Groote Schuur Hospital Research Articles

Foreword

In 2014, four of Emeritus Prof. Peter (fondly known as PB) Beighton’s past PhD students decided that they would like to honour him for his leadership and the influence that he had on their professional lives, and collaborated on a project to compile a Festschrift in his honour. They are Prof. Michael Hayden, now living in Canada, the first PhD graduate that PB supervised in 1979, together with Profs Jacquie Greenberg from the University of Cape Town (UCT), Alan Bryer from UCT and Groote Schuur Hospital (GSH), and Lawrence Stephen from the University of the Western Cape (UWC). Prof. Lawrence Stephen was the last PhD graduate that Prof. Beighton supervised before he officially retired in 1999. Many colleagues who have worked over the past 5 decades and who continue to work with him were invited to contribute to this supplement to the SAMJ . The Festschrift includes the history behind Peter Beighton, who was born, grew up and trained in the UK and came to UCT in 1972. His legacy includes the impact that he made on those who trained under him in SA, as well as throughout the world. The Festschrift includes the history of genetics and current genetic practice in South Africa, as well as the influence that he has had on medical genetics in general, dental genetics and now genomics going into the new millennium. Tributes have been received from people all over the world, attesting to his outstanding leadership and mentorship, and highlight how he influenced the climate, growth and development of genetics at UCT, and scientific and technological fields in genetics and genomics over the past few decades. This Foreword includes a message from Emeritus Prof. Stuart Saunders – former Head of Department (HoD) of Medicine at GSH in the 1970s when PB arrived at UCT – followed by some words from Emeritus Prof. J P van Niekerk, former Dean of the UCT Faculty of Health Sciences in the 1980s. Profs Greenberg, Bryer and Stephen conclude the Foreword, while Prof. Hayden introduces the legacy that Prof. Beighton has passed on.

No limbits! The feasibility of providing low-cost 3D printed below elbow and below knee limb replacements in a resource limited setting

Background: South Africa faces the challenge of producing large numbers of prostheses each year. Three-dimensional (3D) printing was investigated as a potential method of efficiently providing prostheses.Objective: To evaluate the need for below-knee (BK) and below-elbow (BE) limb replacements at Groote Schuur Hospital; and to determine the feasibility of providing low-cost 3D printed limb replacements at Groote Schuur Hospital (GSH).Methods: We performed a literature review and conducted interviews with staff at the Amputation clinic. Information regarding the need for BE and BK prostheses, qualifying criteria, durability and cost of traditional prostheses, and manufacture times was collected. Communication with e-NABLE and a senior biomechanical engineer provided further information. We investigated the feasibility of producing a 3D printed prosthesis by printing and assembling a prosthetic hand.Results: 3D printing reduces the cost of a BE prosthesis by approximately 26.6% and shortens the manufacturing time; however, 3D printing technology is currently unable to provide adequate weight bearing BK prostheses and is not as cost efficient as traditional manufacturing techniques. Conclusion: It is feasible to provide 3D printed BE prostheses in a resource-limited setting; however, BK prostheses face design challenges and are more costly than those traditionally made.

Abstracts from The 12th Symposium of the International Neurotrauma Society February 1-4, 2016 Cape Town, South Africa.

Abstracts from The 12th Symposium of the International Neurotrauma Society February 1-4, 2016 Cape Town, South Africa.

Epidemiology of acute spinal cord injuries in the Groote Schuur Hospital Acute Spinal Cord Injury (GSH ASCI) Unit, Cape Town, South Africa, over the past 11 years.

