Academic literature on the topic 'Charlotte Maxeke Johannesburg Academic Hospital - Radiotherapy'

Purpose: To retrospectively analyze the radiation doses delivered to patients undergoing fluoroscopy examinations in terms of the skin dose and the dose-area product (DAP). Materials and Methods: The subjects of this study were patients who underwent fluoroscopy examinations at Charlotte Maxeke Johannesburg Academic Hospital, South Africa during the period August 2007 to March 2008. The skin dose and dose-area product values were obtained from a built-in DAP-meter installed on a digital Philips Medical Systems MultiDiagnost Eleva fluoroscopy unit. The following cases were analyzed namely barium swallow, barium meal, barium enema, hexabrix swallow, gastrografin meal, voiding cystourethrogram, fistulogram, myelogram, nephrostomy and loopogram. Results: An analysis of three hundred and thirty one examinations is presented. From the recorded data the following quantities were deduced: the mean- and range of the skin doses and DAPs, mean screening time and mean fluoroscopy duration. An analysis of the screening time for the various examinations showed a weak correlation (r = 0.59) between skin dose and screening time, while a poor correlation (r = 0.42) was deduced between DAP reading and screening time. Conclusion: There is a wide spread in the radiation doses registered for any one given type of examination. The large variability in the radiation dose delivered proves that fluoroscopic examinations stand to gain from dose optimization. The usefulness and potential use of DAP meters with regards to dose optimization in radiology is shown. In line with efforts to optimize dose from diagnostic radiography examinations the authors recommend the establishment of diagnostic reference levels (DRLs) in South Africa for the most frequent examinations in general radiography, fluoroscopy, mammography and computed tomography. Keywords: patient dose, genetic risk, dose optimization, dose reference levels

AbstractBackgroundThe accurate and precise measurement of triglycerides is important due to the adverse effects associated with hypertriglyceridaemia. Most laboratory methods are based on enzymatic hydrolysis of triglycerides with measurement of the total glycerol. An elevated free glycerol concentration may result in overestimation of triglyceride concentrations. The removal of free glycerol by blanking may therefore be of clinical importance. The aim of this study was to compare the glycerol blanking and non-glycerol blanking triglyceride methods.MethodsThis was a method comparison study of 1518 samples from both in-patients and out-patients at Charlotte Maxeke Johannesburg Academic Hospital. Triglycerides were measured in each sample using both the blanking and the non-blanking methods. Analytical performance was assessed based on the National Cholesterol Education Program (NCEP) goals. Clinical impact was assessed according to the NCEP Adult Treatment Program III (ATP III) risk classification.ResultsThe method median was significantly higher in the non-blanking compared to the blanking method (1.33 vs. 1.12 mmol/L, p < 0.0001) in all patients. The average bias was above the total allowable error of 15% across all groups. There was a significant change in NCEP ATP III risk classification, with fewer patients classified as normal (67.6% vs. 74.6%, p < 0.0001) with the non-blanking method compared to the blanking method.ConclusionsThere was a significant error when glycerol blanking for triglyceride determination was not performed. The non-blanking triglyceride method overestimates triglyceride concentrations. This does not only exceed analytical performance goals, but also impacts on patient categorisation and clinical decision making in all patients.

Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: This thesis investigates the complexities involved in Health Information Systems. The focus is on the factors of a) efficiency and b) usability. A case study is made of a recently implemented system in Charlotte Maxeke Johannesburg Academic hospital. The first objective of the research was to gain a deeper understanding of the complexities of Health Information Systems, and secondly to evaluate the situation at Charlotte Maxeke Johannesburg Academic Hospital. In Chapter 1 a detailed introduction of the thesis is offered. This includes, explaining what triggered the research, the objective of the research and the methodology used to conduct the research. In Chapter 2 the focus is on a literature review of Health Information Systems, system fundamentals and planning and implementation. It is clear that without a methodology, systems development becomes haphazard and subsequently a risky and expensive undertaking. While change is pervasive, introducing operational efficiencies sometimes may necessitate reviewing of information systems and business strategy, knowledge management and process orientation. In Chapter 3 the issue of usability is investigated. Several healthcare institutions have implemented information systems but evaluations of the usability of these systems are still under debate. For purposes of this research an evaluation method for system usability and survey questionnaires were developed. In Chapter 4 the case study of Charlotte Maxeke Johannesburg Academic Hospital is reported. The chapter also describes the data collection design, research limitations and delimitations, survey findings and interpretations. In Chapter 5 the implications and applications of Health Information Systems are discussed. After analysis of the survey results, it appears that the impact and benefits of the new Health Information System are only positive or realized in the patient administration division. The rest of the health professionals continue to manually capture clinical notes and other management information on pieces of papers, spread sheets and word documents. The thesis comes to the conclusion that despite widespread use of technology in other sectors, clinicians in hospitals do not use implemented automated systems. Implementation of systems is complex and problems associated with usability are not resolved and that traditional systems implementation methodologies may not apply.
AFRIKAANSE OPSOMMING: Die tesis ondersoek die faktore wat Gesondheidstelsels (HIC) ingewikkeld maak. Die fokus is op a) doeltreffendheid, en b) bruikbaarheid (uit gebruikersoogpunt). ‘n Gevallestudie word gemaak van ‘n stelsel wat onlangs by Chalotte Maxeke Johannesburg Akakdemiese Hospitaal in gebruik geneem is. Die eerste doelwit van die ondersoek was om die ingewikkeldheidsgraad van sodanige stelsels te probeer bepaal, en tweedens om die situasie in die hospitaal self te evalueer. In hoofstauk 1 word die agtergond en aanleiding tot die ondersoek uiteengesite, woel as die metodologiese keuses wat gemaak is. Hoofstuk 2 bied ‘n oorsig oor relevante literatuur ten ospigte van HIC. Dit is duidelik stlselontwikkeling riskant, onnodig duur en koersloos is as dit sonder ‘n duidelike metodologie geïmplementeer word. Verandering vind voortdurend plaas en die implementering van oprasionele doeltreffendheid mag vernadering in besigheidstrategie, informasiestelsels, kennisbestuur en processoriëntasie noodsaaklik maak. In hoofstuk 3 word bruikbaarheid ondersoek. Verskeie mediese instellings het soortgelyke stelsels in gebruik geneem, maar die bruikbaarheid daarvan is steeds onseker. Vir die doeleindes van hierdie tesis is ‘n eie evaluasiemetode ontwikkel en ‘n vraelys op grond daarvan opgestel. Hoofstuk 4 rapporteer die gevallestudie in Charlotte Maxeke Johannesburg Akademiese Horspitaal hospital. Datakolleksie, navorsingsafbakening en – beperkinge, sowel as vraelysresultate word aangebied. Hoofstuk 5 bespreek die implikasies en toepassings van HIC. Dit blyk dat die voordele van die stelsel slegs deur die pasiëntadministrasieafdeling geniet word. Alle ander afdeling gaan steeds voort met papiergebaseerde inligtingstelsels, aangevaul deur ad hoc gebruik van Excel en woordprossering. Die tesis kom tot die gevolgtrekking dat kliniese personeel avers is teen die gebruik van geoutomatiseerde informasiestelsels.

