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Item Open Access Factors influencing infrainguinal reverse vein bypass patency at Universitas Academic Hospital: a retrospective review(University of the Free State, 2020-09) Khambule, M. L.; Malan, A. F.Introduction and Aim: Peripheral arterial disease is a serious global healthcare concern with a subgroup of patients requiring revascularisation for chronic limb-threatening ischaemia. Open bypass surgery remain a valuable tool in the armamentarium of revascularisation options and several factors are known to affect the patency of a bypass procedure. Literature in this regard is, however, lacking in the South African population. Methods: This was a retrospective cohort analytic study of infrainguinal reverse vein bypasses performed at a central academic hospital in South Africa between January 2012 and December 2016 for the indication of chronic limb-threatening ischaemia. 211 patients with a total of 219 bypass procedures were included. Patency data was assessed for 138 bypasses with 79 patients (36.1%) lost to follow-up and 2 patients (0.9%) who demised. Results: 156 (73.9%) were males and 55 (26.1%) were females. The median age was 61 years. The majority of the patients (78.2%) had hypertension and were known smokers (83.4%), whereas only 32.2% had diabetes mellitus and 11.4% had renal impairment. The human immunodeficiency virus status was unknown in the majority (70.6%) of patients. 83.1% of bypasses were performed for the indication of tissue loss in addition to rest pain. The proximal anastomosis was performed from the common femoral artery in 47.9% of cases and the distal anastomosis to the tibialis posterior artery in 27.9% of cases. Most patients (26.9%) had a single vessel runoff. The median diameter of greater saphenous vein utilised was 2.7mm. 26.1% of grafts demonstrated early graft failure within 30 days compared to 45.7% demonstrating patency beyond 12 months. Age, race, hypertension, diabetes, renal failure, the presence of tissue loss, level of the proximal and distal anastomoses and number of runoff vessels had no significant effect on graft patency. Female gender, a small greater saphenous diameter as well as a single anterior tibial vessel runoff, however, proved to be statistically significant indicators of early graft failure. Smoking, on the other hand, was associated with a longer graft patency beyond 12 months. Conclusions: Female gender, small vein diameter and a single anterior tibial runoff vessel are independent predictors of early graft failure. Smoking, on the other hand, is associated with prolonged patency beyond 12 months which is in contrast to the majority of existing literature.Item Open Access Ultrasound thyroid nodule size and histological findings(University of the Free State, 2020-07) Coetzee, Eldridge Fabian; Arko-Cobbah, E.Introduction: Thyroid nodules occur in 4-7% of adults with a malignancy risk of 5-15%. Ultrasound plays an important role in the clinical workup of patients with solitary thyroid nodules to differentiate malignant from benign disease. Objectives: To determine if ultrasound single thyroid nodule size can predict the probability of thyroid malignancy. Method: Retrospective cross-sectional study of all thyroidectomies done (benign and malignant) from 2010 to 2016. Ethical clearance was obtained from University of the Free State (HSREC 0664/2017). Data was analyzed by means of descriptive statistics, namely frequencies and percentages for categorical data, medians, and percentiles for numerical data, were calculated. Associations regarding cancer were done for numerical data by means of Kruskal-Wallis test and contingency tables by means of Chi-square or Fischer’s exact test. A p-value of < 0.05 was considered statistically significant. Diagnostic test statistics were calculated, namely sensitivity, specificity, positive and negative predictive values, and likelihood ratios. Results: The overall incidence of thyroid cancer was 24.6%. The median age of thyroid cancer patients was 52.9 years and for benign disease 54 years. Female patients with thyroid cancer were 78.7% and for benign disease 90.1%. Male patients with cancer were 21.2%, for benign disease 9.9%. Papillary thyroid cancer remains the most common type of cancer at 87.8 % and follicular thyroid cancer 12.1%. The average size of thyroid cancer on histology was 2.1 cm and 3.2 cm for the non-cancer group, statistically significant with p-value of 0.0015. Ultrasound nodular size for cancer was 1.7 cm; and 1.9 cm for non-cancer group with p-value 0.209. The association between ultrasound size and histology size for cancer group were not significant with p-value 0.99. Size difference for non-cancer group between histology and ultrasound was significant with p-value 0.02. Conclusions: The study did not prove our hypothesis that ultrasound single nodule size alone, can predict the risk of thyroid cancer. Diagnostic test results with 95% CI reveals a sensitivity of 96%, but a low specificity of 22% to predict the risk of thyroid cancer.Item Open Access Patient and tumour factors affecting the histology of sentinel lymph node biopsy in breast cancer patients at Universitas Academic Hospital, Bloemfontein(University of the Free State, 2020-07) Letsoara, R. S.; Pearce, N.Introduction: SLNB has become accepted standard staging tool in clinically node negative breast cancer patients. Aim(s): Primary aim was to determine factors (demographics and tumor factors) affecting histology of SLNB. Secondary aim was to determine the histological characteristics of the SLNB and final histological status of the axilla if SLNB was positive. Methods: Retrospective analytical study of patients who underwent mastectomy or lumpectomy with SLNB from 2007 to 2016 (n=60) at Universitas Academic Hospital. Results: Demographics : Age ranged from 36 to 90 years and its association with positive SLNB histology was close to statistically significant (p-value 0.0242). Tumour factors: Location of the tumour, type of tumour, size of tumour all with pvalue of 1.000, histological type (p-value 0.7464), grade (p-value 0.6244), lymphovascular infiltration (p-value 1.000) and hormonal receptors status (ER-positive p-value 0.6434, PR-positive p-value 0.7290, HER-positive p-value 0.2341 and ER/PR/HER-positive p-value 1.000) did not have statistically significant association with positive SLNB histology. There was a statistically significant association between positive SLNB histology and final histology of the axilla (p-value <0.001). Conclusion: The study did not prove our hypothesis that, tumour size, site, grade, lymphovascular infiltration and hormone receptors will affect histology of SLNB. Age nearly affected histology of SLNB. Small sample size and incomplete lymphovascular infiltration reporting might have affected results. There was statistically significant association between histology of SLNB and histology of the axilla.Item Open Access Vein size and demographics: is there a correlation?