Browsing by Subject "Surgery"

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    A manikin-based simulation study of a dispatch operator directed CPR algorithm within the Western Cape setting and the self- reported comfort around its execution
    (2021) De Caires, Leonel Paulo; Stassen, Willem; Evans, Katya
    Background: There is little data in Africa regarding dispatch guided telephonic CPR. This study looks at the quality of CPR performed when compared to AHA guidelines, by untrained laypersons when given telephonic CPR instructions using the Western Cape EMS Guidecards algorithm for telephone assisted CPR. Methods: In this prospective observational, simulation study, participants were given telephonic hands-only CPR instructions using the Western Cape EMS Guidecards. CPR quality (hand placement, rate, depth and chest recoil) was analysed and then followed by a questionnaire looking at the self-reported comfort regarding the execution of said instructions. Results: Overall quality of CPR by participants (n=50) was suboptimal with no participant complying with current CPR guidelines. Demographic factors influenced quality where males pushed on average deeper (40.8mm vs 28.5mm, p=0.004) when compared to females. Correct hand placement and chest exposure were directly related to the caregivers' home language with English making it more likely to correctly perform these instructions (p=0.01 and p=0.002, respectively). Self-reported comfort had no effect on executed CPR quality. Conclusion: The quality of CPR performed by laypersons, when directed by a call-taker using the Western Cape Provincial EMS Guidecards Algorithm, can be suboptimal in terms of compression rate, depth, full chest recoil and baring of the chest. There is an urgent need to find more effective ways, in the Western Cape EMS, to improve executed CPR quality when guided by a trained telephone operator.
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    A retrospective audit of the outcomes of the Fellow Of College Of Surgeons (FCS) (General Surgery) Final Examinations
    (2018) Kahn, Miriam; Kahn, Delawir; Navsaria, Pradeep H; Klopper, Juan
    Background and aim: An audit of the Fellowship of the College of Surgeons FCS (SA) Final Examination results has not been previously performed. The purpose of this study was to review and determine any predictors of outcome. Methods: The results of the FCS (SA) Final Examinations from October 2005, to and including, October 2014, were retrieved from the College of Medicine of South Africa database. The current format of the examinations consists of: two written essay question papers, an OSCE, two clinical cases and two vivas. These were retrospectively reviewed and analyzed. Predictors of failure or success were determined. Analysis was performed using IPython for scientific computing. Assumptions for the normal distribution of numerical values were made based on the Kolmogorov-Smirnov test and quantile-quantile plots. Normally distributed variables were analyzed by parametric tests. In all other cases nonparametric tests were employed. An alpha value of 0.05 was chosen to indicate statistical significance, using a confidence level of 95%. Results: During the 10-year study period, 472 candidates attempted the examinations. A total of 388 (82,2%) candidates were successful in the written component of the examination and were subsequently invited to participate in the oral/clinical component of the examinations. 9 Overall, 296 (62,7%) of candidates passed and 176 (37,3%) failed. A total of 19 candidates achieved less than 50% for both papers, yet still managed an average of more than 45%. A total of 15 (79%) of these candidates went on to fail the examination. There were 51 candidates who were invited to the oral examinations despite an average of less than 50% in the two papers, and 34 (67%) failed the overall examination. Similarly, 126 candidates were invited having failed one of the two papers of which 81 (64.3%) ultimately failed. A total of 49 candidates failed the OSCE, 82% of these candidates failed overall. There was strong correlation between paper one and paper two (r = 0.56, p-value < 0.01), oral one and oral two (r = 0.41, p-value < 0.01) and case one and case two (r = 0.38, p-value < 0.01). Similar correlations were seen between the averages of the papers versus the orals (r = 0.52, p-value < 0.01), the papers versus the cases (r = 0.5, p-value < 0.01) and the papers versus the OSCE (r = 0.54, p-vale < 0.01). Conclusion: The written papers are the main determinant of invitation to the second part of the examination. Candidates with marginal scores in the written component had an overall failure rate of 67%. Failing one paper and passing the other, resulted in an overall failure rate 64,3%. Failing the OSCE resulted in an overall 82% failure rate. With the high failure rate of candidates with marginal scores and with the inter-examination variability of the papers, it might be prudent to revisit both the process of invitation selection and the decision to continue with the long-form for the written component.