Spinal cord injury (SCI) is devastating to both patient and society, with acute management and ongoing care being extremely expensive. Few epidemiological data are available on SCIs in South Africa (SA). To identify the epidemiological profile of SCI patients at Groote Schuur Hospital (GSH), Cape Town, SA, and identify seasonal trends and peak periods. As the majority of the injuries are preventable, these data are important to develop prevention strategies. A retrospective review of prospectively collected data was conducted on all patients admitted to the Acute Spinal Cord Injury (ASCI) Unit at GSH from 1 April 2003 to 31 March 2014. All cases registered on a prospectively maintained database were included in the study. The total number of patients admitted to the ASCI Unit was 2,042, with an average of 185 admissions per year. The male/female ratio was 5.25:1. The 21-30-year-old age category was the largest, comprising 33.5% of the patients. The most prevalent cause of injury was motor vehicle accidents (44.6%), followed by violence-related injuries (27.2%). Thirty-two point two per cent of patients needed ventilatory support, and 91.5% of mechanically ventilated patients were successfully weaned. December was the busiest month in the unit. In patients in whom neurological deficit was incomplete, the average motor function improvement was 16.0%. Data capturing and analysis of SCIs should be encouraged in SA to guide management and prevention strategies, and to optimise outcomes. This study establishes the ASCI Unit at GSH to be one of the key role players in acute SCI management in SA.

Outcome of patients with primary immune-complex type mesangiocapillary glomerulonephritis (MCGN) in Cape Town South Africa.

Background and AimMesangiocapillary glomerulonephritis (MCGN) is a common cause of chronic kidney disease in developing countries. Data on the renal outcome of patients with idiopathic MCGN is limited. The aim of this study is to investigate the outcome of patients with idiopathic MCGN presenting to the Groote Schuur Hospital (GSH) Renal Unit in Cape Town.Materials and MethodsA retrospective study of patients with idiopathic MCGN followed up at our clinic. Seventy-nine patients with no identifiable cause of MCGN were included for analysis. A composite renal outcome of persistent doubling of serum creatinine or end stage renal disease (ESRD) was used. Kaplan Meier survival and Cox regression analysis were used to assess survival and identify factors predicting the outcome.ResultsThe mean age at biopsy was 33.9±13.6 years and 41.8% were black. Mean duration of follow up was 13.5±18.8 months. Twenty-three patients (34.2%) reached the composite endpoint. Overall, median renal survival was 38.7±11.7 months (95% CI 15.7–61.8) with 2-year and 5-year renal survival of 61% and 40.3% respectively. No significant difference was found for renal survival between males and females, treatment or non-treatment with immunosuppression, presence or absence of crescents or histological type of MCGN (p>0.05). On univariate Cox-regression analysis, factors found to be associated with the outcome were the estimated glomerular filtration rate at biopsy (OR 0.97 [95%CI: 0.95–0.99], p<0.0001), black race (OR 3.03 [95%CI: 1.27–7.21], p = 0.012) and presence of interstitial fibrosis in the biopsy (OR 2.64 [95%CI: 1.07–6.48], p = 0.034). Age, systolic blood pressure and attaining complete or partial remission approached significant values with the endpoint.ConclusionsThe outcome of idiopathic MCGN in Cape Town is poor and requires further prospective studies to improve our understanding of this common disease.

Founders of pediatric pathology: Roc Kaschula.

