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1.
Pediatr Transplant ; 24(2): e13644, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31943592

RESUMO

BACKGROUND: Outcomes for the pediatric kidney transplant program in Johannesburg (1984-2003) were found to be suboptimal. In this study, we compared (a) early (era 1:1984-2003) to contemporary (era 2:2004-2017) outcomes and (b) compared contemporary outcomes between the public and private sector hospitals in our program. METHODS: We conducted a retrospective record review of all pediatric (<18 years) KA transplants performed in our kidney transplant program at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Wits Donald Gordon Medical Centre (WDGMC) from 2004 to 2017. We collected the following data per site: number of recipients, transplants performed, mean follow-up time, and grafts lost; per recipient: age at time of transplant, sex, self-reported population group; transplant history; donor type; etiology of ESKD; recipient and graft survival. Outcomes for era 1 were based on data published on our kidney transplant program, based at CMJAH. RESULTS: At CMJAH (public sector), there was no improvement in recipient and graft survival over time. In the contemporary analysis, 1-, 5-, and 10-year recipient survival, as % (95% CI) was 93 (84-97); 76 (64-84); 59 (44-70) for CMJAH, and 98 (90-99); 95 (86-99); 82 (54-94) for WDGMC (private sector). Similarly, 1-, 5- and 10-year graft survival was 75 (63-84); 55 (42-66); 36 (24-49) for CMJAH, and 96 (87-99); 84 (73-91); 64 (48-76) at WDGMC. CONCLUSION: Contemporary outcomes for the pediatric kidney transplant program at WDGMC are comparable to outcomes achieved in middle- and high-income settings. However, outcomes at CMJAH are suboptimal, reflecting numerous health system, infrastructural and human resource challenges.

2.
Pediatr Transplant ; 24(2): e13660, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31985168

RESUMO

Children who undergo liver transplantation and subsequently develop BSI are at risk for adverse outcomes. Research from high-income settings contrasts the dearth of information from transplant centers in low- and middle-income countries, such as South Africa. Therefore, this study from Johannesburg aimed to describe the clinical and demographic profile of children undergoing liver transplantation, and determine the incidence and pattern of BSI and associated risk factors for BSI during the first year after liver transplant. Pediatric liver transplants performed from 2005 to 2014 were reviewed. Descriptive analyses summarized donor, recipient, and post-transplant infection characteristics. Association between BSI and sex, cause of liver failure, age, nutritional status, PELD/MELD score, graft type, biliary complications, and acute rejection was determined by Fisher's exact test; and association with length of stay by Cox proportional hazards regression analysis. Survival estimates were determined by the Kaplan-Meier method. Sixty-five children received one transplant and four had repeat transplants, totaling 69 procedures. Twenty-nine BSI occurred in 19/69 (28%) procedures, mostly due to gram-negative organisms, namely Klebsiella species. Risk for BSI was independently associated with biliary atresia (44% BSI in BA compared to 17% in non-BA transplants; P = .014) and post-operative biliary complications (55% BSI in transplants with biliary complications compared to 15% in those without; P = .0013). One-year recipient and graft survival was 78% (CI 67%-86%) and 77% (CI 65%-85%), respectively. In Johannesburg, incident BSI, mostly from gram-negative bacteria, were associated with biliary atresia and post-operative biliary complications in children undergoing liver transplantation.