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    A Retrospective Review of the Technical Success of Endoscopic Stenting for Malignant Gastric Outlet Obstruction
    (2022) Tait, Déan; Chinnery, Galya
    Introduction: Palliation of patients with advanced and irresectable malignancies causing gastric outlet obstruction (GOO) with the endoscopic placement of a self-expanding metal stent (SEMS) has become standard. Internationally, technical success rates are high. This study reviewed endoscopic stent placement for malignant GOO compared to other international high-volume endoscopy units, looking into local success rates, pathology, and patient demographics. Methods: A retrospective review of patients presenting to the Groote Schuur Hospital Upper Gastrointestinal Unit with irresectable malignant GOO between 1 March 2018 and 31 August 2021 was performed, evaluating demographics, technical success, pathology, and immediate and late stent complications. Results: One hundred and fourteen patients, 44 (38.6%) female and 70 (61.4%) male, were referred for palliative stenting of malignant GOO; distal obstructive gastric cancer (74.6%) and obstructing pancreatic malignancies (14.9%) being the two most frequent indications. Median age was 63.5years (IQR: 53.25-70) with 48.2% having at least one comorbidity and 48.3% performance scores of 3 or 4. The majority (96; 85.7%) required only one stent, 15 patients (13.4%) had a second stent placed, and one patient required four stents. In total, 132 stent insertion attempts were undertaken. With primary placement, three technical failures were experienced. One stent was initially incorrectly placed but immediately correctly repositioned, while two failed insertions were referred for surgical gastrojejunostomy, equating to a technical success rate of 97.4%.Four immediate stent insertion related complications occurred (3.1%), two related to sedation, one stent placed too distally requiring repositioning and an oesophagogastric junction perforation with procedural death. Fifteen late-stent complications occurred with thirteen stent blockages due to tumour in-growth (10%), one stent fracture and one stent with poor radial expansion. The stent blockages occurred between 3 to 548 days after placement (median 107 days, IQR: 80 – 275 days). Salvage stenting was 100% successful in the 14 cases with late stent complications that required re-stenting. Conclusion: Technical insertion success rates of primary and salvage duodenal stenting for malignant GOO are on par with international high-volume units. The leading pathology locally is gastric adenocarcinoma, with palliative stenting remaining a feasible and accessible option.
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    Allotransplantation of free vascularised skin flaps
    (1988) Lechtape-Grüter, Reinhard
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    An audit of emergency hernia operations: Surrogate of system failure or incidentalomas?
    (2020) Nkgudi, Boitumelo; Kloppers, Jacobus; Rayamajhi, Shreya
    Background: Hernia emergencies common surgery. Around 20 million groin hernia operations occur world-wide, and these form 70% of all hernia operations. Incisional hernias complicate 15- 30% of laparotomies and 20% of these present as emergencies. Watchful waiting is often applied for groin, ventral and incisional hernias in patients who are asymptomatic or those who are poor surgical candidates. The factors associated with poor outcomes include - elderly patients, multiple comorbidities, delays in presentation, those which are incarcerated or strangulated and delays in getting to theatre. Management of emergency hernias include resuscitative efforts to address life threatening problems, and thereafter performing the safest and most durable repairs. Aim: We aim to elucidate patient and health care systems factors that contribute to hernia emergency presentations and to document the mortality and morbidity of such presentations in our unit. Method: We aim to review case files of all patients above 18 years of age who had their emergency surgery for a complicated hernia. All elective cases will be excluded. Conclusion: This study will contribute to understanding emergency hernias in south Africa and will seek to improve patient care in our setting. A hernia registry has recently been established and thus we will be able to contribute to its foundation.
