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Biomedical subjects

J Moodley

Publications and source records attributed to J Moodley.

At least 145 records · Page 8Linked to original sources
PubMed1999

Thoracoscopic splanchnicectomy: pilot evaluation of a simple alternative for chronic pancreatic pain control.

Achieving adequate pain control in patients with chronic pancreatitis remains a surgical challenge. The quest for a procedure that retains all of the residual pancreatic tissue in the absence of ductal dilatation remains elusive. This study sought to evaluate the feasibility and efficacy of thoracoscopic splanchnicectomy and attempted to outline the surgical anatomy appropriate to an adequate denervation. Of 17 patients considered suitable for the procedure, 16 had a sucessful outcome, which was statistically significant (p < 0.001). The longest follow-up of 30 months suggests that the procedure may be more enduring than percutaneous procedures. However, the surgical anatomy is not predictable owing to the racemose arrangement of the splanchnic fibers, and a long pleurotomy with transection of all medial fibers is necessary to effect denervation. Thoracoscopic splanchnicectomy may effect immediate pain relief with negligible morbidity and absent mortality. Although the follow-up period is short, the patient with the longest follow-up remains pain-free at 30 months. This procedure warrants scrutiny for its role in long-term pancreatic pain control.

Adult↗
PubMed1999

5,10 methylenetetrahydrofolate reductase polymorphism in black South African women with pre-eclampsia.

The polymorphic C677T mutation in the gene encoding 5,10 methylenetetrahydrofolate reductase has been shown to be a risk factor for pre-eclampsia in Japanese and European women when inherited as a homozygous trait. We attempted to verify these findings in a black African population with a high incidence of pre-eclampsia. No difference in frequency of the T-allele was observed in 105 women with pre-eclampsia, compared with 110 healthy pregnant normotensive women. Only one woman with pre-eclampsia was TT homozygous, suggesting that methylenetetrahydrofolate reductase polymorphism is not an important factor in the pathogenesis of pre-eclampsia in black South African women.

Adolescent↗
PubMed1999

Major threats to childbirth in developing countries.

Biological, psychological or social elements may constitute a threat to childbirth. In developing countries, major threats to childbirth mainly caused by restricted health service budgets may be overcome by the introduction of appropriate screening tests, implementation of evidence-based medicine protocols, and a primary health-care approach to maternity services.

Developing Countries↗
PubMed1999

Urinary tissue kallikrein excretion in black African women with severe pre-eclampsia.

BACKGROUND: A study of tissue kallikrein excretion in African women with severe pre-eclampsia. METHODS: Random untimed urine samples were collected from all women (n=198) recruited to this study; 66 women with severe pre-eclampsia, 66 normotensive pregnant women of similar length of gestation and 66 normotensive non-pregnant women. Urine specimens were analyzed for urinary tissue kallikrein using a selective, synthetic chromogenic tripeptide substrate (S2266) having the sequence H-D-Val-Leu-Arg-pNA. RESULTS: Urinary tissue kallikrein levels were decreased in women with severe pre-eclampsia compared with those of gestation matched normotensive pregnant women at 28 weeks of gestation (1.55+/-0.95 vs. 3.02+/-1.35 ng TK/microg protein; p<0.0001) and at near delivery date (1.21+/-0.53 vis. 3.11+/-1.2 ng TK/microg protein; p<0.0001). In the normotensive pregnant group, there was no significance difference in urinary tissue kallikrein excretion close at delivery date compared to 28 weeks of gestation (3.02+/-1.35 vs. 3.11+/-1.21 ngTK/microg protein; p=0.23). No statistical difference in urinary tissue kallikrein excretion was observed between normotensive pregnant and normotensive non pregnant women (3.02+/-1.35 vs. 2.97+/-1.12 ngTK/microg protein; p=0.16). Urinary tissue kallikrein excretion correlated positively with urinary creatinine levels at 28 weeks of gestation (r=0.69; p<0.0001) and close to delivery date (r=0.84; p<0.0001). There was no correlation between neonatal birthweight and urinary tissue kallikrein levels (r=-0.44; p=0.41). CONCLUSION: The decreased levels of urinary tissue kallikrein excretion in pre-eclamptic patients suggests an etiological role for this serine protease in hypertensive disorders of pregnancy.

Adult↗
PubMed1999

Pregnancy outcome in primigravidae with late onset hypertensive disease.

