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Biomedical subjects

J E Krige

Publications and source records attributed to J E Krige.

At least 73 records · Page 4Linked to original sources
PubMed1993

Traumatic pancreatic pseudocysts.

Fifteen patients who developed pseudocysts following pancreatic trauma were evaluated to determine outcome in relation to the nature and site of pancreatic duct injury. Pseudocysts developed in eight patients operated on within 48 h of abdominal trauma and in seven who were initially treated conservatively. In none was duct injury diagnosed during initial management. Presentation was a median of 20 (range 8-360) days after injury. In 14 patients, pseudocysts (mean diameter 9 (range 3-16) cm) were confirmed by computed tomography or ultrasonography. Endoscopic retrograde pancreatography (ERP) demonstrated the site and severity of the duct injury in eight of 11 patients. Two patients with side duct injury on ERP were treated successfully without intervention. Pseudocysts arising from distal duct injuries (four patients) were treated by percutaneous aspiration or catheter drainage, although one patient required subsequent distal resection for recurrent pancreatitis caused by a pancreatic duct stricture. Three patients with duct injuries in the neck or body with pancreatic disruption underwent distal pancreatectomy. Proximal duct injuries with mature pseudocysts (three patients) were drained internally. Three patients had complicated pseudocysts (haemorrhage in one, sepsis in two) that necessitated emergency laparotomy and external drainage; one of these patients died from sepsis. These findings suggest that traumatic pancreatic pseudocysts that follow peripheral duct injury may resolve spontaneously, whereas those associated with distal duct injuries can be treated by percutaneous aspiration or catheter drainage. Proximal duct injuries, however, require surgical intervention using either resection or internal drainage, depending on the maturity of the cyst wall.

Adult↗
PubMed1993

Plantar melanoma in black South Africans.

The outcome of treatment in 40 black patients (27 women, 13 men; mean age 62.9 years) with plantar melanoma over a 13-year period was analysed to evaluate the efficacy of wide local excision with split skin grafting. Substantial delay in seeking medical attention occurred in 35 patients. At presentation, 20 patients had stage I disease, one stage II, 15 stage III and four stage IV. Acral lentiginous melanoma (27 patients) was the most common histological type. The mean Breslow depth was 6.9 mm and 35 patients had lesions of Clark level IV or V. The mean surface area or plantar lesions was 13.3 cm2. Wide local excision with split skin grafting was used in 29 patients; four patients with neglected advanced plantar lesions had below-knee amputation and seven with metastatic disease did not undergo surgery. Graft sepsis occurred in six patients and local recurrence in two. Nine patients were alive at follow-up; the 5-year survival rate was 25 per cent. Delay in presentation and locally advanced disease may explain the poor prognosis of plantar melanoma in black South Africans.

Adult↗
PubMed1993

Randomised trial of targeted chemotherapy with lipiodol and 5-epidoxorubicin compared with symptomatic treatment for hepatoma.

Lipiodol injected into the hepatic artery is selectively retained in hepatomas so has been used as a vehicle for cytotoxic drugs. This study compared treatment with 5-epidoxorubicin emulsified in lipiodol and infused into the hepatic artery with symptomatic treatment alone in a randomised trial. Of 136 patients with hepatoma 78 (57%) were not eligible, eight (6%) refused to take part, and 50 entered the trial (chemotherapy: n = 25, symptomatic treatment: n = 25). The two groups had similar prognostic indices. Seven of 25 patients allocated to chemotherapy were unable to receive it. The slight survival disadvantage associated with chemotherapy was not significant (median survival 48 days compared with 51 days, log rank chi 2 = 0.07, p > 0.05). Patients given chemotherapy spent significantly longer in hospital, however (median three days compared with one, p = 0.0008). Changes in symptoms and indices of tumour growth did not differ significantly between the two groups. It is concluded that infusion of 5-epidoxorubicin emulsified in lipiodol for hepatoma increased morbidity but did not affect survival. In addition, most patients were unsuitable for this treatment because of advanced disease. The patients in the trial had a short median survival time so the conclusions may not be valid for other patients with hepatoma.

Adolescent↗
PubMed1993

The stomach in cirrhosis. The legend of Proteus retold.

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) (watermelon stomach) are increasingly recognized as separate nosological entities detectable by careful upper gastrointestinal endoscopy and meticulous histological assessment. The have a significant phenomenological overlap; both usually present with gastric mucosal hemorrhage and have a striking association with cirrhosis. However, the distinct endoscopic and histological features, which are discussed in this paper, enable physicians to differentiate PHG from GAVE. Portal hypertension as the prerequisite of PHG necessitates surgical (portosystemic shunting) or medical (beta-blockade) portal decompressive therapy, whereas the angiodysplasia-like lesions in watermelon stomach are successfully treated by electrocoagulation or laser therapy.

Angiodysplasia↗
PubMed1992

Therapeutic perihepatic packing in complex liver trauma.

