The modern approach to pectus repair

Since 1949, the Ravitch repair for pectus excavatum and carinatum was the gold standard. This is a destructive, aggressive procedure, which has a significant recurrence rate when it is poorly performed. When performed in the very young, it can result in an asphyxiating chondrodystrophy. This is a condition in which the chest wall fails to grow owing to the growth plates having been resected, resulting in pulmonary failure as an adult.http://www.ajtccm.org.za/index.php/SARJam2020Cardiolog

Thoracoscopy : the past, the present and the future! A personal journey

Thoracoscopy, in my opinion, is underutilised in Africa, for a multiplicity of reasons. These include a lack of expertise, the perceived cost and difficulties in obtaining and maintaining equipment. The benefits, however, in improved surgery and decreased surgical pain and rapid return to productive work outweigh by far the so-called disadvantages. In my opinion, thorascopic techniques should be routine in all our academic departments. Our newly qualified thoracic surgeons should be trained in video-assisted thoracic surgery.http://www.ajtccm.org.za/index.php/SARJCardiolog

Cardiothoracic surgery in South Africa : a history

Cardiothoracic surgery in South Africa began in Cape Town spreading to the rest of the country, and since the end of apartheid slowly reaching other sub-Saharan African countries. It is a story of brilliant innovators, of the evils of the disease of apartheid but also of what is possible if you are determined and prepared to work hard. The early leaders came from the University of Cape Town (UCT) with Christiaan Barnard, Donald Ross and Rodney Hewitson all in the same class of 1946 with Ben Le Roux and Bob Frater soon after. It is a story of world class professionals in a sea of poverty. The heart transplants performed by Barnard stimulated the whole university and eventually had an effect in raising the standard of medicine in South Africa. Despite the apartheid laws at the time the cardiac unit at UCT was run as multiracial as it was possible at the time with all patients receiving the same care. Apartheid also had an effect on the emigration of many highly talented graduates to other countries. The end of apartheid caused great changes to healthcare in the country, many of great benefit but also some not so good. As UCT influenced the rest of South Africa, the South African medical fraternity can affect the rest of sub-Saharan Africa to the benefit of all its people.https://jtd.amegroups.orghj2023CardiologySurger

Challenging beliefs : a review of the paradigm shift in the treatment of pectus excavatum from radical resection to minimally invasive bracing and non-surgical vacuum bell suction

In 1997, Nuss introduced a minimally invasive non-destructive procedure for pectus excavatum, which revolutionised the treatment of the condition. This review will give a brief history on the management of this condition, followed by a review of 1 034 cases that have been repaired from 2008 to 2018.http://www.ajtccm.org.za/index.php/SARJhj2021CardiologySurger

Unintended consequences of the COVID-19 pandemic in Africa

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Recommendations for lung cancer screening in Southern Africa

Lung cancer remains the leading cause of cancer-related deaths in southern Africa. Early trials of chest radiograph-based screening in males at high risk for lung cancer found no mortality benefit of a radiograph alone, or a radiograph plus sputum cytology screening strategy. Large prospective studies, including the National Lung Screening Trial, have shown an all-cause mortality benefit when lowdose computed tomography (LDCT) was used as a screening modality in patients that are at high risk of developing lung cancer. The South African Thoracic Society, based on these findings, and those from several international guidelines, recommend that annual LDCT should be offered to patients between 55–74 years of age who are current or former smokers (having quit within the preceding 15 years), with at least a 30-pack year smoking history and with no history of lung cancer. Patients should be in general good health, fit for surgery, and willing to undergo further investigations if deemed necessary. Given the high local prevalence of tuberculosis (TB) infection and post-TB lung disease, which can radiographically mimic lung cancer, a conservative threshold (nodule size ≥6 mm) should be used to determine whether the baseline LDCT screen is positive (thus nodules <6 mm require no action until the next annual screen). If a non-calcified, solid or partly solid nodule is ≥6 mm, but <10 mm with no malignant features (e.g., distinct spiculated margins), the LDCT should be repeated in 6 months. If a solid nodule or the largest component of a non-solid nodule is ≥10 or ≥6 mm and enlarging or with additional malignant features present, definitive action to exclude lung cancer is warranted. Patients should be screened annually until 15 years have elapsed from date of smoking cessation, they turn 80, become unfit for a curative operation or significant changes are observed.K Dheda is supported by the South African MRC (RFA-EMU-02-2017) and the EDCTP (TMA- 2015SF-1043 & TMA-1051-TESAII).http://jtd.amegroups.comam2020Cardiolog

Pectus carinatum : when less is more

Awareness of pectus carinatum has increased among the medical community over the last several decades, as innovative options for nonsurgical treatments have become more widely known. Management alternatives have shifted from open resective to minimally invasive strategies, and finally, to reshaping the chest using both surgical and non-surgical modalities. We aim to review the evolution of the diagnosis and treatment of pectus carinatum up to its current management.http://www.ajtccm.org.za/index.php/SARJam2020Cardiolog

Unintended consequences of the COVID-19 pandemic in Africa

As we write this, a patient is in a local South African Hospital on a ventilator following a cardiac arrest after a massive pulmonary embolus. He recently returned from overseas. When he arrived, he had a cough and phoned his doctor, who instructed him to be tested for COVID-19 before a consultation. The results were delayed for a few days. Before the patient received the results which were negative, he had his pulmonary embolus, was admitted where he had a cardiac arrest with anoxic brain injury. This was an unintended and unreported consequence of the COVID-19 pandemic. The law of intended consequences has been defined as “The actions of people, and especially of governments, always have effects that are unanticipated or unintended.”https://patsjournal.orghj2021CardiologySurger

COVID-19 in Africa : preparing for the storm

In response to COVID-19, Africa should develop robust collaborative research programmes, funded by African governments and partners, to include epidemiological, health system, implementation, clinical trials, immunological and virological research.https://theunion.org/our-work/journals/ijtldhj2021CardiologySurger