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Biomedical subjects

J Terblanche

Publications and source records attributed to J Terblanche.

At least 181 records · Page 10Linked to original sources
PubMed1979

Patterns of hepatic injury induced by methyldopa.

Twelve patients with liver disease related to methyldopa were seen between 1967 and 1977. Illness occurred within 1--9 weeks of commencement of therapy in 9 patients, the remaining 3 patients having received the drug for 13 months, 15 months and 7 years before experiencing symptoms. Jaundice with tender hepatomegaly, usually preceded by symptoms of malaise, anorexia, nausea and vomiting, and associated with upper abdominal pain, was an invariable finding in all patients. Biochemical liver function tests indicated hepatocellular necrosis and correlated with histopathological evidence of hepatic injury, the spectrum of which ranged from fatty change and focal hepatocellular necrosis to massive hepatic necrosis. Most patients showed moderate to severe acute hepatitis or chronic active hepatitis with associated cholestasis. The drug was withdrawn on presentation to hospital in 11 patients, with rapid clinical improvement in 9. One patient died, having presented in hepatic failure, and another, who had been taking methyldopa for 7 years, showed slower clinical and biochemical resolution over a period of several months. The remaining patient in the series developed fulminant hepatitis when the drug was accidentally recommenced 1 year after a prior episode of methyldopa-induced hepatitis. In this latter patient, and in 2 others, the causal relationship between methyldopa and hepatic dysfunction was proved with the recurrence of hepatitis within 2 weeks of re-exposure to the drug.

Adult↗
PubMed1979

A new look at the arterial supply of the bile duct in man and its surgical implications.

The blood supply of the human bile duct has been re-evaluated using high resolution resin casts prepared from 24 fresh human cadavers. The refined technique used yielded casts of all vessels, including capillaries, and produced a clear picture of the blood supply of the human bile duct for the first time. The arterial supply of the supraduodenal duct was shown to be axial, with the main vessels, which have been named the 3 o'clock and 9 o'clock arteries, running along the lateral borders. The retroportal artery, which has not been described by previous workers, was present in all complete casts and was a major source of the axial blood supply to the supraduodenal duct in 32 per cent of them. The major importance of this new knowledge of bile duct blood supply may well lie in the understanding of the aetiology of postoperative bile duct strictures and in their prevention. An explanation is proposed for the long strictures sometimes seen after minimal surgical trauma to the bile duct, based on damage to the small vessels supplying the duct; guidelines to prevent such damage are presented. Ischaemia of the bile duct may also explain some of the biliary problems that have followed human liver transplantation and other procedures involving biliary anastomosis, such as Whipple's operation.

Arteries↗
PubMed1979

Liver transplantation.

This assessment of the role of liver transplantation in treating end-stage liver disease today is based on two major series, one from Denver and the other from the Cambridge/Kings College Hospital, England. The findings of these groups are highlighted, as are the changes in technique that have led to considerably improved survival in the past two years.

Age Factors↗
PubMed1979

A prospective evaluation of injection sclerotherapy in the treatment of acute bleeding from esophageal varices.

In a 25 month study of massive upper-gastrointestinal hemorrhage, 64 patients were shown to have esophageal varices on emergency endoscopy. Twenty-four patients were actively bleeding from varices and were treated with a Sengstaken tube, and in 22 this was followed by emergency injection sclerotherapy using a rigid esophagoscope and general anesthesia. These 22 patients were followed prospectively and had 51 episodes of endoscopically proven active bleeding from esophageal varices which required Sengstaken tube control of hemorrhage during 36 separate admissions. This group included our total experience of injection sclerotherapy in acute variceal bleeding. The majority (14 of 22 patients) had alcoholic cirrhosis. Definitive control of variceal bleeding during the period of hospitalization was achieved in 33 hospital admissions (92%), usually with a single injection (27 hospital admissions: 75%). The results were satisfactory in 26 hospital admissions (72%). There were nine deaths (41% overall patient mortality rate), but no patient died primarily of variceal bleeding, and exsanguinating variceal bleeding was no longer a problem. The mortality rate per injection was 18%, and the mortality rate per hospital admission was 25%. Injection sclerotherapy is proposed as the emergency treatment of choice for patients with proven bleeding esophageal varices who do not stop bleeding on initial conservative treatment.

Acute Disease↗
PubMed1979

A prospective controlled trial of sclerotherapy in the long term management of patients after esophageal variceal bleeding.

The preliminary results of the first 25 months of a prospective randomized controlled clinical trial, designed to compare repeated injection sclerotherapy with conservative medical management in the long term treatment of all patients shown to have previously bled from esophageal varices, are presented in detail. To date, 31 patients have been randomized, 15 in the chronic injection group and 16 in the control medical management group. In addition, five patients excluded for geographic reasons have been injected out of trial. Ethanolamine oleate has been injected into the varices, using a modified rigid esophagoscope under general anesthesia. The preliminary results have been encouraging. It has been possible to eradicate esophageal varices in the chronic injection group and, once the varices had been eradicated, no patient had recurrence of variceal bleeding. On the other hand, recurrent variceal bleeds have remained a continuing problem in a number of the patients in the control study. A longer follow-up period will be required to assess both the quantitative and the qualitative aspects of survival and to determine how long esophageal varices will remain eradicated as well as how frequently repeated injections will be required.

