The place and the person: named buildings, rooms and places on the campus of the Faculty of Health Sciences, University of Cape Town.

The University of Cape Town Faculty of Health Sciences, in its hundredth year, carries a strong current of its development in the inscriptions on its pediments, doorways and notice boards. These names describe the Faculty in each of its stages of evolution, and evoke a rich history. The named look down from their portraits with pride at the passing students, the staff, and the flourishing Faculty.

Implications of anastomotic leakage after total gastrectomy for gastric carcinoma.

BACKGROUND/OBJECTIVES: Oesophagojejunal anastomotic leakage is a serious complication following total gastrectomy, and is reported to be decreasing in frequency. This study was an audit of the radiological and clinical frequency of such leakage and its consequences. METHODS: A retrospective (1983-2000) cohort study was undertaken in a tertiary institution where 175 patients had undergone a total gastrectomy for gastric carcinoma with oesophagojejunal reconstruction using a stapling device and a 50 cm J-loop. Anastomotic leakage was sought 3-9 days postoperatively using a Gastrograffin (diatrizoate meglumine) swallow. RESULTS: Leakage was demonstrated in 7 patients (4%), being subclinical in 2, minor in 4, and fatal in 1. There was no correlation between leakage and patient factors (age, medical risk, haemoglobin, albumin), surgical factors (surgical seniority, approach, reconstruction, splenectomy, lymph node dissection) or tumour factors (stage, nodes examined, and margin positivity). However, intraoperative difficulties or mishaps were recorded in most cases of leakage. Subclinical leakage was marked by an uneventful postoperative course, and low-volume enterocutaneous fistulas were self-limiting. One patient developed a subphrenic abscess that required drainage. One patient suffered an intrathoracic leak which proved fatal. CONCLUSIONS: Anastomotic leakage was an infrequent complication of total gastrectomy when using a stapling device and a 50 cm J-loop. It was related to intraoperative surgical difficulty and mishap rather than conventional patient and tumour factors. It was subclinical or self-limiting, if occurring in the abdomen, but fatal if in the chest.

Expression of gastric mucin in the stomachs of two patients with Menetrier's disease: an immunohistochemical study.

Menetrier's disease is a rare gastric condition characterized by marked proliferation of the mucosa and variable mucus secretion and achlorhydria. We report, for the first time, minor variations in MUC1-7 distribution in the mucosa of two stomachs from patients with Menetrier's disease, when compared with a normal stomach. All stomachs stained positively for MUC4, 5AC and 6 and showed no or little staining with MUC2 and 3. Thus, Menetrier's disease is characterized by an excess quantity of mucus secretion, but differs little from normal stomachs with regards to the types of mucin produced. The mucins, MUC1-7, are found with variable distribution in different body tissues; MUC4, MUC5AC and MUC6 are typically found in gastric mucosa.

A study of the patient factors affecting reconstruction after mastectomy for breast carcinoma.

Breast shape may be retained after surgery for breast cancer with either wide local excision (WLE) and radiotherapy or mastectomy (M) and immediate reconstruction (M+R). We determined the proportions of patients who would be suitable for these options, would accept them, and if they declined M+R their reasons for doing so. Over a 10-month period 177 women were assessed at a combined breast clinic by general and plastic surgeons and by radiation oncologists. A prospective record was made of the patient demographic data, the clinical decisions (and their reasons), and the patient choices (and their reasons). A transverse rectus abdominis myocutaneous flap was the commonest method of reconstruction. One hundred thirty-five (76%) were judged to be suitable for locoregional surgery. Of these M+R was offered to 83 patients, whereas 53 were not considered because of combinations of cosmetic considerations (31), risk factors (25), old age (13), and oncological factors (nine). Fifty-one of the 83 (61%) offered M+R declined it because they preferred a simpler procedure (34), regarded breast appearance as unimportant (15), preferred breast conservation (five), did not have a partner (three), felt that they were too old (two), or had religious reasons (two). Ultimately 69 (51%) underwent M, 34 (25%) WLE, and 32 (24%) M+R. There was no correlation between acceptance or not of M+R and age, race, employment, education level, or marital status. We conclude that many patients were suitable for M+R, but fewer than half accepted it; this decision was unrelated to age, race, employment, or marital status.

Extraction, isolation, and SDS-PAGE analysis of purified gastric mucin in a patient with Menetrier's disease.

Menetrier's disease is a rare condition characterized by marked proliferation of gastric mucosa with variable mucus secretion and achlorhydria. Although crude mucus secretion and gastric aspirates have been evaluated in this disease for output of dry matter, hexosamine, fucose, protein content, and transforming growth factor alpha activity, we report for the first time the isolation, purification, and gel electrophoresis of mucin from crude mucus scrapings. The fragmentation pattern of mucin in Menetrier's disease demonstrated less large polymeric mucin than the control. There was also a band of approximately 55-65 kd M, on polyacrylamide gel electrophoresis similar to that found in gastric carcinoma or peptic ulcer, but absent in the control specimens.