3.
Clin Infect Dis ; 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31125061

RESUMO

BACKGROUND: Post-licensure studies have shown an association between rotavirus vaccination and intussusception. We assessed the risk of intussusception associated with Rotarix® (RV1) administration, at six and 14 weeks of age, in an upper-middle income country, South Africa. METHODS: Active prospective surveillance for intussusception was conducted in eight hospitals from September 2013-December 2017. Retrospective case enrolment was done at one hospital from July 2012-August 2013. Demographic characteristics, symptom onset and rotavirus vaccine status were ascertained. Using the self-controlled case-series method, we estimated age-adjusted incidence-rate ratios within 1-7, 8-21, and 1-21 days of rotavirus vaccination in children aged 28-275 days at onset of symptoms. In addition, age-matched controls were enrolled for a subset of cases (n=169), and a secondary analysis performed. RESULTS: There were 346 cases included in the case-series analysis. Post-dose one, there were zero intussusception cases within 1-7 days, and five cases within 8-21 days of vaccination. Post-dose two, 15 cases occurred within 1-7 days, and 18 cases within 8-21 days of vaccination. There was no increased risk of intussusception 1-7 days after dose one (no cases observed) or dose two (relative incidence (RI): 1·71; 95% confidence interval (CI) 0·83-3·01). Similarly, there was no increased risk 8-21 days after the first (RI: 4·01; 95% CI 0·87-10·56) or second dose (RI: 0·96; 95% CI 0·52-1·60). Results were similar for the case-control analysis. CONCLUSIONS: The risk of intussusception in the 21 days after the first or second dose of RV1 was not higher than the background risk among South Africa infants.

4.
J Pediatr Gastroenterol Nutr ; 68(5): 700-705, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30676519

RESUMO

OBJECTIVES: We aimed to investigate national allocation policies for pediatric liver transplantation (LT). METHOD: A survey was prepared by the European Society for Paediatric Gastroenterology Hepatology and Nutrition Hepatology Committee in collaboration with the North American Studies of Pediatric Liver Transplantation consortium. The survey was sent to pediatric hepatologists and transplant surgeons worldwide. National data were obtained from centrally based registries. RESULTS: Replies were obtained from 15 countries from 5 of the world continents. Overall donation rate varied between 9 and 35 per million inhabitants. The number of pediatric LTs was 4 to 9 per million inhabitants younger than 18 years for 13 of the 15 respondents. In children younger than 2 years mortality on the waiting list (WL) varied between 0 and 20%. In the same age group, there were large differences in the ratio of living donor LT to deceased donor LT and in the ratio of split liver segments to whole liver. These differences were associated with possible discrepancies in WL mortality. CONCLUSIONS: Similarities but also differences between countries were detected. The described data may be of importance when trying to reduce WL mortality in the youngest children.

5.
AIDS ; 32(16): F13-F19, 2018 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-30281558

RESUMO

OBJECTIVE: Transplant a liver from an HIV-positive mother to her HIV-negative child to save the child's life. DESIGN: A unique case of living donor liver transplantation from an HIV-positive mother to her HIV-negative child in South Africa. Two aspects of this case are ground-breaking. First, it involves living donation by someone who is HIV-positive and second it involves controlled transplant of an organ from an HIV-positive donor into an HIV-negative recipient, with the potential to prevent infection in the recipient. METHODS: Standard surgical procedure for living donor liver transplantation at our centre was followed. HIV-prophylaxis was administered preoperatively. Extensive, ultrasensitive HIV testing, over and above standard diagnostic assays, was undertaken to investigate recipient serostatus and is ongoing. RESULTS: Both mother and child are well, over 1 year posttransplantation. HIV seroconversion in our recipient was detected with serological testing at day 43 posttransplant. However, a decline in HIV antibody titres approaching undetectable levels is now being observed. No plasma, or cell-associated HIV-1 DNA has been detected in the recipient at any time-point since transplant. CONCLUSION: This case potentially opens up a new living liver donor pool which might have clinical relevance in countries where there is a high burden of HIV and a limited number of deceased donor organs or limited access to transplantation. However, our recipient's HIV status is equivocal at present and additional investigation regarding seroconversion events in this unique profile is ongoing.


