Browsing by Author "Panieri, Eugenio"
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- ItemOpen AccessA 40-50kDa Glycoprotein Associated with Mucus is Identified as α-1-Acid Glycoprotein in Carcinoma of the Stomach(2012) Chirwa, Nthato; Govender, Dhirendra; Ndimba, Bongani; Lotz, Zoe; Tyler, Marilyn; Panieri, Eugenio; KAHN, DELAWIR; Mall, Anwar SBackground and Aim: Secreted gastric mucins are large O-glycosylated proteins of crude mucus gels which are aberrantly expressed in malignancy. An albumin associated 55-65kDa glycoprotein was previously shown in mucus gels in gastric cancer. The aim of this study was to investigate its expression and identification in human gastric tissue. Methods: Mucins were purified from crude mucus scrapings of 16 partial and 11 total resections and a rabbit polyclonal antibody was raised to the 55-65kDa glycoprotein. The location and expression of the glycoprotein was examined in normal gastric mucosa (n=20), intestinal metaplasia (n=18) and gastric cancer (n=27) tissue by immunohistochemistry. Mucins were analyzed by isoelectric focusing (IEF) on 2-D polyacrylamide gels. Identification of the 40-50kDa glycoprotein was by MALDI-TOF MS technique. Plasma levels were examined by Western blotting. Results: Extensive SDS-PAGE analysis gave a PAS positive glycoprotein in the 40-50kDa range, in patients with gastric cancer but not normals. It was expressed in parietal and columnar cells of normal gastric tissue and intestinal metaplasia respectively, and in 22 of 27 gastric cancer specimens. In 2-D PAGE stained with Coomassie Blue there were 3 spots positively identified as alpha-1-acid glycoprotein (AGP) by MALDI-TOF MS technique. PAS staining revealed a single bright spot in the same position but could not be identified. Preliminary measurements showed slightly higher levels of AGP in plasma of patients with gastric carcinoma. Conclusion: AGP levels are increased in gastric tissue and in the plasma of those with carcinoma of the stomach.
- ItemOpen AccessA Clinical Approach to Common Surgical Scenarios: A Handbook for Students and Junior Doctors(The Authors, 2020-01) Panierie, Eugenio; Cairncross, Lydia; Boutall, Adam; Bernon, Marc; Malherbe, Francois; Panieri, Eugenio; Malherbe, FrancoisAimed at students and junior doctors, the purpose of this book is to provide a guide to the evaluation of common surgical problems as well as test diagnostic and troubleshooting skills when there is nobody to help or ask for advice.
- ItemOpen AccessDelay in provision of breast cancer care in patients seen at a district hospital diagnostic breast unit in South Africa(2018) Ng'ang'a, Mukuhi; Panieri, Eugenio; Malherbe, FrancoisBackground: There is evidence to show that delays in breast cancer management are detrimental to patient outcome. The aim of this study was to determine time trends and causes of delay in a newly established diagnostic breast clinic based at a district hospital in South Africa. Method: All patients who presented to Mitchells Plain District Hospital Breast Clinic from January to December 2015 and had a diagnosis of breast cancer were included in this study. The intervals between the time she first noted her symptoms to initial contact with a health professional and delivery of definitive therapy was documented. Patient delay referred to the interval from when the patient first noted her symptoms to her initial contact with a health care provider. Provider delay referred to the interval between the first hospital visit and onset of therapy. Result: A total of 33 patients were enrolled in this study. The median overall total delay (time lapse between the moment the patient first noticed her symptoms to time definitive anti-cancer treatment was started) was 157days, (range 29 to 839 days). Median patient delay (time lapse between the moment the patient first noticed her symptoms and the visit to a health professional) was 56 days, (range 7 to 730 days). Median overall provider delay (time lapse between the patients' first encounter with a clinician to time definitive anti-cancer treatment was started) was 84 days, (range 22 to 338 days). Median Referral delay was 11 days (range 4 to 39 days). Median Diagnostic delay was 15 days (range 9 to 135 days) and median treatment delay was 45 days (range 5 to 246 days). Conclusion: The median overall total delay for patients diagnosed with breast cancer at Mitchells Plain District Hospital does not compares well with institutions in developed nations but it is similar to studies done in developing nations. The largest contributor to this delay was patient delay. The main contributors to provider delay was related to diagnosis (almost exclusively related to tissue diagnosis) and treatment (mainly patients who received surgery as their first definitive therapy).
