Anal sphincter reconstruction for incontinence due to non-obstetric sphincter damage.

Objective: To assess the outcome after anal sphincteroplasty in patients with anal incontinence following non-obstetric anal sphincter damage.

Design: A prospective study carried out in an urban teaching hospital over five years (1994-1998).

Patients And Methods: Fourteen patients, median age of 30 years, all undergoing anal sphincter reconstruction.

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Background: There are differing views regarding the management of oesophageal injuries with some authors advocating mandatory operation while others prefer a selective, conservative approach. This study was undertaken to establish whether conservative management of cervical oesophageal injuries is safe and effective.

Patients And Methods: This is a retrospective study carried out over 5 years (1994-1998).

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.

Renal trauma secondary to stab, blunt and firearm injuries--a 5-year study.

Objective: To review our experience of renal trauma at King Edward VIII Hospital, Durban.

Design: Retrospective study over 5 years.

Setting: Tertiary referral hospital in an urban area.

Asymptomatic hyperparathyroidism caused by a giant parathyroid adenoma.

On routine investigation a 57-year-old woman was found to have primary hyperparathyroidism caused by a giant parathyroid gland. The gland was removed successfully and histological examination proved it to be a parathyroid adenoma.

Thyroid carcinoma at King Edward VIII Hospital, Durban, South Africa.

Background: Western literature depicts papillary carcinoma as the most common thyroid malignancy followed by follicular carcinoma.

Objective: To assess the clinical pattern of thyroid carcinoma among African and Indian patients.

Setting: King Edward VIII Hospital, Durban, South Africa.

Solid and cystic papillary epithelial neoplasm of the pancreas. A report of 3 cases.

This is a report of 3 female patients presenting with solid and cystic papillary epithelial neoplasms of the pancreas (SCPEN). All 3 lesions were incidental findings. SCPEN is an uncommon low-grade malignant tumour that is histologically distinct from ductal adenocarcinoma and islet cell tumour, occurs chiefly in young women, and is amenable to surgery.

Pemphigus in South Africa.

Background: Pemphigus is an autoimmune disease characterized by intraepidermal blistering. We describe the demography, prevalence, clinical features, response to treatment, and human leukocyte antigen (HLA) characteristics of pemphigus in Kwa-Zulu Natal, South Africa.

Methods: All patients with pemphigus were prospectively recruited over 12 years from January 1987 to December 1999.

Penetrating chest injuries in the firearm era.

Background: firearm wounds of the chest are now common at our institution. The management algorithm for firearm wounds has not been evaluated for this mode of injury.

Methods: records of all patients with penetrating chest injuries admitted to an urban tertiary hospital over 1 year were retrieved and analysed.

Congenital diaphragmatic hernia repair--impact of delayed surgery and epidural analgesia.

This study was undertaken to assess the impact on mortality and the need for postoperative ventilation of intra- and postoperative epidural analgesia and delayed surgery in neonates with congenital diaphragmatic hernia. The study was a retrospective chart review of 35 neonates with congenital diaphragmatic hernia treated in Durban between 1988 and 1993. The mortality rate was 30%, with too few patients having delayed surgery to demonstrate a benefit from this policy.

Tinea pedis et unguium in the Muslim community of Durban, South Africa.

Background: In a pilot study performed in eight mosques in the Durban area, it was found that the prevalence of tinea pedis et unguium in the adult Muslim male population regularly attending mosques was higher than in the nonMuslim male population. The aims of the present study were: (i) to determine the prevalence of tinea pedis et unguium in the adult Muslim male population regularly attending mosques; (ii) to investigate the role of mosque carpets and ablution areas in the spread of infection; and (iii) to develop strategies to combat the infection.

Method: Seventy-eight regular worshippers comprising adult Muslim males, chosen at random from five mosques in the Durban area, were examined for clinical evidence of tinea pedis et unguium.

Favourable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas.

The records of 152 patients with pancreatic injury treated over a 5-year period were reviewed. The diagnosis was made at laparotomy in all patients. Gunshot wounds, stab wounds and blunt trauma occurred in 63, 66 and 23 patients respectively with mean ages of 28, 28 and 30 years.

Hypercalcaemia and multiple osteolytic lesions in childhood acute lymphoblastic leukaemia.