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    An audit of the workload of an acute surgery unit in a tertiary academic hospital before and after the closure of a referring community hospital
    (2015) Moodie, Quintin Keith; Klopper, Juan; Kahn, Delawir
    Aim: An audit of the workload of an Acute Care Surgery Unit in a Tertiary Academic Hospital and an assessment of the impact on this Unit by the closure of a busy Community Hospital. Background: The primary mission of the Acute Care Surgery service is to provide timely surgical assessment, operative and/or non-operative management of the acutely ill non-trauma surgical patient. Both locally and internationally, fewer surgeons are perusing general practice, opting instead for subspecialty training, with no or only minimal time spent in emergency surgical care. This is demonstrated for example by evidence that some colorectal surgeons refer diseases of the appendix to the general surgeon, reflecting the narrow point of care that is being practiced in certain fields of surgery. In many cases acute care surgery has been described as a multidisciplinary approach involving Emergency and Trauma Surgery, and Critical Care Medicine.(1-3) In South Africa the rules and regulation by the Health Professions Council stipulates the requirement of training and qualifying as a General Surgeon, before pursuing Fellowship training in a field of subspeciality. As treatment paradigms shift and surgical emergency disease management evolves, we need properly trained surgeons that are willing to pursue the optimal emergency care (surgical or non-operative) for specific conditions in patients presenting with these acute surgical emergencies.(2,4) Groote Schuur Hospital (GSH) is privileged in its provision of an Acute Care Surgical Unit (ACSU) that functions in a tertiary environment and is affiliated with the University of Cape Town (UCT), the leading ranked University on the African Continent. The ACSU in GSH has 28 dedicated beds, and functions as a secondary and tertiary level General Surgery Unit excluding all acute trauma care. Provision is also made for the management of primary level surgical diseases. A neighboring surgical referral hospital, GF Jooste Hospital (GFJH), has 90 dedicated surgery beds. It is a Community Hospital, which caters for primary and secondary level diseases. Acute care is also given to tertiary level trauma and emergency surgical diseases. The unit at GFJH will be closing to allow for a reconstruction of the building, and thus the patient population will require access to alternate facilities whilst awaiting the reopening. A subset of these patient will have to be accommodated at GSH.
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    The biochemical analysis of mucus and mucins in respiratory diseases with a focus on tuberculosis
    (2016) Mofokeng, Henrietta Refiloe; Mall, Anwar Suleman
    Respiratory diseases are a major cause of death in South Africa, with TB being one of the major respiratory illnesses. The respiratory tract is lined by a layer of mucus which protects the airways and lungs against injury by foreign agents. The main constituents of this layer of mucus are mucins. MUC5AC and MUC5B are the predominant respiratory tract mucins. However, little is known of the association between respiratory mucins and TB. This study aimed at describing the types and role of respiratory mucins in TB. Fifty six sputum samples, 17 tracheal aspirates and 95 bronchoalveolar lavages (BALs) were collected in 6M guanidinium hydrochloride and inhibitors. The airway mucus was divided into TB and non-TB groups. Mucins were reduced and alkylated with DTT and iodoacetamide and purified by density gradient ultracentrifugation in caesium chloride. Identification of MUC5AC, MUC5B, MUC2 and MUC7 were determined by western blotting and confirmed by immunohistochemistry. Western blot data proved the dominance of MUC5AC and MUC5B mucins in airway mucus. In comparison to the non-TB group, a higher secretion of MUC5AC than MUC5B in patients with TB was observed. MUC5AC also showed distinct behavioural characteristics in its fractionation in a caesium gradient compared to MUC5B. The presence of MUC5AC and MUC5B in different fractions suggests varying glycosylation of the mucin. Varying populations of MUC5B were observed in sputa with 3 new glycoforms shown in TB. A small group of TB patients had MUC7 in the sputa (and not in the lavage) and there were varying amounts of MUC2 in some TB samples and non-TB mucus. At tissue level, MUC5B was found to be the main secreted gel-forming mucin. MUC5B and MUC7 were found to play a role in the protection again infection by Mycobacterium tuberculosis in tuberculous granulomas. Using proteomics it was demonstrated that respiratory mucus protein expression differs in, tracheal aspirates, BALs and sputa. Although inter-individual variations were observed in all samples, similar proteins were expressed in relation to the functioning of the lung. O-glycan analysis showed that the majority of the O-glycans detected were sialylated and that core 3 and 4 O-glycan structures diminished in the presence of HIV.