Introduction: Although cervical cancer can be prevented through known interventions it still remains a major cause of mortality in developing countries. Currently in South Africa there is little literature on cervical cancer radiotherapy treatment and its prognostic factors. Knowledge of prognostic factors helps in understanding the determinants of a disease better and optimize treatment strategies. The aim of this study was to determine overall survival rate and to investigate potential prognostic factors for cervical cancer in patients who underwent radiotherapy during the period of 1 January 2004 to 31 December 2006 at the Division of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital. Methods: This was a retrospective cohort study of 900 patients who were treated with radiotherapy between 1 January 2004 and 31 December 2006. Patient and treatment related data was obtained from the hospital treatment records. Follow-up was then censored as of 31st of December 2008. Subjects of this study had either mono-therapy or a combination of therapies: external beam radiotherapy, brachytherapy and chemotherapy. A Cox regression model was fitted to determine the prognostic and predictive factors of cervical cancer. Kaplan Meier methods were used to establish the effect of different socio-demographic and clinic-pathological factors on overall survival. The overall two year survival was also determined. Results: At 2 years post-treatment for each individual patient, 26 out of 900 patients had died, 281 were still alive and 593 lost to follow up leaving 307 patients available for analysis. The overall 2 year mortality rate was 45 per 1000 person years and highest in the period of 0-6 months. In the final model, completion of brachytherapy remained a significant predictor of survival (HR=0.04, 95% CI: 0.01-0.11, p<0.001) after adjusting for all other factors. Furthermore, HIV status was the only significant prognostic factor (HR=3.23, 95% CI: 1.04- 10, p=0.042). Patients who had brachytherapy treatment prescribed and completed the prescription were 96% less likely to die compared to those who didn’t complete it at any point in time, after adjusting for age and HIV status. Patients who were HIV positive were approximately three times more likely to die as compared to HIV negative patients at any point in time after adjusting for age and completed brachytherapy. The overall 2-year survival rate was 92% for this group of patients. Conclusion: Completion of the brachytherapy prescription was a significant predictor of treatment outcome, while the patient’s HIV status was also a significant prognostic factor for treatment. Patients who were HIV positive were three-times more likely to die compared to HIV negative patients. The overall 2-year survival rate was 92%, however, these results need to be interpreted with caution due to the large loss to follow-up in this patient population. Prospective clinical trials are recommended in the future to confirm the validity of the findings of this work in a representative patient population. In addition this work puts forward some suggestions to optimize treatment of cervical cancer patients in typical university teaching public health centres in South Africa.

A dissertation submitted in accordance with the requirements for the degree of Master of Science in the Faculty of Science at theUniversity of Witwatersrand, Johannesburg, 2012.
AIM: This studied aimed at analysing the set-up error (margin) of head and neck cases, treated in a vacuum formed acrylic shell with an in-house immobilisation system. METHODS AND MATERIALS: Two population groups were studied, namely virtual simulated and intensity modulated radiotherapy (IMRT) cases. All cases were treated with the in-house immobilization system, which located centrally, but not longitudinally, to the treatment couch. Verification of the couch position, other than the isocentric angle, was not activated. The virtual simulated cases consisted of two lateral fields with a matched anterior neck field. The borders of these fields were chosen by the radiation oncologist. The IMRT cases were planned by a medical physicist and consisted of 6-9 fields of 3-4 intensity levels each. Digitally reconstructed radiographs (DRRs) of the 2 lateral fields and the anterior neck field for the virtual simulated cases, and the 2 lateral and anterior composite fields at the same isocentre for the IMRT cases, were printed and represented the ideal patient position. On the first day of treatment, megavoltage verification films were taken of the treated or positioning fields respectively. These verification films were compared to the DRRs and approved by a radiation oncologist. The absolute bed position in the vertical (Y), lateral (X) and longitudinal (Z) directions at the time of film approval, was used as the reference or ideal position. The absolute readings of the couch position that were captured daily over the course of treatment were then compared to the initial couch position to give an indication of the systematic and random errors. One linear accelerator was used in this study and weekly mechanical quality control (QC) was performed on it. RESULTS: The total number of daily fractions (F) studied in this thesis was 5644 and 600 for virtual simulated and IMRT cases respectively. The systematic error of this population was 4.7 and 4.4 mm for the virtual simulated and IMRT cases respectively. This compares well with published results using a similar immobilisation system. The random error of this population was 7 mm and 6.1 mm for the virtual simulated and IMRT cases respectively. This is three times larger than the results reported in the literature (using a similar immobilization device). CONCLUSION: Offline monitoring of couch position provides insight into setup margins and this can contribute to realistic institutional planning target volumes. Better results were obtained in the IMRT cases and this could be due to the requirement for weekly verification imaging. Lack of radiation therapist vigilance and insufficient training were most likely responsible for the individual cases with systematic variations of larger than 3 cm. The data confirm that the immobilisation system can be located to a fixed position on the tabletop; this will allow online verification of absolute bed position for treatment and further decrease the chance of incorrect setup.

