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Biomedical subjects

B G Lindeque

Publications and source records attributed to B G Lindeque.

32 records · Page 2Linked to original sources

The value of magnetic resonance imaging in the staging of musculoskeletal tumours.

In view of the changes that are occurring in the management of musculoskeletal tumours and the importance of precise pre-operative staging, a study to determine the value of magnetic resonance imaging (MRI) as a modality for this purpose was undertaken. Sixty-four patients were examined and 70 MRI examinations were carried out. Fifteen cases were found to be benign and 49 malignant. As a result of the accuracy of these MRI examinations and their remarkable similarity with the pathological specimens, which was shown to be statistically significant (P less than 0,005), we propose a modification to the sequence of the diagnostic staging modalities for musculoskeletal tumours.

Adolescent↗

Fibromyxoma of the bone.

Fourteen patients with fibromyxoma of the bone, a rare but relatively overlooked entity, are described. This tumor is different from a chondromyxoid fibroma in age distribution, clinical behavior and histologic appearance. Fibromyxoma occurs frequently in later life (after 50 years of age). It is usually not clinically aggressive and lacks the lobular pattern, chondroid matrix and cell variety of chondromyxoid fibroma. Secondary aneurysmal bone cysts developed in three patients. It behooves the pathologist to screen patients with aneurysmal bone cysts for evidence of pre-existing fibromyxoma, especially if the patient is less than 40 years of age. Treatment consists of curettage with or without cryosurgical procedures. Marginal excision may be necessary for an occasional aggressive lesion.

Adolescent↗

Ultrasonographic criteria for the conservative management of antenatally diagnosed fetal ovarian cysts.

Routine antenatal ultrasonography at regular intervals will detect fetal ovarian cysts. Before the era of ultrasound, the attending physician was unaware of the presence of these cysts. It is therefore imperative that a protocol for the management of asymptomatic, antenatally diagnosed ovarian cysts be developed. The vast majority of these cysts are benign and functional; laparotomy during the neonatal period is not only unnecessary but may be harmful. In a prospective study undertaken at Tygerberg Hospital, Parowvallei, South Africa, six ultrasound criteria were drawn up for the safe, conservative management of these neonates. Adherence to these criteria enabled us to manage five of seven neonates conservatively. Laparotomy in one neonate showed a benign functional ovarian cyst. Retrospectively, this case should have been managed conservatively. In the remaining neonate a laparotomy for an acute abdomen demonstrated torsion of an ovarian cyst, emphasizing the necessity for adequate follow-up.

Female↗

Pseudoaneurysm of the popliteal artery with an unusual arteriographic presentation. A case report.

Pseudoaneurysms caused by osteochondromas during the second decade of life are well known. Arteriography is generally helpful in the diagnosis of a false aneurysm. In a 30-year-old man, the case was unique in that the arteriogram failed to show the aneurysm at all. Physical examination revealed yellow discoloration and tiny hemangiomas of the skin over the fossa poplitea. More emphasis should be placed on the physical examination and less on the arteriogram in making a correct diagnosis.

Adult↗

The role of surgery in the management of carcinoma of the vagina.

Treatment for vaginal carcinoma should be individualized. Surgery is an option to be considered in an attempt to improve both survival and the quality of life following therapy. Most patients with superficial Stage I vaginal carcinoma can be managed surgically. In patients with central non-metastatic Stage IV disease exenterative surgery should be considered, as well as in patients with central recurrence following radiotherapy. In suitable patients the results of surgery are good, and using modern techniques the incidence of complications is acceptably low.

Combined Modality Therapy↗

Fat embolism and the fat embolism syndrome. A double-blind therapeutic study.

Fifty-five adults who had sustained a tibial fracture, or a femoral fracture, or both, were subjected to a double-blind randomised study to determine the efficacy of methylprednisolone in treating the fat embolism syndrome. This drug maintained arterial oxygen levels, stabilised or reduced the serum level of free fatty acids, and decreased the risk of the fat embolism syndrome in a statistically significant proportion of patients. Gurd's criteria for the diagnosis of the fat embolism syndrome were found inadequate. Other more sensitive criteria for early diagnosis and effective management were determined. There were no deaths or serious morbidity in our series.

Adolescent↗

Prevalence of primary papillary peritoneal neoplasia in patients with ovarian carcinoma.

Primary papillary peritoneal neoplasia (PPPN) is a recently recognized disease entity. Macroscopically it resembles ovarian carcinoma. On microscopic examination it also superficially resembles serous ovarian adenocarcinoma, but in PPPN the epithelial cells are single-layered and well differentiated with very rare mitoses, and numerous psammoma bodies are found. In a retrospective review of 61 consecutive patients with serous or papillary ovarian adenocarcinoma seen over a 7-year period, 4 patients with PPPN were found (6,5%). One of these patients was in clinical stage 1, 2 were in stage II and 1 was in stage III. All had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy. Two of these patients received additional chemotherapy and 1 radiotherapy. After 3, 3, 8 and 4 years there were no recurrences in these patients, in contrast to a 29,1% 5-year survival rate for the other patients with serous carcinoma. Cytological examination of ascitic fluid specimens performed in 3 of the 4 patients with PPPN demonstrated the presence of highly differentiated serous tufted cells.