Ronald Otto Christian Kaschula, known as Roc, is a man of Africa. He was born in the former Southern Rhodesia, now known as Zimbabwe, in 1935, the eldest of 5 children. His father was a farmer of Western Slav origin whose family immigrated to South Africa in 1858, and his mother was of Afrikaans origin. His parents married in Zimbabwe. He was raised on a farm in the Gutu District in central Zimbabwe. At the age of 5 Roc was homeschooled by his mother for the 1st year. At the age of 6 he went as a boarder to the nearest farm school, which was called the Soti Source Primary School. This was during World War II, when there was a shortage of petrol. In order to conserve petrol the fathers from his area would take turns fetching the 6 local children home 3 times a year for the school holidays. Roc has memories of traveling in his father’s pick-up truck with the other boys; on other occasions he came home in a horse and mule– drawn cart belonging to one of the other fathers. After 4 years at the farm school he was sent as a boarder to schools in Gwelo—the Cecil John Rhodes Primary School, followed by the Chaplin School. Although unknown to him at that time, he watched his future wife play hockey for Girls’ High School, when she traveled with her team from Salisbury to play against Chaplin School farther to the south. Roc developed rheumatic fever and schistosomiasis as a child. His ill health brought him into contact with the family general practitioner, Dr McGladdery, from Ireland, who realized his potential and encouraged the young Roc to spread his wings and study medicine in Cape Town, South Africa. In order to do this, he won a scholarship provided by the State Lottery and was assisted by a government loan. A medical classmate, J.P. van Niekerk, also a former Dean of the Medical Faculty at the University of Cape Town, remembers traveling down to Cape Town with Roc in his Simca car after the university vacation. The trip from Gwelo to Cape Town spanned 2000 km, and it took Roc 2 days to complete the journey. Roc appeared more serious than the rest of his class, but he had a wry sense of humor and was adventurous in a quiet and understated way. He played 2nd-league field hockey for the University of Cape Town Hockey Club, and once he qualified as a doctor, he played social tennis and squash. He was also interested in South African cricket and rugby. Roc completed his undergraduate training in 1959. As an intern, Roc spent 2 months of the following year at the Red Cross Children’s Hospital in the surgical wards. He was then advised to spend a year studying pathology prior to returning to Zimbabwe to work off his government loan. He planned to work for the well-known physician Michael Gelfand in Salisbury. However, after a year of pathology, his request to serve Zimbabwe was turned down, as the government medical service wanted medics with basic training in forensic pathology. He remained in Cape Town and completed his MMed in Pathology in 1964. In 1965, he joined the South African Society of Pathologists. The Red Cross Children’s Hospital opened its doors to patients in 1956, when Roc was a 3rd-year medical student. His future wife Sheila had also moved from Zimbabwe to Cape Town and was one of the 1st student nurses to work there as part of her training. The pathology department at Red Cross Children’s Hospital was opened in 1957 by Dave Mackenzie, who played a major role in establishing Roc as a pediatric pathologist. As a 1st-year registrar in pathology, Roc met a glamorous staff nurse, Sheila Darby, in the Urology Department at Groote Schuur Hospital (GSH). They both shared an upbringing in Zimbabwe. They married in 1963 and produced 3 healthy children. Sheila put her nursing career on hold to raise the family until the youngest child, Wendy, began school. She then started working part time at Red Cross Hospital with Professor Cyril Karabus. She took an oncology course in 1986 and spent the last 12 years of her career working in a gynecologic practice providing individually tailored chemotherapy for patients. She retired in 2003. Roc and Sheila’s 2 eldest children followed the family’s medical tradition and studied medicine in Cape Town. Roc’s son is an orthopedic *Corresponding author, e-mail: Helen.wainwright@uct.ac.za Pediatric and Developmental Pathology 17, 413–418, 2014

Abnormal cervical cytology requiring colposcopy among women under the age of 30 years in the Western Cape Province, South Africa

Background. Although cervical cancer is the second most common cancer among women in South Africa, the Department of Health’s current national screening policy only offers women a free cervical smear at 30, 40 and 50 years of age. Methods. Data on cervical smears were obtained from the computerised records of the Cytopathology Laboratory at Groote Schuur Hospital (GHS), Cape Town, for the years 2009 and 2010. Total and age-specific prevalences of women who had undergone cervical smear screening were calculated. Results. Of a total of 108 542 cervical smears processed at GHS, 21% were cervical smears taken from women under 30 years of age; 3 080 women were referred for colposcopy at GSH, and 19% of these women were under 30 years of age. Conclusion. These results suggest that ‘first-time’ screening at 30 years could be too late for many young women with invasive or micro-invasive cancer.

The burden of imported malaria in Cape Town, South Africa.

The Western Cape Province of South Africa (SA) is not malaria endemic; however, a considerable number of patients present with malaria to our healthcare services. To establish the frequency of patients presenting with malaria at Groote Schuur Hospital (GSH), Cape Town, SA, and to describe their demographics, clinical outcomes and laboratory findings. An observational, retrospective, descriptive study was conducted, which included all patients presenting with smear-positive malaria to GSH over a 4-year period between 1 April 2008 and 31 March 2012. During the study period, 134 malaria patients presented to GSH for management; 85% (n=114) were male, median age was 27 years. Of the total smear-positive tests, 96% (n=128) were Plasmodium falciparum, 3% (n=4) P. ovale, and in 1% (n=2) the species was not identified. The number of malaria patients increased markedly, from 6 cases in 2008 to 50 cases in 2012. Of the patients, 48.3% (n=57) were from Somalia, 8.5% (n=10) from SA and 29% (n=30) from other African countries. One SA patient acquired transfusion-transmitted malaria from a pooled platelet product, and the other SA patients had travelled to malaria-endemic areas. The remaining cases were from countries outside of Africa, including 13% (n=15) from Bangladesh. Almost two-thirds (62%; n=72) were admitted to hospital with a median length of stay of 3 days (range 1 - 32). Clinical outcomes were good with only one death and the remaining patients being discharged. Imported malaria is imposing a significant burden on health resources. The costs of medical care for the emergency treatment of foreign nationals needs to be recognised, and adequately budgeted for.