A research report submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in the field of Medical Physics. 2017
Aim The aim of this research was to contribute to clinical implementation of the small field dosimetry Code of Practice (CoP) that is due to be published by the International Atomic Energy Agency (IAEA) in collaboration with the American Association of Physicists in Medicine (AAPM) (1). A 6 cm × 6 cm virtual machine-specific reference (fmsr) field was established in a clinical 60Cobalt teletherapy beam used for conventional radiotherapy at Charlotte Maxeke Johannesburg Academic Hospital, and relative output factors were measured down to a set field size of 1 cm × 1 cm using three different models of Physikalisch-Technische Werkstatten (PTW) small field ionization chambers. Materials and Methodology The measurements were all performed on a Cobalt teletherapy unit (MDS Nordion Equinox, S/N 2009) in a PTW MP3 water phantom. The small field ionization chambers that were used were a PTW 31016 3D pinpoint 0.016 cm3, a PTW 31006 pinpoint 0.015 cm3 and a PTW 31010 semiflex 0.125 cm3. A calibrated PTW 30013 Farmer 0.6 cm3 ionization chamber was used to provide traceability for the cross calibration. A ―daisy chain‖ methodology was used to perform the cross calibration in a virtual fmsr field of 6 cm × 6 cm and then establish the absolute dose rate in a 4 cm × 4 cm field. Relative output factors as a function of field size were measured with each small field ionization chamber and then compared to published results. Results Small square fields from a 60Cobalt beam were created using the secondary collimators integrated into the unit. Equivalent square fields were calculated using the profiles obtained by the three ionization chambers during scanning and were in agreement with the ones that were programmed into the console. The coincidence of the central axis of the beam and the point of measurement for each detector was determined from the beam profiles. The cross calibration and daisy chain measurements resulted in a consistent dose rate of within + 0.6% in the 4 cm × 4 cm field when measured with the four different ionization chambers. For 6 cm × 6 cm, 4 cm × 4 cm, 3 cm × 3 cm and 2 cm × 2 cm field sizes, relative output factors obtained from the uncorrected detectors’ response agreed to within + 0.8 % between the three small field ionization chambers. The variation in the 1 cm × 1 cm field size was + 8.1 %. When compared to published data, large differences in field size correction factors were obtained. Conclusion Small field dosimetry in a 60Cobalt photon beam using three different PTW small field ionization chamber models was investigated. A cross calibration in a virtual msr field was done followed by a daisy chain process to determine the dose rate in a small field. Dose profiles and relative output factors were then measured and compared. The lack of lateral charge particle equilibrium and volume averaging effect was evident when using the PTW 31010 semiflex chamber in a 1 cm × 1 cm field. The PTW 31006 pinpoint and 31016 3D pinpoint were in close agreement for field sizes down to 1 cm × 1 cm with the 3D pinpoint performing as the best detector in this study. The optimal positioning of a detector should be determined from beam profile scans and not the engineering diagrams. The PTW 31016 3D pinpoint and PTW 31006 pinpoint are recommended for the determination of output factors in small field sizes. However, field output correction factors are required for both detectors in field sizes under 2 cm × 2 cm. Small field data published in the British Journal of Radiology (BJR) Supplement 25 (2) should not be used to benchmark dosimetry in modern 60Cobalt teletherapy units.
MT 2017

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Radiation Oncology Johannesburg, 2016
Purpose: To assess the improvement in swallowing status, overall survival and treatment related complications in patients with Carcinoma of the Oesophagus treated with palliative radiotherapy. Methods: A retrospective analysis of patients with advanced squamous cell carcinoma of the oesophagus who were treated for palliation from May 2007 to June 2012 at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was done. Ninety- nine patients received palliative radiation therapy during this period, 63% were male and 37% female with a mean age of 60, 6 years. The predominant site of lesion was middle 3rd (56%) and 86, 9% of patients had lesions more than 5cm in length. Patients received palliative External beam irradiation (EBRT) with or without High dose rate brachytherapy (HDRBT) as per the CMJAH, Department of Radiation Oncology protocol. Results: There was an overall significant improvement in swallowing status (p<0,001). Eighty –four patients (85%) had an improvement in swallowing score after treatment. The effect of treatment was not significant in the relationship between the change in swallowing status and treatment group. Overall mean time to progression was 3, 7 months. The median overall survival was 7, 7 months. The type of treatment did not affect survival significantly, unadjusted (p=0, 31) or adjusted for prognostic parameters (age, sex, length of lesion, site of lesion, and pre-treatment swallowing status) (p=0.29). There were treatment related complications in 32% of cases, consisting of ulcerations (24%), tracheo- oesophageal fistula (5%) and strictures (3%). Conclusion: In patients with advanced squamous cell oesophageal carcinoma, palliative radiotherapy is an effective modality in improving a patient’s dysphagia and thus quality of life.