Assuntos
Quimioprevenção/métodos , Infecções por HIV/patologia , Infecções por HIV/prevenção & controle , Falência Hepática/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Adulto , DNA Viral/sangue , Feminino , HIV/isolamento & purificação , Anticorpos Anti-HIV/sangue , Humanos , Lactente , RNA Viral/sangue , África do Sul , Resultado do Tratamento , Carga Viral
6.
Pediatr Surg Int ; 34(8): 813-821, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29679134

RESUMO

Congenital aphallia is a rare anomaly with little supporting literature and controversial management. The aim of this review is to assess the most recent literature with a focus on staged management of these cases. We performed a PubMed search of all English literature in the past 10 years using the term aphallia. Twenty-three articles were identified of which six were excluded. A further three papers meeting our criteria were found in the references to papers initially identified. We found that management can be staged in three phases: short, intermediate and long-term. We conclude that optimal short-term management centers on resuscitation and urinary diversion as necessary, intermediate-term management entails urethrorectal fistula division, urethrostomy and neophallus creation and long-term management results in successful neophalloplasty, urethroplasty, prosthetic implant and continued protection of the upper urinary tracts with a Mitrofanoff. All this within a multidisciplinary team ensuring shared decision-making with the patient and their family.


Assuntos
Doenças do Pênis , Pênis/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Doenças do Pênis/congênito , Doenças do Pênis/diagnóstico , Doenças do Pênis/cirurgia , Pênis/cirurgia
7.
J Surg Res ; 209: 112-121, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28032547

RESUMO

BACKGROUND: Intestinal obstruction in newborns is associated with intestinal motility disorders after surgery. Alterations in the enteric nervous system (ENS) might cause abnormal peristalsis, which may then result in intestinal motility disorders. We aimed to quantify alterations in the myenteric plexus after a ligation and to test if these alterations were reversible. METHODS: Small intestines of chicken embryos were ligated in ovo at embryonic day (ED) 11 for either 4 d (ED 11-15) or 8 d (ED 11-19). Both treated groups and control group were sacrificed and intestinal segments examined by means of both light and electron microscopy. RESULTS: The number of proximal myenteric ganglia increased (ED 19, 30.7 ± 3.16 versus 23.1 ± 2.03; P < 0.001) in the 8-d ligature group but had values similar to the control group in the 4-d ligature group. The size distribution was skewed toward small ganglia in the 8-d ligature group (ED 19, 83.71 ± 11.60% versus 3.88 ± 4.74% in the control group; P < 0.001) but comparable with the control group in the 4-d ligature group. Subcellular alterations in the 4-d ligature group were reversible. CONCLUSIONS: The pathologic alterations in the ENS were fully reversible in the 4-d ligature group. This reversibility might be linked to the degree of immaturity of the ENS.


Assuntos
Sistema Nervoso Entérico/embriologia , Regeneração Nervosa , Animais , Embrião de Galinha , Sistema Nervoso Entérico/ultraestrutura
8.
Case Rep Pediatr ; 2017: 7940365, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29410927

RESUMO

Hepatic hemangiomas are considered to be the most common benign tumors of the liver. They are often found incidentally while investigating for other causes of liver disease. Hemangiomas that are less than 10 cm are not expected to cause any problems. Typically, they do not enlarge and, apart from regular follow-up, no definitive treatment is indicated. This is a posthumous case report of a male child with a medium-sized hemangioma from infancy, complicated by cryptogenic cirrhosis and hepatopulmonary syndrome. It demonstrates the challenges of managing a child with such complicated conditions in a resource-limited setting.