(University of the Free State, 2019-12) Roberts, Nadia; Pearce, N. E.Peripheral arterial occlusive disease has a high prevalence worldwide, as well as in our population, and contributes to an immense burden of morbidity and mortality. Due to the systemic nature of especially atherosclerotic vascular disease, most patients also have cardiovascular and cerebrovascular involvement at the time of presentation, adding to the huge impact on the patient and the economy. Lower limb amputation is associated with a 50% 5-year mortality rate, thus peripheral arterial disease itself is also responsible for considerable mortality rates. Attempting to re-establish perfusion to an ischaemic limb is crucial in saving the limb and the life of the patient. Options for revascularisation of patients with limb-threatening ischaemia include open and endovascular approaches, each with its own indications and shortcomings. In the case of open infra-inguinal bypass grafting, the great saphenous vein is the preferred conduit used to replace the diseased segment. It has been proven to perform superiorly to synthetic grafts with respect to long-term patency, adequate length, and swift harvesting. This vein is also used in other autogenous bypass procedures, including coronary bypass graft surgery and arterio-venous fistula grafts for access in renal replacement therapy. Occlusion of the graft, or graft-failure, is one of the dreaded complications of any bypass procedure, and can be divided into primary or secondary failure, according to the time from procedure to the establishment of the diagnosis. Both scenarios are detrimental to the salvage rate of the limb, and can also indirectly contribute to the demise of the patient. Many factors have been associated with primary graft failure, particularly the size of the conduit graft, which was the main focus of our study. Our primary aim was to determine the average great saphenous vein size in our study population, and our secondary aim was to demonstrate a relationship between vein size and demographic variables like race, age and gender. The study was a cross-sectional retrospective study, using data over 10 years from January 2006 to December 2015. All patients underwent vein mapping with ultrasound pre-operatively prior to a lower limb bypass procedure in Universitas Academic Hospital, and the demographics of these patients were then analysed. A total of 811 patients were included and the meteorological season was used as a surrogate indication of the average temperature in the vascular suite to account for the influence of ambient temperature on vaso-action and vein size. The average size of the great saphenous vein in our study population was found to be 4.08 mm. After analysis, it was found that black patients had smaller veins than white patients (p < 0.0001) and men had smaller veins than women (p = 0.0217). Vein measurements were smaller during summer months, and there was no significant difference between vein sizes in different age groups. Owing to the existing risk of small conduit size for graft failure, vein size plays an important role in the choice of procedure used to revascularize limbs in patients with critical ischaemia, whether acute or chronic. The results from our study may assist in improving selection of patients suitable for open surgery based on demographic parameters, thus decreasing poor outcomes of revascularisation procedures and decreasing complications associated with graft failure.Item Open Access Factors predicting outcome in adult trauma patients admitted to a Tertiary ICU(University of the Free State, 2019-02) Ndaku, Reabetswe Bardott; Pearce, N. E.Introduction: Trauma remains an important cause of mortality and morbidity in South Africa. In our centre, intensive care unit access is under severe strain. There is limited data specifically in our centre documenting the factors contributing to mortality and increased length of stay in ICU. Objectives: To elucidate the outcome (as measured by mortality and length of stay) of patients that are admitted to Intensive care unit following trauma. Method: A cross-sectional study dating from 2011 to 2015. Ethical clearance obtained from University of the Free State committee: HSREC 46/2016. Data analysed by means of SPSS 15.0 with frequencies and percentages and standard deviations. Stepwise logistic regression analysis was performed and the odds ratios, 95% CI and p-values calculated for risk factors. A p-value of < 0.05 was considered statistically significant. Results: The most prevalent mechanism of injury was assault (31%). Burns had the highest mortality rate (80%), primary orthopaedic patients had the longest length of stay recorded (128 days). Age was shown to be an independent predictor of outcome (p-value =0.016). Patients transferred from non-trauma centres did not have a statistically significant worse outcome (p-value = 0.58). Mortality rate of trauma patients admitted to ICU was 57.6%. Conclusions: There is an association between neurosurgical admissions and poorer outcome. No correlation between non-trauma centres transfer-ins and worse outcome was established; this is possibly an indicator of adequate resuscitation, stabilisation and effective referral systems in place. Our mortality rate is higher than that of international centres and this would need to be further studied.