MT2016

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Medicine. Johannesburg, 2014
Background: The causes of renal dysfunction in children treated for childhood cancers are multifactorial and clinical manifestations of dysfunction include hypertension, proteinuria and varying degrees of renal insufficiency. This study aimed to determine the different residual effects of cancer therapy on the renal system and factors associated with the residual effects in children treated for childhood cancers. Patients and Methods: The study was a descriptive cross sectional study that assessed 130 children, between the age of 1 and 18 years, who had completed treatment at Charlotte Maxeke Johannesburg Academic Hospital and were being followed up at the paediatric oncology clinic of the hospital. Results: After a median follow-up post treatment of 2 years, the various manifestations of renal dysfunction identified in the survivors included; decreased GFR, hypomagnesaemia, hypophosphataemia, proteinuria, haematuria and hypertension. In total, 34 survivors (26.15%) had at least one manifestation of renal dysfunction after completing treatment. The most prevalent manifestation of renal dysfunction detected was decreased GFR (17.69%). Hypomagnesaemia and hypophosphataemia were present in 8 (6.15%) and 6 (4.62%) of the survivors respectively. Patients who had renal dysfunction pre-treatment were three times more likely to have renal dysfunction post-treatment. Ifosfamide, Carboplatinum, and nephrectomy were significantly associated with a reduction in GFR Conclusion: A significant number of the survivors had a decreased GFR while some of them had hypomagnesaemia and hypophosphataemia. There was a strong association between pre-treatment and post-treatment renal dysfunction. These findings are very important in terms of decision making for individual patients with respect to selecting treatment modalities and dosages and also with respect to instituting nephro-protective measures to avoid further damage to the kidneys during and after treatment.

A research report submitted to the Faculty of Medicine in a partial fulfillment of the requirements for a degree of Master of Medicine in the specialty of Radiation Oncology (MMED Rad Onc) at the University of the Witwatersrand, Johannesburg October, 2017.
Background: Cancer induced hypercalcemia (CIH) is the most frequent metabolic oncologic emergency and occurs in up to 44.1% of all cancer patients at some time in their disease course. It occurs in patients with both solid and hematologic malignancies. CIH occurs mostly in patients with advanced cancer and is an indicator of poor prognosis. Timely diagnosis and intervention is lifesaving and also may enhance patient compliance with primary and supportive treatment and quality of life. This study aimed to describe the incidence, clinical patterns and treatment outcomes of hypercalcemia in cancer patients receiving Radiation therapy in Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg. Materials and Methods: This was a retrospective descriptive study, 125 patients who were admitted at the Radiation oncology ward CMJAH for hypercalcemia management from January 2012 to December 2015, were analyzed. Demographic data, relevant clinical information such as Stage of the disease, type of cancer, level of hypercalcemia, toxicity and Response to the treatment were recorded. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS_version 23). The incidence of hypercalcemia, clinical patterns, treatment outcomes and toxicities were evaluated. The study was approved by the Human Research Ethics Committee medical (HRECM) of the University of Witwatersrand with Clearance certificate number M140546. Results: Of the 125 patients analysed, males to females ratio was 1:1. The most frequent site of primary cancer diagnosis in patients with hypercalcemia was gynaecological malignancies 31 (24.8%), followed by head and neck cancers 23 (18.4%), prostate 19 (15.2%), breast cancer 17 (13.6%), gastrointestinal malignancies 12 (9.6%), multiple myeloma 5 (4%), lung cancer 3 (2.4%) and other malignancies 15 (12%). Most patients had metastatic disease and uncontrolled primary disease 78 (62.4%) compared to primary controlled disease 47 (37.6%). Bone metastasis were present in 51 (41%) of patients. Clinical presentation of patients with hypercalcemia was mainly Neuromuscular 41 (32.8%), nausea/vomiting 37 (29.6%), Polyuria 20 (16%), mental 16 (12.8) and Polydipsia 9 (7.2%). Most of patients had severe hypercalcemia with pre-treatment corrected serum calcium level of > 2.9 mmol/L 77 (61.6%), 28 (22.4%) had Corrected serum Calcium between 2.71-2.89 mmol/L and 20 (16%) had corrected serum calcium between 2.56-2.70 mmol/L. One hundred and four patients (83.2%) received hydration + bisphosphonates and 21 (16.8%) of patients received hydration alone and non-received haemodialysis. One week post treatment majority of patients had ≤2.55 mmol/L Serum level of Calcium 81 (64.8%), 11 patients (8.8%) had serum level of calcium 2.56-2.71 mmol/L, 23 patients (18.4%) had serum calcium between 2.71-2.89 mmol/L and only 10 patients (8.0%) had serum level of calcium ≥2.9 mmol/L. The corrected serum calcium was 2.4770 ± 0.34512 mmol/L one week after treatment. One month post treatment majority of patients 99 (79.2%) remains to have normal serum level of calcium ≤2.55 mmol/L and only about 11 (8.8%) patients had ≥2.9 mmol/L. Forty four patients (35.2%) had relapse in 33 days (median) time and were subsequently treated with hydration and bisphosphonates. As the patients were enrolled from radiation oncology ward, most were treated with either radiation alone 72 (57.6%) or Concurrent chemo radiation 15 (12.0%) as treatment modalities for their primary cancer. Patients who received chemotherapy first and then radiotherapy for the treatment for their primary cancer were 37 (29.6%). Fourteen (58%) patients with pre-treatment calcium level of 2.56-2.70 mmol/L received hydration alone and 76 (98%) of patients with serum pre-treatment calcium of ≥2.9 mmol/L were treated with hydration + bisphosphonates (P=0.001). Side effects to bisphosphonates were mainly gastrointestinal: Nausea/vomiting 42 (33.6%) patients, Constipation 14 (11.2%), abdominal pain 13 (10.4), Diarrhoea 11 (8.8) and anorexia 1 (0.8) patients. Other toxicities reported were fever 12 (9.6%) patients and hypocalcaemia 14 (11.2%). Eighteen patients (14.4%) did not report any side effect to treatment. Conclusion: Hypercalcemia of malignancy is a common finding in patients with advanced stage cancers. Hypercalcemia of malignancy usually presents with markedly elevated calcium levels and patients are therefore usually symptomatic. For acute management of hypercalcemia, rehydration is the mainstay of treatment because all patients tend to have dehydration. Bisphosphonates are potent calcium lowering agents, but they require careful administration and are contraindicated in patients with declined renal function. Common bisphosphonates toxicities are mainly gastrointestinal: Nausea/vomiting, constipation, abdominal pain, diarrhoea and anorexia. Other toxicities reported were fever and hypocalcaemia.
LG2018

A research report submitted to the University of the Witwatersrand in partial fulfilment for the degree of Master of Medicine 2016.
