the main tumor component is not addressed. The earlier that medial optic nerve decompression is performed and the better the preoperative visual acuity, the greater the likelihood of favorable long-term visual outcomes.