Developing a Pipeline of African Global Surgery Scholars.

Global surgery is developing as new discipline in many countries. Global surgery primarily aims to improve access to quality surgery in low-and-middle Income countries (LMICs). Thus, ensuring appropriate LMIC representation and leadership in global surgery research, projects, and innovations, is essential. There is a paucity of pathways for students and young clinicians in LMICs to attain training in and exposure to global surgery research and projects. If equity in global surgery leadership and scholarship is truly desired, steps need to be taken to ensure that more students and young clinicians in LMICs are exposed to global surgery as an academic discipline and are offered pathways to practice and leadership. This paper explores ways of ensuring this through increased exposure, increased training and increased funding.

Charles F M Saint - South Africa's original surgical pioneer.

Charles F M Saint, a 33-year-old graduate from the University of Durham, Newcastle upon Tyne, was appointed to establish the first department of surgery in South Africa (SA) at the University of Cape Town (UCT) in 1920. A mentee of the celebrated British surgeon, Prof. James Rutherford Morison, Saint's distinguished surgical pedigree and exceptional academic and clinical achievements underpinned his astute leadership and legendary ability to inspire, essential qualities necessary for the founding professor of SA surgery. Saint's imprimatur gave primacy to teaching and a priority to skilled, rigorous and fundamental undergraduate instruction, expounding the Morison-Saint philosophy, which made the department the seedbed of SA surgery. He was the first to introduce basic research programmes in clinical departments. During his tenure, Saint received wide international recognition and honours and when he retired in 1946, he had taught more than 1 300 students, trained 7 professors of surgery and over 40 specialist surgeons, instilling his distinctive brand of disciplined, caring surgery. In his 26 years at UCT and Groote Schur Hospital, Saint laid the foundations and built a department of surgery with a global reach and an enduring legacy at the southern tip of Africa.

Transition from child- to adult-orientated care for children with long-term health conditions: a process, not an event.

Long-term health conditions in childhood include both congenital conditions and acquired diseases. Children with long-term health conditions face issues and potential secondary problems that are different from those of adults with chronic diseases. Transition to adult-orientated care for such children and adolescents is a major challenge. Transition needs to be prepared for and planned. A variety of possible transition models exists, depending on circumstances.

Spina bifida: a multidisciplinary perspective on a many-faceted condition.

Open spina bifida or myelomeningocele (SBM) is the most common birth defect involving the central nervous system, second only in incidence to congenital cardiac disease. Outcomes in this disorder were poor until the mid-20th century, when modern neurosurgical techniques (closing the lesion and treating hydrocephalus) and treatment for the neuropathic bladder addressed the major causes of mortality, although SBM may still be poorly treated in the developing world. Initial management - or mismanagement - has a profound impact on survival and long-term quality of life.

Low prevalence of latex sensitivity in South African spina bifida children in Cape Town.

Spina bifida children have a high prevalence of latex allergy in studies reported from Europe and the USA. This study investigated the prevalence of latex allergy in a cohort of 24 spina bifida children at the Red Cross Children's Hospital from Cape Town, South Africa. The children were investigated using a detailed questionnaire, skin prick tests (ALK-Abello), ImmunoCap RASTs, Western blotting and ELISA, using the purified latex proteins Hev b1 and Hev b3 and whole latex preparation. A low overall prevalence of latex sensitization of 16.7% was found in the children. Children who were sensitive reacted to water insoluble to Hev b1 and Hev b3 proteins. The low prevalence of latex sensitization in the South African children may not be entirely explained by stringent latex avoidance. The children were from a low socioeconomic social status and 'hygiene' and other factors should be considered.

Brain abscesses - the Groote Schuur experience; 1993 - 2003 : neurosurgery

Objective. To review management and outcome of patients with brain abscess treated at Groote Schuur Hospital (GSH) between 1993 and 2003. Patients and methods. Case notes; radiological results and laboratory records were reviewed retrospectively for 121 patients at GSH who underwent a neurosurgical procedure for treatment of a brain abscess between 1993 and 2003. Patients not treated surgically were excluded. Follow-up with serial computed tomography (CT) scans; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels and the temperature chart were used to determine the duration of parenteral antibiotic treatment and the need for repeat surgical evacuation of pus by either aspiration or excision of the capsule. Results. The mean patient age was 33 years; with a male-to-female ratio of 5:1. Headache; depressed level of consciousness and pyrexia were the commonest presenting symptoms. Other symptoms included seizures and hemiparesis. The frontal lobe was the commonest site (44); the majority of abscesses occurred as a result of infection following trauma. Mastoiditis (21) and sinusitis (8) were the second and third most common causes. Organisms were identified in 81of cases; polymicrobial infections occurred in half of these. Thirty-three different organisms were identified; the majority of which were Gram-positive bacteria. Anaerobes were present in 23; while methicillin-resistant Staphylococcus aureus was identified in 1 patient. Nocardia was seen in 3 patients; 2 of whom were diabetic. The average duration of parenteral antibiotic therapy was 15 and 19 days for excision and aspiration respectively. Accurate ESR records were available in 75of cases; with a positive predictive value in 81; while CRP (in use since 1999) was helpful in 92of cases. Outcome. Sixteen patients (13) died; 12 of whom had been admitted with a Glasgow Coma Score (GCS) of less than 4T/15. Thirteen patients developed epilepsy. On discharge; patients continued to take oral antibiotics for another 4 weeks; at the end of which they were reviewed at the neurosurgery outpatient department. Conclusion. Compared with previous studies from this hospital; mortality and morbidity have been diminishing progressively. GCS at the time of admission remains the most important prognostic factor

Congenital malformations of the brain--a neurosurgical perspective at the close of the twentieth century.

Current classifications, indications for surgery, operative options and outcome statistics available to neurosurgeons for the management of congenital encephaloceles, arachnoid cysts and the Dandy-Walker complex are reviewed.

Serum CA 125 concentrations in women with endometriosis or uterine fibroids treated with gonadotrophin-releasing hormone agonist analogues.

We assessed the possible role of CA 125 in the monitoring of gonadotrophin-releasing hormone (GnRH) agonist analogue therapy in women with endometriosis and uterine fibroids. Serum concentrations of this cell surface antigen did not correlate with uterine volume and appeared to have no value in the assessment of shrinkage of uterine fibroids during GnRH agonist treatment. While CA 125 levels were not always elevated in subjects with endometriosis, they fell during treatment in all patients. The change accurately reflected therapeutic progress in these women and was of particular value in those patients who had commenced therapy with elevated levels. It is suggested that CA 125 may be useful in the monitoring of therapeutic progress in selected patients with endometriosis treated with GnRH agonists; the need for surgical follow-up may be obviated.