9.
S Afr Med J ; 106(2): 169-71, 2016 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-26821896

RESUMO

BACKGROUND: The Health Professions Council of South Africa requires that a research project be submitted and passed before registration as a specialist. OBJECTIVE: To describe surgical registrars' perceptions of the compulsory research project. METHOD: Ethics clearance was received before commencing the study. A questionnaire was developed to collect feedback from surgical registrars throughout South Africa (SA). Completed questionnaires underwent descriptive analysis using MS Excel. Fisher's exact test and the χ2 test were used to compare perceptions of the research-experienced and research-naive groups. RESULTS: All medical schools in SA were sampled, and 51.5% (124/241) of surgical registrars completed the questionnaire. Challenges facing registrars included insufficient time (109/124), inadequate training in the research process (40/124), inadequate supervision (31/124), inadequate financial resources (25/124) and lack of research continuity (11/124). Of the registrars sampled, 67.7% (84/124) believed research to be a valuable component of training. An overwhelming percentage (93.5%, 116/124) proposed a dedicated research block of time as a potential solution to overcoming the challenges encountered. Further proposals included attending a course in research methodology (79/124), supervision by a faculty member with an MMed or higher postgraduate degree (73/124), and greater research exposure as an undergraduate (56/124). No statistically significant differences were found between the perceptions of the research-experienced and research-naive groups. CONCLUSION: Challenges facing surgical registrars in their efforts to complete their research projects were identified and solutions to these problems proposed. It is heartening that respondents have suggested solutions to the problems they encounter, and view research as an important component of their careers.

10.
S Afr Med J ; 106(2): 172-6, 2016 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-26821897

RESUMO

BACKGROUND: It is important for centres participating in transplantation in South Africa (SA) to audit their outcomes. Wits Donald Gordon Medical Centre (WDGMC), Johannesburg, SA, opened a transplant unit in 2004. The first 10 years of kidney and pancreas transplantation were reviewed to determine outcomes in respect of recipient and graft survival. METHODS: A retrospective review was conducted of all kidney-alone and simultaneous kidney-pancreas (SKP) transplants performed at WDGMC from 1 January 2004 to 31 December 2013, with follow-up to 31 December 2014 to ensure at least 1 year of survival data. Information was accessed using the transplant registers and clinical records in the transplant clinic at WDGMC. The Kaplan-Meier method was used to estimate 1-, 5- and 10-year recipient and graft survival rates for primary (first graft) kidney-alone and SKP transplants. RESULTS: The overall 10-year recipient and graft survival rates were 80.4% and 66.8%, respectively, for kidney-alone transplantation. In the kidney-alone group, children tended towards better recipient and graft survival compared with adults, but this was not statistically significant. In adults, recipient survival was significantly better for living than deceased donor type. Recipient and graft survival were significantly lower in black Africans than in the white (largest proportion in the sample) reference group. For SKP transplants, the 10-year recipient survival rate was 84.7%, while kidney and pancreas graft survival rates were 73.1% and 43.2%, respectively. CONCLUSION: Outcomes of the first 10 years of kidney and pancreas transplantation at WDGMC compare favourably with local and international survival data.

11.
S Afr Med J ; 106(2): 189-92, 2016 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-26821901

RESUMO

BACKGROUND: Childhood mortality is high in low- and middle-income countries. Burns are one of the five leading causes of childhood injury mortality in South Africa (SA). While there is an abundance of literature on burns in the developed world, there are far fewer publications dealing with childhood mortality related to burns in Africa and SA. OBJECTIVE: To describe the mortality of children admitted to a dedicated paediatric burns unit, and investigate factors contributing to reducing mortality. METHODS: A retrospective review was performed of patients admitted to the Johnson and Johnson Paediatric Burns Unit, Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, between May 2009 and April 2012. RESULTS: During the study period, 1 372 patients aged ≤10 years were admitted to the unit. There were 1 089 admissions to the general ward and 283 admissions to the paediatric burns intensive care unit (PBICU). The overall mortality rate was 7.9% and the rate for children admitted to the PBICU 29.3%; 90.8% of deaths occurred in children aged ≤5 years. Of children admitted with an inhalational injury, 89.5% died. No child with a burn injury >60% of total body surface area (TBSA) survived. CONCLUSIONS: Our overall mortality rate was 7.9%, and the rate declined significantly over the 3-year study period from 11.7% to 5.1%. Age ≤5 years, the presence of inhalational injury, burn injury >30% of TBSA and admission to the PBICU were significant risk factors for mortality.