Adenocarcinoma, Papillary↗

Infectious osteitis pubis. Case reports.

Two cases of spontaneous septic osteitis of the pubis in patients who had not previously undergone intrapelvic or abdominal surgery are presented. Early diagnosis and evaluation of the immunological system are discussed. Drainage of the pus and thorough debridement of the affected bone are the hallmarks of correct treatment. The administration of suitable antibiotics with simultaneous correction of immunological deficiencies will result in eventual cure.

Adolescent↗

[Hand infections--approach and management].

Infections of the hand are always very serious conditions and should therefore be treated aggressively. Early diagnosis, adequate anaesthesia, a bloodless field and thorough drainage including debridement, elevation and early active mobilization are the cornerstones of treatment. Antibiotics need not be given routinely, but under certain circumstances (for example in the case of human bites) combination antibiotic treatment is imperative. Management of hand infections along these lines is most rewarding and should prevent a chronic infection or a disastrous osteitis which would result in a permanent lesion and disablement. The management of specific hand infections is discussed.

Adult↗

Treatment of vaginal candidiasis in pregnancy with a single clotrimazole 500 mg vaginal pessary.

A single vaginal pessary containing clotrimazole 500 mg (Canesten; Bayer-Miles) was used to treat candidiasis during a prospective, mycologically controlled trial among 46 patients in the second and third trimesters of pregnancy. Positive cultures were obtained from vaginal swabs before commencement of treatment. Swabs were taken 1 week and 1 month after treatment. Four patients were lost to follow-up. One week after treatment 83,3% of the patients were cured on microscopic and mycological examination, and all of the patients had relief of symptoms. The recurrence rate was 5,7% after 1 month. Of the 7 patients in whom treatment was unsuccessful, 3 were available for repeat treatment and all 3 responded successfully to a second course.

Candidiasis, Vulvovaginal↗

Microsatellite instability in uterine sarcomas.

Studies have shown a 15-30% frequency of microsatellite instability in endometrial cancer. In addition, we found a 21% frequency of microsatellite instability in endometrial cancer. Our aim was to investigate the presence of microsatellite instability and loss of heterozygosity in uterine sarcomas. The records of 69 women referred to Kalafong Academic and Pretoria Academic Hospital with a primary diagnosis of uterine sarcoma were reviewed. At histological review of 43 cases with a primary diagnosis of leiomyosarcoma, diagnosis of mitotically active leiomyoma was made in 21. Diagnosis of carcinosarcoma was made in 21 cases and endometrial stromal sarcoma in five. In all cases, genomic DNA was extracted from normal myometrium and tumor and analyzed for microsatellite instability and loss of heterozygosity. High-frequency microsatellite instability was absent in leiomyosarcoma, endometrial stromal sarcoma, and mitotically active leiomyomas and was observed in 1 (5%) carcinosarcoma. Loss of heterozygosity for chromosome 11 was present in 8/48 (17%) of uterine sarcomas, equally distributed between leiomyosarcomas (4/22 = 18%) and carcinosarcomas (4/21 = 19%). There was no loss of alleles in endometrial stromal sarcoma nor mitotically active leiomyomas. In conclusion, it is suggested that tumor suppressor genes may play a role in the tumorigenesis of uterine mesenchymal cells, whereas mismatch repair genes contribute to the carcinogenesis of endometrial cancer.

Carcinosarcoma↗

Urine cytology as a screening test for bladder infiltration in cervical cancer.

Ultrasound is currently used as a screening test for bladder infiltration in patients with advanced-stage cervical cancer at our institution. Cystoscopy is reserved for patients with abnormal bladder ultrasound findings. This study was undertaken to reevaluate this policy and to compare the results of different screening tests. The study was carried out in Pretoria academic complex. All newly diagnosed cervical carcinoma patients stage II and above were included in this study. The standard staging investigations were done on all patients. In addition, urine midstream and catheter specimens were sent for cytology. Cystoscopy and biopsy were performed on all patients. Two hundred twenty-eight patients were enrolled into this study. At cystoscopy, 47 patients had bladder mucosa suspicious of malignant infiltration, of which 17 had bladder mucosa infiltration diagnosed on histology. Urine catheter cytology has a sensitivity of 94% and specificity of 82% for bladder mucosa infiltration. The predictive value of a positive test is 31% and for a negative test is 99%. Catheter urine cytology is a very useful screening test for bladder infiltration in patients with cervical cancer. Cystoscopy should be reserved for patients with abnormal urine cytology in resource-poor settings with a large burden of disease.

Biopsy↗