Browsing by Author "Apffelstaedt, J. P."

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    Assessment of the delayed repair of uncomplicated inguinal hernias in infants
    (Medpharm, 2020-03) Botes, S. N.; Edge, J.; Apffelstaedt, J. P.; Sidler, D.
    BACKGROUND: Potential strangulation of infant inguinal hernias is the main indication for their urgent repair. Lack of theatre time delays repair and prolongs hospitalisation. We report a series of patients with uncomplicated hernias who were discharged home to have their elective surgery at a later stage and assessed the outcomes of this approach METHODS: A retrospective audit was performed of all infants with an inguinal hernia from January 2010 to June 2015. Incomplete records and infants operated after their first birthday were excluded. Two groups were identified; immediate surgery for infants with uncomplicated hernias, and delayed surgery for infants with uncomplicated hernias. Incarceration/ strangulation rates in the interim period were documented for the delayed group, and comparison made between the groups regarding perioperative and anaesthetic complications and length of postoperative hospital stay RESULTS: The mean time delay between diagnosis and repair was 8.78 weeks. None of the hernias in the delay group strangulated while awaiting repair. There was no significant difference in the perioperative complications between the two groups. Out ofthe 70 cases in the immediate repair group, there was 7 (10%) surgical and 4 (5.7%) anaesthetic complications. The delayed group (169 infants) had 8 (4.7%) surgical and 6 (3.6%) anaesthetic complications. The incarceration rate after being discharged home was 4.1%. This group of infants had no anaesthetic or surgical complications. Length of hospital stay postoperatively was 1.43 days in the immediate group and 1.3 in the delayed group (p = .485 CONCLUSION: Delayed repair, up to 2 months later, for uncomplicated infant hernia carries a small risk of incarceration but does not increase the rate of strangulation or other complications
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    Performance data of screening mammography at a dedicated breast health centre
    (Health and Medical Publishing Group (HMPG), 2008) Apffelstaedt, J. P.; Steenkamp, V.; Baatjes, K.
    Background. Mammographic screening has become part of routine health care. We present a first analysis of screening mammography in a dedicated breast health centre in Africa. Objective. To establish a performance benchmark and provide data for health care policy and funding decisions on screening mammography. Method. All mammography performed between January 2003 and August 2008 was entered into a prospective database. Mammography was performed exclusively by certified mammographers and double-read by experienced readers. Results. Outcomes were classified in a simplified classification system based on the Breast Imaging Reporting and Data System (BIRADS). In 40-49-year-old women, 3 192 mammograms led to a recall rate of 4.7%, a biopsy rate of 1.9% and a cancer diagnosis rate of 3.8 per 1000 examinations, for women of 50 years and older, the corresponding figures were 4 446, 5.4%, 2.6% and 9.7 per 1 000. Of the cancers detected, 31% were in situ and, of the invasive cancers, 81% were node-negative. These figures were established by a dedicated surgeon-led team and fall within the range expected in organised screening programmes in resource-rich environments, providing a first benchmark for screening mammography in Africa.
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    Young breast cancer patients in the developing world : incidence, choice of surgical treatment and genetic factors
    (Medpharm Publications, 2007-10) Kruger, W. M.; Apffelstaedt, J. P.
    Carcinoma of the breast is the most common cause of cancer in women in Western society. Although breast cancer occurs predominantly in older premenopausal and postmenopausal women, it also occurs in young women. Literature defines breast cancer in a young woman (or early onset breast cancer) as occurring in a woman less than 35 years of age. A diagnosis of breast cancer in a young woman impacts severely on all aspects of her life, as well as on those around her. In Africa and other developing countries, the breast cancer burden is increasing and poor reporting and data availability may underestimate the exact numbers. The average age of diagnosis may be younger for women in developing countries than for women in developed countries. African patients are more likely to be premenopausal at diagnosis and the breast cancers tend to be more advanced at presentation than in other population groups in a country such as South Africa. The choice of surgical treatment in early onset cancer depends on various factors. Young age is an independent risk factor for worse outcome regardless of whether a patient had a mastectomy or breast conserving therapy. Breast conserving treatment is an option for treatment of breast cancer in a young patient given the correct indications and that the patient is fully informed about the high risk of local recurrence. The extent of genetic factors such as mutations on BRCA 1 and 2 (BReast CAncer 1 and 2) genes is still largely unknown on the continent of Africa, and much research still needs to be done. In the USA, only 5-10% of early onset breast cancers are attributable to mutations on BRCA 1 and 2 genes, and another 15-20% of early onset breast cancers are due to gene polimorphisms and environmental factors. General breast awareness among women of all age groups in Africa should be promoted. This includes how to perform self breast examinations and to seek urgent medical attention when a breast lump is discovered. In time, given the resources, good screening programmes on this continent to detect breast cancer at its earliest presentation would be the ideal.