12.
Afr J Paediatr Surg ; 12(1): 12-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25659543

RESUMO

BACKGROUND: Ligation of the embryonic gut is an established technique to induce intestinal obstruction and subsequently intestinal atresia in chicken embryos. In this study, we modified this established chicken model of prenatal intestinal obstruction to describe (1) the kinetics of morphological changes, (2) to test if removal of the ligature in ovo is possible in later embryonic development and (3) to describe morphological adaptations following removal of the ligature. MATERIALS AND METHODS: On embryonic day (ED) 11, small intestines of chick embryos were ligated micro surgically in ovo. In Group 1 (n = 80) gut was harvested proximal and distal to the ligation on ED 12-19. In Group 2 (n = 20) the induced obstruction was released on day 15 and gut was harvested on ED 16-19. Acetyl choline esterase staining was used as to assess resulting morphological changes. RESULTS: A marked intestinal dilatation of the proximal segment can be seen 4 days after the operation (ED 15). The dilatation increased in severity until ED 19 and intestinal atresia could be observed after ED 16. In the dilated proximal segments, signs of disturbed enteric nervous system morphology were obvious. In contrast to this, release of the obstruction on ED 15 in Group 2 resulted in almost normal gut morphology at ED 19. CONCLUSION: Our model not only allows the description of morphological changes caused by an induced obstruction on ED 11 but also-more important - of morphological signs of adaptation following the release of the obstruction on ED 15.


Assuntos
Obstrução Intestinal/embriologia , Intestino Delgado/embriologia , Animais , Embrião de Galinha , Modelos Animais de Doenças , Motilidade Gastrointestinal/fisiologia , Obstrução Intestinal/fisiopatologia , Intestino Delgado/fisiopatologia
13.
Afr J Paediatr Surg ; 12(1): 91-3, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25659562

RESUMO

A three-year-old child developed a large tracheo-oesophageal fistula secondary to a button battery being lodged in the upper oesophagus for 36 hours. The diagnosis was confirmed with a contrast swallow. Operative access was gained through a combined right cervical incision and complete median sternotomy. Repair of the fistula required a segmental resection of both the trachea and oesophagus followed by primary anastomosis.


Assuntos
Queimaduras por Corrente Elétrica/complicações , Deglutição , Esofagoplastia/métodos , Esôfago/lesões , Corpos Estranhos/complicações , Traqueia/lesões , Fístula Traqueoesofágica/cirurgia , Queimaduras por Corrente Elétrica/diagnóstico , Queimaduras por Corrente Elétrica/cirurgia , Pré-Escolar , Remoção de Dispositivo/métodos , Esofagoscopia , Esôfago/cirurgia , Feminino , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Radiografia Torácica , Traqueia/cirurgia , Fístula Traqueoesofágica/diagnóstico , Fístula Traqueoesofágica/etiologia
14.
Eur J Pediatr Surg ; 25(2): 220-5, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24515733

RESUMO

BACKGROUND: Anorectal malformations (ARMs) are a major congenital anomaly in neonates. There is significant geographical variation in the birth prevalence varying from 1:1,500 to 1:5,000 live births. There is no published literature on the birth prevalence of ARM occurring within the referral area for The University of Witwatersrand tertiary hospitals in South Africa. METHODS: Retrospective data were collected from the Pediatric Surgical Department, University of the Witwatersrand. Patient records for a 6-year period from January 2005 to December 2010 were obtained from Chris Hani Baragwanath Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital. The number of live births per year for a specific municipal district was obtained from the National Department of Health. The χ(2) test for trend test was used to determine statistically significance. RESULTS: The birth prevalence for ARM in 2010 was shown to be 1:3,989 live births (2.5/10,000 live births) for the University of Witwatersrand tertiary hospital referral area. A statistically significant overall increase in the birth prevalence of ARM from January 2005 till December 2010 was demonstrated (p < 0.0001). The municipal districts of Johannesburg (p = 0.0015) and Ekurhuleni (p = 0.0066) revealed the greatest increase in birth prevalence. CONCLUSION: This study has provided current statistics on the birth prevalence of ARM in the University of Witwatersrand tertiary hospital referral area, as well as demonstrating a positive incremental trend in the occurrence of this condition over a 6-year period. Future studies will examine the birth prevalence in several other provinces of South Africa. Results from the collective data will then be used to form conclusions regarding any regional or national changes in the birth prevalence of ARM as well as to identify any epidemiological trends.


