Papers by Eugenio Panieri
South African Journal of Surgery, 2003
Oesophagojejunal anastomotic leakage is a serious complication following total gastrectomy, and i... more 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. 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. 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 ...
South African Journal of Surgery, 2002
1. S Afr J Surg. 2002 Feb;40(1):3-4. Skin-sparing mastectomy--increasing the options of patients ... more 1. S Afr J Surg. 2002 Feb;40(1):3-4. Skin-sparing mastectomy--increasing the options of patients with breast cancer. Panieri E, Hudson DA. PMID: 12082965 [PubMed - indexed for MEDLINE]. Publication Types: Editorial. MeSH Terms: ...
licenses/by-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that... more licenses/by-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited. Received: 2011.10.13; Accepted: 2012.12.05; Published: 2012.02.09 Background and Aim: Secreted gastric mucins are large O-glycosylated proteins of crude mucus gels which are aberrantly expressed in malignancy. An albumin associated 55-65kDa glycoprotein was previously shown in mucus gels in gastric cancer. The aim of this study was to investigate its expression and identification in human gastric tissue. Methods: Mucins were purified from crude mucus scrapings of 16 partial and 11 total resections and a rabbit polyclonal antibody was raised to the 55-65kDa glycoprotein. The location and expression of the glycoprotein was examined in normal gastric mucosa (n=20), intestinal metaplasia (n=18) and gastric cancer (n=27) tissue by immunohistochemistry. Mucins were analyzed by isoelectric focusing (IEF) on 2-D polyacrylamide gels. Ident...
MNG refers to an enlarged thyroid gland with multiple nodules. Challenges specific to MNG include... more MNG refers to an enlarged thyroid gland with multiple nodules. Challenges specific to MNG include evaluating the patient, determining the risk of malignancy within the multiple nodules, selecting patients who require surgery, and planning an appropriate surgical approach to address the disease without undue risk of complications. MNG is generally presumed to be a response to oversecretion of Thyroid Stimulating Hormone (TSH). The thyroid hyperplasia is probably due to reduced production of thyroid hormones relative to the metabolic demand of the body. This can be due to a congenital or an acquired defect. Morphological and molecular studies suggest a degree of polyclonal aetiology. MNGs are sometimes familial and one study suggests linkage to a DNA mother as chromosome 14q 2.
CME: Your SA Journal of CPD, 2010
This edition of CME focusing on benign breast disease is long overdue - breast symptoms are commo... more This edition of CME focusing on benign breast disease is long overdue - breast symptoms are common, and when the dreaded carcinoma is excluded, all too often patients are left to fend for themselves, with little guidance about the management of the actual underlying concern or pathology.
The gland encircles the anterior and lateral aspects of the cervical trachea and is applied to th... more The gland encircles the anterior and lateral aspects of the cervical trachea and is applied to the surface of the larynx. Lateral to the gland are the carotid sheath (common carotid artery, internal jugular vein and vagus/Xn) and the sternocleidomastoid (SCM) muscle (Figures 1, 2). Anterior to the thyroid are the infrahyoid strap muscles (sternohyoid and sternothyroid) (Figure 3). The deep/medial anatomical relations are the thyroid (caudad to attachment of sternothyroid muscle to oblique line) and cricoid cartilages, trachea, inferior constrictor and cricothyroid muscles, oesophagus, superior and inferior thyroid arteries, and RLNs (Figures 3, 4, 5). Superior Laryngeal n (Internal)
International Journal of Surgery Case Reports
Annals of African Surgery
Background: There is limited data on the incidence and risk factors for developing postoperative ... more Background: There is limited data on the incidence and risk factors for developing postoperative hypoparathyroidism (POHP) in the South African setting. Objectives: This study aims to calculate the incidence of postoperative hypoparathyroidism in a South African tertiary setting, and to compare local risk factors for POHP to international published data. Methods: All patients who underwent a total or completion thyroidectomy at an academic referral center from January 2010 to December 2015 were included. Data reviewed included post-operative parathyroid hormone (iPTH) level, demographics, type of operation and lymphadenectomy, size of thyroid glands resected, final histology, extra capsular extension of carcinomas, number of lymph nodes resected, and the number of parathyroid excised. Results: Postoperatively, 29% of patients were diagnosed with hypoparathyroidism. Overall, there was no association between POHP and age or gender. In patients with
South African Journal of Oncology
Background: Desmoid tumours (DT) are rare soft tissue tumours that do not metastasise but are loc... more Background: Desmoid tumours (DT) are rare soft tissue tumours that do not metastasise but are locally aggressive. Management options are varied and the response to treatment can be unpredictable. Aim: The aim of this study was to describe the clinical presentation, management strategies and outcomes for adult patients who were treated for DT. Setting: The study was conducted at Groote Schuur Hospital in Cape Town, South Africa, and all patients from 2003 to 2016 who presented with DT were included. Method: This was a retrospective review of records. Data collected included: demographics, DT-associated conditions, site and size of tumour, histological findings, treatment modalities, follow-up and outcomes. Results: Seventy patients with histologically confirmed DT were identified. The majority were women (86%) and 77% presented with a painless mass. The commonest site was the anterior abdominal wall (47%). Definitive surgery was performed in 46 (66%) patients, whereas 13 (19%) had definitive radiotherapy. Nine patients received adjuvant radiotherapy postsurgery for involved or close margins. Recurrence developed in 20% of patients post-surgery. In the primary radiotherapy group, one patient had disease progression. Two patients with mesenteric DT died because of bowel obstruction. Conclusion: This retrospective review of patients affected by DT at a single centre demonstrates the rarity of the condition, the unpredictable natural history and the variety of treatment options available. Many of our findings are similar to other published studies, except the mean size of DT which was bigger. Treatment outcomes following surgery or radiotherapy seem acceptable, although study limitations are noted.
