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Biomedical subjects

J Terblanche

Publications and source records attributed to J Terblanche.

At least 91 records · Page 5Linked to original sources
PubMed1989

Sucralfate in the prevention of porcine experimental peptic ulceration.

Sucralfate is the first drug to be shown to prevent ulceration in bile duct-ligated pigs. Usually such ulceration is uniformly fatal. Seven pigs in each of four groups in this study received only saline, or sucralfate (1 g every six hours), famotidine (40 mg per day), or misoprostol (200 micrograms every six hours). A Foley catheter was placed into a gastrectomy after bile duct ligation. Similar groups of sham-operated pigs were also prepared. After 48 hours, all saline-, famotidine-, or misoprostol-treated pigs showed severe macroscopic ulceration, whereas only two of those treated with sucralfate showed minimal macroscopic ulceration. Until now, only highly selective vagotomy has reduced ulceration caused by bile duct ligation. The present results suggest that acid inhibition is not the only important factor in healing bile duct ligation-induced peptic ulceration.

Alprostadil↗
PubMed1989

The aminopyrine breath test predicts the outcome of hepatic transplantation in pigs.

The aminopyrine breath test has been performed on Day 1 and Day 7 in pigs following experimental liver allografting. The results show that at 24 hr after surgery there was a significant reduction in liver function in all animals as measured by the elimination rate constant of 14CO2 in the breath. This was very profound in the group that died within 5 days (0.09 +/- 0.01 hr-1) and was significantly different from the group that survived (0.16 +/- 0.01 hr-1). There appears to be a critical value of the elimination rate constant (= 0.12 hr-1) which predicts death within 5 days. These results would justify a trial of the aminopyrine breath test in patients after liver transplantation.

Aminopyrine↗
PubMed1989

Reticuloendothelial function and plasma fibronectin in a murine model of intra-abdominal sepsis.

The lung is the target organ most frequently involved in the early phase of multiple organ failure. Microembolisation of the pulmonary vasculature by bacterial and non-bacterial particles and debris with failure of the clearance mechanism of the reticuloendothelial system (RES) and depletion of plasma fibronectin have been implicated in the pathogenesis. The present study examined the concurrent changes in plasma fibronectin, RES phagocytic function, organ localisation of bacterial and non-bacterial particles and the levels of circulating endotoxin and fibrin degradation products in a clinically relevant murine model of severe intra-abdominal infection. Progressive sepsis was associated with deteriorating RES phagocytic function to 45% of control values within 48 h of sepsis induction. There was decreased hepatosplenic uptake and increased pulmonary localisation of bacterial and lipid emulsion particles. Plasma fibronectin increased in septic animals within 48 h suggesting increased fibronectin production. These changes would support the hypothesis that altered RES function may facilitate pulmonary microembolisation in the pathogenesis of septic multiple organ failure.

Abdomen↗
PubMed1989

The surgeon's role in the management of portal hypertension.

Patients with portal hypertension are referred to surgeons for several reasons. These include the management of continued active variceal bleeding; therapy after a variceal bleed to prevent further recurrent bleeds; consideration for prophylactic surgical therapy to prevent the first variceal bleed; or, rarely, an unusual cause of portal hypertension which may require some specific surgical therapy. Injection sclerotherapy is the most widely used treatment for both acute variceal bleeding and long-term management after a variceal bleed. Unfortunately it has probably been overused in the past. The need to identify the failures of sclerotherapy early and to treat them by other forms of major surgery is emphasized. The selective distal splenorenal shunt is the most widely used portosystemic shunt today, particularly in nonalcoholic cirrhotic patients. The standard portacaval shunt is still used for the management of acute variceal bleeding as well as for long-term management, particularly in alcoholic cirrhotic patients. For acute variceal bleeding the surgical alternative to sclerotherapy or shunting is simple staple-gun esophageal transection, whereas in long-term management the main alternative is an extensive devascularization and transection operation. Liver transplantation is the only therapy that cures both the portal hypertension and the underlying liver disease. All patients with cirrhosis and portal hypertension should be assessed as potential liver transplant recipients. If they are candidates for transplantation, sclerotherapy should be used to treat bleeding varices whenever possible, as this will interfere least with a subsequent liver transplant.

Esophageal and Gastric Varices↗
PubMed1989

Long-term injection sclerotherapy treatment for esophageal varices. A 10-year prospective evaluation.

Long-term injection sclerotherapy after proved variceal bleeding was assessed in 245 patients. The majority had alcoholic cirrhosis and the patients were equally distributed between modified Pugh-Child's risk grades A, B, and C. Esophageal varices were eradicated in 88% of the 140 patients who survived long enough for analysis, and remained eradicated for a mean of 19.4 months. The incidence of recurrent variceal bleeding after the first hospital admission was 0.02 bleeding episodes per patient month of follow-up study and was markedly reduced after eradication of varices. The overall cumulative survival rates at 1, 5, and 10 years were 54%, 39%, and 29%, respectively. The prognosis was influenced by the risk grade and the number of variceal bleeds before entering the study and to a lesser extent by the etiology of the cirrhosis. Fifty-two per cent of the patients died during the 10-year period. Liver failure was the major cause of death. Complications were mostly of a minor nature but they became cumulative with time. Minor complications included mucosal slough and injection-site leak, although the latter had an associated mortality risk. Significant esophageal stenosis and esophageal rupture were rare. As a result of this study a more radical surgical policy is proposed for sclerotherapy failures. These are defined as patients in whom varices are difficult to eradicate or who continue to have major variceal bleeds. Such patients should be subjected to either a portosystemic shunt or a devascularization and transection procedure.

