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Biomedical subjects

J R Botha

Publications and source records attributed to J R Botha.

At least 55 records · Page 3Linked to original sources
PubMed1985

Transplantation for diabetic nephropathy.

The results of renal transplantation for end-stage diabetic nephropathy in 17 patients--11 receiving cadaver (CD) grafts and 6 related living donor (RLD) grafts--are reported. The transplants were rejected in 5 cases, in 4 acutely, and these patients were returned to haemodialysis; 3 of them subsequently died. One patient died of heart failure, but the graft was still functioning. The remaining 11 patients enjoy good renal function. The outcome was superior to results on dialysis, particularly for RLD grafts, and was comparable to results of transplantation for non-diabetic renal failure. Visual acuity tended to stabilize or improve after transplantation, but peripheral vascular disease progressed. Blood glucose control was suboptimal and requires more attention. Lipoproteins did not differ from those in non-diabetic patients. Renal transplantation is feasible and probably the preferred method of treatment for end-stage diabetic nephropathy.

Adult↗
PubMed1985

Source of cadaver kidneys for transplantation at Johannesburg Hospital.

The Johannesburg Hospital Renal Transplantation Unit obtains cadaver kidneys from throughout the Transvaal; they are also exchanged with other transplantation centres in the RSA. Analysis of the cause of death of kidney donors shows that motor vehicle accidents, suicide and cerebrovascular disease make up the majority. An encouraging feature has been the significant contribution from non-teaching hospitals and private institutions in the Johannesburg area and the effort made by more remote hospitals to help to ensure an adequate supply.

Adolescent↗
PubMed1985

Pregnancy after renal transplantation.

During the 13 year period 1971 to 1984 there were 38 pregnancies in 21 renal transplant patients at the Johannesburg Hospital. Twenty-two ended with live births and included two sets of twins; there were nine spontaneous abortions, six therapeutic abortions, and one stillbirth. Maternal complications were mild in the majority but five patients suffered deterioration in renal function, two undergoing transplant nephrectomy as a result of this. There were seven neonatal deaths, including both sets of twins; death was due to prematurity in six and congenital malformation (diaphragmatic hernia) in one. A further infant had congenital pyloric stenosis which was corrected surgically. Pregnancies were analysed according to whether or not their outcome was successful. Those with a successful outcome had less exposure to warfarin during pregnancy (p = 0.0025) and showed a tendency towards lower immunosuppressive doses of prednisone and azathioprine although these did not reach significance. Although these results indicate an unhappy prognosis for both the mother and fetus, two redeeming features are to be noted. Pregnancy outcome improved markedly in the latter years, possibly owing to non-exposure to warfarin, less immunosuppression, and improvement in neonatal care, and four of the five mothers who suffered deterioration in renal function were notoriously unco-operative in their medical care. Pregnancy can only be recommended in the transplanted patient who has stable renal function, is compliant in taking of medications, and whose graft is of such age that the immunosuppressive drug dose is minimal. Warfarin should be avoided.

Abnormalities, Drug-Induced↗
PubMed1984

Acyclovir in cytomegalovirus infection 3 1/2 years after renal transplantation. An unusual case and dramatic response.

Late cytomegalovirus (CMV) infection in renal allograft recipients is uncommon. The treatment of CMV infection is controversial, with numerous claims of successful treatment with different drugs. We report the successful use of acyclovir in a serious case of CMV infection occurring in a young woman 3 1/2 years after a renal transplant. This result is encouraging and supports the future use of acyclovir in the treatment of CMV infection in this and other settings.

Acyclovir↗
PubMed1984

Vascular access for haemodialysis--experience at Johannesburg Hospital.

Experience with angio-access in patients with chronic end-stage renal failure undergoing haemodialysis, including those with arteriovenous fistulas constructed within the past 3 years, is reviewed. In patients in group 1, 137 fistulas were constructed; the patency rate at 2 years was 66% and at 4 years 47%. Complications were due to thrombosis, aneurysm and poor operative technique. In group 2 fistulas were constructed from synthetic material in 33 patients; the patency rate at 2 years was 44% and at 4 years 36%. Complications were due to thrombosis and sepsis. No correlation was found between raised fibrinogen levels and fistula or graft failures. Dialysis needles of different gauges were compared; the 16-gauge Terumo needle was found to cause no hemolysis and was adequate for use in dialysis.

Adolescent↗
PubMed1984

Non-typhoid salmonella infections after renal transplantation. A serious clinical problem.