South African Journal of Oncology
Background: Breast-conserving therapy (BCT) is a wide local excision of the tumour usually follow... more Background: Breast-conserving therapy (BCT) is a wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer. There has not been a formal audit to review BCT outcomes in our unit.Objectives: To determine excision margins, re-excision and local recurrence rates.Methods: A histopathological and oncology records’ review of BCT patients from 01 January 2006 to 31 December 2010. The health faculty’s ethics committee granted approval. Data points accrued included age, histological tumour size, nodal status, tumour type, oestrogen receptor status, lymphovascular invasion, volume of specimen, margin status, management of involved or close margins, radiotherapy, ipsilateral breast recurrence rate and duration of follow-up.Results: A total of 192 patients had BCT. The mean age is 53 years. A median of 229.5 cm3 volume of specimen was excised. Infiltrating ductal carcinoma was the...
Journal of the American College of Surgeons
Cancer immunology, immunotherapy : CII, Jan 3, 2018
Breast cancer remains one of the leading causes of cancer-associated death worldwide. Conventiona... more Breast cancer remains one of the leading causes of cancer-associated death worldwide. Conventional treatment is associated with substantial toxicity and suboptimal efficacy. We, therefore, developed and evaluated the in vitro efficacy of an autologous dendritic cell (DC) vaccine to treat breast cancer. We recruited 12 female patients with stage 1, 2, or 3 breast cancer and matured their DCs with autologous tumour-specific lysate, a toll-like receptor (TLR)-3 and 7/8 agonist, and an interferon-containing cocktail. The efficacy of the vaccine was evaluated by its ability to elicit a cytotoxic T-lymphocyte response to autologous breast cancer cells in vitro. Matured DCs (≥ 60% upregulation of CD80, CD86, CD83, and CCR7) produced high levels of the Th1 effector cytokine, IL12-p70 (1.2 ng/ml; p < 0.0001), compared to DCs pulsed with tumour lysate, or matured with an interferon-containing cocktail alone. We further showed that matured DCs enhance antigen-specific CD8 + T-cell responses...
World Journal of Surgery
Despite the existence of multiple validated risk assessment and quality benchmarking tools in sur... more Despite the existence of multiple validated risk assessment and quality benchmarking tools in surgery, their utility outside of high-income countries is limited. We sought to derive, validate and apply a scoring system that is both (1) feasible, and (2) reliably predicts mortality in a middle-income country (MIC) context. A 5-step methodology was used: (1) development of a de novo surgical outcomes database modeled around the American College of Surgeons&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; National Surgical Quality Improvement Program (ACS-NSQIP) in South Africa (SA dataset), (2) use of the resultant data to identify all predictors of in-hospital death with more than 90% capture indicating feasibility of collection, (3) use these predictors to derive and validate an integer-based score that reliably predicts in-hospital death in the 2012 ACS-NSQIP, (4) apply the score in the original SA dataset and demonstrate its performance, (5) identify threshold cutoffs of the score to prompt action and drive quality improvement. Following step one-three above, the 13 point Codman&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s score was derived and validated on 211,737 and 109,079 patients, respectively, and includes: age 65 (1), partially or completely dependent functional status (1), preoperative transfusions ≥4 units (1), emergency operation (2), sepsis or septic shock (2) American Society of Anesthesia score ≥3 (3) and operative procedure (1-3). Application of the score to 373 patients in the SA dataset showed good discrimination and calibration to predict an in-hospital death. A Codman Score of 8 is an optimal cutoff point for defining expected and unexpected deaths. We have designed a novel risk prediction score specific for a MIC context. The Codman Score can prove useful for both (1) preoperative decision-making and (2) benchmarking the quality of surgical care in MIC&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s.