- ItemOpen AccessFive-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center(2017) Nashidengo, Pueya Mekondjo; Cairncross, Lydia Leone; Panieri, EugenioBackground: Breast cancer burden is on the increase in the developing world. Breast-conserving therapy (BCT) is prescribed for early breast cancer. It is the wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer presenting to the Groote Schuur Hospital's Oncology and Endocrine Surgical unit, Cape Town South Africa. There has not been a formal audit to review the outcomes of BCT in the unit. Objectives: The objective of this study is to determine and analyse the excision margins for all the wide local excisions and the re-excision and local recurrence rates during the study period. Methods: This is a histopathological and oncology records review of the patients that have undergone BCT in the unit from the 1st of January 2006 until the 31st of December 2010. The University of Cape Town's Faculty of Health Sciences Human Research Ethics Committee granted approval. Data points accrued included patient age, pathological tumour size and nodal status, histological tumour type, oestrogen receptor status, presence of lymphovascular invasion, volume of specimen excised, margin status, management of involved or close margins, completeness of radiotherapy, ipsilateral breast recurrence rate and total duration of follow up. Results: A total of 192 patients had BCT during the study period. The mean age is 53 years (range 25 to 84 years). A median of 229.5 cm3 volume of specimen was excised (range 4 cm3 to 10530 cm3). Infiltrating ductal carcinoma was the commonest histological type at 79.1%. 42.7% were pT1 tumours, 49.0% pT2 tumours and 2.6 % pT3. The resection margin status are: positive margins rate of 15.1%, 8.3 % close margin (≤ 1 mm), 35.9% 1 – 5 mm, 23.4% 6 – 10 mm and > 10 mm 17.2%. An overall of 26 (13.5%) patients underwent a repeat surgical procedure. 16 (8.3%) had re-excision and 10 (5.2%) had a mastectomy. Residual tumour was present in 50% of the re-excisions and 63.6% of mastectomies. As per category of the resection margins, 68.9% of patients with positive margins had repeat surgery (48.3% re-excision and 20.6% mastectomy). 31.1% of patients with positive margins did not have repeat surgery despite the indication due to advanced age, loss to follow up or residual tumour on the deep chest wall margin. 80.8% patients completed radiotherapy treatment post breast-conserving surgery. At a median follow up of 60 months (range 1 to 108 months), a total of 11 (6.8%) patients had ipsilateral breast local recurrence. Median time to recurrence is 39 months (range 12 to 106 months). Conclusion: Positive and close margin re-excision and local recurrence rates in our unit are acceptable and comparable to other units in South Africa and internationally.
- ItemOpen AccessNovel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes(2018) Spence, Richard Trafford; Panieri, EugenioBackground Despite the existence of multiple validated risk-assessment and quality benchmarking tools in surgery, their utility outside of High Income Countries is limited. We sought to derive, validate and apply a scoring system that is both 1) feasible, and 2) reliably predicts mortality in a Middle Income Country (MIC) context. Methods A 5-step methodology was used: 1. Development of a de novo surgical outcomes database modeled around the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) in South Africa (SA Dataset) 2. Use of the resultant data to identify all predictors of in-hospital death with more than 90% capture indicating feasibility of collection 3. Use these predictors to derive and validate an integer-based score that reliably predicts in-hospital death in the 2012 ACS-NSQIP 4. Apply the score in the original SA dataset and demonstrate it’s performance 5. Identify threshold cutoffs of the score to prompt action and drive quality improvement. Results Following Step one-three above, the 13 point Codman’s score was derived and validated on 211,737 and 109,079 patients, respectively, and includes: 1) age≥65 (1), partially or completely dependent functional status (1), preoperative transfusions≥4 units (1), emergency operation (2), sepsis or septic shock (2) American Society of Anesthesia (ASA) score ≥3 (3) and operative procedure (1-3). Application of the score to 373 patients in the SA dataset showed good discrimination and calibration to predict an inhospital death. A Codman Score of 8 is an optimal cutoff point for defining expected and unexpected deaths. Conclusion We have designed a novel risk prediction score specific for a MIC context. The Codman Score can prove useful for both 1) preoperative decision-making and 2) benchmarking the quality of surgical care in MIC’s.
