The profile and outcome of small bowel atresia at Universitas Academic Hospital.

BACKGROUND: In patients with intestinal atresia, associated congenital anomalies and prematurity are the main predictors of mortality in high-income countries (HIC). In low-and middle-income countries (LMIC), late referrals and lack of resources contribute to mortality. This study aims to describe the outcome of small bowel atresia at a tertiary institution in a LMIC. METHODS: A retrospective descriptive and analytical study was done on all neonates admitted with small bowel atresia from 1 January 2010 to 31 October 2016. Birth demographics, status on arrival, atresia type, surgical interventions and clinical course were analysed in relation to outcomes including mortality. RESULTS: The study included 92 patients. Thirty-three patients had duodenal atresia and 59 jejunal atresia. Median gestation was 34 weeks, with average birth weight 2.2 kg. Seven were diagnosed antenatally and 13 (14.1%) were born in a tertiary institution. A cardiac congenital anomaly was present in 43.5%. Late referrals comprised 72.8%. Sixty per cent were dehydrated and 55.4% were septic on arrival. The median age at surgery was 7.5 days after being admitted, for a median of 2 days. The median age reaching full feeds was 18 days, and 28.6% had a feeding intolerance. The median number of septic episodes were two and the median length of stay 28 days. Of the 92 patients, 8.7% were palliated and 10.9% died. Mortality was strongly associated with prematurity and sepsis with hospital stay. CONCLUSION: Despite late referrals, our mortality was comparable to HICs. We overcame this burden due to access to resources, sophisticated equipment and a low surgical complication rate. The length of stay could be decreased with a feeding protocol and discharge goals.

Dr James Barry (1789-1865): the Edinburgh years.

Dr James Barry, a surgeon in the British Army from 1813 until his retirement in 1859, became famous after his death following the revelation that he was in fact a woman who had masqueraded as a man for no less than 56 years. This paper reviews Margaret Bulkley's student years at the University of Edinburgh from the time of her adoption of the identity of the youth calling himself James Barry. The deception was perpetrated in order to obtain a medical degree and the three year MD curriculum was completed without discovery. Few facts are known about these years (1809-1812) and the work of Lisa Rosner has been invaluable as a source of prosopographical information to apply to our knowledge of James Barry's experiences during his time at Edinburgh. Contemporary letters and an Army document also assist in developing this unique and extraordinary story, revealing much that was previously unknown as well as some data, which in earlier work were incorrectly reported.

Health implications of lipopolysaccharide endotoxins in domestic container water used by rural households in South Africa.

This study assessed the occurrence of endotoxins, cyanobacteria and enterobacteria in untreated drinking water stored in domestic water containers by rural households in South Africa. Endotoxins, cyanobacteria, total coliforms and Escherichia coli were measured in the following numbers and ranges in container-water samples: 4-54 microg l(-1), 69-64,505 cells ml(-1), 9,000-280,000 CFU/100 ml and 90-1,100 CFU/100 ml, respectively, in source water and 0.23-24.7 microg l(-1), 1-501,187 cells ml(-1), 25-1,584,893 CFU/100 ml and 1-25,118 CFU/100 ml, respectively, in water from containers. The concentrations of these contaminants in water often exceeded guidelines. Container type, especially those that permit light into the vessel, played a significant role in the occurrence of these contaminants. Limited guidelines, as well as the absence of health evidence, make it uncertain whether the high levels of endotoxins in the containerised drinking water could cause a health effect in healthy persons. Most importantly, in the context of exposure to endotoxins potentially derived from high levels of cyanobacteria and enterobacteria such as coliforms in the water, a case is made for possible health effects in immune-compromised individuals exposed to water containing endotoxins and the bacteria that potentially produce it.

Significance of bacteria associated with invertebrates in drinking water distribution networks.

