South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric surgical patients.

BACKGROUND: Children comprise a large proportion of the population in sub-Saharan Africa. The burden of paediatric surgical disease exceeds available resources in Africa, potentially increasing morbidity and mortality. There are few prospective paediatric perioperative outcomes studies, especially in low- and middle-income countries (LMICs). METHODS: We conducted a 14-day multicentre, prospective, observational cohort study of paediatric patients (aged <16 yrs) undergoing surgery in 43 government-funded hospitals in South Africa. The primary outcome was the incidence of in-hospital postoperative complications. RESULTS: We recruited 2024 patients at 43 hospitals. The overall incidence of postoperative complications was 9.7% [95% confidence interval (CI): 8.4-11.0]. The most common postoperative complications were infective (7.3%; 95% CI: 6.2-8.4%). In-hospital mortality rate was 1.1% (95% CI: 0.6-1.5), of which nine of the deaths (41%) were in ASA physical status 1 and 2 patients. The preoperative risk factors independently associated with postoperative complications were ASA physcial status, urgency of surgery, severity of surgery, and an infective indication for surgery. CONCLUSIONS: The risk factors, frequency, and type of complications after paediatric surgery differ between LMICs and high-income countries. The in-hospital mortality is 10 times greater than in high-income countries. These findings should be used to develop strategies to improve paediatric surgical outcomes in LMICs, and support the need for larger prospective, observational paediatric surgical outcomes research in LMICs. CLINICAL TRIAL REGISTRATION: NCT03367832.

Diagnostic performance of dobutamine stress echocardiography: A South African experience.

BACKGROUND: Dobutamine stress echocardiography (DSE) is a well-established modality for the diagnosis of coronary artery disease, but there are no reported diagnostic data in southern Africa. Objectives. To compare the safety, sensitivity and specificity of a South African (SA) DSE programme with larger, international series. Methods. All patients undergoing DSE from 2019 to 2021 at a single SA centre were included. A new wall motion abnormality (≥2 segments) signified inducible ischaemia. Results. A total of 106 patients (mean (standard deviation) age 61 (11) years, 68% male) were analysed. Six patients (6%) experienced chest pain during DSE and 4 (4%) developed an atrial arrhythmia. The sensitivity and specificity for epicardial coronary stenosis were 77% and 74%, respectively, changing to 82% and 72% when excluding those who had previous coronary artery bypass surgery. Conclusion. The sensitivity, specificity and safety of an SA DSE programme were comparable to international series. A DSE programme is feasible in a resource-constrained environment.

A study of the mantle technique for Hodgkins disease using thermoluminescent dosimetry.

A study of the mantle technique for Hodgkins disease patients was embarked upon using thermoluminescent dosimetry (TLD) and a RANDO phantom. There was concern that the technique using Co-60 and turning the patient over for the posterior field may not be optimal as it was felt that the axillary areas of these patients were being under-dosed. A variety of treatment set-ups were performed on a 60-Cobalt unit at extended SSD. The phantom was planned for treatment lying supine for the anterior field and prone for the posterior field. Measurements were made in the neck, hilum and axillae using various combinations of compensators and lead filters. The combination of full field compensators and a lead filter gave the best results in the phantom but did not give satisfactory axillary readings in the patient situation. This was attributed to the difference in shape and AP separation of the patient when lying prone. RANDO, being solid, retains its shape. Treatment was then planned for a 6 MV linear accelerator using a vertical couch extender which enables the patient to remain supine throughout the treatment by increasing the table height to allow the posterior portal to be treated through the couch. Full field compensation was found to give an adequate dose to all the measured areas. This technique has since been performed on 28 patients being treated for Hodgkins disease at the Hillbrow Hospital, and the average axillary dose recorded in these patients is 88.6% of the prescribed dose.

The diagnosis of Wesselsbron disease in a new-born lamb by immunohistochemical staining of viral antigen.

Wesselsbron disease (WSL) was diagnosed in a 2-d-old lamb on a farm in the north-eastern Free State Province where a few abortions and neonatal deaths occurred in sheep in April 1994. The liver of the lamb was slightly swollen and orange-brown and, microscopically, it revealed single or small groups of necrotic hepatocytes that were randomly scattered throughout the lobules. Other histopathologic hepatic lesions included the presence of acidophilic bodies, intranuclear inclusion bodies in a few hepatocytes, neutrophils in the parenchyma, mild Kupffer-cell and bile-ductular proliferation and infiltration of mixed inflammatory cells in the portal tracts. Immunohistochemical staining of sections of formalin-fixed specimens of the liver with polyclonal antibody against WSL virus revealed positive staining in acidophilic bodies, cytoplasmic fragments of necrotic liver cells, the cytoplasm of degenerated hepatocytes and, rarely, in intranuclear inclusions. Positive staining was also obtained in liver sections from two newborn lambs experimentally infected with WSL virus. The results of this investigation showed that the immunohistochemical staining of sections of formalin-fixed liver can be used to confirm the diagnosis of WSL in new-born lambs.

Computerized tomography in pneumatocoeles after paraffin ingestion.

Paraffin pneumonia is a common form of poisoning but pneumatocoeles are an uncommon complication. This is a report of the computerized tomography (CT) of seven patients who developed pneumatocoeles after the ingestion of paraffin. The finding on the CT are presented and the situation and characteristics of the pneumatocoeles are indicated.

Pneumatoceles as a complication of paraffin pneumonia.

Paraffin pneumonia is a common form of poisoning, but pneumatoceles are an uncommon complication. This is a report of 6 patients who developed pneumatoceles after the ingestion of paraffin. These children's ages varied from under 18 months to 4 years; they were clinically more ill and were hospitalised longer than those who did not develop pneumatoceles. The pneumatoceles were discovered at the earliest on day 6 and, although extensive and in 2 cases bilateral, caused no clinical impairment of respiratory function. The pneumatoceles appear to resolve spontaneously but this may take more than 200 days.