Liver transplantation for viral hepatitis - which patients will benefit?

Liver transplantation constitutes a significant part of the hepatologist's armamentarium and has become the treatment of choice for most patients with chronic end-stage liver disease. The results continue to improve and many centres are now able to achieve 1-year survival figures in excess of 90% in selected patients. The surgical techiques involved in liver transplantation and the immunosuppressive protocols used postoperatively have been standardised. In contrast, the indications for and contraindications to liver transplantation continue to be modified. Large numbers of patients have undergone liver transplantation in recent years and analyses of large series of patients have made it possible to determine more accurately the outcome of liver transplantation in specific hepatic disease processes. As a result, subsets of patients who are more likely to survive long term have been identified. This is particularly true of patients with viral hepatitis

Paediatric surgery in the RSA - practice and training

A survey of the current practice 'of general paediatric surgery in South Africa and Namibia was conducted by tneans of a postal questionnaire. One hundred and eighty-one replies were obtained (52%).Analysis showed that although surgeons are located predominantly in the major cities, 18% practised in the larger towns or rural areas. Although paediatric surgery represents a small volume of their work, most surgeons do attend to the surgical needs of children. The majority of surgeons have received some paediatric surgical training but this was considered inadequate by nearly half of all surgeons and by 60% of those who qualified in the last 10 years.Current postgraduate training at most of our universities involves a 3 - 6-month rotation, but from our survey this is considered insufficient in practice and there appears to have been some deterioration in paediatric surgical training in recent years. Steps needed to maintain paediatric surgical standards are discussed

Special Article: Current concepts in the management of gastro-oesophageal reflux in infants

No Abstrac

Ambulatory paediatric surgery

No Abstract

Epidemiological aspects of liver abscesses in children in the Western Cape Province of South Africa

A high incidence (28 per 100,000 admissions) of liver abscesses is reported in children from the Western Cape Province of South Africa. Of a total of 84 childhood hepatic abscesses over a 10-year period, 51 per cent (43 patients) were primary pyogenic, 30 per cent (25 patients) amoebic, 2 per cent (two patients) Ascaris, and 17 per cent (14 patients) were culture negative. Protein calorie malnutrition was evident in 56 per cent of cases. Amoebic abscesses originated in patients from rural areas, whereas pyogenic abscesses occurred in patients from urban and periurban environments. Staphylococcus aureus was cultured in 85 per cent of pyogenic liver abscesses. Gram negative organisms were identified in four cases of amoebic hepatic abscess where secondary infection occurred. Co-existing parasites of Ascaris lumbricoides and Trichuris trichiura were identified in the stools of 31 per cent of patients. A low (4.8 per cent) mortality is reported for this series.Articl

Is tube caecostomy safe in the surgery of Hirschsprung's disease?

[No abstract available]Articl

Challenges associated with paediatric pain management in Sub Saharan Africa

AbstractThe African child is particularly vulnerable to disease and injury, and subsequently, to pain and suffering. Factors such as inadequate training, language barriers, cultural diversity, limited resources and the burden of disease prevents sick and injured children from receiving basic pain care. This situation can only be rectified by providing pre and post graduate training on the safe use of analgesic preparations, the availability of drugs and government support

A 25-year review of the acute scrotum in children

No Abstrac

The outcome of solid tumors occuring in the neonatal period

Sixty-six solid neoplasms occurring in neonates treated at the Red Cross Childrens Hospital over a 34-year period (1957-1991) were reviewed and recalled for long-term follow-up (mean 10.4 years). Associated congenital abnormalities were rare, but chromosomal abnormalities were detected in 3 patients, one of which was familial. Teratomatous germ-cell tumours predominated, followed by neuroblastomas and soft-tissue tumours; 23 had malignant morphologic appearances and 43 were morphologically non-malignant. Seventy-nine per cent presented within the 1st week of life, 41% of these within the first 24 h. Although most sacrococcygeal teratomatous germ-cell tumours were benign, malignancy was present in 2 patients (1 of these presented during the 1st week of life). A further 11 sacrococcygeal teratomas were found on light microscopy to include immature elements and had unpredictable clinical behaviour; 2 of these later metastasized despite adequate surgical clearance. All 4 patients with mesoblastic nephromas and 1 with a neonatal Wilm's tumour survived. In addition, 6 of the 10 patients with a neuroblastoma survived long-term. One of 3 patients with a rhabdomyosarcoma survived as well as 1 of 2 with a hepatoblastoma. Congenital fibrosarcomas, although morphologically aggressive, had an excellent outcome. Surgical excision was performed in all cases, and overall patient survival on long-term follow-up was 66% (44 patients). These survivors included 10 (41%) of those with malignant tumours and 24 (84%) with potentially malignant tumours. Metastatic spread or secondary tumours were shown to occur at variable stages, and early, frequent, and regular fellow-up is recommended. Complications of extensive surgery resulted in 3 temporary and 2 long-term problems. Other adverse effects of therapy were observed in survivors of chemo- or radiation therapy, where poor growth was noted in 9 (82%), behavioural disturbances in 3 (27%), and intellectual impairment in 4 (36%).Articl