3. Electronic Theses and Dissertations (ETDs) - All submissions

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    An audit of the spectrum of male breast pathology imaged at CMJAH Breast Imaging Department
    (2020) Murfin, Tarryn-Lee
    Background: Breast pathology awareness is generally a characteristic of the female population due to greater incidence of malignant disease and the implications of morbidity and mortality. Male breast pathology receives less attention, although referrals of men to Breast Imaging units are increasing. In lower-middle income countries such as South Africa, a higher rate of HIV disease and growing number of men receiving HAART, an identifiable risk factor for male breast disease, is present. Clinical, mammographic and ultrasonographic review of male breast disease is of increasing importance, to assess both hospital prevalence and spectrum of disease. Objectives: The primary objective is to evaluate both the prevalence and spectrum of male breast disease referred to a tertiary Breast Imaging Unit. The secondary objective is to identify aetiological risk factors for different male breast diseases . Methods: This is a descriptive retrospective cross sectional audit of males presenting to the Breast imaging unit at Charlotte Maxeke Johannesburg Academic Hospital, South Africa, over the 3 year period (1st January 2016 to 31st December 2018). Both Imaging, histology, MC&S and serology were documented for retrospective statistical analysis. Results: The study group consisted of 261 of which the mean age was 46 years (range 13 -83). Benign breast disease with gynaecomastia predominating (85.44%), infectious diseases (2.29%) and miscellaneous group of benign disease (5.37%). Malignant disease of the breast (5.3%) or adjacent tissue (1.4%) accounted for a total of 6.9% of cases. Male breast cancer has similar histopathology and molecular subtype in comparison to Female breast cancer in recent reports. In young and middle age South African men, gynaecomastia is most frequently associated with HIV where in this study 35% of the patients were seropositive. Further investigation of viral load and CD4 counts were infrequently performed. In the elderly men with gynaecomastia, obesity, diabetes and liver disease were not infrequent co-morbidities. However, liver function and endocrine tests were rarely done. Scrotal ultrasonography is mandatory in adolescent boys to exclude both oestrogen-producing tumours and varicoceles. Conclusions: In this retrospective audit of 261 men referred to a tertiary Breast Imaging Unit, there was a wide spectrum of benign and malignant disease. However, the finding that 5.4% of men had male breast cancer was unexpected. This highlights the importance of histological biopsy of any radiologically suspicious pathology. The 34,87% (91/261) HIV seropositive subgroup of male patients displayed similar spectrum and distribution of both benign and malignant male breast disease, as that of their HIV seronegative and non-tested majority within this study group. Consistent HIV serological testing is required as the patients did not reflect that they originate from a high HIV positive referral population group. This would allow for both HIV seropositivity and HAART regimes effects on male breast disease to be better evaluated and concluded upon. This review audit highlights the necessity for multidisciplinary team follow-up and audits, as a critical part of approach and management of both benign and malignant male breast disease. It’s imperative that patients are counseled to highlight the importance of their diagnosis, implications of treatment and the need to attend follow-up appointments. Where short falls are noted, a reviewed protocol orientated towards better approach and management plans is required to maximize the efficacy of a multidisciplinary team in Clinical Male breast disease overall.
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    Body iron excretion
    (1975-05-19) Green, Ralph
    An attempt was made to document iron losses from the body as a whole, as well as from individual excretory routes using a combination of radioisotopic and chemical techniques. The purpose of this work was to gain a better understanding of external body exchange, and to resolve some of the existing controversies regarding the magnitude of daily iron losses. The basis for this controversy is extensively reviewed in the thesis
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    Determining the validity of the mycobacterium polymerase chain reaction assay in histological samples showing granulomatous inflammation with a negative ziehl-neelsen stain
    (2016-11-04) Lakhoo, Deepna Govind
    Background: Mycobacterium tuberculosis (Mtb) poses a major global health problem. According to the World Health Organization, South Africa is a country with one of the highest reported incidence rates of this disease. Key to overcoming this preventable and treatable disease lies in establishing a reliable and rapid diagnostic approach. Aims and Objectives: This study aims to investigate the validity of the mycobacterium polymerase chain reaction (PCR) assay applied to formalin-fixed, paraffin-embedded tissue in which the histology showed granulomatous inflammation with no demonstrable acid-fast bacilli. Methods: A retrospective, cross sectional and non-interventional study was conducted on 121 histopathology cases showing granulomatous inflammation with a negative Ziehl-Neelsen (ZN) stain. The mycobacterium PCR results obtained in these cases were compared against the results of mycobacterium culture obtained from a specimen derived from the same or related site as the biopsy. Results: The mean age of the study population was 35.3 years and the study cohort included 63 males and 58 females. The sensitivity of nested mycobacterium PCR (detecting the 133 base pair product of the heat shock protein 65 kilo Dalton gene), was 64.1% and the specificity was 68.2%. The positive and negative predictive values were 49% and 80% respectively. Twenty six of the 121 cases studied had a false positive result (21.5%). CONCLUSION: There are many factors that may influence the result of a PCR assay and the interpretation thereof. Some of these factors include the inability of the test to distinguish between live and dead bacilli, the high risk of carry over contamination, and the paucibacillary nature of certain samples with an unequal distribution of the few bacilli that may be present. Although the sensitivity and specificity of mycobacterium PCR on paucibacillary, formalin-fixed, paraffin embedded tissue is suboptimal, the interpretation of these results must be performed in conjunction with the overall clinical presentation of the patient.
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    The role of nucleophosmin fusion sequences in the oncogenic activation of the (2;5) translocation protein, nucleophosmin-anaplastic lymphoma kinase (NPM-ALK)
    (1996) Bischof, Daniela
    The NPM-ALK fusion gene, formed by the t(2;5)(p23;q35) in non-Hodgkin's lymphoma encodes a 75kDa hybrid protein that contains the amino-terminal 118 amino acid residues of the nucleolar phosphoprotein nucleophosmin (NPM) joined to the entire cytoptasmic portion of the receptor tyrosine kinase, anaplastic lymphoma kinase (ALK). The transforming ability of NPM-ALK is demonstrated and it is shown that oncogenesis by the chimaeric protein requires the activation of its kinase function as a result of oligomerisation mediated by the NPM segment. [Abbreviated Abstract. Open document to view full version]
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