Browsing by Author "Panieri, E"

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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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    National survey of surgeons' attitude to laparoscopic surgical training in SA
    (2004) Apostolou, C; Panieri, E
    Aim. Laparoscopic surgery forms an integral component of modern surgical practice. The perception exists that laparoscopic training in South Africa has been unplanned and under-resourced. This study set out to assess the opinions of surgeons and surgical trainees with regard to the various facets of laparoscopic surgical training. Methods. A national survey was conducted, using a questionnaire distributed to surgical staff of all academic surgical centres. Multiple variables were assessed, predominantly using the following numerical scoring system: 5 – strongly agree; 4 – agree; 3 – neutral; 2 – disagree; 1 – strongly disagree. Results. There were 122 respondents: 77 trainees and 45 consultants. The majority strongly agreed that laparoscopic training is essential for local surgical registrars. Current laparoscopic training was assessed as being average. Cholecystectomy, diagnostic laparoscopy, antireflux surgery and appendicectomy were the laparoscopic procedures deemed most important in training. The average number of laparoscopic cholecystectomies respondents thought were required for competency was 24. The major hurdle to training was lack of equipment and equipment shortages, and the majority felt that laparoscopic skills facilities and laparoscopy seminars would optimally augment training. Conclusion. Surgeons and trainees in academic units recognise the importance of laparoscopic training, but feel that it is currently not optimal. Consensus exists on appropriate procedures and what the hurdles are to training in our context. This knowledge can be applied to improve laparoscopic surgical training in South Africa.
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    Nodal disease predicts recurrence whereas other traditional factors affect survival in a cohort of South African patients with differentiated thyroid carcinoma
    (BioMed Central, 2018-11-19) Robertson, B; Parker, M; Shepherd, L; Panieri, E; Cairncross, L; Malherbe, F; Ross, I L; Omar, F; Hunter, A
    Background and aim Information on patients with differentiated thyroid carcinoma in South Africa is limited. The objective of this study was to review demographics and tumour characteristics in a cohort of patients with differentiated thyroid carcinoma, presenting to Groote Schuur Hospital and evaluate risk factors for recurrence and survival. Patients and methodology Retrospective demographic and clinical data were collected on all patients referred between January 2003 and December 2013. Prognostic factors for recurrence free survival and cancer specific survival were assessed using univariate and multivariate analyses. Results The total number of patients was 231.The median age at presentation was 44 years and 82% were female patients. The pathological sub-types were papillary (60.6%), follicular (38.9%) and poorly differentiated (0.5%). Total thyroidectomy was performed in 191 patients and 30 patients required neck dissections. A total of 171 (74%) patients received 131Iodine. The recurrence free and cause specific survival rates at 10 years were 83 and 91%, respectively. Nodal disease at presentation was the only significant risk factor for recurrence (p <  0.001) on multivariate analysis. Significant risk factors for cause specific mortality were age ≥ 45 years (p = 0.006), follicular pathology (p = 0.004), extra-thyroid extension (p = 0.013) and residual tumour (p = 0.004). Conclusions Consistent with international trends, patients with differentiated thyroid carcinoma treated at Groote Schuur Hospital had a favourable prognosis. The known risk factors associated with recurrence and survival in this South African cohort were consistent with those reported in developed countries.
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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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    Vocal cord paralysis secondary to multinodular goitre
    (Health and Medical Publishing Group, 2006) Mulwafu, W; Panieri, E; Garb, M; Duffield, M
    A 71-year-old man was referred to the ear, nose and throat (ENT) department from the neurology department for evaluation of dizzy spells experienced over 6 years. He had multiple medical problems that included ischaemic heart disease, myelodysplasia, hypertension and diabetes mellitus. He also reported a recent onset of hoarseness of voice.