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    Cancer free survival in mutation positive HNPCC individuals with colorectal adenomatous polyps identified on surveillance colonoscopy
    (2013) Swart, Oostewalt; Goldberg, Paul
    The prevalence of colorectal cancer (CRC) places it in the top five cancers worldwide and is the second most common cause of cancer related death. Developed populations have a 5-6% lifetime risk of CRC(l). The South African Cancer Registry (last updated 2004) shows a 1/98 and 1/150 life time risk for developing CRC in males and females respectively (2).
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    Civilian popliteal artery injuries : a ten year audit in an urban trauma centre
    (2011) Banderker, Mohammed Asif; Navsaria, Pradeep H
    The aim of this study is to identify factors associated with limb loss in patients with popliteal artery injuries. Retrospective chart review of a prospectively collected data base of all patients with popliteal artery injuries presenting to the Groote Schuur Hospital Trauma Centre from 01 January 1999 to 31 December 2008. Demographic data, mechanism of injury, hemodynamic status, limb status (viable, non-viable or ischaemic), special investigations, associated injuries, ischaemic time, surgical treatment and amputation rate were analysed.
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    Complications of anti-reflux surgery in gastro-esophageal reflux disease with special reference to dysphagia
    (2009) Brink, Abraham Justinus; Bornman, PC
    All patients who underwent revision laparoscopic surgery from January 202 to July 2008 in the UCT Private Academic /Groote Scruur Hospital complex for intractable dysphagia and who did not respond to consevative treatment were reviewed. Patients with peri-oesophagel fibrosis as the dominant cause for their dysphagia were identified during surgrry and closely followed up. This study was focused on those patients' pre- and post-operative course.
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    The current management of penetrating cardiac trauma
    (2012) Nicol, Andrew John; Kahn, Delawir
    The vast majority of patients with penetrating cardiac injuries do not reach the hospital alive as the pre-hospital mortality rate for these injuries is in the region of 86%. The patients that do reach the hospital alive are potential survivors and it is obviously crucial that any cardiac injury is detected and managed appropriately. Most of these injuries present with either cardiac tamponade or hypovolaemic shock and are relatively straightforward to diagnose and require immediate surgery. There is, however, a group of patients that are relatively stable with an underlying cardiac injury and it is in these patients that a potential or occult cardiac injury needs to be identified.
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    Damage control laparatomy for abdominal gunshot wounds: indications, mortality and long term outcomes
    (2017) Twier, Khaled; Navsaria, Pradeep H
    Background: Outcomes of patients subjected to damage control laparotomy (DCL) for abdominal gunshot wounds (GSWs) remains relatively unknown. There is limited evidence as to which variables may reliably predict morbidity and mortality. The aim of this study was to evaluate the impact of DCL on long term morbidity and survival, to determine clinical characteristics associated with increased mortality, and to evaluate the indications for DCL in patients with abdominal GSWs. Methods: A retrospective study of patients who underwent a damage control laparotomy for abdominal GSWs at Groote Schuur Hospital (GSH) was conducted. Data was collected on 50 consecutive trauma patients over a 4.5 years period (between August 1st, 2004 and September 30th, 2009). Patients were stratified by, age, preoperative and intraoperative physiological parameters, trauma indices, numbers and locations of abdominal GSWs, extra abdominal involvement, intensive care unit and hospital length of stay, morbidity and mortality. Unadjusted and adjusted estimates of the association between these factors and the odds of survival were computed with univariate and multivariate logistic regression. Results: Most of the patients were male (96%) with a mean age 29.7 year. Most patients had a single abdominal gunshot wound (60%). Liver injuries were the most common injury (58%) followed by small bowel (44%), 20 majors venous (40%), and colonic injury (38%) injuries. The overall mortality was 54%. The mean of length stay in the intensive care unit was 7 days with overall mean hospital length of stay of 13 days. Factor an associated with a decreased odd of survival included Penetrating abdominal trauma index(PATI) >25, pre-operative infusion of less than two litres of crystalloids, intra-operative blood lactate level >8mmol/L, massive transfusion >10 units PRBCs. Conclusion: The overall mortality of patients requiring DCL for abdominal GSWs was 54%. In this limited study, there is significant evidence that after controlling for confounding PATI score of >25 is associated with a decreased odds of survival (OR:0.20, p-value 0.04).
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    Delay 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, Francois
    Background: 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).