High prevalence of cisplatin-induced ototoxicity in Cape Town, South Africa.

Cisplatin is administered as the first-line treatment of soft-tissue cancers. It has a reported cure rate of up to 85%, but is associated with a high incidence of ototoxicity, characterised by irreversible bilateral hearing loss and affecting 23 - 50% of adults who receive the drug. To determine the incidence of cisplatin-induced ototoxicity at Groote Schuur Hospital (GSH), Cape Town, South Africa. retrospective cross-sectional study of cisplatin-receiving cancer patients attending GSH between January 2006 and August 2011. A total of 377 patients were recorded as receiving cisplatin therapy during the study period. A 300% increase in new cisplatin-receiving patients receiving audiological monitoring was observed between 2006 and 2010. However, only patients with all clinical data as well as baseline and follow-up audiometric analyses were investigated. One hundred and seven such patients were identified, 55.1% of whom developed cisplatin-induced ototoxicity while receiving high-dose (> or = 60 mg/m2) cisplatin treatment. Higher cumulative cisplatin dosages were associated with development of significant hearing loss (p = 0.027). The odds of developing cisplatin-induced hearing loss were elevated for patients with head and neck tumours and lymphoma (p = 0.0465 and p = 0.0563, respectively) and were significantly lower for those with reproductive cancers (p = 0.0371). Comprehensive audiological monitoring should be available for every patient during cisplatin treatment to minimise the development of disabling hearing loss.

Resource implications of adopting a restrictive neonatal blood transfusion policy

Blood transfusions (BTFs) are not without risk and pose a significant financial burden on resource-limited services. In line with current international evidence, the nursery at Groote Schuur Hospital (GSH), Cape Town, South Africa, introduced a restrictive BTF protocol to minimise transfusions and manage costs. To determine whether adopting a restrictive BTF policy results in fewer transfusions. Data were retrospectively collected on all infants who received BTFs in the GSH nursery over a 6-month period following adoption of a restrictive BTF policy in 2010. BTF figures for a similar time period before the restrictive policy, during 2008, were obtained for comparison. After introduction of the restrictive BTF policy, 42 of 1 097 infants admitted (3.8%) received a total of 64 BTFs. In comparison, 102 of a total of 940 infants (10.9%) admitted during a period of the same length before introduction of the restrictive BTF policy received a total of 121 transfusions. Comparison between the number of BTFs administered before and after the restrictive policy showed a highly statistically significant difference (p<0.001). The total cost of the blood products used in the two 6-month periods was R91 870 v. R48 640, based on current prices. By adopting a restrictive policy, we were able to halve the number of BTFs, reduce risks associated with transfusions, and achieve significant cost benefits. Following evidence-based guidelines results in high standards of care, while also making the most effective use of resources.

Open globe injuries in patients seen at Groote Schuur Hospital, Cape Town, South Africa

Ocular trauma accounts for a significant proportion of admissions to the eye ward at Groote Schuur Hospital (GSH), Cape Town, South Africa. There are few published studies on ocular trauma in South Africa. Some studies elsewhere have shown an association between open globe injuries and recent alcohol use, but no such study has been conducted in this country. To identify causes of and outcomes after open globe injuries at GSH, with emphasis on the association between assault and alcohol use as well as the relationship, if any, between victim and assailant. This was a prospective case series of all adult patients admitted to GSH with open globe injuries over a 2-year period. Ocular findings were recorded with a minimum 3-month follow-up period. There were 249 open globe injuries. Assault had occurred in 183 (73.5%), and 66 (26.5%) were accidental. In the assault-related cases, 95 (51.9%) of the assailants were reported to have used alcohol and 121 (66.1%) of the victims admitted to alcohol use prior to the assault. There was a statistically significant relationship between ethanol use and type of injury, 71.4% of assault cases overall being associated with ethanol use. In assault-related cases, the assailant was known to the victim in 113 cases (61.7%). Of the patients, 78.7% had a final acuity of <3/60 in the traumatised eye. A significant number of open globe injuries due to assault are related to ethanol abuse and occur when the victim and assailant are known to each other. Such injuries are likely to have a poor prognosis.

