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Biomedical subjects

J R Botha

Publications and source records attributed to J R Botha.

At least 19 recordsLinked to original sources
PubMed1997

Parathyroid function after successful renal transplantation.

PURPOSE: The aim of this retrospective study was to assess parathyroid function after renal transplantation in patients with good renal function (creatinine < 133 mumol/l). METHODS AND MATERIALS: Of 1,628 patients on whom we performed renal transplantation, 210 have stable good renal function as defined above. Total calcium (Ca), creatinine, albumin and parathyroid hormone (PTH) values were obtained from patient records at varying intervals after transplantation, and in 91/210 patients pre-transplant values were available. Patients who had undergone parathyroidectomy before the transplant were excluded from the study. Follow-up ranged from 6 months to 24 years. RESULTS: These 210 patients were divided into 4 groups according to PTH and Ca levels. Group 1 consisted of 118 patients (56%) with normal Ca and PTH levels and group 2 of 69 patients (33%) with normal Ca but persistently high PTH levels, of whom 25 persistently have Ca levels in the high normal range. The reason for the inappropriate PTH levels is not obvious. In group 3 there were 18 patients (8%) with high Ca and PTH levels. They have disease requiring parathyroidectomy. Group 4 comprised 5 patients (3%) with low Ca and high PTH levels. In the 91 patients for whom pre-transplant PTH values were available, 16/46 patients with tertiary hyperparathyroidism (3 degrees HPT) have normalised after transplant, 12/46 patients have ongoing 3 degrees HPT post transplant, while 4/45 patients with less severe disease (secondary HPT) have developed 3 degrees HPT (P < 0.059). CONCLUSIONS: In 56% of patients with good renal function after transplant parathyroid function is normal. Thirty-three per cent have high PTH levels with normal Ca, but 36% of these are in the high normal range. Eight per cent have persistent 3 degrees HPT. Post-transplant parathyroid dysfunction correlates with the severity of pre-transplant disease.

Calcium↗
PubMed1994

Renal allograft preservation: a comparison of University of Wisconsin solution and of hypothermic continuous pulsatile perfusion.

A study was performed to compare early allograft function in kidneys preserved with University of Wisconsin (UW) solution to kidneys preserved by hypothermic pulsatile perfusion. The study consisted of two sets of data. The first set was a donor-paired study (matched data) of 30 heart-beating, hemodynamically stable donors. After removal from the donor each cooled kidney was individually prepared for preservation. One kidney was flushed with +/- 500 ml of UW solution and stored in UW solution on slushed ice. The other kidney was continuously perfused with cooled (4-6 degrees C) cryoprecipitated plasma. The kidneys were transplanted into suitable recipients in a random sequence. Twelve donors were excluded from the study because one or both kidneys were transplanted into recipients who had previously been transplanted. The remaining 36 kidneys were implanted into two similar groups after a mean of 19 hours in the pulsatile perfusion group and 18 hours in the UW solution group. The second set of data consisted of all the kidneys preserved in UW solution (n = 62) at our institution and of 57 kidneys preserved by hypothermic continuous pulsatile perfusion during the same period (mixed data) and was used to evaluate the effect of prolonged preservation (longer than 24 hours) on delayed graft function. Both of these groups were also comparable. Acute tubular necrosis (ATN) was defined as the need for dialysis during the 1st week after transplantation, and delayed function as the delayed clearance of creatinine during the early post-operative phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1993

Successes and failures of endoscopic injection haemostasis for bleeding peptic ulcers. A prospective clinical study.

Fifty-two consecutive patients with upper gastrointestinal haemorrhage, shock (systolic blood pressure less than 100 mmHg) and a peptic ulcer showing endoscopic stigma of recent haemorrhage underwent attempts at endoscopic haemostasis. The ulcers were injected with a dilute solution of adrenaline followed by 5% ethanolamine oleate. Active bleeding was present in 22 patients (42%) at initial endoscopy. Bleeding was controlled in 40 patients (77%) in hospital. Failure occurred more frequently in duodenal ulcers than gastric ulcers (46% v. 7%; P < 0.004), and in giant (more than 2 cm diameter) duodenal ulcers (6/7) than smaller duodenal ulcers (3/15). We recommend early surgery for large posterior duodenal ulcers in preference to endoscopic injection methods.