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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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    Describing the most common presenting complaints, their priority and corresponding diagnoses at Khayelitsha Emergency Centre
    (2019) Naidoo, Antoinette Vanessa; Bruijns, Stevan
    Introduction Emergency centres have to be equipped to provide high-quality care to a number of undifferentiated patients with varying acuity of illness. This study aimed to identify the most common presenting complaints and corresponding linked diagnoses, in total and for each category of the South African Triage Scale (SATS) at Khayelitsha Emergency Centre (EC). Methods A retrospective, cross-sectional, chart review was used. The sample consisted of patients who presented to Khayelitsha EC in January and June 2015. Charts were reviewed via the Electronic Content Management system. Data were collected on demographic profile, triage priority, presenting symptoms at triage, and ICD-10 diagnosis. Results 4006 of 4928 charts that were reviewed were suitable for inclusion. Triage acuity was 28.0% (n=1123) green, 34.2% (n=1372) yellow, 25.7% (n=1030) orange and 3.5% (n=141) red. The most common presenting complaints were trauma (10.3%) and pain (10.1%); the majority of these patients presented in the yellow and green triage categories. The most common diagnosis made in the EC was pneumonia (7.0%) - most frequently presenting as shortness of breath (8.7%) and cough (5.6%). Medical conditions presented with a higher acuity at triage. Presenting complaints documented at triage and those reported by clinicians correlated an acceptable 70.1% of cases (r=0.71). Diarrhoea and vomiting were the predominant symptoms in summer whereas shortness of breath and cough were more frequent in winter. Triage acuity was similar for both months. Conclusion Individual symptoms presented with varying priority and resulted in a variety of eventual diagnoses which showed differences across categories. Presenting complaints provide granularity to otherwise undifferentiated triage priorities. Future research should focus on time-in-motion work to determine the mean clinical care time each of these complaints require. This should allow a calculation of the mean clinical care time for each triage priority. In turn this can be turned into a calculation for optimal staffing.
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    Describing the resistance patterns of necrotising fasciitis in Acute Care Surgery
    (University of Cape Town, 2020) Mabogoane, Tumiso; Kloppers, Jacobus; Rayamajhi Shreya
    Objective: This study aims to identify the microorganisms and antibiotic resistance patterns in necrotising fasciitis. Methods: This is a retrospective audit over two consecutive years (June 2015 - July 2017) of all patients who had surgery for necrotising fasciitis at an ACS unit. Results: Necrotising fasciitis accounted for 15% of all skin and soft tissue sepsis that required surgery. There were 10 male (52.6%) and nine female (47.4%) patients. The most common co-morbidity was diabetes mellitus in 10 (52.6%) patients, the compliance and control were monitored by glycosylated haemoglobin (HbA1C) in 50% of the diabetic group, with a mean of 8.98 (Range 5-12.9). Fifteen percent of cases (n=3) had a confirmed diagnosis of HIV, with a negative result in eight (42%). ICU was required in three patients two of whom were on inotropes and one patient required renal replacement therapy. Surgery was performed within 24 hours for 11 (57%) patients. The most common anatomical site for debridement was perineum in nine patients (47%). Monomicrobial infection was the most common subtype of necrotising fasciitis with methicillin sensitive staphylococcus aureus in five (26%) as the predominant microbe. Gram-negative organism Escherichia-coli was the second most common monomicrobial infection. All Gram-positive organisms were sensitive to cloxacillin and coamoxiclavulanic acid. Two gram negatives(15%) of the 13 organisms cultured were resistant to co-amoxiclavulanic acid. The 30 day mortality was 15%. Conclusion- Necrotising fasciitis is a rare but lethal infection. In our limited series, monomicrobial infection is the most common subtype. 15% of the community acquired organisms were resistant to the empiric antibiotic of choice co-amoxiclavulanic acid.
