Browsing by Author "Numanoglu, A"

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    Cervical lymph node biopsy - watch the nerves!
    (2006) Numanoglu, A; Rode, H
    Experience with the delayed diagnosis and severe consequences of accessory nerve injury following cervical gland lymph node biopsy prompted us to survey the practice of South African paediatric surgeons and to ascertain the incidence of accessory nerve injury. Cervical lymph gland biopsies are often performed for diagnostic and therapeutic purposes and although spinal accessory nerve (SAN) injury seldom occurs, it remains a significant injury. The operation is relatively minor and cervical glands are commonly biopsied/removed in South Africa by junior doctors, registrars and general practitioners. The operation is often performed as a day case under suboptimal circumstances, despite the fact that it is common knowledge that posterior triangle nodular biopsy carries the risk of iatrogenic damage to the accessory nerve.
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    Four decades of conjoined twins at Red Cross Children's Hospital - lessons learned
    (Health and Medical Publishing Group, 2006) Rode, H; Cywes, S; Lawrenson, J; Numanoglu, A; Fieggen, A G; Brown, R A; Davies, M R Q; Hewitson, J P; Hoffman, E B; Jee, L D; Mann, M D; Matthews, L S; Millar, A J W; Peter, J C; Thomas, J; Wainwright, H
    Conjoined twins represent a rare but fascinating congenital condition, the aetiology of which remains obscure. Over the past four decades, the paediatric surgeons at Red Cross Children's Hospital have been involved in the management of 46 pairs of conjoined twins, of which 33 have been symmetrical and 12 asymmetrical. Seventeen symmetrical twins have undergone separation with 22 children (65%) surviving; all of the live asymmetrical twins survived separation. We describe the important features of this unique cohort, outline our approach to management and present the results of this approach. We consider some of the ethical and moral dilemmas we have confronted, and discuss the prenatal diagnosis, obstetric implications and postnatal care of these children, including the relevant investigations and anaesthetic and surgical management. Specific aspects related to the cardiovascular system, hepatobiliary and gastrointestinal tracts, urogenital tract, central nervous system and musculoskeletal system are highlighted.
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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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    Meningococcal septicaemia complications involving skin and underlying deeper tissues - management considerations and outcome
    (Health and Medical Publishing Group, 2007) Bickler, SW; Bosenberg, A T; Numanoglu, A; Rode, H
    Objective: To describe surgical experience with purpura fulminans related to meningococcaemia in a single institution, and to suggest a management protocol. Methods: A retrospective review was done of patients admitted to the intensive care unit at Red Cross War Memorial Children's Hospital in Cape Town with the clinical diagnosis of purpura fulminans. Results: During a 28-year period (1977 - 2005) 112 children (average age 3.4 years) were treated for meningococcaemia with purpura fulminans. Overall mortality was 10.7%. Local treatment consisted of measures to improve circulation, infection control and healing of necrotic tissue. Demarcation of necrotic areas was evident at 5.5 days and the average area of skin necrosis was 14% total body surface area (range 2 - 85%). The lower limbs were predominantly affected. Purpura fulminans resolved in 35 children (31.2%) without skin necrosis. Skin grafting was required in 77 children (68.8%). Factors associated with a poor outcome for peripheral extremity salvage were progressive irreversible skin changes, early disappearance of distal pulses, tense cold swollen extremities and intense pain on passive movement of the affected extremity. Amputations were performed proximal to the area of necrosis, on average 27 days after injury. Conclusions: Meningococcaemia is a disease with potentially devastating consequences. Early surgical consultation is essential. Skin- and soft-tissue-releasing incisions should be considered early to reduce the incidence of extremity necrosis. Small necrotic areas usually separate spontaneously with secondary healing or can be excised and sutured. Larger necrotic areas should be excised only after demarcation has been established, and can be covered with delayed skin grafting. Amputation should be conservative but may require revision.
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    Overview of a paediatric renal transplant programme
    (2006) McCulloch, M; Gajjar, P; Spearman, W; Burger, H; Sinclair, P; Savage, L; Morrison, C; Davies, C; Ruysch van Dugteren, GPA; Maytham, D; Wiggelinkhuizen, J; Pascoe, M D; McCurdie, F J; Pontin, A; Muller, E; Numanoglu, A; Millar, A J W; Rode, H; Khan, D
    INTRODUCTION: Renal transplantation is the therapy of choice for children with end-stage renal failure. There are many challenges associated with a paediatric programme in a developing country where organs are limited. METHODS: A retrospective review was undertaken of 149 paediatric renal transplants performed between 1968 and 2006 with specific emphasis on transplants performed in the last 10 years. Survival of patients and grafts was analysed and specific problems related to drugs and infections were reviewed. RESULTS: On review of the total programme, 60% of the transplants have been performed in the last 10 years, with satisfactory overall patient and graft survival for the first 8 years post transplant. At this point, transfer to adult units with non-compliance becomes a significant problem. Rejection is less of a problem than previously but infection is now a bigger issue--specifically tuberculosis (TB), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections with related complications. A wide variety of drugs are available for tailoring immunosuppression to minimise side-effects. CONCLUSION: It is possible to have a successful paediatric transplant programme in a developing country. However, to improve long-term outcomes certain issues need to be addressed, including reduction of nephrotoxic drugs and cardiovascular risk factors and providing successful adolescent to adult unit transition.
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    The risks of gastrointestinal injury due to ingested magnetic beads
    (2014) Cox, S; Brown, R; Millar, A; Numanoglu, A; Alexander, A; Theron, A
    Accidental ingestion of foreign bodies is a common problem in children. Magnetic bead toys are hazardous, having potentially lethal consequences if ingested. These magnets conglomerate in different segments of bowel, causing pressure necrosis, perforation and/or fistula formation anywhere along the gastrointestinal tract. A clinical diagnostic pitfall is that the appearance on the initial abdominal radiograph may be misinterpreted by the uninitiated as a single metallic object without any intervening intestinal wall. Symptoms do not occur until complications have developed, and even then, unless magnet ingestion is suspected, treatment may initially be mistakenly expectant, as with any other foreign body. After observing a case of multiple magnet ingestion that led to the rapid onset of small-bowel inter-loop fistulas and peritonitis, we attempted to reproduce the likely sequence of events in a laboratory setting using fresh, post-mortem porcine bowel as an animal model and placing magnetic toy beads within the bowel lumen. Pressure-induced perforation appeared extremely rapidly, replicating the operative findings in two of our cases. We propose that if magnet ingestion is suspected, early endoscopic or surgical retrieval is mandatory. Appropriate, rapid surgical intervention is indicated. Laparoscopy offers a minimally invasive therapeutic option.