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Biomedical subjects

J E Krige

Publications and source records attributed to J E Krige.

107 records · Page 6Linked to original sources
PubMed1988

Strangulated obturator hernia: can mortality be reduced?

We describe two patients with strangulated obturator hernia to enhance clinical awareness of the varied presentations of this uncommon hernia, which occurs especially in elderly women with either recurrent abdominal pain or partial intestinal obstruction, a positive Howship-Romberg sign, and an absent thigh adductor reflex. Early laparotomy for unexplained bowel obstruction is essential to avoid the complications associated with strangulated obturator hernia.

Aged↗
PubMed1988

Prophylactic hyperthermic limb perfusion in stage I melanoma.

Ninety-three patients with stage I primary cutaneous malignant melanoma of the lower limb were treated by wide local excision and hyperthermic isolated regional perfusion with melphalan (L-phenylalanine dihydrochloride) in a prospective non-randomized study between 1976 and 1982. Eighteen patients (19.4%) developed recurrent melanoma. Nine had recurrent regional disease, one with in transit metastases and eight with positive regional nodes. Nine patients developed distant metastases. No patient had locally recurrent disease. This series confirmed the close correlation between tumour microstaging, melanoma recurrence and survival. Seventy-nine per cent of patients were disease-free at 5 years. Males had deeper lesions (mean 4.56 mm) and increased recurrence (33%) than females (mean 3.36 mm and 13%). Superficial spreading melanoma had the most favourable prognosis of the three histological types. Overall survival was 83% (female 86%; males 64%) at 5 years. Significant morbidity occurred in two patients with deep vein thrombosis. Adjuvant therapy using hyperthermic regional perfusion provides improved local and intransit control of limb melanoma.

Adult↗
PubMed1987

Major lower intestinal haemorrhage. Angiographic localisation and current management.

Thirty-four patients with major lower intestinal bleeding underwent emergency selective mesenteric angiography during a 6-year period. Angiography identified a bleeding site in 16 patients (47%). Diverticulosis, found in 22 patients (65%), and angiodysplasia, found in 4 (12%), were the most common causes of major colonic bleeding and originated more frequently from the right colon. Eight patients (24%) bled from less common sources. Radiological control of bleeding was unreliable with a significant complication rate. Fourteen of 16 patients with positive angiograms and 6 of 18 patients with negative angiograms required surgery for persistent major bleeding. Angiographic localisation of colonic bleeding allowed limited resection in 9 of 11 patients with control of haemorrhage in 8 (89%). Fourteen of 34 patients were managed non-operatively; of these 2 had minor recurrent bleeding. The overall mortality rate was 29%, the operative mortality rate 40% and the non-operative mortality rate 14%. A rational diagnostic approach is presented, emphasising the role of selective mesenteric angiography in the management and surgical strategy of major lower intestinal bleeding.

Adult↗
PubMed1987

Unresectable fibrolamellar hepatocellular carcinoma treated with intra-arterial lipiodolised doxorubicin. A case report.

Hepatocellular carcinoma is often an aggressive tumour and, if unresectable, carries a poor prognosis, especially in the presence of jaundice. We report on a jaundiced patient with an unresectable fibrolamellar hepatocellular carcinoma treated with intra-arterial lipiodolised doxorubicin (Adriamycin). The initial response of the patient has been encouraging. This form of therapy deserves further evaluation in patients with unresectable hepatocellular carcinoma.

Adult↗
PubMed1987

Primary sclerosing cholangitis: biliary drainage and duct dilatation.

A further extension of the U-tube technique is described in the treatment of six patients with primary sclerosing cholangitis who developed progressive jaundice and recurrent biliary sepsis. All six patients had operative intrahepatic duct dilatation and U-tube placement. Three patients in addition had a Roux-en-Y hepaticojejunal anastomosis. Five patients are improved and are well after a median follow-up period of 56 months. Two patients have had the U-tube removed electively. Three patients with progressive disease required further percutaneous catheter dilatation of intrahepatic strictures via the U-tube tract. Application of the technique permits evaluation of the biliary system by tube cholangiography and provides access in complex cases for repeated therapeutic intrahepatic stricture dilatation.

Adult↗
PubMed1987

Popliteal artery trauma: a high risk injury.

The clinical presentation and management of 28 popliteal artery injuries following penetrating and blunt trauma during a 6 year period is reviewed. Clinical and Doppler evaluation identified an arterial injury in 24 (85 per cent) patients. In eight (29 per cent) patients with arteriovenous fistulae or false aneurysms, pedal pulses were palpable during initial assessment. Three (10.7 per cent) patients had limb amputation attributable to delayed vascular repair, crush injury and sepsis. End-to-end arterial repair following blunt trauma resulted in early failure with thrombosis in two patients. Autogenous vein grafting was used in 12 patients and is advocated in all blunt popliteal arterial injuries. Routine repair of associated venous injuries and liberal criteria for early fasciotomy were used. Exoskeletal fixation or skeletal traction for compound and comminuted fractures is recommended for simplicity of application and wound management. The significant functional orthopaedic disability following blunt arterial trauma at the knee is emphasized.

