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Biomedical subjects

J E Krige

Publications and source records attributed to J E Krige.

At least 91 records · Page 5Linked to original sources
PubMed1991

Simplified hepatic resection with the use of prolonged vascular inflow occlusion.

Ten consecutive patients scheduled to undergo liver resection were studied prospectively with the use of a standard protocol, which included routine vascular inflow occlusion to reduce blood loss and blood transfusion requirements. Fibrin sealant was sprayed on the raw liver surface, and abdominal drainage was not performed. No deaths occurred, and the postoperative course was remarkably smooth. The normothermic liver ischemic times of 30 to 122 minutes (mean, 73 minutes) were well tolerated. The amount of blood transfused was reduced to a mean of 2 U (range, 0 to 4 U). The occurrence of infected intraabdominal bile collections in two patients with preexisting biliary tract infection suggested that abdominal drainage should be performed in such patients. Vascular inflow occlusion is recommended for all liver resections.

Adult↗
PubMed1991

Colonic complications after toxic tribal enemas.

Tribal enemas obtained from traditional healers are used widely in Southern Africa for a variety of indications. Inclusion of injurious substances such as potassium dichromate may cause serious colonic and renal complications. Nine such patients, in seven of whom chromate use was confirmed, presented after a mean delay of 7.3 days. All patients had bloody diarrhoea and vomiting and three underwent major colonic resection, requiring a total of ten procedures. One patient suffered mechanical perforation of the rectum, with subsequent necrotizing fasciitis, necessitating rectal excision. Eight patients had acute renal failure and seven required dialysis. One patient died. At follow-up one patient has chronic renal failure and only three are completely well. Although local medical practitioners are aware of the problem, the challenge of preventing harmful cultural practices remains.

Acute Kidney Injury↗
PubMed1991

Accurate intraoperative transhepatic U tube placement.

Cholangiocarcinoma of the main hepatic duct junction is best treated by curative resection, although this is not often possible as most lesions are associated with local infiltration, portal vein invasion or metastases. For unresectable lesions, we advocate the use of a wide bore U tube followed by radiotherapy. Placement of the U tube must be accurate and meticulous. This paper describes a simplified method allowing accurate intraoperative transhepatic U tube placement.

Adenoma, Bile Duct↗
PubMed1991

Conservative surgery for trauma to the pancreatic head: is it safe?

The results of conservative operative management (involving no pancreatic resection) for 13 patients presenting with trauma to the pancreatic head over a period of 10 years were reviewed. Seven patients with injury of the pancreatic head without duodenal or ductal involvement made an uneventful recovery after simple drainage. The average hospital stay was 6.7 days. The remaining six patients with either duodenal (four patients) and/or ductal involvement (five patients) developed 22 major complications. One of these patients died of multiple organ failure, and the rest had an average hospital stay of 43 days. Injury of the vena cava was noted in five patients, but was not significantly associated with additional morbidity or mortality. Although simple drainage of pancreatic head injuries is associated with a low mortality, there is an unacceptably high incidence of complications if either the duodenum or pancreatic duct is involved. The authors recommend that simple drainage be restricted to patients in whom neither of these structures is injured.

Adult↗
PubMed1991

Long-term management after variceal bleed--the current role of sclerotherapy.

While injection sclerotherapy has been accepted as the treatment of choice for acute variceal bleeding, its role as a definitive long-term treatment modality has not yet been clearly defined. This paper will critically analyse the current status of this technique, now widely used, and a comparison will be made with conventional medical management. The review will be based on the 10 years' Cape Town experience and the published series on this subject. A long-term management strategy will also be discussed.

Acute Disease↗
PubMed1990

Bacteremia after injection of esophageal varices.

Elective sclerotherapy for esophageal varices produces bacteremia in 4% to 53% of patients. The clinical importance of this phenomenon is uncertain. This study was undertaken to re-assess the incidence and clinical relevance of post-sclerotherapy bacteremia. Blood cultures were taken prior to and at 5 min and 4 h after endoscopy in 50 patients for whom sclerotherapy was planned. In the 41 patients in whom varices were injected, positive cultures were obtained 5 min after sclerotherapy in only 4 patients (10%) and all but 1 patient had other possible causes of bacteremia. After 4 h, all blood cultures were sterile. No infective complications were identified. Bacteremia appears to be an infrequent and transient event after elective sclerotherapy. Only patients with prosthetic heart valves or endocardial abnormalities require antibiotic prophylaxis.

Adult↗
PubMed1990

Malignant melanoma of the external ear.

Twelve patients with primary melanoma of the external ear were treated during a 10-year period. Ten patients were males. Median melanoma depth was 2.1 mm and seven patients had lesions deeper than 2 mm. Eight of 12 lesions were either Clark level IV or V. Six patients had wedge excisions of the primary lesion and all developed recurrent disease (local: three). Six patients underwent wide excision and none developed local recurrence. All patients with primary disease less than 2 mm are alive. Only two of seven patients with lesions deeper than 2 mm have survived. The definitive excision for melanoma of the ear should encompass wide margins despite the cosmetic consequences. Lesser procedures inevitably lead to local recurrence. Melanoma deeper than 2 mm penetration on the ear in our series had a poor prognosis.

Adult↗
PubMed1990

Subungual melanoma of the hand.

Thirteen patients with subungual melanoma on the fingers had a mean delay before diagnosis of 1.2 years. Four patients presented with local recurrence after inadequate initial treatment and two presented with systemic metastases. Mean primary subungual melanoma thickness was 6.1 mm. and nine patients had Clark level IV or V disease. All patients underwent digital amputation. Two of seven patients who had localised disease initially are alive at 29 and 44 months. One of four patients who had locally recurrent melanoma is alive at 36 months. Both patients with systemic disease at presentation died. Advanced disease and delayed presentation contributed to the poor prognosis of subungual melanoma in our patients.