Adult↗
PubMed1992

Renal hyperparathyroidism.

The indications for surgical treatment of renal HPT in patients with chronic endstage renal failure are symptomatic disease or failed medical management. The indications for patients who have had a kidney transplant are symptomatic disease and persistent hypercalcemia. It should be noted, however, that the current approach favored in the literature in asymptomatic, mild post-transplant hyperparathyroidism is conservative. Total parathyroidectomy with autotransplantation is the most popular surgical method reported. I have done subtotal parathyroidectomy and reserved total parathyroidectomy for selected patients. My recurrence rate is comparable to that reported. The actual survival rate in our two groups of patients was 58 percent for the dialysis patients and 79 percent for the transplant patients. The actuarial survival rates at 1, 5, and 10 years in the two groups were 95 and 92 percent; 59 and 67 percent; and 32 and 67 percent. The use of diphosphonates and medical rather than surgical control needs further study, as do the long-term effects of conservative treatment of asymptomatic post-transplant hyperparathyroidism.

Actuarial Analysis↗
PubMed1991

The relevance of more sensitive ancillary crossmatch techniques in predicting early cadaver renal graft outcome.

The predictive value of varying levels of antibody activity, its class and antigen specificity in sera of 81 recipients of cadaver renal allografts was evaluated. Recipients for transplantation were selected on the basis of a negative dye uptake T-cell crossmatch, after which the more sensitive 51Cr release technique was employed in a blind study using unseparated donor target cells. Recipient sera with peak panel reactivity and current samples were evaluated before and after reduction with dithiothreitol to destroy the IgM subclass. Double absorption with pooled platelets allowed antibodies against HLA class I antigens to be distinguished from those against HLA class II/non-HLA antigens. Optimal levels of cytotoxicity were established, giving a sensitivity of 73%. Data were assessed in terms of positive predictive value, and showed that conventional T-cell crossmatching is adequate for the primary transplant group, but more sensitive ancillary tests are indicated for regrafts. In this category of patients, IgG antibodies, whether against HLA class I antigens or HLA class II/non-HLA antigens, were highly predictive of early graft loss (positive predictive value 50%-100%). Using this protocol for patient selection, 1-month graft survival would have improved from 73% to 96%.

Adolescent↗
PubMed1990

Escherichia coli O157:H7 haemorrhagic colitis. Report of the first South African case.

Escherichia coli O157:H7, although recognised 15 years ago, has only become a significant pathogen since 1982 when two outbreaks of haemorrhagic colitis due to this organism were described in the USA. Since then, numerous such outbreaks have been reported. Recent experience with a patient presenting with E. coli O157:H7-induced haemorrhagic colitis is described. The main features, pathological findings and investigations are described and the principles of management outlined.

Aged↗
PubMed1989

Time-dependent changes in serum gastrin measurements after parathyroidectomy.

A prospective study involving 7 patients with primary hyperparathyroidism and hypergastrinaemia was conducted to assess the time-dependent change in serum gastrin value before and after parathyroidectomy and to determine at which postoperative stage persistent hypergastrinaemia may be indicative of an associated gastrinoma (Zollinger-Ellison syndrome). Five of the 7 patients had hypergastrinaemia in the early postoperative period. One patient had a strikingly high serum gastrin level pre-operatively (1,500 pg/ml). The mean serum gastrin value declined to within the normal range 6 weeks after parathyroidectomy, except in 1 patient who had a gastrinoma. It is concluded that hypergastrinaemia in patients with primary hyperparathyroidism should only be considered significant if pre-operative gastrin levels are strikingly supranormal and/or levels fail to normalise by the 6th postoperative week.

Adult↗