Adolescent↗
PubMed1987

Recurrent pancreatitis caused by a calcified ascaris in the duct of Wirsung.

A case report of recurrent pancreatitis in a 20-yr-old woman due to an impacted calcified Ascaris remnant within the duct of Wirsung is presented. Endoscopic retrograde cholangiography identified a filling defect in the proximal main pancreatic duct. Transampullary endoscopic retrieval failed to extract the calculus and operative intervention was required to remove the calcified worm remnant.

Adult↗
PubMedDate not supplied

Long-term management of variceal bleeding: the place of varix injection and ligation.

Injection sclerotherapy remains the most widely used long-term management for patients after an esophageal variceal bleed. Sclerotherapy treatments should be repeated weekly until the varices are eradicated. Follow-up endoscopy every 6 to 12 months is required for life. Whenever varices recur, further weekly injection treatments are administered until re-eradication is achieved. Failure of sclerotherapy must be diagnosed early and an alternative salvage procedure performed. We currently recommend the distal splenorenal shunt. Although the complications of sclerotherapy are not great, they are cumulative with time. Unlike most surgical procedures for portal hypertension, the technique of performing sclerotherapy is not standardized, making the comparison of controlled trials difficult. The current status of controlled trials comparing sclerotherapy with other treatments is evaluated. We conclude that repeated injection sclerotherapy is at present the initial treatment of choice for patients after an esophageal variceal bleed. The technique of the new procedure of esophageal variceal ligation is described. As with sclerotherapy, weekly treatment sessions are recommended until the esophageal varices are eradicated, followed by long-term endoscopic surveillance and repeat ligation treatment when varices recur. The four controlled trials that have compared variceal ligation with sclerotherapy favor ligation. Ligation eradicated esophageal varices with fewer treatment sessions and a lower complication rate. One trial demonstrated improved survival. Complications due to the overtube are being increasingly reported but were not a problem in the controlled trials. Although esophageal variceal ligation or ligation plus sclerotherapy may ultimately prove to be superior to sclerotherapy alone, more data are required before a final conclusion can be reached.

Clinical Trials as Topic↗
PubMedDate not supplied

Injection sclerotherapy for variceal bleeding in patients with irresectable hepatocellular carcinoma.

BACKGROUND/AIMS: Patients with cirrhosis and advanced hepatocellular carcinoma are seldom cured, and have limited survival. Bleeding from esophageal varices in such patients is a major complication which, if untreated, may be a terminal event. This study evaluated the efficacy of injection sclerotherapy in controlling acute bleeding from esophageal varices and the benefit of repeated injection to eradicate varices in patients with cirrhosis and irresectable hepatocellular carcinoma. METHODOLOGY: Between 1975 and 1997, nineteen of 688 patients (2.8%) treated for bleeding esophageal varices had cirrhosis and irresectable hepatocellular carcinoma. There were 13 men and 6 women; median age, 42 years (range: 20-81). Eight patients were Child's-Pugh grade B and 11 grade C; 11 patients were Okuda stage II and 8 stage III. RESULTS: In 13 patients (68.4%) bleeding was controlled by injection sclerotherapy after a mean of 3 injections (range: 1-5), and of these esophageal varices were completely eradicated in 7 patients (53.9%), none of whom rebled. Twelve patients (63%) were discharged from hospital and had a mean survival of 100 days. Seven patients died in hospital, 5 of liver failure precipated by recurrent bleeding and 2 of hepatocellular carcinoma. Median survival for Child's-Pugh grade B patients was 80 days (range: 9-405) compared to 28 days (range: 8-117) for the grade C (P = 0.25). CONCLUSIONS: Injection sclerotherapy controlled acute variceal bleeding in most patients with hepatocellular carcinoma and provided effective palliative therapy with no further bleeding after eradication of varices.

Adult↗
PubMedDate not supplied

Expression of p53 tumor suppressor gene, oncoprotein c-erbB-2, cellular proliferation and differentiation in malignant and benign pancreatic lesions.

The expression of oncoprotein, tumor suppressor gene, cellular proliferation and differentiation markers were studied in 64 malignant and benign pancreatic tumors, adjacent and distant to the tumor duct epithelium. Activity of these markers was compared to 16 cases of chronic pancreatitis. Tumor suppressor gene p53 and transforming growth factor alpha were overexpressed in the majority of malignant tumors. The expression of c-erbB-2 oncoprotein and cellular proliferation marker Ki67 was less common in malignant lesions, but was absent in the benign cases. The positive staining of all markers in ductal epithelium outside of the tumor, particularly in pancreatic duct carcinoma, suggest the ductal histogenesis of this malignancy. The presence of c-erbB-2 and Ki67 in malignant lesions only suggest their possible use in the differentiation of pancreatic malignancies and chronic pancreatitis.

Adenoma↗