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Biomedical subjects

E J Coetzee

Publications and source records attributed to E J Coetzee.

32 records · Page 2Linked to original sources
PubMed1980

Intra-uterine growth in infants of diabetic mothers.

The birth weight, length, head circumference and body proportions of infants born to women with well-controlled diabetes were compared with those of infants born to poorly controlled diabetics. The latter infants were significantly heavier, with a greater weight/length ratio and a smaller head circumference/weight ratio, while their length, and head circumference/length ratio were appropriate for age. The size and body proportions of infants born to well-controlled diabetics were normal. Hairiness of the pinna was observed in infants born to both well- and poorly controlled diabetics, and may prove to be a useful clinical sign in identifying the infant of a diabetic mother.

Anthropometry↗
PubMed1980

Laparoscopic sterilization on a day-case basis.

A prospective series of 307 patients who underwent laparoscopic sterilization on a day-case basis is presented. Of these, 196 patients attended for the 6-month and 117 for the 1-year follow-up visit. There were 5 Blacks, 197 Coloureds and 105 Whites. Sterilization was done by means of tubal cauterization (137), Hulka-Clemens clips (34) and Falope rings (136). Although 18% of patients were under 30 years old, 16% were 40 years of age or older. A marked tendency to low parity was evident, 43% of Coloureds and 90% of Whites being para 3 or less. The main operative problem was uterine perforation. Of the patients 17% were not discharged on the day of operation. By the 5th postoperative day 86% had returned to normal working activities. Significantly more postoperative abdominal pain was reported in the clip and ring groups. Seven pregnancies occurred in the series, 6 after tubal cauterization and 1 after the application of Falope rings. On patient was probably pregnant at the time of the operation. Most patients reported no change in libido at the 1-year follow-up visit, and in 20% libido was increased Mild pelvic infection was the only significant finding at the 6-month and 1-year follow-up visits. Apart from the disturbingly high pregnancy rate and the relatively large number of patients who were not discharged on the day of operaton, the sterilization programme has been most acceptable.

Adult↗
PubMed1980

Ketonuria in pregnancy--with special reference to calorie-restricted food intake in obese diabetics.

Early morning ketonuria, as judged by Ketostix testing, occurred in 19% of urine samples from insulin-independent diabetic pregnant women eating 1000 calorie diets, in 14% from diabetics on higher calorie diets, and in 7% of urines from nondiabetic pregnant women. Ketostix test was never found to be positive in blood, even when it was 2+ in urine samples, and acetoacetate levels were always below 1 mmol/L. Enzymatic estimations of acetoacetate (AA) and beta-hydroxybutyrate (BB) in urine and plasma samples revealed (1) no significant differences in range or mean between the groups receiving different restricted diets or full diets, the highest value observed for plasma AA being 0.34 mmol/L; (2) that Ketostix became positive at a concentration of AA above 1 mmol/L and that such a value in urine corresponded to plasma levels of between 0.06 and 0.1 mmol/L, i.e., double the normal; and (3) a 50-100-fold increase in urine AA when blood levels exceeded 0.08 mmol/L. Neonates born to diabetic mothers with ketonuria had no fetal distress or asphyxia neonatorum. The lowest Apgar score at 5 min was 8; 80% of neonates had a score of 10. Hence, positive Ketostix tests in urine samples do not indicate toxic levels in the blood, and a 1000 calorie diet for obese pregnant diabetics appears to be safe as regards neonatal outcome.

Adult↗
PubMed1979

Gycosuria as an indication for glucose tolerance testing during pregnancy.

The indications for and results of all glucose tolerance tests (GTTs) performed at the Antenatal Clinic, Groote Schuur Hospital, Cape Town, over a period of 1 year, and the indications for a GTT in the first 80 newly diagnosed diabetics over a 4-year period are analysed. Out of 558 GTTs, only 17 tentative diagnoses of 'gestational diabetes' were made. The most rewarding single indication for a GTT was repeated glycosuria, which was an indication in 61 out of the 80 newly diagnosed diabetics. A combination of two indications in the same patient was related to twice as many abnormal GTTs as a single indication, while reported previous diabetes or hyperglycaemia certainly merited confirmation. Reasons for repeating GTTs are discussed, as well as the management of 'borderline' and 'potential' diabetics. It is emphasized that 'diabetes' or 'hyperglycaemia' diagnosed during pregnancy is not equivalent to a definite diagnosis of diabetes in the non-pregnant state.

Female↗
PubMed1979

Diabetes newly diagnosed during pregnancy: A 4-year study at Groote Schuur Hospital.

As a result of active screening for gestational diabetes of the population attending various antenatal clinics in the Cape Peninsula, 127 patients with a repeatedly diabetic glucose tolerance test (GTT) were discovered; in many the GTT was grossly abnormal. The most useful screening factor was repeated glycosuria. Because they had booked late, 22 patients received virtually no treatment, and 1 patient aborted. Treatment of the remaining 104 patients was achieved principally by regulating diet, but when this failed metformin or glibenclamide therapy was instituted. Insulin was used when diet and oral drugs failed. Diabetic control was considered adequate if fasting blood glucose levels remained below 5,5 mmol/l and if postprandial levels were below 7 mmol/l. Most patients (67) were well controlled on a strict dietary regimen, and there were no perinatal deaths in this group. Glibenclamide and metformin, judging from this small series, appear to be safe for use in gestational diabetics. The overall perinatal mortality in treated patients was 10/1 000 as compared with an effective perinatal mortality of 145/1 000 in the 'untreated' group. Neonatal morbidity was similar to that in other reported series. Hypoglycaemia was seldom a problem and 79% of birth weights were between the 10th and the 90th percentiles.