Background Cervical cancer is the 3rd most common female malignancy worldwide. It is classified and managed according to stage as defined by the FIGO Committee on Gynaecology Oncology classification of 2009. Stage specific treatment is tailored according to prognosis and risk of recurrence as determined by tumour type, tumour size, tumour grade, lymph node metastases, lymphovascular space involvement (LVSI), parametrial spread and presence of any other metastatic deposits at presentation. This study only concentrated on patients who presented with Stage IB1 and 1B2 tumours managed by Class III / Meig’s Radical / Wertheim’s hysterectomy and bilateral pelvic lymphadenectomy. Aims Primary Outcome 1. Assess disease free interval and overall survival 2 years post-operatively. Secondary Outcomes 1. Assess adequacy of patient selection 2. Assess risk factors for recurrence 3. Compare recurrence risk of HIV positive patients versus HIV negative patients. 4. Determine surgical and post-surgical complication rate. Materials and Methods This was a retrospective institutional cohort study conducted at the Charlotte Maxeke Johannesburg Academic Hospital. All patients with Stage IB1 or IB2 cervical cancer treated with Wertheim hysterectomies between 2002 and 2012 were included. Surgical records, histology records, further postoperative management records and gynaecological outpatient follow up records were used to collect data for the patients. Histological findings post-operatively determined further management. Surgical margins had to be 10mm clear of tumour with no positive lymph nodes otherwise external beam radiotherapy and brachytherapy or chemo-radiotherapy were recommended in addition to primary surgical management. Results Of the 72 patients initially identified, 69 patients were suitable for study inclusion. The mean age of the study population was 45 years. Study population racial distribution: 68.12% were Black, 26.09% were White, 2.9% were Coloured and 2.9% were Indian. Average parity and gravidity of patients alive at the end of the study was 2.86 and 3.56; while average parity and gravidity of patients deceased at the end of the study was 2.5 and 2.8 respectively. Study population ECOG status: 16% were ECOG 0, 83% were ECOG 1 and 1% were ECOG 2. Overall survival at the end of the study was 86% and patients were disease free postoperatively for an average of 5 years. Thirty three percent of the patients were disease free for more than 5 years. Preoperative clinical staging and postoperative histological staging correlated only in 61% of cases. Correct management by Wertheim’s hysterectomy was rendered to 75% of patients whereas the remainder were incorrectly managed and should have had either a simple hysterectomy with no pelvic lymphadenectomy or radiotherapy only as primary therapy. More advanced stages, tumours ≥ 4cm, adenomatous cell type, > 5mm depth of invasion, >7mm lateral spread, higher number of nodes positive for metastatic disease, surgical margins  10mm, positive lympohovascular space, parametrial and pouch of Douglas (POD) involvement were factors that had a poorer prognosis with regards overall survival, disease-free interval or both. Poorly differentiated tumours were more likely to recur but did not have a poorer prognosis compared with regards to overall survival or disease free interval at 2 or more years compared to well and moderately differentiated tumours. Mortality of HIV reactive patients was 16.7% compared to 12.5% for HIV non-reactive patients. This difference was not statistically significant at the 95% confidence level. HIV status also did not increase risk of recurrence. Lower CD4 counts were shown to have a lower disease-free period and overall survival. Intra-operative surgical complication rate was 6%. Immediate post-operative complication rate was 16%. Of the patients who required DXT or DXT and chemotherapy 33% had side-effects or complications from adjuvant therapy. Patients treated with DXT and chemotherapy had had more side-effects than those treated with DXT only. Conclusion The mean age of the study population was 45 years. This was lower compared to other larger studies possibly due to younger presentation related to HIV disease. HIV positive patients with lower CD4 counts were shown to have poorer prognosis with regards to survival. HIV status was not shown to be a risk factor for recurrence. The overall survival and disease-free period at 5 years was similar to that of other international studies. Only two thirds of the patients were adequately selected for surgery according to the institution’s criteria for a Wertheim’s hysterectomy and therefore it may be necessary to reconsider the pre-operative assessment of these patients. More advanced stages, tumours ≥ 4cm, adenomatous cell type, poor differentiation, > 5mm depth of invasion, >7mm lateral spread, higher number of nodes positive for metastatic disease, surgical margins ≤ 10mm, positive lympohovascular space, parametrial and pouch of Douglas involvement were factors that had a poorer prognosis with regards to recurrence, overall survival and disease-free interval. However, the rates of recurrence were not statistically significant at a 95% confidence level.