The implication of invertebrates found in drinking water distribution networks to public health is of concern to water utilities. Previous studies have shown that the bacteria associated with the invertebrates could be potentially pathogenic to humans. This study investigated the level and identity of bacteria commonly associated with invertebrates collected from the drinking water treatment systems as well as from the main pipelines leaving the treatment works. On all sampling occasions bacteria were isolated from the invertebrate samples collected. The highest bacterial counts were observed for the samples taken before filtration as was expected. There were, however, indications that optimal removal of invertebrates from water did not always occur. During the investigation, 116 colonies were sampled for further identification. The isolates represent several bacterial genera and species that are pathogenic or opportunistic pathogens of humans. Diarrhoea, meningitis, septicaemia and skin infections are among the diseases associated with these organisms. The estimated number of bacteria that could be associated with a single invertebrate (as based on average invertebrate numbers) could range from 10 to 4000 bacteria per organism. It can, therefore, be concluded that bacteria associated with invertebrates might under the worst case scenario pose a potential health risk to water users. In the light of the above findings it is clear that invertebrates in drinking water should be controlled at levels as low as technically and economically feasible.

Monitoring of water transfer from Katse Dam into the Upper Vaal river system: water utility's perspective.

Water quality is of prime importance to Rand Water's core business of ensuring a reliable supply of good quality drinking water to more than 10 million people. Rand Water has, therefore, implemented a water quality monitoring programme of the source water as well as the drinking water produced. The establishment of the Lesotho Highlands Water Transfer scheme necessitated the expansion of the monitoring programme. In 1996, Rand Water and Lesotho Highlands Development Authority (LHDA) signed an agreement to jointly develop an extensive water quality monitoring programme for the Lesotho Highlands Water Project (LHWP). Prior to this agreement, monitoring was mainly undertaken by consultants on behalf of LHDA in the main feeder rivers within the Katse Dam catchment (donor system). On the recipient system (Ash/Liebenbergsvlei), extensive physical and chemical monitoring was undertaken by Rand Water and Department of Water Affairs and Forestry (DWAF). Biological monitoring was however only carried out superficially prior to the release of water. Information gained from carrying out biological and chemical assessments clearly indicates that the water from LHWP has negatively impacted on the biological communities in the recipient system. The importance of detailed before and after biological and physiochemical monitoring of both donor and recipient systems is emphasised.

An unusual case of acute urinary retention in young females.

Urinary retention is an unusual problem in females and may be psychogenic, especially in the young. However it is important to remember that there are also organic causes for retention. We present 2 cases of an uncommon cause of urinary retention in the young female, namely hematocolpos.

The freshwater river crab, Potamonautes warreni, as a bioaccumulative indicator of iron and manganese pollution in two aquatic systems.

The aim of this study was to determine the potential use of the freshwater river crab, Potamonautes warreni, as a bioaccumulative indicator of iron and manganese pollution in aquatic ecosystems. Water and sediment analysis of the two study sites (Germiston Lake and Potchefstroom Dam) revealed that while levels of manganese were higher in Germiston Lake, iron concentrations were higher in Potchefstroom Dam. Metal analysis of P. warreni revealed that while the crabs from Potchefstroom Dam contained slightly higher iron levels than those from Germiston Lake, manganese concentrations in P. warreni from the latter site were significantly higher than those in the crabs from the former site. Iron and manganese levels in these organisms were influenced by the size, mass, and sex of the crabs on occasion, but these relationships were not always consistent at both of the sites. The results of this study clearly indicate that the ultimate levels of iron and manganese attained in P. warreni do vary depending on the site from which animals are collected. From this, it is suggested that these crustaceans be incorporated into biomonitoring protocols, particularly in areas that are subjected to elevated metal levels in the environment

Effect of copper on blood coagulation of Oreochromis mossambicus (Cichlidae).

