Haemorrhage - the main presenting feature of diverticular disease of the colon in blacks

Haemqrrhage is one of the less common presentations of diverticular disease. This retrospective 5 year study of 23 patients has identified it as the main presentation (74%) among South African blacks in whom the disease is uncommon, but emerging as a clinical problem. Women constituted a statistically significant majority of patients with bleeding (76%); this was in excess of their overall proportion among patients with diverticular disease (61%) (P =0,018)

A five-year audit of lower limb amputations below the knee and rehabilitation outcomes: The Durban experience

Introduction: Lower limb amputation (LLA) due to diabetes mellitus (DM) is a growing epidemic worldwide.Objectives: To determine the prevalence of LLAs at Addington Hospital from 2010 to 2014 and to explore the rehabilitation outcomes of amputees.Design and setting: A retrospective chart review of LLAs below the knee was undertaken at Addington Hospital.Subjects: Patients who underwent LLAs were filtered from theatre registers.Methodology: A data collection sheet included demographic profile, diabetic status, level of amputation, limb orientation and rehabilitation outcomes.Outcome measures: Study endpoints were prevalence, compliance and rehabilitation outcomes.Results: From 2010 to 2014, 767 LLAs in 667 patients were identified. Mean age was 59 (13.2) years. M:F ratio was 1:1. Of these, 354 patients (53.1%) had DM. Level of amputation was below-knee 57%, trans-metatarsal 12.4% and toectomy 30.6%. Only 116 patients (17.4%) were referred for physiotherapy, of whom 95 (81.9%) attended. Median frequency of physiotherapy visits was five and four for diabetic and non-diabetic amputees respectively. Mobility after rehabilitation was with a walking frame (49%), crutches (32%), prosthesis and crutches (8%), wheelchair-bound (9%) and independent gait (1%).Conclusion: Over half of amputations were associated with DM. The gender incidence was similar. Referral to physiotherapy and adherence there to was poor

Amoebic liver abscess - results of a conservative management policy

Objective. To evaluate the safety and efficacy of conservative management of amoebic liver abscesses.Design. A prospective study carried out over a 1-year period.Setting. Inpatients and outpatients in a tertiary referral institution.Subjects. Amoebic liver abscess was diagnosed on clinical, ultrasonographic, and serological features. All patients were treated with metronidazole. The indication for ultrasound guided aspiration of the abscess was failure to improve clinically within 48 - 72 hours.Main outcome measures. Clinical improvement, clinical deterioration and failure of clinical improvement (persistent pain).Results. In total 178 patients (male-to-female ratio 5:1) with 203 abscesses were treated during this period. Of these, 23 patients required  percutaneous aspiration and 150 patients were managed without intervention and clinically resolved spontaneously. Abscesses requiring aspiration tended to be larger than those managed without aspiration (10.7 cm v. 8.2 cm) (p = 0.003). There were no complications following aspiration. Mean hospital stay was longer (12.3 days) for patients who underwent aspiration compared with those who did not (6. 7 days) (p = 0.031). Only 5 patients presented with ruptured abscesses, 1 cutaneously and 4 intraperitoneally, with the only death in this latter category.Conclusion. Conservative medical management of amoebic liver abscess is safe. Percutaneous ultrasound-guided aspiration is indicated only in patients who fail to improve clinically after 48 - 72 hours rather than on rigid criteria

A Comparison Of Preoperative Hypoalbuminaemia With The NNIS And SENIC Risk Scores For The Prediction Of Surgical Site Infection In A South African Setting

ArticleIntroduction: Preoperative hypoalbuminaemia is a risk factor for surgical site infection (SSI) in the South African (SA) setting. However, the predictive accuracy of preoperative hypoalbuminaemia has not been tested against established SSI risk stratification models in our setting, which could have important implications for SSI prevention strategies. With reference to SSI in SA settings, the study objective was to compare the overall predictive accuracy of preoperative hypoalbuminaemia with that obtained for the SENIC/NNIS risk scores. Method: This was a sub-analysis of a pre-existing laparotomy patient registry (N = 439). Variables collected as part of the registry included preoperative serum albumin measurements and all parameters of the SENIC/NNIS risk scores. Preoperative hypoalbuminaemia was defined as preoperative serum albumin of < 30 g/L. The study outcome was SSI up to 30 days postoperatively. Overall predictive accuracy was determined through a receiver-operator-characteristic (ROC) curve analysis, with results presented as C-statistics (95% confidence intervals [CI]). Results: The C-statistics obtained for preoperative hypoalbuminaemia, the SENIC risk score, and the NNIS risk score were 0.677 (CI: 0.609–0.746), 0.652 (CI: 0.582–0.721), and 0.634 (CI: 0.563–0.705). Conclusion: All three methods display similar predictive accuracy for SSI. However, preoperative hypoalbuminaemia has several practical advantages over the SENIC/NNIS scores which must be considered