Adolescent↗
PubMed1978

The effect of gastrin on gastric ulceration in pigs after bile duct ligation.

Pigs develop gastric ulceration spontaneously and after bile duct ligation. Despite increased basal acid secretion, serum gastrin levels are not elevated, and a possible 'protective' role of gastrin was proposed. Continuous intravenous infusion of synthetic human gastrin did not protect from gastric ulceration, but was associated with simultaneous duodenal ulceration. Another ulcerogenic mechanism must be invoked.

Animals↗
PubMed1978

alpha-Fetoprotein in liver disease.

Ther serum concentration of alpha-fetoprotein (AFP) was measured by radio-immunoassay in 98 patients with liver disease including hepatoma, chronic active hepatitis, alcoholic cirrhosis, and acute virus B hepatitis. Raised AFP levels, above 30 ng/ml, were found in 87% of patients with acute viral hepatitis, in 82% of patients with primary liver cell carcinoma, in 58% with chronic active hepatitis and in 14% of patients with alcoholic cirrhosis. However, levels above 1 000 ng/ml were found only in patients with hepatoma and in acute viral hepatitis.

Adolescent↗
PubMed1978

Liver tumours associated with the use of contraceptive pills.

The possible association between benign liver tumours and the use of oral contraceptives is reviewed. The possible aetiological role of the pill, the confusion regarding the pathology of these lesions, and the presentation and diagnosis of the 4 clinical categories are discussed. These categories are: an incidental, asymptomatic lesion; a mass in the abdomen; upper abdominal pain; and shock due to rupture, with intraperitoneal haemorrhage. The importance of an awareness of the condition and the use of liver scanning, ultrasound and hepatic angiography in making a diagnosis, are emphasized. Biopsy is essential to establish the diagnosis and to differentiate benign from malignant tumours. A policy of treatment for the patients with different clinical presentations is detailed.

Adenoma↗
PubMed1978

Pancreatic ascites and pleural effusions.

Two cases of pancreatic ascites are presented and reviewed, together with 92 cases of internal pancreatic fistula reported in the recent literature. Alcohol abuse is the predominant aetiological factor, and chronic pancreatitis with an associated pseudocyst the most common pathological finding. The diagnosis depends on clinical suspicion and can be confirmed by the estimation of amylase and protein levels in the aspirated fluid. Medical treatment includes the aspiration of fluid accumulations, inhibition of pancreatic secretion, and nutritional augmentation. The use of pancreatography is recommended as a guide to the appropriate surgical procedure in patients who do not respond to medical therapy. Overall results indicate a cure rate of 77% and a mortality of 19%.

Adolescent↗
PubMed1978

Peptic ulcer and gastrin in pigs.

Previous studies have shown that bile duct ligation in pigs results in gastric ulceration. It has been suggested in human peptic ulceration that there may be no associated rise in the serum gastrin level. This study was conducted to determine the portal and peripheral gastrin levels in sham-operated and bile-duct-ligated pigs, together with the basal acid concentration and the response to a protein meal. There was an increase in basal acid concentration in bile-duct-ligated animals, but the serum gastrin levels remained in the normal range. Two of the six sham-operated control pigs had peptic ulcers at the time of sacrifice, and these two were the only sham-operated control pigs which did not demonstrate a significant postoperative rise in the serum gastrin level. At no stage was a significant difference between portal and peripheral vein serum gastrin levels demonstrated. These studies suggest that the increased gastric acid secretion in this form of peptic ulceration in the pig may not be entirely gastrin-mediated.

Animals↗
PubMed1978

The effect of feeding and starvation upon immunoreactive glucagon in the pancreatectomized pig.

The response of 13 pigs to total pancreatectomy was compared with the response of 9 animals to sham operation. Approximately half of each group had free access to food while the remainder received oral water only. Completeness of pancreatectomy was confirmed at autopsy, and the disappearance of insulin and the rise in blood glucose to 14-19 mmol/l. Immunoreactive glucagon (IRG) increased in fed pancreatectomized pigs from the 3rd day postoperatively to a level of 350-400% of basal values by the 8th day. There was no rise in starved pancreatectomized animals, or in either group of sham-operated animals. The rises in glucose, free fatty acids, triglycerides and ketones were similar in the two groups of pigs.

Acetoacetates↗
PubMed1978

The prevention of peptic ulceration by highly selective vagotomy in a new peptic ulcer experimental model: the bile duct-ligated pig.

Bile duct ligation produced gross peptic ulceration of the pars esophagea of the stomach, with a 70% mortality rate from hemorrhage or perforation. The situation and histological appearance of the ulcers was identical to the peptic ulcers that occur spontaneously in pigs. Previous work has shown that these ulcers are associated with gastric hypersecretion. The technique of highly selective vagotomy was established in the pig and was shown to have no short-term adverse effects. In a group of 10 pigs, highly selective vagotomy virtually eliminated pars esophageal peptic ulceration and significantly prolonged survival after bile duct ligation. The bile duct-ligated pig experimental peptic ulcer model should be of value in studying peptic ulceration and methods of treatment. Further investigation is required to determine the cause of death in those animals in which peptic ulceration is prevented by treatment, such as highly selective vagotomy.

Alkaline Phosphatase↗