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Tuberculous prostatitis: a condition not confined to the immunocompromised
Get PDFTuberculous (TB) prostatitis is rare; usually occurring in immunocompromised men. It can mimic benign prostatic hyperplasia (BPH), chronic prostatitis or prostate cancer. This report in an immunocompetent 72-year-old man adds to the clinical spectrum of the five prior reported cases. A low threshold for prostatic biopsy led to a histological evaluation and subsequent microbiological confirmation of TB. This attests to the value of such an approach in arriving at the correct diagnosis and the institution of appropriate anti-tuberculous therapy even amongst immune-competent men
The deltopectoral flap in the management of tracheostomal stenosis post laryngectomy and radiotherapy
Get PDFBackground: Tracheostomal stenosis is a distressing complication with a high incidence rate post laryngectomy. We aimed to assess the deltopectoral flap (DPF) for tracheostomal stenosis correction in irradiated patients.
Methods: Six patients with tracheostomal stenosis, 3 of whom developed restenosis after prior use of local flaps, were managed using a DPF to reconstruct the defect following a vertical incision release of the stenotic band down to the inferior tracheal cartilaginous ring. Healing absence of restenosis, alleviation of the symptoms of difficulty in breathing and clearance of secretions were considered a successful composite endpoint.
Results: Over a median follow-up period of 11 months all patients maintained patency, and symptoms of difficulty in breathing and clearing of secretions were alleviated.
Conclusion: The deltopectoral flap is a rapid, reliable flap for the management of tracheostomal stenosis in irradiated patients. It brings well-vascularised tissue into the site of reconstruction and, in the short term, stomal patency and symptom relief were achieved. 
Bilateral internal carotid artery occlusion with compensatory perfusion in a HIV-infected patient
Get PDFHIV infection occlusive arteriopathies may result in neurological symptoms. We report a case of bilateral complete occlusion of the extracranial portions of the internal carotid arteries in a HIV+ve patient who presented with a syncopal episode due to intraventricular haemorrhage. Compensatory blood flow from the posterior cerebral circulation via the circle of Willis resulted in small telangiectatic vessels arising from the posterior cerebral circulation which probably accounted for this rare haemorrhagic complication of an occlusive arteriopathy. 
The demographics and outcomes of burn patients admitted to Worcester Hospital
Get PDFBackground: Worcester Hospital is a regional healthcare facility in the Western Cape, South Africa, without a dedicated burns unit. Currently there is limited data available of burns patient management outside of academic institutions in South Africa. To describe the incidence and demographics, and to determine the outcomes of burn patients admitted to Worcester Hospital.
Methodology: A retrospective descriptive study of burn patients admitted to Worcester Hospital between 1 September 2016 and 31 August 2017.
Results: A total of 66 burn patients were included in this study which accounted for 1.6% of the total surgical admissions for this time period. The mean age of the patients was 39 (SD ± 19) years with a male predominance (59%). The mechanism of burn was mostly flame burns (71%); 16 patients (24%) were burned with hot fluids and 3 patients (5%) sustained electrical burns. The median TBSA was 9% (IQR: 5–28). Ten patients (15%) required critical care unit admission. The burn patients’ median length of stay was 6 days (IQR: 2–11 days) versus 2 days (IQR: 1–5 days) for non-burn general surgery patients. Fifty burn patients (76%) required surgical intervention comprising of either debridement or skin grafting, or a combination of this. Forty-four patients (67%) underwent skin grafting procedures and the median TBSA grafted was 5% (IQR: 3.5–9.5). The median time from admission to first surgical procedure was 25 hours (IQR: 18.33–51.08). The in-hospital mortality rate was 23% and of the 15 mortalities, 9 patients (60%) had TBSA of 30% or more and therefore classified as a major burn.
Conclusion: Burn injuries treated at Worcester Hospital are often severe and require significant resources. This study supplies critical information regarding the burden of burn related injuries managed at a regional level. 
Childhood intussusception: a multicentre study in a middle-income country
Get PDFBackground: The outcome in infants and young children of intestinal obstruction due to intussusception is well documented in high-income countries. Our aim was to investigate the current pattern of presentation, management and outcome of childhood intussusception in a middle-income country using a multicentre approach.
Methods: Records of children managed for intussusception in three centres in South West Nigeria were retrospectively reviewed and analysed.
Results: One hundred and ninety children managed for intussusception were analysed. The male-to-female ratio was 1.8:1. The median age was 7 months with a peak age incidence of 3–6 months. Peak incidence was recorded during the dry season. Passage of bloody stool, vomiting, abdominal pain and fever were the most common presenting features. Seventy-three (38.4%) of the patients presented with the classic triad. The median duration of symptoms was three days and only 19 (10.1%) patients presented in less than 24 hours. Ileocolic intussusception was the most common anatomic type, occurring in 166 (87.4%) patients, and was significantly associated with age. Twenty-two (56.4%) had successful hydrostatic reduction, while 165 (88.2%) required surgery. Forty (21.1%) patients suffered postoperative complications. Eleven (5.8%) of the patients died. The median duration of hospital stay was six days, and this correlated with the duration of symptoms and the length of hospital stay.