BACKGROUND: The perinatal mortality associated with pre-eclampsia is extremely high and it is mainly associated with early onset disease in multiparous women. Hypertension without proteinuria in late pregnancy may not be associated with high perinatal mortality rates. OBJECTIVE: To establish the perinatal outcome in primigravidae women with hypertension occurring in late pregnancy, that is, at thirty fourth week or later. DESIGN: Prospective case-control study. SETTING: Labour ward of King Edward VIII Hospital, Durban, South Africa. PATIENTS: Three hundred and twenty two primigravidae consisting of 161 hypertensives and 161 controls. MAIN OUTCOME MEASURES: Maternal and foetal morbidity and mortality. RESULTS: The hypertensive group was divided into those with proteinuria (group a) and without proteinuria (group b). The mean birthweight of babies born to proteinuric hypertensives was significantly lower than that of hypertensives without proteinuria and the normotensive group (2.4 kg (a) versus 2.8 kg (b) versus 3.02 kg (c) respectively--a versus b, p = 0.0001; a versus c, p = 0.001; b versus c, p = 0.009). There were nine perinatal deaths and all occurred in the proteinuric hypertension group. CONCLUSION: Primigravidae with late onset proteinuric hypertension had smaller babies and higher perinatal mortality than their aproteinuric hypertensive and normotensive controls.

Adolescent↗
PubMed1999

Effect of misoprostol for cervical ripening prior to pregnancy interruption before twelve weeks of gestation.

BACKGROUND: Liberalization of the law in respect of legal abortions has led to a search for an appropriate technique for termination of pregnancy. The technique should be cheap, easy to perform and have minimal or no complications. AIM: To evaluate the effectiveness of performing manual vacuum aspiration (MVA) with and without the use of misoprostol to the procedure. DESIGN: Randomised control study. SETTING: Obstetrics and Gynaecology Department, University of Natal Medical School, South Africa. RESULTS: One hundred and thirty six women were recruited; 70 women were assigned to the misoprostol group. Of these, 11 (15%) did not show any change in cervical score. Their mean cervical dilatation was similar to the control group (3.3 versus 31; p > 0.06). In the group whose gestational age was less than eight weeks, the time taken to complete the procedure, quantity of products of conception and cervical dilatation, were different from that of the control group, and this reached statistical significance except quantity of products of conception in primigravidae. In pregnancies greater than eight weeks gestation, all parameters assessed, such as cervical dilatation, quantity of products of conception was significantly different from the control group, in both multi- and primigravidae. Pain score was similar for all gestations. CONCLUSION: Misoprostol is of specific value during MVA for voluntary interruption of pregnancy.

Abortion, Induced↗
PubMed1998

Cerebral magnetic resonance imaging in eclampsia: a series of 12 cases.

The object of this study was to assess the ability of magnetic resonance imaging (MRI) to detect the cerebral abnormalities associated with eclampsia and therefore to establish its place in our management of the condition. This study was of particular relevance to our institution because eclampsia is common in our patient population. This was a prospective study in which 13 patients with an initial diagnosis of eclampsia received MRI brain scans. Of 12 patients with a final diagnosis of eclampsia, seven (58.3%) showed the typical MRI changes of eclampsia, namely cerebral hyperintensities representing focal areas of oedema. In five patients (41.6%) the scans were normal. The rate of abnormality detection was surprisingly low. We conclude that the reason for this was the time delay in obtaining the scans. The cerebral changes in eclampsia can be rapidly reversible. Future studies must aim to perform MRI within 48 hours of seizure activity. MRI is more sensitive than computed tomography scanning but has no practical advantages over computed tomography except where the diagnosis is in doubt.

Journal Article↗
PubMed1998

Prolactin as a tumour marker in cancer of the cervix.

The aim of this study was to determine the possible usefulness of prolactin as a tumour marker in cancer of the cervix. Serum prolactin levels were measured using an enzyme linked immunosorbent assay in 105 women divided into malignant, pre-malignant and control groups. Elevated levels of prolactin were found in 42.9% of patients with malignant disease, 22.9% of controls and 14.2% of individuals with premalignant disease. The differences were not statistically significant. Although prolactin levels were found to be elevated in some patients with malignant disease of the cervix, further studies are needed to establish whether this is of clinical significance.

Journal Article↗
PubMed1998

The response of the dietary anti-oxidants vitamin E and vitamin C to oxidative stress in pre-eclampsia.

The relationship of oxidants and anti-oxidants in preeclampsia with reference to the dietary anti-oxidants vitamin C and vitamin E was investigated. Three groups of patients were studied in the third trimester of pregnancy: normotensives ( n = 32), mild pre-eclamptics ( n = 15) and severe pre-eclamptics ( n = 31) with a group of healthy non-pregnant women ( n = 18) serving as a control. Total anti-oxidant concentration, the concentrations of vitamin C, vitamin E, superoxide dismutase, uric acid and the concentration of total oxidant activity, as reflected by lipid peroxides, were measured in plasma or red blood cells. Total anti-oxidants and vitamin C concentrations were significantly lower in pre-eclamptic patients than in pregnant controls (P < 0.05), with the concentrations in the pregnant controls being significantly lower than in the non-pregnant controls (P < 0.05). There was no significant difference in vitamin E concentration for all four groups. Superoxide dismutase activity was significantly lower in the normal pregnancy group. Lipid peroxides were significantly increased in the three pregnant groups (P < 0.05) with no differences noted between these groups. The relationship of oxidants to anti-oxidants in pregnancy and pre-eclampsia is dependent on many factors but balance appears to be upset in pre-eclampsia. The reduction in anti-oxidant concentrations in pre-eclampsia suggests either a primary deficit or consumption of the anti-oxidants measured. Of the dietary anti-oxidants studied, vitamin C was most affected in pre-eclampsia.