Adolescent↗
PubMed1979

The use of ultrasound in the diagnosis of pelvic masses.

Two hundred and two patients were referred to the ultrasound department for evaluation of a pelvic mass during 1977, and of these only 120 underwent an operation enabling a definitive diagnosis to be made. The diagnostic accuracy of ultrasound was compared with the final operative diagnosis. The great majority (98%) of pelvic masses could be detected, and ultrasound was accurate in predicting the antatomical site of a pelvic lesion in 88% of cases. Uterine lesions were precisely diagnosed in 87% of cases, but only 30% of adnexal conditions could be specifically recognized. Numerous situations in which ultrasound provided additional information of great clinical value were noted.

Adnexal Diseases↗
PubMed1979

Metformin in management of pregnant insulin-independent diabetics.

Sixty pregnant "maturity-onset" (insulin-independent), established and gestational, diabetics were treated with Metformin in the second and third trimester after dietary treatment had failed. The incidence of Metformin failure was 53.8% in the established diabetics and 28.6% in the "gestational" diabetics. The 27 Metformin failures were transferred to other therapy, leaving for further analysis 33 patients who received Metformin up till delivery. Two neonatal deaths occurred in this group (1 congenital abnormality and 1 preterm infant) giving a perinatal mortality of 61/1000. This compares with a perinatal mortality of 103/1000 in the Metformin failure group and 105/1000 in a group of insulin-dependent diabetics treated during the same period. Apart from a high incidence of neonatal jaundice requiring phototherapy the infant morbidity in the Metformin group was low. The mothers of 3 infants with congenital abnormalities had received Metformin only during the last trimester of their pregnancy.

Apgar Score↗
PubMed1978

Technical problems and early complications of laparoscopic sterilization done on a day-case basis.

Two hundred and sixteen patients were selected for laparoscopic sterilization on a day-case basis. Patients were sterilized by electrocautery, by applying Silastic bands (Falope rings), and by means of Hulka-Clemens clips. Three patients required laparotomy and 35 patients were discharged the day after the operation. By the 3rd day 146 (69%) and by the 5th day 184 (86%) patients had returned to their routine work. From the technical and immediate postoperative point of view, there appears to be relatively little difference between the three techniques. There may be slightly more risk of thermal complications with bipolar cauterization, a slightly highly incidence of postoperative abdominal pain with the Silastic band applicator, and slightly more difficulty in applying the Hulka-Clemens clip. These problems are all reduced by experience and proper training of the operator, which is essential. Our experience confirms that laparoscopic sterilization is safe, efficient, and feasible as a day-case procedure, and that it has major advantages in terms of patient convenience and acceptability as well as reduction in hospitalization costs.

Adult↗
PubMed1978

Antenatal diagnosis in practice.

Over a period of 5 years, 434 women at risk of having abnormal babies have had antenatal daignostic tests carried out during the first half of their pregnancy by the laboratories of the Department of Human Genetics, University of Cape Town. From these investigations, it was predicted that 13 fetuses had chromosomal abnormalities, 6 had severe central nervous system defects and 4 had autosomal recessive metabolic disorders. In addition, 4 cases with X-linked recessive traits were monitored and 3 male fetuses were recognized. Affected pregnancies were terminated except for 1 with a fetal sex-linked disorder where the parents revoked their original decision. The diagnosis was confirmed by fetal autopsies in all cases except 4 (2 spontaneous abortions and 2 out-of-town terminations). There was only 1 case where culture failed and the pregnancy went to term with the birth of a baby with Down syndrome. Antenatal diagnosis is now an important part of normal clinical practice. The fact that the fetal abnormalities were recognized in 6% of pregnancies is justification for the use of this procedure.

Amniocentesis↗
PubMed1978

Krabbe's disease in an infant and her fetal sibling. A case report.

Degenerative diseases of the cerebral white matter are rare, but have severe consequences. The diagnosis of one such disorder, Krabbe's disease, may be made by biochemical analysis of cultured fibroblasts. As the disease is inherited as an autosomal recessive trait, there is a high risk of affected children being born to a heterozygote couple. A description is given of an infant with Krabbe's disease and of the monitoring of the mother's second pregnancy in which an affected fetus was found.

Amniotic Fluid↗
PubMedDate not supplied

The management of non-insulin-dependent diabetes during pregnancy.

We propose a rational regimen for management of non-insulin-dependent pregnant diabetics (NIDD), using appropriately constituted calorie-restricted diets with the oral agents metformin and glibenclamide as may be necessary, with rapid recourse to insulin if the latter do not produce excellent control of blood glucose. Using this regimen between June 1974 and December 1983 we have managed 423 new diabetics (ND, diagnosed during pregnancy) with a perinatal mortality (PNM) of 14 per 1000 and 268 established diabetics (known diabetics, KD) with a PNM of 70/1000 (57/1000 since 1978). A further 80 NIDDs were 'untreated', i.e., not seen by us until near term; these suffered a PNM of 313/1000. Side-effects of the drugs have been few and mild, they are not teratogenic; 'starvation ketosis' does not occur; neonatal hypoglycaemia is preventable by using continuous insulin infusion during delivery. We suggest that the regimen outlined here is acceptable to the patients, is safe, gives excellent results and furthermore teaches the diabetic mother proper dietary control and combats lifelong obesity. It should be useful especially in developing countries in which pregnant, overweight NIDDs are common. Precise control of the blood glucose is essential.

Adult↗