Therapeutic Advances in Medical Oncology
Sarcomas are a heterogeneous group of neoplasms of mesenchymal origin. Approximately 80% arise fr... more Sarcomas are a heterogeneous group of neoplasms of mesenchymal origin. Approximately 80% arise from soft tissue and 20% originate from bone. To date more than 100 sarcoma subtypes have been identified and they vary in molecular characteristics, pathology, clinical presentation and response to treatment. While sarcomas represent <1% of adult cancers, they account for approximately 21% of paediatric malignancies and thus pose some of the greatest risks of mortality and morbidity in children and young adults. Metastases occur in one-third of all patients and approximately 10–20% of sarcomas recur locally. Surgery in combination with preoperative and postoperative therapies is the primary treatment for localized sarcoma tumours and is the most promising curative possibility. Metastasized sarcomas, on the other hand, are treated primarily with single-agent or combination chemotherapy, but this rarely leads to a complete and robust response and often becomes a palliative form of treatm...
Brachytherapy, 2017
A 23-year-old lady had an incompletely excised perianal sarcoma. Brachytherapy as the sole treatm... more A 23-year-old lady had an incompletely excised perianal sarcoma. Brachytherapy as the sole treatment, rather than further surgery or external beam radiotherapy, was considered to be the best option with the least morbidity. Although brachytherapy techniques with iridium-192 for anal and rectal carcinoma are well described using a perianal template, the size of the template was not suitable for a two-plane implant that needed to be in situ for about 4 days. An anal canal applicator was designed, which carried three templates about 15 mm apart inside it, to ensure accurate alignment of the tubes, and an inferior template that was 90 mm from the perianal skin. Three inner and three outer tubes of iodine-125 seeds were designed to treat a 2 o&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;clock h wedge of perianal tissue as a temporary implant. A thin metal shield was placed around a hole to protect the uninvolved anal canal. The tubes were inserted under general anesthetic and delivered a dose of 59 Gy at 0.8 Gy/h over 75 h. A spinal anesthetic was maintained for the duration of the insertion. The treatment was well tolerated, and the patient is well and clear of disease 6 years later with minimal morbidity. Iodine-125 is a low-energy isotope, readily available in our unit, that can be easily screened to reduce morbidity to surrounding normal tissues. In the form of seeds, it provides a flexible system that can be adapted to different tumor sites as required, as illustrated in this case.
Journal of Surgical Research, 2016
Background: Surgical outcomes research is limited in areas of the world with the greatest unmet s... more Background: Surgical outcomes research is limited in areas of the world with the greatest unmet surgical need and likely greatest variation in outcomes. Measurement alone may improve outcomes-the so-called Hawthorne effect. The purpose of this multi-center cohort study was to identify factors that are both feasible to collect and are associated with a major adverse event following a targeted procedure in Cape Town, South Africa. Methods: A collaborative of four acute care surgical units was formed to develop a dataset with minimal data burden describing outcomes following an emergency exploratory laparotomy during a 3-month period (February-April 2015). Controlling for patient, problem, provider, procedure and process predictors, multivariate models were built to identify risk factors for a major adverse event and higher resource use following surgery in our collaborative. Results: The outcomes of 450 exploratory laparotomies from the four participating hospitals were audited, 319 (70.9%) were for non-trauma and 131 (29.1%) were for trauma. The major adverse event rate was 15.7% (95% CI 12.6-19.4). In the multivariate analysis, factors associated with the primary outcome included age, American Society of Anesthesia score of greater than 2, bowel resection, pre-operative CT scan and a non-therapeutic laparotomy. A major adverse event was associated with all three outcomes assessing increased resource utilisation. Conclusion: This study supports the comparative outcome assessment of a high volume or high risk procedure as a proxy for measuring the quality of care provided in a surgical collaborative. Such an exercise can identify opportunities for quality improvement. Auditing the outcomes of all operations at a hospital is difficult. Choosing one or two operations as proxies for the quality of all surgical care provided has been recently proposed [1]. We chose to study Emergency Laparotomy, (EL) recently declared by the The Lancet Commission on Global Surgery to be a, 'Bellwether procedure', or one that all district hospitals should be able to provide safely [9]. Specifically, we aimed to identify factors that are both feasible to collect and are associated with a major adverse event after emergency laparotomy in Cape Town, South Africa. We hypothesized that a major adverse event was further associated with increased resource utilisation.
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Papers by Eugenio Panieri