Assuntos
Anus Imperfurado/epidemiologia , Malformações Anorretais , Humanos , Recém-Nascido , Prevalência , Estudos Retrospectivos , África do Sul/epidemiologia , Centros de Atenção Terciária
15.
Pediatr Infect Dis J ; 33 Suppl 1: S104-6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24343606

RESUMO

This case report describes diagnosis and management of intussusception in an 8-month-old baby girl seen at the Ventersdorp District Hospital, South Africa. According to the vaccination card, the child had been immunized with rotavirus vaccine with the last dose given 6 months and 2 weeks before presentation to Ventersdorp Hospital. This case of intussusception was unlikely associated with rotavirus vaccination.


Assuntos
Intussuscepção/diagnóstico , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/efeitos adversos , Feminino , Humanos , Lactente , Intussuscepção/etiologia , Intussuscepção/cirurgia , Vacinas contra Rotavirus/administração & dosagem , África do Sul
16.
S Afr Med J ; 104(11): 7310, 2014 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-29183444

RESUMO

Paediatric hepatobiliary treatment, including hepatology, paediatric surgery and transplantation, is classified as quaternary and tertiary care and is difficult to access in South Africa. A dedicated part 2 of the SAMJ presents the South African experience together with articles by international experts in the field.

17.
S Afr Med J ; 104(11): 799-802, 2014 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-29183445

RESUMO

BACKGROUND: A paediatric liver transplant programme was started at the Wits Donald Gordon Medical Centre, Johannesburg, South Africa (SA), in November 2005. We reported on the first 29 patients in 2012. Since then we have performed a further 30 transplants in 28 patients, having met the major challenge of donor shortage by introducing a living related donor programme and increasing the use of split liver grafts. OBJECTIVE: To review the Wits Donald Gordon Medical Centre paediatric liver transplant programme to date. We describe how the programme has evolved and specifically compare the outcomes of the first cohort with the most recent 28 patients. METHODS: Case notes of all paediatric liver transplants performed between 14 November 2005 and 30 June 2014 were retrospectively reviewed. Data were analysed for age and weight at transplantation, indication and type of graft. Morbidity and mortality were documented, specifically biliary and vascular complications. Comparison was made between Era 1 (November 2005 - October 2012) and Era 2 (November 2012 - June 2014). RESULTS: A total of 59 transplants were performed in 57 patients. Age at transplantation ranged from 9 months to 213 months (mean 82.39 months) and weight ranged from 5 kg to 62 kg (mean 21 kg). A total of 23 whole livers, 10 reduced-size grafts, 14 split liver grafts and 12 living donor liver transplants (LDLTs) were performed. Eight patients were referred with fulminant hepatic failure (FHF), all in Era 2. Of these, three patients were successfully transplanted. Of the 57 patients, 45 are alive and well with actuarial 1-year patient and graft survival of 85% and 84%  and 5-year patient and graft survival of 78% and 74%, respectively. Sixteen (25.42%) biliary complications occurred in 15 of our 59 transplants. Seven patients developed significant vascular complications. Comparing Era 1 with Era 2, mean age at transplant decreased from 100.86 months to 64.73 months, mean weight from 25.2 kg to 16.9 kg, and type of graft utilised changed with a trend away from the use of whole livers and reduced-sized grafts to split livers and segment 2,3 LDLT grafts. CONCLUSION: Initially limited by a shortage of donor organs, we aggressively explored optimal utilisation, splitting liver grafts from deceased donors as often as possible and establishing an LDLT programme. This increased access to donor livers allowed us to include patients with FHF and to perform retransplantation in recipients with early graft failure. It remains to offer liver transplantation to the entire paediatric community in SA, in conjunction with the only other established paediatric liver transplant unit, at Red Cross War Memorial Children's Hospital in Cape Town.