Journal Article↗
PubMed1998

Pharmacokinetics and antiretroviral activity of lamivudine alone or when coadministered with zidovudine in human immunodeficiency virus type 1-infected pregnant women and their offspring.

The safety, pharmacokinetics, and antiretroviral activity of lamivudine alone and in combination with zidovudine was studied in pregnant women infected with human immunodeficiency virus type 1 (HIV-1) and their neonates. Women received the drugs orally from week 38 of pregnancy to 1 week after delivery. Neonate therapy began 12 h after delivery and continued for 1 week. Both treatment regimens were well-tolerated in women and newborns. Lamivudine and zidovudine pharmacokinetics in pregnant women were similar to those in nonpregnant adults. Lamivudine and zidovudine freely crossed the placenta and were secreted in breast milk. Neonatal lamivudine clearance was about half that in pediatric patients; zidovudine clearance was consistent with previous reports. HIV-1 RNA could be quantified in 17 of the 20 women. At the onset of labor/delivery, mean virus load had decreased by approximately 1.5 log10 copies/mL in both treatment cohorts. Although not definitive for HIV-1 infection status, all neonates had HIV-1 RNA levels below the limit of quantification at birth and at ages 1 and 2 weeks.

Administration, Oral↗
PubMed1998

Traumatic thoracobiliary fistula: report of a case successfully managed conservatively, with an overview of current diagnostic and therapeutic options.

Thoracobiliary fistula is a rare complication of hepatic trauma that may present a diagnostic and therapeutic challenge. We report a case of a thoracobiliary fistula complicating thoracoabdominal trauma. Although numerous imaging modalities are able to detect the condition, optimal imaging is achieved with endoscopic retrograde cholangiography, which provides anatomic delineation and has the therapeutic potential of a sphincterotomy. Conservative therapy consists of a safe temporizing measure during the workup and may, on occasion, be the only therapy that is necessary provided that controlled drainage of the fistula is achieved. The current recommendation would be the exhaustion of nonoperative therapeutic modalities before resorting to surgical intervention.

Abdominal Injuries↗
PubMed1998

Intrapartum amnioinfusion for meconium-stained liquor in developing countries.

BACKGROUND: Intrapartum amnioinfusion (AI) has been reported to decrease perinatal mortality and morbidity in women with meconium-stained liquor. Such work has not previously been performed at King Edward VIII Hospital (KEH), in a developing country, where the incidence of meconium-stained liquor is said to be extremely high. OBJECTIVE: To establish whether AI during the intrapartum period for meconium-stained liquor decreases Caesarean section rates for fetal distress and decreases perinatal morbidity. METHOD: Informed consent was obtained from patients in labour who were 3-8 cm dilated, with meconium-staining of the liquor, grades I to III inclusive, and who had a normal cardiotocograph on presentation at term. Sixty patients were included in the trial; 30 had AI. The control group was managed by standard methods. The study group had an amnioinfusion of 0.9% normal saline at 15 ml/min under continuous cardiotocographic monitoring, until a volume of 11 was completed. This was repeated if delivery did not occur within 4 h. RESULTS: The mean pH of umbilical arterial blood was significantly higher in the AI group (7.30 versus 7.23; P = 0.0029). In addition fewer patients in this group developed hypoxic ischaemic encephalopathy (0 versus 2 controls) or meconium aspiration syndrome (1 versus 4 controls). This was not statistically significant. Caesarean section for fetal distress was performed on fewer patients in the AI group (3 versus 7 controls), although this was not statistically significant. CONCLUSION: These results demonstrate that amnioinfusion is an effective technique for improving the perinatal outcome of pregnancies complicated by meconium-stained liquor in labour. The decrease in Caesarean sections for fetal distress, though not statistically significant in this study, has clinical relevance. Furthermore, this study suggests that amnioinfusion is cost effective in a busy, high-risk labour ward unit and consequently should become standard practice in the management of meconium-stained liquor in labour.

Adult↗
PubMed1998

Infertility profile at King Edward VIII Hospital, Durban, South Africa.

A prospective observational study over a 6-month period on women presenting with infertility was conducted at King Edward VIII Hospital (KEH), South Africa. The aim of the study was to establish the patient profile and investigations performed on women presenting with infertility. One hundred women were recruited. The mean age of the women was 31 years and 60% had secondary infertility. The mean duration of infertility was 7.2 years; 61% had histories suggestive of pelvic inflammatory disease and approximately half (49%), had had previous infertility investigations; 16% of the women were HIV (human immunodeficiency virus) antibody positive and 16% had positive syphilis serology. Tubal factors were identifiable in 77%, ovulatory factors in 21% and uterine factors in 21%. Male factor infertility was present in 21%. The study confirms that in developing countries, tubal factors are the commonest cause of infertility.

Adult↗