Cavitron assisted liver resection in a child.
Resection of a liver tumor using the cavitron ultrasound dissector is described. The technique is safe and minimizes blood loss.
Adenoma, Bile Duct↗
Biomedical subjects
S R Thomson
Publications and source records attributed to S R Thomson.
Significant hyperamylasaemia in conditions other than acute pancreatitis.
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Acute Disease↗
Health care provision and surgical education in South Africa.
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)
Delivery of Health Care↗
Attenuated gastric mucosal blood flow predicts non-healing of benign gastric ulcers.
BACKGROUND: A subset of benign gastric ulcers do not respond to therapy and may require surgery. A predictor of non-healing may allow modification of therapy. Gastric mucosal blood flow plays an important role in gastric ulcer pathogenesis and healing. AIMS: Mucosal blood flow was measured with Laser Doppler flowmetry at initiation of and during therapy to assess the variability of mucosal blood flow in healing and non-healing ulcers as a possible predictor of healing. METHODS AND SUBJECTS: Mucosal blood flow was measured at the mid-antrum in 105 normal human stomachs and on the circumference of 26 benign gastric ulcers. The gastric ulcers were followed up with repeat endoscopy and repeat measurements were made. RESULTS: The ulcers that healed had significantly higher mucosal blood flow than normal stomachs at both initial and follow-up measurement (59.8 +/- 26.1 vs. 75.7 +/- 17.5 and 69.8 +/- 13.7). The refractory ulcers persistently had significantly lower mucosal blood flow than normal stomachs and healing ulcers (59.8 +/- 26.1 vs. 45.2 +/- 21.9 and 39.2 +/- 6.7). CONCLUSIONS: Gastric mucosal blood flow seems to increase in response to mucosal injury and healing. Attenuation of this response is associated with delayed healing. Attenuated peri-ulcer mucosal blood flow may predict non-healing of a benign gastric ulcer.
Adult↗
Resting metabolic rate of esophageal carcinoma patients: a model for energy expenditure measurement in a homogenous cancer population.
In cancer patients controversy exists as to the nature of changes in resting metabolic rate (RMR) and their contribution to cachexia. This study describes the fasting indirect calorimetry, and nutritional measurements made on a homogeneous group of Black patients with carcinoma of the esophagus. It compares them with a reference group. All cancer patients had localized disease and were markedly malnourished. They were on average 20 to 25% lighter than reference subjects. In the cancer patients, the triceps skinfold thickness (TSF) in mm and the hand grip strength in kg/m2, mean and SD, were, respectively, 7.3 +/- 2.8 and 28 +/- 6 for men and 12 +/- 5 and 22 +/- 3.5 for women, and were significantly lower than those of the reference subjects. Fat-free mass was calculated from the TSF measurements. In men with cancer RMR (6.06 MJ/day +/- 0.56) was significantly lower than the reference subjects values (7.07 MJ/day +/- 0.64) p = 0.002. In women with cancer RMR was on average 2 MJ/day less than in controls but this difference failed to reach significance. However, when expressed per kg fat free mass, or per kg body weight this difference is no longer apparent the RMR being 0.14 MJ/kg/fat free mass in both groups. Our interpretation is that there is no direct effect of the tumour on RMR and that energy expenditure changes are secondary to body composition changes.
Black or African American↗