The effect of copper on the blood coagulation in freshwater fish, Oreochromis mossambicus was investigated. These fish were exposed to sublethal copper concentrations over short-term (96 hr) and long-term (4 wk) periods, at 29 +/- 1 degree C (summer) and 19 +/- 1 degree C (winter), in experimental flow-through systems. Copper concentrations applied during short-term exposures were 0.16 mg/l and 0.40 mg/l, respectively, while 0.40 mg/l copper was applied during the long-term exposures. After a photocymographic observation of blood, during all the phases of coagulation was made, it was evident that there were delays in the blood coagulation times, as well as decreases in the shear modulus (elasticity) of the clots formed, after the exposure of the fish to copper concentrations at both temperatures. Copper was found to induce haemophilia at 29 +/- 1 degree C and 19 +/- 1 degree C, while at the latter it also induced thrombocytopenia. Thus exposure to copper lead to coagulation defects, which caused haemorrhage in the body tissue, which can eventually cause the death of those fish.

The effect of copper on the blood chemistry of Clarias gariepinus (Clariidae).

Environmental stressors, both natural and humanly induced, could cause changes in cellular function which alter the physiology of organ systems in fish. The need to comprehend and predict the condition which stress metals will pose on fish, and extrapolate the effect of pollutants from laboratory to population levels, have forced scientists to search for physiological and biochemical indicators of health and sublethal toxicant effects. Hematological evaluation of fish blood provides valuable facts concerning the physiological response of fish to changes in the external environment. Furthermore, hematological variables are well known for their clinical value in prognosis and diagnosis. Sublethal responses after exposure to toxicants can be determined by commonly applied techniques. Measurements for a number of hematological and carbohydrate metabolic variables were recorded at winter and summer temperatures after fish, acclimated for 3 months to experimental conditions, were exposed to sublethal concentrations of copper for 96 hr in a continuous-flow experimental system. Controls were run at the same time to establish essential baseline hematological values. Fish were exposed to the mean copper concentration as was found in the Olifants River, Kruger National Park, during summer (0.05 +/- 0.032 mg liter-1) and winter (0.085 +/- 0.032 mg liter-1) to establish the effect thereof on the variables mentioned. The results proved that the concentration of copper in the river exerts a physiological effect on Clarias gariepinus at 21 +/- 1 and 28 +/- 1 degrees C which manifests in changed blood chemistry. Pathological conditions, such as erythrocytopenia, leucocytosis, hyperglycemia, and hyperprotonemia, are evident. The fish physiologically adapted to the environmental change, which does not necessarily reflect a state of normality.

Bioconcentration of atrazine in the banded tilapia, Tilapia sparrmanii.

1. The bioconcentration of atrazine was determined in the liver, muscle, heart, gonads and brain of Tilapia sparrmanii exposed to high concentrations of atrazine. 2. The highest concentrations were recorded in the ovaries (50.6 micrograms/g) and in the liver (40.1 +/- 5.5 micrograms/g). This may be attributed to the higher lipid content of these organs, while the liver also accumulates atrazine as a result of its detoxification function. 3. The bioaccumulation factors for atrazine in the liver, muscle, heart, gonads and brain ranged from 0.9 to 20.0. Bioconcentration of atrazine in banded tilapia was found to be low, even after exposure to external atrazine concentration much higher than detected in natural surface water.

Effects of chromium during pH change on blood coagulation in Tilapia sparrmanii (Cichlidae).

1. Tilapia sparrmanii was exposed to 0.098 mg/l potassium dichromate. 2. The effect of chromium on blood coagulation was measured with a thrombelastograph at a pH of 5, 7.4 and 9 over 96 hr, as well as an uncontrolled pH after 2 weeks of exposure. 3. The prolonged kinetic times and reduced maximal amplitudes at a pH of 7, 4 and 9, differed significantly from the control values. 4. Thrombelastograms reflected a decrease in the clotting ability of fish blood, with an increase in pH, which is typical of thrombocytopenia. 5. It was evident that the exposure of fish to chromium led to clotting defects that caused internal bleeding.

The effect of hexavalent chromium at different pH values on the haematology of Tilapia sparrmanii (Cichlidae).