Growth Velocity of Extremely Low Birth Weight Preterms at a Tertiary Neonatal Unit in South Africa

There is wide variation in the feeding practices of extreme low birth weight (ELBW) preterms often guided by tradition and resources. The feeding regimen at Groote Schuur Hospital (GSH) nursery, a tertiary neonatal unit, follows a restricted use of parenteral nutrition and concentrates on early introduction of breast milk. There is a need to determine whether this approach achieves acceptable growth velocity. This study aims to describe the growth velocity of ELBW babies at GSH. This was a retrospective cohort study. Infant hospital records of all ELBW babies born at GSH from 1 March to 31 August 2010 were accessed from a previously collected database and relevant data extracted. Growth data were collected from birth to 8 weeks postnatal age or discharge, whichever came first. Ninety-one ELBW babies were born during the study period. Forty were excluded from the study. Thirty died before discharge, and 10 were excluded for other reasons. The mean (SD) gestation of the cohort was 28.5 (1.6) weeks, and the median (range) birth weight was 875 (640-995) g. The overall mean (SD) growth velocity was 14 (2.9) g/kg/day. There was no statistically significant association between the growth velocity and the type of feed given, days to establishing full enteral feeds, time to regaining birth weight, HIV exposure status, intra-uterine growth restriction or exposure to antenatal steroids. In our cohort of ELBW infants, growth velocity was within the range currently deemed acceptable by international consensus.

Twelve-month outcomes of patients admitted to the acute general medical service at Groote Schuur Hospital

Hospitalisation for medical illness has ongoing impact on individuals, healthcare services and society beyond discharge. This study's objective was to determine the 12-month mortality and functional outcomes of patients admitted to the acute medical service at Groote Schuur Hospital (GSH). Follow-up, using the hospital records system and provincial death registry, together with telephonic interviews or home visits, was attempted for 465 medical inpatients admitted to GSH between 14 September and 16 November 2009. Functional outcomes were assessed using the Katz activities of daily living (ADL) score and Barthel index (BI). Outcome measures. The major study outcomes included: 12-month mortality (overall and unexpected), changes in functional status and pre- and post-admission employment rates. Inpatient mortality was 11%. At 12-month follow-up, 35% (145/415) were deceased and 30% (125/415) could not be traced; 38% (55/145) of deaths were considered expected and unexpected mortality was associated with age >40 years (p=0.02) and an admission urea >7.0 mmol/l (p=0.004). Katz ADL deteriorated in 15% (21/143) of interviewed patients and was associated with age >50 years (p=0.005); 23% (33/143) had improved Katz ADL associated with admission human immunodeficiency virus (HIV) (p=0.01), tuberculosis (TB) infection (p=0.05) and sepsis (p=0.02). Employment rates declined from 41% (59/145) pre-admission to 18% (26/145) at 12 months (p<0.001), with little increase in the number of persons receiving disability grants. Twenty per cent (29/145) of patients required hospital readmission and this was associated with ADL functional decline (p=0.01). There was a very high overall mortality of 42% in patients admitted to the general medical wards. Significant employment decline and readmission rates highlight the additional economic and societal burdens of hospitalisation due to medical illness in the survivors.