LG2018

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine 2016, Johannesburg
Background and objectives: In recent years, Clostridium difficile infection has become more common and more resistant to therapy resulting in significant in-patient morbidity and mortality. The aim of this study was to describe the characteristics of patients with Clostridium difficile infection at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa. Methods: This was a retrospective analysis of the records of 154 adult in-patients with confirmed Clostridium difficile infection on stool samples during the period 1 January 2013 to 30 June 2014. Patient demographics, clinical presentation, risk factors, HIV status, treatment, severity indicators and outcomes were analysed. Patients were catagorised as having either healthcare-associated or community-acquired Clostridium difficile infections. HIV-positive patients were compared with HIV-negative patients and the survivors were compared with the non-survivors. Results: Overall, 83 (53.8%) patients were female and the median age was 39 years (Interquartile range: 31-52). The most common symptom was watery diarrhoea (92.9%) followed by fever (27.3%). Overall, 145 (97.9%) patients had been exposed to antibiotics in the last 30 days, 54 (35.1%) to immunosuppressives, 48 (31.2%) to gastric acid suppressants and 65 (42.2%) patients had previous hospital admissions. In total 73 (47.4%) patients died. Only two cases of community-acquired Clostridium difficile infections were identified. There was no difference in outcomes of HIV-positive patients compared to HIV-negative patients. The non-survivors tended to have a greater number of severity indicators compared to the survivors. Conclusion: Patients with Clostridium difficile infection in this study were younger than expected with a higher mortality than that reported in the Western world. The number of iv community-acquired Clostridium difficile infections was less than reported in previous studies.
GR2018

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Ophthalmology. Johannesburg, 2018.
Purpose: The aim of this study was to determine the visual acuity and anatomical outcome of retinal detachment repair at Charlotte Maxeke Johannesburg Academic hospital. Methods: Retrospective record review (clinical audit) of outcomes in patients who had retinal surgery (pars plana vitrectomy) for either rhegmatogenous retinal detachment or diabetic retinal detachment (tractional detachment or combined tractional and rhegmatogenous detachment) at Charlotte Maxeke Johannesburg Academic hospital during the period from 1 January 2010 to 31 December 2014. Results: During the specified time period 941 pars plana vitrectomies (including repeat surgery) were performed at the hospital. After exclusion for indications other than retinal detachment repairs and for missing or incomplete records, a total of 164 records of 164 patients were reviewed. The patients were divided into two groups: a rhegmatogenous retinal detachment group (n=99) and a diabetic retinal detachment group (n=65). Rhegmatogenous retinal detachment Ninety nine patients with rhegmatogenous detachment were included in the study, 62% male and 38% female. The mean age (± standard deviation) was 48(±18.4) years. The most common cause of rhegmatogenous detachment was trauma followed by cataract surgery, accounting for 37 % and 21% of all causes respectively. Sixty three percent of these detachments involved the macula at the time of presentation, and 58% had proliferative vitreoretinopathy (PVR). Eighty three eyes (84%) obtained vision improvement or stabilization and retinal attachment. Forty eyes (40%) had visual acuity improvement, 43 eyes (43%) retained the same vision. Successful anatomical reattachment of the retina was obtained in 93% (n=92) of eyes including those that needed a repeat surgery. Diabetic retinal detachment Sixty five patients with diabetic retinal detachment were included in the study. Sixty three percent (n=41) were males and the mean age (± standard deviation) was 54± 12.2 years. Sixty eight percent (n=44) had tractional retinal detachment and 32% (n=21) had a combined tractional and rhegmatogenous retinal detachment. Thirty two percent of patients had detachments associated with vitreous haemorrhage, and 60% had macular involving detachments. Forty six eyes (71%) obtained vision improvement or stabilization and attachment of the retina; 36.9% (n=24) had visual acuity improvement, 33.9% (n=22) retained the same visual acuity and 29.2% (n=19) lost vision. Eighty five percent (n=55) had successful anatomical reattachment of the retina and 15% (n=10) had re-detachments after surgery. Conclusions: This study found that the majority of patients, whose files were reviewed, benefited from surgical intervention for rhegmatogenous and diabetic retinal detachment in terms of stabilisation or improvement of vision. The major limitation of this study is the large number of missing or incomplete records. The results of this study are therefore not generalisable to our retinal detachment patient population.
LG2018