Are Lower Preoperative Serum Sodium Levels Associated With Postoperative Surgical Site Infection? Results From A Propensity Matched Case-Control Study

ArticleBackground: We previously reported a statistical trend toward a harmful association between lower preoperative serum sodium levels and surgical site infection (SSI) in South African (SA) laparotomy patients. Serum sodium tests are widely available and could serve as a cost-effective method for preoperatively identifying patients at risk for SSI who might benefit from additional preventative strategies. We sought to investigate the possible association between lower serum sodium levels and SSI further, in a larger sample of SA patients undergoing various surgical procedures. Objective: To determine if lower preoperative serum sodium levels are associated with SSI in SA surgical patients. Method: This was a propensity matched case-control study involving data from 729 surgical patients who attended a quaternary SA hospital between 01 January 2012 and 31 July 2016. Cases were defined as patients who developed SSI. Controls were defined as patients who did not develop SSI. Multivariate logistic regression was used to investigate the association between preoperative serum sodium levels (in mmol/L) and SSI. Results: Lower preoperative serum sodium levels were associated with a higher risk of SSI (odds ratio per 1.0 mmol/L decrease in serum sodium: 1.051, 95% confidence interval: 1.007–1.097; p = 0.026). Conclusion: Although we report a statistically significant association between lower preoperative serum sodium levels and a higher risk of SSI, the magnitude of this effect size (odds ratio) is minimal and clinically insignificant. Preoperative serum sodium levels are unlikely to be useful for SSI risk stratification in our setting

Octupole correlations in the structure of O2 bands in the N=88 nuclei150Sm Gd

Knowledge of the exact microscopic structure of the 01 + ground state and first excited 02 + state in 150Sm is required to understand the branching of double β decay to these states from 150Nd. The detailed spectroscopy of 150Sm and 152Gd has been studied using (α,xn) reactions and the γ -ray arrays AFRODITE and JUROGAM II. Consistently strong E1 transitions are observed between the excited Kπ = 02 + bands and the lowest negative parity bands in both nuclei. These results are discussed in terms of the possible permanent octupole deformation in the first excited Kπ = 02 + band and also in terms of the “tidal wave” model of Frauendorf.Web of Scienc

Incisional Hernia: Experience in a Single Surgical Unit

Background: Incisional hernias are a common problem in general surgery and they have a varied aetiology. The aim of this study was to document a single unit experience with the management of incisional hernias at King Edward VIII Hospital, Durban, South Arica. Patients and Methods: This was a prospective audit of incisional hernias in a single surgical unit from January 2001 to May 2004. All patients underwent open repair. Clinical data and intra-operative findings were documented. Results: A total number of 77 patients were seen of which 70 were female. Fifty three (68.8%) and 24 (31.2%) of patients underwent elective and emergency surgery respectively. A total of 56 patients had previously undergone gynaecological surgery compared to 21 who had undergone general surgery. There was a documented history of previous sepsis in 4 (7%) of patients. There was 1 sheath defect in 36 patients, 2 defects in 9 patients, 3 defects in 10 patients, 4 or more defects in 9 cases. In 55 patients the original suture could not be identified. Gangrenous bowel was present in 3 patients. Only 3 (3.9%) of the patients had a mesh repair. The rest (96.1%) underwent tissue repair. Morbidity rate was 17% and there were no deaths. Five patients needed management in the ICU. Hospital stay was 8 + 11 years Conclusion: Most incisional hernias followed gynaecological surgery. There was no evidence of a nonabsorbable suture having been used at the original operation in over half of the patients. We recommend that meticulous technique is essential in closing the abdominal incision

Blocking of coupling to the 0

The concept that the first excited 0+ states in N = 90 nuclei are not a $\beta$ -vibration but a second vacuum formed by the combination of the quadrupole pairing force and the low density of oblate orbitals near the Fermi surface is supported by the blocking of this collective mode in 154Gd from coupling to the [505]11/2- single-particle quasi-neutron orbital in 155Gd . The coupling of this orbital to the 2+ $\gamma$ -vibration in 154Gd is observed since this coupling is not Pauli-blocked