- ItemOpen AccessPatient reported outcome measures (PROMs) in breast cancer patients after immediate breast reconstruction using the Breast-Q(2020) Möller, Ernst Lodewicus; Cairncross, Lydia; Panieri, Eugenio; Hudson, DonaldBackground Mastectomy is the mainstay of surgical treatment for women with breast cancer in South Africa. The increase in breast reconstruction after a mastectomy has prompted the need to evaluate patient reported outcome measures (PROMs) for this set of operative intervention. This study aimed to assess clinical and patient reported outcome measures in immediate breast reconstruction patients using the BREAST-Q and compare these with international cohorts. Methods A cross-sectional study was performed on all patients who underwent immediate breast reconstruction between January 2011 and December 2016. This consisted of a retrospective clinical record review of perioperative outcomes, and a quality of life analysis using the BREAST-Q Post-Reconstruction questionnaire. Outcome predictors were identified using Chi-square, Fisher exact, One-way ANOVA, Student t-tests and Kruskal Wallis analysis of variance. A random-effect single arm meta-analysis was performed to compare the BREASTQ scores with international cohorts. Results A total of 52 patients were included with a mean age of 43.2 (+/-9.5) years. Eighteen patients (34.6%) developed early complications; of these 8 (44.4%) were major. Thirty-one patients (59.6%) developed late complications; of these 18 (58.1%) were major. Fifteen patients (28.8%) had failed reconstruction. There was a significantly higher risk of failure following a total mastectomy (TM) (p=0.02), tissue expander reconstruction (TE) (p< 0.01) and stage 2 breast cancer (p=0.01). Patients who underwent nipple reconstruction and immediate-delayed reconstruction before 12 months, reported higher well-being and satisfaction scores. Compared to international cohorts our BREAST-Q scores were lower but fall within the 95% confidence interval for Sexual Well-Being and Satisfaction with Nipples and Care. Conclusion Immediate breast reconstruction poses a high risk of complications and reconstructive failure especially, with TM and TE. Our BREAST-Q scores are comparable to international studies and may be useful in guiding patient consent.
- ItemOpen AccessThe management of desmoid tumours at Groote Schuur Hospital: A retrospective review of current practice(2019) Pickard, Henri Du Plessis; Cairncross, Lydia; Panieri, EugenioBackground: Desmoid tumours (DTs) are rare soft tissue tumours that do not metastasise but are locally aggressive. Management options are varied and the response to treatment can be unpredictable. Aim: The aim of this study was to describe the clinical presentation, management strategies and outcomes for adult patients who were treated for DT. Setting: The study was conducted at Groote Schuur Hospital in Cape Town, South Africa and all patients from 2003 to 2016 who presented with DT were included. Method: This was a retrospective review of records. Data collected included: demographics, DT-associated conditions, site and size of tumour, histological findings, treatment modalities, follow-up and outcomes. Results: Seventy patients with histologically confirmed DT were identified. The majority were women (86%) and 77% presented with a painless mass. The commonest site was the anterior abdominal wall (47%). Definitive surgery was performed in 46 (66%) patients, whereas 13 (19%) had definitive radiotherapy. Nine patients received adjuvant radiotherapy post-surgery for involved or close margins. Recurrence developed in 20% patients post-surgery. In the primary radiotherapy group, one patient had disease progression. Two patients with mesenteric DT died because of bowel obstruction. Conclusion: This retrospective review of patients affected by DT at a single centre demonstrates the rarity of the condition, the unpredictable natural history and the variety of treatment options available. Many of our findings are similar to other published studies, except the mean size of DT which was bigger. Treatment outcomes following surgery or radiotherapy seem acceptable, although study limitations are noted.