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    Development of a multi-stage purification process for serum-derived exosomes and evaluation of their regenerative capacity
    (2020) de Boer, Candice; Davies, Neil
    Exosomes are secreted membrane vesicles (30-100 nm) found in tissue culture media and various body fluids that have potential as therapeutics and disease biomarkers. Current literature has reported regenerative benefits for blood-derived exosomes but the majority of these studies purified exosomes using ultracentrifugation (UC), a method that has been found to have high levels of protein contamination. Here the regenerative capacity of exosomes isolated by size exclusion chromatography (SEC), a method shown to reduce protein contamination, from human serum was assessed. SEC isolates were found to contain suitably sized vesicles and exosomal markers (CD9, CD81 and TSG101). These isolates allowed for cellular uptake of a range of fluorescent labels and enhanced cellular fibroblast proliferation and endothelial sprout formation in a 3D spheroid-based angiogenesis assay. Further to this, functionality was shown to be retained after incubation of the isolates for 21 days at 37°C. Though a promising indication of regenerative potential, it was found that the isolates contained significant levels of ApoB containing lipoproteins (up to 15 µg ApoB/ml). It was shown that these lipoproteins were predominately the very low and intermediate density lipoproteins. It was found that low-density lipoprotein can impact exosome uptake studies that use fluorescent nucleic acid, protein and lipid dyes. As a substantial extraneous lipoprotein content could also interfere with other downstream applications and analyses such as proteomic analysis, a multistep purification method was developed. A simple 3-step density gradient (DG) UC was introduced prior to SEC that incorporated a high-density iodixanol cushion overlaid by a 18% iodixanol step containing UC concentrated human serum that was then overlaid with 6% iodixanol. This DG relied on flotation to remove lipoproteins. After the multi-step purification (UC DG SEC) ApoB and ApoA1 were not detectable by enzyme-linked immunosorbent assay and western blotting respectively. The UC DG SEC isolates were positive for CD9 and TSG101 and morphologically, as viewed by transmission electron microscopy, had the canonical exosome shape and size. Nanoparticle tracking analysis showed that though exosome marker levels were similar, there were 100 times more particles in SEC purified isolates relative to those from UC DG SEC, emphasising the extent of lipoprotein removal. Proteomic analysis identified 224 proteins in UC DG SEC isolates relative to the 135 from SEC, with substantial increases in exosome-associated proteins and reductions in lipoproteins. The UC DG SEC exosomes still elicited a significant increase in cell proliferation of human dermal fibroblasts but no increase in endothelial sprout formation. After subcutaneous implantation in a rat model, the highly purified exosomes potentially increased an angiogenic response. In conclusion, we show that serum SEC-derived exosomes with much reduced protein content do have regenerative properties but contain contaminating lipoproteins. Our new isolation technique isolated purer serum exosomes that retained cell proliferation stimulation and potentially enhanced an in vivo angiogenic response. This approach should render the isolated exosomes more suitable for biomarker discovery, molecular composition determination and biological function analysis.
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    Drug eluting hydrogels design, synthesis and evaluation
    (2012) Ahrenstedt, Lage; Bezuidenhout, Deon; Hult, Anders
    Hydrogels have successfully proved themselves useful for drug delivery applications and several delivery routes have been developed over the years. The particular interest in this work was to design, synthesise and evaluate in situ forming drug eluting hydrogels, which have the potential to ameliorate the healing of cardiovascular diseases.
