Browsing by Author "Butt, J. L."

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    Bone involvement in patients with cervical carcinoma : a single-institution cohort study
    (Taylor & Francis, 2019-12-13) Butt, J. L.; Botha, M. H.
    Introduction: Bony metastases in cervical carcinoma are rare; however, autopsy studies indicate that they are underdiagnosed. A retrospective study was undertaken to describe the risk factors and tumour characteristics and estimate the prevalence of bone involvement in women with cervical cancer at a tertiary institution in South Africa. Methods: A retrospective cohort analysis of women with cervical cancer diagnosed between 2014 and 2015 was undertaken. Demographic, treatment and follow-up data were collected for all women with bone metastases confirmed by imaging. Descriptive statistics were generated. Results: The study identified 642 patients with cervical carcinoma, of whom 25 (3.89%) were diagnosed with bone involvement. Ten women had bone involvement at diagnosis and 15 women at recurrence, occurring a median of 286 days after primary treatment. Survival after the diagnosis of bone metastases was short, with 88% of patients dying within six months. The WHO performance status score at diagnosis was a significant predictor of survival (p = 0.024). A prognostic score was utilised and those with a high score had a significantly shorter survival (median 61 days) than those with a low score (median 158 days) (p = 0.0065). Conclusions: Although bone metastases are rare in women with cervical cancer, they are important to recognise. Healthcare workers should be vigilant regarding increased analgesic use and chronic pain, as these may indicate bone involvement. As survival is short, a prognostic score is valuable in tailoring treatment. A patient’s quality of life may be greatly improved by an appropriate radiotherapy and palliative care plan.
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    Retrospective review of the medical management of ectopic pregnancies with methotrexate at a South African tertiary hospital
    (Health and Medical Publishing Group, 2014) De Waard, L.; Butt, J. L.; Muller, C. J. B.; Cluver, C. A.
    Background. An ectopic pregnancy can be a life-threatening condition. Early diagnosis with ultrasonography and quantitative betahuman chorionic gonadotrophin (β-hCG) measurement has improved early and accurate diagnosis and treatment. Medical management with methotrexate internationally has a success rate of up to 93%, but there is a paucity of data on this treatment option in developing countries. Objective. To determine the success of methotrexate treatment for ectopic pregnancies at a referral hospital in a developing country. This non-surgical, outpatient treatment seems a good option in hospitals with an ever-rising pressure on bed occupation and long waiting lists for emergency surgery. Methods. A 5-year retrospective audit was performed on 124 patients treated for ectopic pregnancies with methotrexate at Tygerberg Hospital, Cape Town, South Africa. Results. With success defined as a β-hCG level of <15 IU/L without requiring surgical intervention, the success rate was 44%. Fifteen per cent of medically managed patients required surgery. The remaining 41% were lost to follow-up. One patient had a major adverse outcome with a ruptured ectopic and required 2 units of blood, resuscitation and emergency laparotomy. Conclusion. Medical management of ectopic pregnancies is a safe and effective management option, as proven by international data, but at Tygerberg Hospital the safety of this treatment modality cannot be guaranteed because of poor follow-up. Improvement in patient selection with consideration of predictors of success and thorough counselling, as well as full informed consent, is recommended before using this treatment modality. A new follow-up system should be developed at Tygerberg Hospital to guarantee patient safety.
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    Vulvar cancer is not a disease of the elderly : treatment and outcome at a tertiary referral centre in South Africa
    (Health & Medical Publishing Group, 2017) Butt, J. L.; Botha, M. H.
    Background. An increase in vulvar cancer in young women is attributed to infection with oncogenic human papillomavirus (HPV). South Africa (SA) has a high prevalence of HPV, and it was therefore hypothesised that women with vulvar cancer here would be younger than in high-income countries (HICs). Objective. To describe age, cancer stage, treatment and outcome of patients with vulvar cancer at a tertiary referral centre in SA. Methods. In a retrospective observational study, patient records of women diagnosed with vulvar cancer between 2001 and 2014 were reviewed and demographic and surgical details captured. Histology results of vulvar biopsies and resected specimens were checked for HPV changes, koilocytes and usual-type vulval intraepithelial neoplasia. Patients were restaged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 staging system to allow for comparison of outcomes. Five-year disease-specific survival probability curves were generated using Kaplan-Meier analysis. Results. The mean age of the 180 patients in the study was 52.5 years. Those who had documented HPV changes on histological specimens had a mean age of 50.4 years. More than 50% of the patients had advanced-stage disease, and 62.7% were treated with primary surgery. Five-year disease-specific survival probabilities were similar to those reported in the literature. Conclusions. Vulvar cancer should not be regarded as a disease of the elderly in SA, as women with vulvar cancer are 10 - 15 years younger than in HICs. A large proportion of patients present with advanced-stage disease. Health professionals should be alert to vulvar lesions, especially in women with abnormal Pap smears, to reduce the morbidity and mortality of this disease.