The role of the Infectious Diseases unit at Groote Schuur Hospital in addressing South Africa’s greatest burden of disease

The greatest burden of disease in South Africa (SA) comes from infectious diseases (ID), with human immunodeficiency virus (HIV) and tuberculosis (TB) dominating the health landscape. However, other infections including community-acquired and imported infections and the rise in hospital-acquired infections pose a considerable threat to public health. We used a prospective cross-sectional study to examine the profile of patients referred to the Infectious Diseases Unit at Groote Schuur Hospital (GSH) between 2008 and 2011. A total of 2 142 patient consultations were performed, the majority at the request of secondary hospital level medical teams; 80% of patients were HIV-infected (with a median CD4 count of 128/mm3). Approximately half of antiretroviral-naïve, HIV-infected patients started antiretroviral therapy in hospital. TB, predominantly extrapulmonary, was the most common diagnosis. Imported infections, notably severe falciparum malaria, accounted for a large number of the 81 different diagnoses in HIV-seronegative patients. Over half of all patients had co-morbidity complicating their clinical presentation. In-hospital mortality was 5.8%, with overwhelming sepsis the cause in 40% of deaths, largely due to hospital-acquired infection, particularly in the HIV-infected cohort. The overwhelming burden of ID in SA is revealed in this experience at GSH, a tertiary level referral hospital serving the Cape metropolitan area. The needs of the population warrant a reappraisal of human resource capacity and training in ID in SA.

UCT’s Medical Faculty and Groote Schuur Hospital

A relationship has existed between the University of Cape Town's Medical Faculty (MF) and Groote Schuur Hospital (GSH) since the MF was established in 1912. However, this was not formalised until the first Joint Staff Agreement was signed in 1951. This close and rewarding association achieved outstanding results and produced significant benefits for both institutions over many years, despite intermittent problems and disputes. More recently, difficulties have been experienced, but it is hoped that these will be overcome.

Anne Digby and Howard Phillips, with Harriet Deacon and Kirsten Thomson, At the Heart of Healing: Groote Schuur Hospital, 1938–2008 (Auckland Park, South Africa: Jacana Media, 2008), pp. xxxii + 398, R250.00, hardback, ISBN: 978-1-77009-642-4.

This seventieth anniversary volume on Groote Schuur Hospital (GSH) in Cape Town, South Africa, is a significant contribution to the country’s medical historiography. It is an analytical account of the world’s first heart transplant institution framed within wider social, financial and political perspectives, and is a contrast to the usual ‘histoire evenementielle’ of health institutions in Southern Africa. Part One gives an overview of the institution, from its protracted birth between the 1910s and the 1930s, to the challenges and changes of the late 1980s to 2000s. Those involved in the hospital experienced many stages of enthusiasm and doubt, as well as changes of vision, structures and practices. This detailed work traces the empirical development of services and the GSH’s management; the second part deals with racial segregation, often seen as South Africa’s main disease, which affected the daily life and work of people involved in the hospital. The authors recall that racial segregation was planned and applied long before the apartheid policy that followed the Afrikaner National Party’s victory in 1948, was made official. From the start, the hospital’s architecture was that of a typical South African public institution, with whites entering through one entrance, and Indians and Africans through another. By becoming a racially integrated institution in 1987, the new GSH took an early step towards curing the racial disease a few years before October 1990, when racial segregation in public hospitals in South Africa was officially brought to an end. The third part, entitled ‘People’, studies the GSH’s well-established teams of doctors, matrons and sisters, as well as those who were still finding their way professionally: dieticians, physiotherapists and occupational therapists. The role that all these people played in the growth of GSH was extremely important, and is examined through the experiences both of the general workers and of the patients. Thus, this book stresses the ‘history from below’ perspective favoured by Roy Porter and Barry Smith. In indicating that the nurses perceived the matron as close to ‘God himself’, and the sisters as close to the Angel Gabriel, the book successfully raises a complex anthropology of relationships between staff within GSH. The relationships between patients were equally complicated. Nostalgic for the privileges afforded by segregation, white patients disliked being squeezed ‘tightly among all colours and odours’ (pp. 115–16), when they had to wait together with non-white patients, and their complaints confirm the complexity of perceptions and consideration of the ‘Other’. The fourth part of the book examines the development of two significant tools used at GSH: clinical medicine and research, which between 1955 and 1985 became the hospital’s strengths. While very analytical, the work is at times too detailed and repetitive, and there is a certain imbalance between the parts, with Part One running to a hundred pages, and Part Two to only thirty-one. An additional annoyance is the awkwardness of having the references at the end of the book, rather than at the end of chapters. But these are small quibbles, and this new history of Groote Schuur Hospital is a timely and fascinating work. It features the medical progress and challenges in a particular context in Africa, and proves that, as a social and biomedical institution, the hospital is a microcosm of society. The book’s main significance, however, is that it challenges a particular way of writing the history of hospitals and medicine in Africa.

