Biomedical subjects
Publications and source records attributed to L W Baker.
Twenty-two cases of arteriovenous fistulae are reviewed retrospectively, with particular emphasis on their clinical presentation, physical signs, investigations and management. This review allows us to make certain conclusions for the future diagnosis and management of this condition.
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Apartheid policies have led to inequalities in the delivery of health care and the training of surgeons in South Africa. The nation's population of 33 million is comprised of 73.6% Blacks, 14.8% Whites, 8.8% Coloureds, and 2.7% Asians. Only 17% of the population are covered by medical insurance (78% of Whites, 28% of Asians, 26% of Coloureds, 4% of Blacks) that funds the private sector which accounts for 46% of the nation's total health care expenditure of 9.2156 million rand. The remainder receive care from curative state hospital based services, which consume 77% of the public expenditure on health. Preventive and promotive health services account for 23%. Only 3.2% of South Africa's gross national product is spent on health care provision for 80% of the population--well short of the World Health Organization's recommendation of 5.8%. This figure translates into a per capita expenditure of 138, 340, 356, and 597 rands for Blacks, Coloureds, Asians, and Whites, respectively. Eight medical schools produce just over 900 graduates per year, 80% of whom are white. The medium of instruction is English at five (Cape Town, Witwatersrand, Natal, MEDUNSA, and Transkei) and Afrikaans at three (Pretoria, Stellenbosch, and Bloemfontein). Natal and MEDUNSA are creations of apartheid and have graduated almost all the Black South African doctors, of whom only 15 are practicing surgeons. Many universities are cognizant that dramatic change is needed to redress such imbalances, and admission policies are changing.(ABSTRACT TRUNCATED AT 250 WORDS)
The etiology of colonic strictures in 263 South African black and Indian patients is presented. Nonmalignant lesions accounted for strictures in two-thirds of the patients and included amebiasis (27), tuberculosis (24), nonspecific colitis (30), ulcerative colitis/Crohn's colitis (11) and other lesions (36). Malignant lesions caused strictures in approximately a third of the black and Indian patients, which is higher than in other reported series in blacks. Accurate clinical diagnosis is difficult and early histologic confirmation is mandatory in order to institute rational management. Strictures of the right colon in the black population are more likely to be benign, except in younger patients. Left-sided colonic strictures have an equal chance of being benign or malignant, and early histologic confirmation is essential. The coexistence of an underlying malignant lesion in association with an inflammatory lesion in an endemic area should always be considered, particularly if it fails to respond to empirical therapy within a short period of time.
In a five year review of 648 patients with chronic pancreatitis, 446 (68.8%) were documented with regional complications consisting of biliary, duodenal or colonic obstruction, pseudocysts, haemorrhage, pancreatic ascites and gastric varices. Although the majority could be treated conservatively, surgical intervention was needed in 129 patients (28.9%). The commonest operations were choledocho-duodenostomy for distal bile duct obstruction, gastro-enterostomy for duodenal obstruction, local resection for colon obstruction, cyst-gastrostomy for pseudocysts, duct-enteric anastomosis for pancreatic ascites and splenectomy for gastric varices. Operative mortality was 8.5% and morbidity 27.9%. During 1-5 year follow-up, re-admission for pancreatitis was needed in 24%. No secondary biliary cirrhosis was encountered in long standing bile duct obstruction, but fibrosis was present in 73% of liver biopsies. Cholangitis occurred in 14%. Angiographic embolisation was useful in the control of massive bleeding from peri-pancreatic visceral arteries. Although relief of pain in chronic pancreatitis has generally been disappointing, regional complications, occurring in the majority of patients, can be corrected satisfactorily by surgical intervention.