Management of sigmoid volvulus in Polokwane-Mankweng Hospital.

OBJECTIVE: To evaluate the outcome of treatment of patients with sigmoid volvulus in the Polokwane-Mankweng Hospital and to identify the best management options for these patients. METHODS: A retrospective study was undertaken of 85 patients with sigmoid volvulus treated in Polokwane-Mankweng Hospital during the period July 1997-May 2004. RESULTS: In total, 85 patients were evaluated (77 males and 8 females, male/female ratio 9:1). The age range was 7-80 years (mean 42 years). Sigmoidoscopic derotation was attempted in 17 patients, and was successful in 10 patients. Laparotomy was done in 84 patients, viz. 75 emergencies and 9 electives. During laparotomy, gangrenous sigmoid colon was found in 30 patients and viable sigmoid in 54 patients. Resection with primary anastomosis was done in 44 patients. Hartmann's procedure was performed in 33 patients. Sigmoidopexy was done in 7 patients. Total hospital mortality was 6% (5 deaths). Mortality in the 84 operated cases was 5% (4 deaths). CONCLUSIONS: There was no mortality in patients undergoing elective resection and primary anastomosis after successful preoperative deflation and in patients with viable sigmoid volvulus who underwent an emergency Hartmann's procedure. There was low mortality in those patients with resection and primary anastomosis on viable sigmoid (3%, 1:39). The highest mortality (1:5) occurred in cases of resection and primary anastomosis of gangrenous sigmoid colon.

Human keratinocyte stem cells survive for months in sodium chloride and can be successfully transplanted.

Human skin fragments can be preserved in anhydric sodium chloride at room temperature for periods of weeks or months and successfully transplanted, retaining normal morphological structure. Skin fragments of 10 x 10 x 6 mm were harvested during elective vascular and orthopedic surgery of lower limbs, dried of blood, and placed in anhydric sodium chloride powder in tightly sealed containers. Prior to transplantation to scid mice, the specimens were desalinated and rehydrated. Specimens preserved for 1-6 months and harvested 3-4 weeks after transplantation revealed intensive incorporation of bromdeoxyuridine (BdUR) into basal keratinocytes (stem cells). They expressed p63 and CD29 (stem cells and transient cells antigens), proliferating cell nuclear antigen (PCNA), and cytokeratin 16 specific for proliferating keratinocytes. We conclude that human epidermal stem cells can survive in a dehydrated state in sodium chloride for months and after transplantation give rise to keratinocyte progenies. Skin fibroblasts and some resident immune cells can also survive.