Packing for control of haemorrhage was used in 22 of 294 patients undergoing surgery for liver trauma over a 6-year period. The major indication for packing was transfusion-induced coagulopathy. Sixteen patients had blunt trauma and six penetrating trauma including five gunshot wounds; 19 patients had major right lobe injuries, three left lobe and five also had hepatic vein injuries. Packing provided definitive control of bleeding in 18 patients but four patients had recurrent bleeding due to hepatic artery injury (three) and hepatic vein injury (one); three required further surgery and bleeding was controlled in the fourth by selective hepatic artery embolization. Six patients died and in two of these recurrent bleeding, despite packs, was a contributing factor. Mean blood loss in the six patients who died was 18 (range 10-30) units, compared with 13.1 (range 8-30) units in survivors. Packs were removed from the 16 survivors at laparotomy at a mean of 3.1 days after insertion; six patients rebled during pack extraction and were successfully repacked. Major morbidity occurred in 12 of the 16 survivors. Seven patients developed intra-abdominal sepsis following packing, one of whom died. Therapeutic liver packing provides life-saving control of hepatic bleeding which is frequently aggravated by coagulopathy. This approach permits resuscitation in an intensive care unit and subsequent planned relaparotomy for retrieval of packs and further intervention as necessary.

Adolescent↗
PubMed1992

Prospective, randomized study comparing amoxycillin-clavulanic acid and cefamandole for the prevention of wound infection in high-risk patients undergoing elective biliary surgery.

The efficacy of amoxycillin-clavulanic acid for prevention of postoperative wound infection was compared with that of cefamandole in 150 patients at risk for infected bile while undergoing elective biliary surgery in a prospective, randomized study. The two groups were comparable for age, sex, risk factors, operative procedures and positive bile cultures. Similar numbers of patients had an uncomplicated postoperative course (amoxycillin-clavulanic acid 70%; cefamandole 73%). Four patients in each group developed wound infection. The incidence of postoperative pneumonia, urinary tract infection and number of days (+/- SD) in hospital (amoxycillin-clavulanic acid 10.1 +/- 4.7; cefamandole 9.7 +/- 5.6) were similar. The efficacy of amoxycillin-clavulanic acid and cefamandole in preventing wound sepsis in high-risk patients undergoing biliary surgery was similar. Economic considerations may favour the use of amoxycillin-clavulanic acid.

Adolescent↗
PubMed1992

Closed degloving injuries: results following conservative surgery.

Closed degloving wounds are uncommon but important injuries because they may be overlooked in the multiply injured patient and, if not treated correctly, may give rise to significant morbidity. This prospective study reports the results of a conservative surgical management policy in 16 patients with closed degloving wounds treated during a 1-year period in a tertiary referral center. Motor vehicle accidents caused most of the injuries, 69 percent of which occurred on the lower limb. The extent of injury ranged from 2 to 12 percent (mean 4.9 percent) of the total body surface area. The diagnosis of closed degloving wound was missed at initial assessment in one-third of patients. A uniform management policy with drainage of the degloved area through a small incision followed by compression bandaging was applied. The volume of blood and necrotic fat evacuated ranged from 15 to 800 ml (mean 120 ml). One patient with necrotic skin initially had excision and primary wound closure performed. Delayed necrosis occurred in one patient in whom extensive degloving occurred and effective compression could not be applied. Ultimate flap viability using this technique was excellent, since only 1 of 16 patents required skin grafting.

Accidents, Traffic↗
PubMed1992

The treatment of esophageal varices.

The etiology, the geographic variation in pathology, and the level of hepatic reserve all affect the prognosis in patients with bleeding from esophageal varices. Acute variceal bleeding requires emergency treatment. The options include pharmacological therapy, balloon tube tamponade, and urgent sclerotherapy used singly or in combination. Immediate sclerotherapy at the time of the initial diagnostic endoscopy is the preferred treatment. Those in whom sclerotherapy fails should be subjected to more major surgery. Patients presenting after a variceal bleed has been controlled should be considered for definitive long-term treatment. The main options are repeated sclerotherapy, a portosystemic shunt, or a devascularization and transection operation. All patients should be evaluated for liver transplantation prior to therapy. Repeated sclerotherapy is widely recommended, with many groups reserving major surgery as a salvage procedure if sclerotherapy fails. Pharmacological therapy remains under review. Prophylactic treatment prior to a variceal bleed should probably be restricted to controlled trials.

Arteries↗
PubMed1991

Delay in the diagnosis of cutaneous malignant melanoma. A prospective study in 250 patients.

The extent and consequence of patient and professional delay in the diagnosis and treatment of 250 consecutive patients with primary cutaneous malignant melanoma was investigated. Mean total delay from the onset of observed change in a melanoma to appropriate therapy was 11.1 months. The major component of delay (9.8 months) was patient related. Seventy-nine (31.6%) patients waited more than 6 months before seeking medical attention. Few patients recognized early melanoma, and 46% responded only to late features (i.e., ulceration or bleeding). Inappropriate professional delay (misdiagnosis or observation without specific action) occurred in 30 consultations (12.4%) and resulted in a further 1.3-month mean delay in treatment. No correlation (r = 0.027) was found between delay in diagnosis and thickness of melanoma for the study population overall. A significant relationship (r = 0.2087; P less than 0.05) was found between longer lag time and advanced disease in 92 patients with nodular melanoma. Asymptomatic melanomas incidentally diagnosed during routine skin surveillance were significantly more favorable (mean depth, 0.89 mm) than symptomatic melanoma (1.76 mm; P less than 0.01). These data suggest that future public education campaigns should emphasize early signs of melanoma and that professional programs should stress routine skin surveillance and prompt referral of suspicious lesions for diagnostic biopsy.

Adolescent↗