A 12 year old boy presenting with hypercalcaemia (calcium 3.25 mmol/l) and osteopaenia with multiple osteolytic lesions was found to have acute lymphoblastic leukaemia without lymph-adenopathy or organomegaly. Hypercalcaemia is a rare feature of acute leukaemia, but the patients previously described all show very similar characteristics, which were highlighted in this patient.

Direct intracompartmental pressure measurement in the management of snakebites in children.

Snakebite remains a source of considerable morbidity in Natal. Despite the availability of specific and polyvalent antivenins, the regional effects of envenomation and inappropriate first-aid result in significant, potentially avoidable, disability--particularly in children. Direct measurement of intracompartmental pressure has been used as an adjunct to clinical assessment of the child with a swollen limb following snakebite in order to diagnose compartment syndrome.

Pituitary function tests in black patients with pseudocyesis.

Pituitary function was evaluated in a group of 10 patients with pseudocyesis. One patient was postmenopausal; the remainder demonstrated normal basal prolactin, luteinising hormone (LH) and follicle-stimulating hormone (FSH) levels and also normal pituitary-adrenal, pituitary-thyroid axes. Oestradiol deficiency was present in 6 patients, while 2 patients demonstrated elevated serum progesterone values, suggestive of a luteal phase.

Benign intracranial hypertension in typhoid fever. A case report.

Benign intracranial hypertension, a previously undocumented neurological complication of typhoid fever, is described in an 11-year-old child. Resolution occurred within 5 days of the start of chloramphenicol therapy and recovery was uneventful.

Anterior decompression of burst fractures with neurological deficit.

We reviewed 30 patients with burst fractures of the thoracic and lumbar spine treated by anterior surgical decompression and fusion between January 1983 and December 1987; 21 had partial neurological involvement while nine had complete paraplegia. At follow-up all patients with partial neurological involvement improved by one to three Frankel grades, whereas of the nine patients with complete paraplegia only one improved. Late kyphotic deformity was seen in 12 patients.

Boomslang bite--diagnosis and management. A report of 2 cases.

Bites by boomslang are uncommon and usually occur in adult snake handlers who are aware of the potentially fatal consequences, i.e. disseminated intravascular coagulation with delayed onset of spontaneous haemorrhage.

Isolated tricuspid valve infective endocarditis. A report of 6 cases.

Six cases of isolated tricuspid valve endocarditis in young women are described. Preceding genital sepsis was a predisposing factor in 4 patients. Cardiac signs are unusual at presentation, rendering the diagnosis difficult.

Therapeutic drug monitoring in a paediatric epilepsy clinic.

In 1988 a therapeutic drug monitoring programme for anticonvulsants was introduced in the paediatric neurology clinic at King Edward VIII Hospital, Durban. Although before this serum drug levels were routinely measured, the new approach involved the application of clinical pharmacokinetics to the results so that an individualised drug profile was available for use in conjunction with clinical evaluation at the patient's next visit. Case reports are presented to illustrate the value of using serum levels in this way.

Nutritional aspects of hypertension.

Hypertension is of importance mainly as a risk factor for heart, brain and kidney disease. To date, efforts have been made to reduce high blood pressure levels rather than to prevent their development, yet primary prevention of hypertension is important. Aspects of nutrition play an important role in the aetiology and non-pharmacological treatment of hypertension, for which the following are recommended: (i) obese hypertensive patients should be encouraged to follow a low-kilojoule diet and to decrease their consumption of saturated fats and cholesterol; (ii) a moderately restricted sodium intake (2 g or 88 mmol/d) should be encouraged in all hypertensives; however, more controlled long-term prospective intervention studies in large populations are necessary to determine the optimal level of dietary intake of salt; (iii) foods rich in potassium should be recommended; and (iv) alcohol intake should be moderate; hypertensives who drink greater than 30-60 ml of ethanol per day need to be told to stop.

Light-chain nephropathy. A report of 2 cases.

Two cases of renal impairment caused by the deposition of monoclonal immunoglobulin light-chain determinants in the glomerular mesangium and basement membranes as well as in the tubular basement membranes of the kidney are described (light-chain nephropathy). Both cases were associated with myeloma. Examinations by light microscopy, immunohistochemistry and electron microscopy are also described.