Adult↗
PubMed1990

Endoscopic sclerotherapy.

Various sclerotherapy techniques have proved successful in the management of acute variceal bleeding and in long-term control of patients after a variceal bleed. We prefer either an intravariceal or a combined intravariceal and paravariceal technique using ethanolamine oleate, but we advocate that individual units utilize the technique with which they have the most experience. The use of an unmodified flexible endoscope has been almost universally accepted. Once active variceal bleeding is diagnosed on emergency endoscopy, immediate emergency sclerotherapy should be performed. When this is not possible, bleeding should be controlled by balloon-tube tamponade with subsequent delayed emergency sclerotherapy after resuscitation. Patients with variceal bleeding that has stopped at the time of the diagnostic endoscopy can either be treated by immediate sclerotherapy or be observed initially and subsequently treated using the long-term management policy of the unit concerned. Over 90% of actively bleeding patients should be controlled using emergency sclerotherapy. Failures are defined as patients who have more than two acute variceal bleeds during a single hospital admission. Such patients should be identified early and treated either by simple staple-gun transection or by an emergency portosystemic shunt. Repeated injection sclerotherapy using a flexible endoscope and the technique with which the group concerned has the most experience is recommended as the primary form of treatment for the majority of patients after a proven esophageal variceal bleed. Repeat injection treatments should probably be performed at weekly intervals until the esophageal varices are eradicated, with follow-up at 6-month or yearly intervals thereafter. Recurrent varices should be treated similarly. Failures of sclerotherapy are defined as patients who have either recurrent bleeds or in whom varices are difficult to eradicate. They require either a portosystemic shunt or a devascularization and transection operation. All patients presenting with cirrhosis and variceal bleeding should be evaluated for liver transplantation; unfortunately, however, few variceal bleeders are candidates for transplantation. Prophylactic sclerotherapy in patients with esophageal varices that have not bled remains unjustified outside of controlled trials. Available trials have produced conflicting data.

Acute Disease↗
PubMed1990

Severe juxtahepatic venous injury: survival after prolonged hepatic vascular isolation without shunting.

Survival following major juxtahepatic venous injury is rare in blunt liver trauma despite the use of intracaval shunting. Prolonged liver arterial inflow control, total hepatic venous isolation and lobectomy without shunting was used in a patient to repair a combined vena caval and hepatic venous injury after blunt liver injury. An extended period of normothermic hepatic ischemia was tolerated. Early recognition of retrohepatic venous injury and temporary liver packing to control bleeding and correct hypovolemia are essential before caval occlusion. Hepatic vascular isolation without shunting is an effective simple alternative technique allowing major venous repair in complex liver trauma.

Accidents, Traffic↗
PubMed1990

A new approach to the management of malignant ascites; a permanently implanted abdominal drain.

A new approach to the problem of intractable malignant ascites in preterminal abdominal carcinoma is presented. Seventeen patients treated with a new implantable silastic drain are described. Symptomatic relief was excellent in all patients for as long as the drain was patent. Complications included abdominal wall cellulitis in two instances and one case of peritonitis, but did not preclude continued drain function in 15 of the 17 cases. In eight of the 17 cases organisms were cultured from the ascitic fluid while the catheter was in situ. Drainage of ascitic fluid in this way appears to be a practical management for intractable malignant ascites.

Abdomen↗
PubMed1990

High or low hepaticojejunostomy for bile duct strictures?

The 19 patients who underwent 22 postoperative repairs of bile duct stricture in our institution between 1973 and 1984 were evaluated to assess whether the recognition of the tenuous blood supply of the supraduodenal bile duct in 1979 had improved the results thereafter. Thirteen of these 22 operations followed a previous biliary tract repair; in 10 of the operations a low anastomosis had been performed without taking blood supply into account. Follow-up was complete and ranged from 5 to 15 years. There were no operative deaths and minimal morbidity. There were three deaths at a later time. Five of the 11 patients treated by surgery to 1979 had a clinically unsatisfactory result: recurrent strictures developed in all five patients. All but one of the eight patients receiving a high hepaticojejunostomy from 1980 had a clinically satisfactory result with no recurrent strictures. The one exception was the patient who had a second repair with separate high right and left hepatic duct anastomoses and who has ongoing symptoms from preexisting secondary sclerosing cholangitis. The results in the five high repairs performed for low strictures were particularly striking: All five were asymptomatic. This study lends support to the hypothesis of an ischemic basis for biliary strictures and to the recommendation that strictures be repaired with a high hepaticojejunostomy.

Adult↗
PubMed1989

Acute colonic pseudo-obstruction. Current diagnosis and management.

Twenty-nine patients with acute colonic pseudo-obstruction were treated over a 6-year period. All had gross abdominal distension which followed either serious systemic illness (23 cases), major surgery (4) or trauma (2). The predominant radiological features were disproportionate segmental or localised dilatation of the caecum and proximal colon, with a relative paucity of distal colonic gas. The correct diagnosis was established and mechanical obstruction excluded in the majority of cases (24) by contrast enema examination. In the remaining 5 cases the diagnosis was made on colonoscopy (4) or at laparotomy (1). Successful colonoscopic decompression was achieved in 2 of 4 cases. Eight patients underwent laparotomy and 3 of 4 patients with caecal perforation and peritonitis died. Two of 21 patients treated conservatively died. Persistence of colonic distension beyond 72 hours, caecal diameter greater than 12 cm or overlying abdominal tenderness indicates urgent decompression. Caecostomy is the advised procedure in patients with non-perforated caecal distension. Prompt recognition and treatment of the condition should eliminate delay in decompression and minimise the risk of caecal perforation.

Acute Disease↗