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    Effectiveness of Moviprep® as colonic preparation - cleansing right colon for Lynch Syndrome (LS) screening: a prospective study
    (2016) De Villiers, David Johannes; Goldberg, Paul A
    Purpose: Each year, a cohort in the Northern Cape undergo colonoscopies as part of a surveillance program for individuals who have a C1528T mutation in the hMLH1 gene that puts them at very high risk for the development of colon cancer (Lynch syndrome). A clean colon is essential as it allows a thorough evaluation and surveillance for small polyps or mucosal lesions mostly encountered in the ascending colon. This study evaluated both the subject acceptance and the effectiveness of a 2L PEG electrolyte lavage solution containing ascorbic acid and sodium ascorbate (Moviprep®) as a preparation solution. Methods: The screening program was divided into two stages. Stage 1, 71 subjects were counselled individually on the importance of bowel cleansing and the use of Moviprep® as their bowel cleansing agent. Preparation was either a) 2L the night prior to colonoscopy or b) 1L the night prior to and the second litre on the morning of the colonoscopy. Subjects were encouraged to drink at least 500ml clear fluid in addition to each litre of Moviprep®. Informed consent was obtained for participation in the study. Stage 2, approximately 6 weeks later, each subject completed a questionnaire, evaluating their experience with Moviprep® and also had their screening colonoscopy performed. Colonoscopies were performed at 4 medical facilities in the Northern Cape. All subjects were assessed for bowel cleanliness on arrival at the facility where colonoscopy was to be performed. If any of the subjects were found to be inadequately cleaned, extra oral preparation was given prior to colonoscopy. The Harefield cleansing scale was used to evaluate the quality of colonic cleansing during each colonoscopy. The colon was divided into 6 segments (rectum, sigmoid, descending-, transverse-, ascending colon and cecum). Preparation was scored as A = all colon segments clean; B = at least 1 segment with residual amounts of brown liquid or semisolid stool, which can easily be displaced or removed; C = at least 1 segment with only partially removable stool, preventing complete visualization; D = at least 1 segment which could not be examined due to solid stool). Grades A or B were considered successful cleansing and grades C or D were considered a failed colonic preparation. Results: A total of 46 subjects had colonoscopies performed. 41(89%) of them had successful and 5(11%) failed preparation. Three of those subjects that prepared successfully had previously undergone right hemicolectomies, leaving 38 with intact colons. 22/38 (58%) subjects achieved an A grade for caecal cleansing and 16/38 (42%) a B grading. 2438 (63%) subjects scored an A grade for the ascending colon and 14/38 (37%) a B grade. A total of 64 subjects completed the questionnaires of which 83% (53/64) had used other colon preparations previously. When asked if they would use Moviprep® again in the future, 89% (57/64) said yes and 11% (7/64) said no. 94% of subjects (60/64) would recommend Moviprep® to friend and family. Conclusion: Moviprep® provided adequate colonic cleansing in 89% of subjects. In addition, nearly 90% of subjects were satisfied with the product and would use it again.
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    Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma
    (2015) Moydien, Mahammed Riyaad; Navsaria, Pradeep H
    Introduction: ERAS programmes employed in elective colorectal, vascular, urologic and orthopaedic surgery has provided strong evidence for decreased lengths of hospital stay without increase in postoperative complications. Aim: The aim of this study was to explore the role and benefits, if any, of ERAS / ERP (early recovery programmes) implemented in patients undergoing emergency laparotomy for trauma at a level 1 trauma centre. Methods: Institutional UCT-HREC approved study. A prospective cohort of 38 consecutive patients with isolated penetrating abdominal trauma undergoing emergency laparotomy were included in the study. The ERP included: early feeding, early urinary catheter removal, early mobilisation/physiotherapy, early intravenous line removal and early optimal oral analgesia. This group was compared to a historical control group of 40 consecutive patients undergoing emergency laparotomy for penetrating abdominal trauma, prior to introduction of ERP. Demographics, mechanism of injury and injury severity scores (ISS and PATI) were determined for both groups. The primary end-points were the length of hospital stay and incidence of complications (Clavien-Dindo classification) in the 2 groups. The difference in means was tested using the t-test assuming unequal variances. Statistical significance was defined as p < 0.05. Results: The two groups were comparable with regards to age, gender, mechanism of injury and ISS and PATI scores. The mean time to solid diet, urinary catheter removal and NGT removal was (non ERAS) 3.6 and (ERAS) 2.8 days [p < 0.035], (non ERAS) 3.3 and (ERAS) 1.9 days [p < 0.00003], (non ERAS) 2.1 and (ERAS) 1.2 days [p < 0.0042], respectively. There was no difference in time from admission to time of laparotomy [(non ERAS) 313 vs. (ERAS) 358] min (p < 0.07). There were 11 and 12 complications in the control and study group, respectively. When graded as per the Clavien-Dindo classification there was no significant difference in the 2 groups (p < 0.59). Hospital stay was significantly shorter in the ERAS group: 5.5 (SD 1.8) days vs. 8.4 (SD 4.2) days [p < 0.00021]. Conclusion: This small pilot study shows that ERPs can be successfully implemented with significant shorter hospital stays without any increase in postoperative complications in trauma patients undergoing laparotomy for penetrating abdominal trauma. Furthermore, the study shows that ERP can also be applied to patients undergoing emergency surgery.