1. The haematology of Tilapia sparrmanii (Smith) was investigated after exposure to 0.098 mg.l-1 hexavalent chromium at three different pH values. 2. Statistically significant changes occurred between the values of parameters of experimental and control fish. 3. At lower pH values erythrocytosis and leucocytosis were evident. 4. At an alkaline (9) pH anaemic and leucopenic conditions were observed. 5. T. sparrmanii adapted to chronic exposure to hexavalent chromium.

Bioconcentration of atrazine, zinc and iron in the blood of Tilapia sparrmanii (Cichlidae).

1. The bioconcentration of atrazine, zinc and iron in the blood of Tilapia sparrmanii has been determined separately in each of six exposure groups. 2. An increased bioconcentration of atrazine in the blood occurred with an increased exposure concentration. 3. With exposure to zinc, there was a gradual decrease in bioconcentration of zinc in the blood of T. sparrmanii with an increased concentration in the water. 4. A similar tendency was observed during iron exposure, except that the decrease in bioconcentration was not significant.

Adult Wilms' tumor. Cisplatin and etoposide for relapse after adjuvant chemotherapy.

The prognosis for patients with adult Wilms' tumor is poor in contrast to pediatric Wilms' tumor. A 23-year-old patient with Wilms' tumor is described who relapsed twice; initially after adjuvant treatment with abdominal irradiation, vincristine, and actinomycin and again after treatment with high dose doxorubicin. The patient was treated with cisplatin and etoposide and is clear of disease 75 months after presentation. She has given birth to a healthy baby.

Percutaneous nephrolithotomy. The first 50 cases.

Initial experience at two centres in Cape Town with a new technique for the removal of urinary calculi is described. The technical difficulties encountered and the methods used to overcome them are outlined. Percutaneous nephrolithotomy has rendered conventional open surgery largely obsolete for treatment of stone disease of the upper urinary tract.

Nonfaecal and faecal losses of Pomadasys commersonni (Teleostei: Pomadasyidae) feeding on the surf clam, Donax serra.

1. The nonfaecal and the faecal production of Pomadasys commersonni, a marine teleost, were investigated at 15, 20 and 25 degrees C. 2. Nonfaecal nitrogen excreted by starved and fed P. commersonni consisted mainly of ammonia-N. 3. The mass component b of the equation, AE = aMb (AE, ammonia-N in Mg-N/hr; M, fish mass in g) ranged from 0.68-0.72 and 0.71-0.75 for starved and fed fish, respectively, and was temperature-independent. 4. The mean percentage of the food energy lost as nonfaecal energy (exogenous plus endogenous) was 4.38 +/- 2.68%. 5. The faeces had a low energy content and ranged from 2.09 to 4.25 kJ/g. 6. Assimilation efficiencies showed some variation and ranged from 7.34 to 99.34% for dry matter and from 96.02 to 99.89% for energy. 7. The mean combined energy loss was 11.77% of the ingested energy.

Nonfaecal and faecal losses of the marine teleost, Lichia amia (Linnaeus, 1758), feeding on live southern mullet, Liza richardsonii (Smith, 1846).

1. Nonfaecal and faecal losses of Lichia amia were determined under controlled laboratory conditions at 15, 20 and 25 degrees C. 2. Ammonia-N was the major form of nonfaceal nitrogen excreted by L. amia and excretion rates were temperature-dependent. 3. The mass component b of the mass/ammonia-N excretion equation was temperature-independent and ranged from 0.63-0.65 and from 0.66-0.73 for starved and fed fish, respectively. 4. Mean nonfaecal energy loss (exogenous plus endogenous) was 3.78 +/- 1.99% of the ingested energy. 5. Assimilation efficiencies varied between individual fish and ranged from 61.24-93.79% (mean 80.76 +/- 7.14%) for dry matter and 87.52-98.22% (mean 94.09 +/- 2.22%) for energy. 6. The mean nonfaecal and faecal energy loss was 23.11 +/- 1.67% of the ingested energy.