A retrospective study of 410 renal transplant recipients showed that 1.96% (8/410) of patients had developed severe non-typhoid salmonella infections. The clinical features seen were fever, leucopenia, pneumonia, diarrhoea, abscesses, pyelonephritis, venous thrombosis and pleural effusion. Neither uraemia nor repeated high doses of steroids seemed to be major precipitating events. All isolates were strains of Salmonella enteritidis. All 8 patients were cured and none became permanent carriers. Salmonella infections cause severe, life-threatening infections in renal transplant patients and require vigorous treatment often with a long-term low-dose regimen. Patients seemed to respond best to chloramphenicol, but ampicillin and co-trimoxazole were useful in some. Bilateral nephrectomy should be performed before the transplantation if the organism is grown from the urine.

Adult↗
PubMed1983

The treatment of end-stage renal disease at the Johannesburg Hospital: a 17-year experience. Part II. The role of transplantation.

Experience with 525 kidney transplants performed at the Johannesburg Hospital from 1966 to 1982 is reviewed. The 1-year graft survival rates for HLA-identical related living donor (RLD) transplants, haplo-identical RLD transplants, and first and subsequent transplants from cadaver donors (CDs) are 95%, 72%, 59% and 52% respectively. One-year patient survival figures for all RLD and all CD transplants are 93% and 78% respectively. There is a slower but steady attrition in both graft and patient survival over the next 10-15 years which is the same for all patients irrespective of donor source. Infection and myocardial infarction remain the major causes of mortality and morbidity. Mortality in the 1st year after transplantation has been reduced dramatically in the last 5 years of the programme. This has coincided with the introduction of a policy of routine pretransplant blood transfusion and a less aggressive approach to the treatment of severe and recurrent rejection episodes. However, the incidence of irreversible graft rejection in the 1st year has remained the same. These results, although gratifying in a broad context, leave no room for complacency. The induction of a state of specific tolerance towards the grafted organ remains the ultimate goal in clinical transplantation.

Actuarial Analysis↗
PubMed1981

Peptic ulceration in the renal transplant patient.

Peptic ulceration in renal transplant patients at Johannesburg Hospital is reviewed. The incidence of ulceration was 4,4%, and a high proportion of patients experienced complications (bleeding or perforation), with a mortality of 18,8%. From our experience, active pre- and post-transplant surgery is advocated in transplant patients, who are at risk from both the development of peptic ulceration and its sequelae.

Adult↗
PubMed1980

The reflux gastroesophageal polyp.

An inflammatory polyp at the gastroesophageal junction due to gastroesophageal reflux is a rare documented finding and its appearance on x-ray has only recently been described. A recently encountered case whose only symptom was of minor episodes of hematemeses is described and the literature is reviewed.

Adolescent↗
PubMed1976

Cross-matching assays of cell-mediated immunity for transplant patients.

Assays of cell-mediated immunity before transplantation were performed on 34 patients who were defined as being at high risk by the presence of preformed lymphocytotoxic antibodies and/or HL-A incompatibilities at FOUR locus. Assays for cell-mediated lympholysis type I (cml I) were performed in donor serum, and for CML II in recipient serum, to assess the possible effect of blocking factors in the patients' sera. A positive (greater than 5% specific Cr release) and in particular a greater than 10% Cr release correlated strongly with graft rejection. The correlation between CML II and graft survival was unimpressive. No clinically beneficial blocking factor was demonstrable in the patients's sera in that 5 of 6 patients with a positive CML I but a negative CML II rejected their grafts. Conversely, 6 of 8 patients with a positive CML II and a negative CML I had excellent long-term courses. The use of CML I assay in the selection of grafts for patients at high risk is recommended.

Cadaver↗
PubMed1976

Pregnancy in renal transplant recipients.

Of the 48 female patients attending the outpatient clinic of the Johannesburg General Hospital Transplant Unit between January 1971 and December 1974, 10 became pregnant. Fifteen pregnancies were recorded, 6 of which ended in abortions. Ten infants were born from the remaining 9 pregnancies and 4 (40%) died in the neonatal period. The main cause of neonatal death was prematurity. One major congenital anomaly, a diaphragmatic hernia, was found. Maternal complications were mild and easily controlled, urinary infection being the commonest. One patient showed a moderate reduction in renal function. Obstruction of labour by the transplanted kidney was not encountered, and the two Caesarean sections were performed for obstetrical reasons unrelated to the renal transplant.

Abortion, Therapeutic↗
PubMed1976

Angiography after renal homotransplantation.

The role of angiography in the investigation of problems encountered among 181 patients who received renal transplants at the Johannesburg General Hospital is analysed. In all, 23 patients underwent arteriography or venography after transplantation for the investigation of problems such as renal dysfunction, hypertension and suspected renal vein or iliofemoral venous thrombosis.

Diagnosis, Differential↗