The UCT Department of Medicine at 90 years: Continuity and Change

To the Editor : The Department of Medicine at the University of Cape Town (UCT) has recently celebrated 90 years of its existence. The first Professor of Medicine, Professor A W 'Oubaas' Falconer, from Aberdeen, Scotland, established the then Division of Medicine at the new UCT Medical School in February 1920. He contributed greatly to the establishment of clinical teaching, then at Somerset Hospital. In 1938 Groote Schuur Hospital (GSH) opened, at which time Falconer retired as Professor of Medicine to become Vice-Chancellor and Principal of UCT.

Chemoradiation in Advanced Vulval Carcinoma

Vulval carcinoma is uncommon, affecting approximately 2 per 100,000 women annually. The treatment of choice is radical vulvectomy and inguinal lymph node dissection. Advanced vulval carcinomas involve midline structures (such as clitoris, urethra, or anus) and/or adjacent pelvic organs or bone, and adequate excision may require urinary diversion, colostomy, or pelvic exenteration. Less morbid and less mutilating therapeutic alternatives have been investigated, particularly chemoradiation, which has shown success in the management of anal carcinomas. Chemoradiation has been used, instead of primary radical surgery, to treat advanced vulval carcinomas at Groote Schuur Hospital (GSH) since 1982. This is a retrospective study of the GSH's experience of the use of chemoradiation as primary therapy for women with advanced vulval carcinoma. Data from patients' medical records were transcribed onto a standardized pro forma, computerized, and analyzed. Between 1982 and 2001, 50 women with advanced vulval carcinomas were treated with chemoradiation at GSH. Fourteen women (28%) who had a complete response to chemoradiation had significantly improved survival compared with 29 (58%) who had a partial response (P = 0.000218). Partial responders who had surgery had significantly better survival than those who did not (P = 0.0064). Other prognostic factors for survival were performance status and tumor stage. Less than a third of the women treated with primary chemoradiation had a complete response. Survival was improved in women who responded partially but had residual disease surgically excised. Performance status, age, and tumor stage were also associated with survival.

The clinical characteristics and outcomes of patients with lone atrial fibrillation at Groote Schuur Hospital

Atrial fibrillation (AF) is a common arrhythmia and is often difficult to manage. The classical risk factors for AF include hypertension, valvular disease, thyroid disease, cardiomyopathies, including ischaemic cardiomyopathies. When AF represents an electrophysiological phenomenon in structurally normal hearts it is termed lone AF. There are currently no studies to describe the clinical characteristics and outcomes of patients with lone AF in Africa. This study's purpose is to describe the clinical characteristics and outcomes of Lone AF patients attending Groote Schuur Hospital (GSH).

Psychiatric emergency service users at Groote Schuur Hospital, Cape Town

Objective. To document and compare the characteristics of patients assessed at a psychiatric emergency service (PES) during April and May of 1988 and 1998.Design. Two cross-sectional surveys.Setting. Groote Schuur Hospital (GSH), Cape Town.Subjects. Patients assessed at the PES, GSH.Outcome measures. These were occupational status, referral source, distance travelled to get to the hospital, and diagnosis.Results. Nine hundred and twenty-five patients made 1 081 visits to the unit during a 2-month period in 1988, while during a similar period in 1998, 364 patients made 477 visits. In the latter period the patients were significantly more likely to be skilled workers or students/scholars, to be referred from within GSH or other health facilities, to have travelled less than 10 km to get to the hospital, and to be suffering from a mood disorder or suicidality (and less likely to be suffering from a substance use disorder).Conclusions. The differences between the two time periods indicate that changes in policy during the period 1988 - 1998 may have impacted on the patient profile at the PES at GSH. It is important to document such changes with a view to informing service planning for both tertiary referral centres and other levels of care.