18.
S Afr Med J ; 104(11): 803-807, 2014 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-29183446

RESUMO

BACKGROUND: It is generally accepted that paediatric solid organ injury should be treated conservatively, unless there is haemodynamic instability unresponsive to resuscitation. When it comes to pancreatic trauma, there is much debate about appropriate management. OBJECTIVES: To review the literature and determine how pancreatic trauma is managed in South African (SA) tertiary institutions and compares with international standards. METHOD: A survey was emailed to 45 paediatric surgical consultants working in various paediatric surgical units in SA, Italy, England and Australia. The questionnaire comprised two scenarios of isolated pancreatic trauma (grade III), the main difference between them being the time interval between initial injury and presentation. In the first scenario, the patient presented 6 hours post injury whereas in the second scenario, the patient presented 6 days post initial injury. The survey enquired about diagnosis and subsequent work-up (including preferred imaging techniques), supportive management (including nutrition), the various options of definitive intervention and follow-up procedure. RESULTS: There were 21 responders from four different countries. In the first scenario, 10 surgeons would operate, 8 would treat conservatively and 3 would perform an endoscopic retrograde cholangiopancreatogram (ERCP) and stent. In the second scenario, 4 surgeons would operation, 13 would treat conservatively and 4 would undertake ERCP with stent. There was no difference in management between the SA surgeons and their international counterparts. CONCLUSION: Management of blunt pancreatic trauma in SA is consistent with that reported in the literature. There is still controversy regarding the optimal management of pancreatic injury involving ducts. No absolute algorithm can be used to treat these patients. All patients should be treated individually and managed with an approach and techniques that are feasible.

19.
S Afr Med J ; 104(11): 829-832, 2014 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-29183452

RESUMO

Paediatric liver transplantation (PLT) is the only therapeutic option for many children with end-stage chronic liver disease or irreversible fulminant hepatic failure and is routinely considered as a therapy by paediatric gastroenterologists and surgeons working in developed countries. In South Africa (SA), a PLT programme is available at Red Cross War Memorial Children's Hospital in Cape Town since November 1991, and another has rapidly developed at the Wits Donald Gordon Medical Centre in Johannesburg over the past decade. However, for most children with progressive chronic liver disease who are reliant on the services provided at public health facilities in SA, PLT is not an option because of a lack of resources in a mismanaged public health system. This article briefly outlines the services offered at Chris Hani Baragwanath Academic Hospital - which is typical of public health facilities in SA - and proposes that resources be allocated to establish an innovative, nationally funded centre that would enable greater numbers of children access to a PLT programme.

20.
S Afr Med J ; 103(12): 925-9, 2013 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-24300631

RESUMO

BACKGROUND: Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject. METHODS: Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted. RESULTS: Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months. CONCLUSIONS: Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient.


Assuntos
Doença Hepática Terminal , Falência Renal Crônica , Transplante de Rim , Transplante de Fígado , Complicações Pós-Operatórias/mortalidade , Adolescente , Adulto , Criança , Pré-Escolar , Fator H do Complemento/deficiência , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Hiperoxalúria Primária/complicações , Nefropatias/complicações , Falência Renal Crônica/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Transplante de Rim/estatística & dados numéricos , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Transplante de Fígado/estatística & dados numéricos , Masculino , Rim Policístico Autossômico Recessivo/complicações , Complicações Pós-Operatórias/etiologia , África do Sul , Taxa de Sobrevida , Resultado do Tratamento
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