Conclusion: Delayed presentation is a persisting challenge in the management of childhood intussusception in Nigeria. Prompt referral to a paediatric surgeon may reduce the surgery rate, associated morbidity and the length of hospital stay. 
The scourge of knife crime: trends in knife-related assault managed at a major centre in South Africa
Get PDFBackground: Knife wounds are common and represent a major burden to the South African healthcare system. This study reviews trends in spectrum, management and outcome of these injuries at a single trauma centre in KwaZulu-Natal (KZN).
Methods: The regional hybrid electronic registry (HEMR) was reviewed for the period January 2013 – December 2018, and all patients who suffered a knife-related assault were identified and reviewed.
Results: During the period under review, a total of 2117 patients suffered a knife-related assault. Regions injured were as follows: head 445, neck 572, face 258, chest 939, abdomen 649, pelvic/urogenital 49, upper limb 418, and lower limb 105. The median ISS was 9 (4–10). Imaging comprised 1242 chest X-rays, 315 abdominal X-rays, 162 abdominal ultrasounds/ FAST, and 929 CT scans of which 634 were CT angiograms. A total of 783 (37%) patients required an operation. The rate of laparotomy was 447/649 (69%) and of thoracotomy/sternotomy/thoracoscopy 95/939 (10%). The rate of vascular exploration for upper and lower limb vascular injury was 101/523 (19%). Mortality was 49/2117 (2.3%).
Conclusion: Although our clinical outcomes over this period appear to be consistent, suggesting a familiarity with managing knife-related trauma, the persistently high rate of knife-related injury suggests that we have failed to develop a preventative strategy to try and reduce this scourge. 
Isolated coronal urethral duplication in an adolescent presenting with enuresis
Get PDFThis report describes an isolated urethral duplication in the coronal plane in a child referred with primary ‘enuresis’. This presentation is unique because duplications usually occur in the sagittal plane. In patients with suspected urethral duplication, magnetic resonance imaging in conjunction with catheterisation of the distal duplicate opening accurately delineates the abnormality, so that individualised treatment strategies can be considered
The role of surgery in Conn’s syndrome – a case of refractory hypertension secondary to an aldosterone secreting adenoma
Get PDFPrimary aldosteronism, eponymously known as Conn’s syndrome, has recently gained recognition as the most common cause of endocrine hypertension. Unilateral subtypes, such as aldosterone secreting adenomas, are managed surgically and are potentially curable. The background of refractory hypertension and hypokalaemia in a forty-year-old man raised suspicions of Conn’s syndrome which was localised to an aldosterone secreting adenoma in the right adrenal gland. The patient underwent a laparoscopic intraperitoneal right adrenalectomy which resulted in normalisation of his plasma aldosterone concentration as well as improved blood pressure control. 
Predictors of the need for surgery in upper gastrointestinal bleeding in a resource constrained setting: the Pietermaritzburg experience
No full textBackground: This review from a tertiary centre in South Africa aims to describe the spectrum and outcome of upper gastrointestinal bleeding (UGIB) and identify risk factors for surgical management and death.
Methods: This was a retrospective review of a prospectively entered database of all adults presenting with UGIB between December 2012 and December 2016. Demographics, presenting physiology, risk assessment scores, outcomes of endoscopy endo-therapy and surgery were reviewed. Comparisons were made between patients who required operative therapy and those who did not, and between survivors and non-survivors.
Results: During the review period, 632 patients were admitted with suspected UGIB. Out of these, 406 (64%) had an identifiable potential source of bleeding and 226 (36%) had no identifiable potential source of UGIB. The latter were excluded from further analysis. Of the 406 patients with a potential source of haemorrhage, there were 249 males (61%) and 157 females (39%). Nine of these were expedited directly to the operating room and never underwent an endoscopy. Of the 397 (98%) who had upper endoscopy 107 (26%) had endotherapy. Forty-six patients (11%) required surgery. They had significantly higher shock index (SI), increased need for transfusion, higher international normalised ratio (INR) and higher serum lactate than the non- operative group. Nine patients went to the operating room without endoscopy. Of the 46 patients who required surgery, 37 underwent an attempt at endoscopic intervention. Transfusion and transfusion volume increased the probability of requiring a laparotomy (p = 0.015) and (0.003) respectively. The independent predictors of need for operation were a raised shock index or serum lactate and Forrest Ia and Ib ulcers. Thirty-nine patients died, giving a mortality rate of 9.6%; ten had a gastric ulcer and 16 had a duodenal ulcer. Survival was significantly higher in the non-operative group (93.1% versus 68.2%; p < 0.001). The odds ratio for mortality in the laparotomy group is 6.73, 95% CI (3.15–14.17). Receiver operator curve (ROC) analysis showed that the pre-endoscopic Rockall score (PER), total Rockall score (TR) and the SI were poor predictors of mortality.
Conclusion: Patients with UGIB in our setting are younger than in high-income countries (HIC) and a larger number fail endoscopic therapy and require open surgery. The mortality in this subset is very high. Detailed analysis of failed endotherapy has the potential to reduce mortality