Adult↗
PubMed1989

A 10-year prospective evaluation of balloon tube tamponade and emergency injection sclerotherapy for actively bleeding oesophageal varices.

During a 10 year study period 234 patients were admitted on 371 occasions with a total of 566 acute variceal bleeding episodes. Of these, 173 patients had 343 variceal bleeds which required balloon tamponade to achieve initial control of bleeding during 229 admissions and were then referred for emergency injection sclerotherapy. Sixty-eight percent of these patients had alcoholic cirrhosis and 42% were poor risk Grade C patients. Injection sclerotherapy was performed initially using the rigid Negus oesophagoscope under general anaesthesia and later using the fibreoptic endoscope under light sedation. Definitive control of variceal bleeding was achieved with sclerotherapy during 197 hospital admissions (92%). Of the 17 failures of emergency sclerotherapy, 4 patients died from uncontrolled bleeding and 13 patients underwent major surgical intervention. Definitive control of variceal bleeding was achieved with a single injection treatment in 138 hospital admissions (70%). Complications were mostly of a minor nature and occurred at a rate of 6% per injection treatment. The overall hospital admission mortality was 36%. The majority of patients died due to liver failure. The mortality in patients who required 4 injection treatments to control variceal bleeding was 71%. Injection sclerotherapy is proposed as the emergency treatment of choice for patients whose variceal bleeding continues or recurs after initial conservative management. Patients whose variceal bleeding is not controlled by 2 injection treatments require more major emergency surgery.

Adolescent↗
PubMed1989

Disturbances of reticulo-endothelial function following experimental liver transplantation.

Reticulo-endothelial function was studied in liver-grafted pigs using intravenous carbon clearance at 24 h and 7 days postgraft. Flushing of auto- or allografts with Ringer's lactate and with or without 4-hour storage caused no change in carbon clearance. Flushing of auto- or allografts with Eurocollins solution and with or without 4-hour storage resulted in delayed carbon clearance at 7 days. The changes appeared to be related to the composition of preservation fluid rather than to its volume or temperature, the duration of storage or the development of rejection.

Animals↗
PubMed1989

Serial mixed lymphocyte culture responses in pigs after liver or kidney auto- or allotransplantation.

In order to investigate further the peculiarly limited response of the transplanted pig liver to rejection, this study investigated serial mixed lymphocyte culture (MLC) responses and suppression of phytohaemagglutinin (PHA)-stimulated lymphocytes by serum from transplanted animals. The responses of lymphocytes from liver allografted pigs were compared with those from sham-operated, liver-autografted or kidney auto- or allografted animals for up to 22 weeks postoperatively. Lymphocytes from operated animals were added to cultures of 2 'universal' donors which were not anaesthetised at any time and which remained lymphocyte donors for the period of each operated pig's survival. After liver allograft, a sustained stimulation of MLC responses was noted which contrasted with the minimal random stimulatory activity seen in the other groups. The response was not seen in lymphocytes from animals subjected to liver autograft. There was a surprising variability in the week-to-week MLC tests of individual animals for which no cause could be found. The serum from liver auto- and allografted pigs had suppressive action on the PHA stimulation of lymphocytes. There was no correlation between the length of survival and the intensity of the pre-operative MLC response. Whilst the biochemical data of liver allografted pigs showed evidence of ongoing hepatocyte damage, the histological changes were less obvious especially in the long-surviving group. This study highlights again the ability of unimmunosuppressed pigs to accept liver allograft and seems to associate this with sustained hepatocyte damage and stimulation of the MLC.

Animals↗
PubMed1989

[Undergraduate dental education: a survey].

This survey of recently qualified dentists indicates that their undergraduate education had not prepared them adequately for private practice. In certain identified disciplines the teaching was considered to be wanting, whilst in others it had been over-emphasised. It can also be concluded that too much time was spent on certain clinical or technical procedures and that ways and means will have to be found to improve the teaching of practice management and comprehensive patient care. Finally, various disciplines in which refresher courses are apparently required, have been identified.

Education, Dental↗
PubMed1989

Incidence and management of complications after injection sclerotherapy: a ten-year prospective evaluation.

The incidence and management of complications of injection sclerotherapy are reviewed in 304 consecutive patients with esophageal varices followed up prospectively for a 10-year period. The 304 patients were injected on 1336 occasions. Three hundred eleven local esophageal complications occurred in 140 patients (complication rate, 23% per injection and 46% per patient). Esophageal mucosal slough, which was diagnosed by endoscopy, occurred on 250 occasions in 126 patients but did not require specific treatment. An injection site leak occurred in 25 patients, was managed conservatively, and was associated with a mortality rate of 28%. Stenosis of the esophagus was found in 32 patients, but only five patients required dilatation for relief of symptoms. Rupture of the esophagus occurred in four patients, three of whom had surgical treatment, and was associated with a mortality rate of 50%. Serious complications were more frequent with the rigid esophagoscope. An injection site leak occurred more frequently after acute sclerotherapy via the rigid esophagoscope. All four patients with rupture of the esophagus were injected electively via the rigid esophagoscope. Although the incidence of serious complications after injection sclerotherapy in this series appears acceptable, complications have been noted to be cumulative with time.

Adolescent↗
PubMed1988

The use of sclerotherapy for the management of oesophageal varices in portal hypertension.

Although sclerotherapy is currently the most widely used treatment for the management of both acute variceal bleeding and the long-term management of patients with varices, its definitive role in the treatment of these patients has yet to be finally proven. Sclerotherapy appears to be the most effective treatment for the majority of patients with acute variceal bleeding. Failures require either a shunt or a transection and/or devascularisation procedure. Current evidence favours simple staple gun transection or a shunt (either a portacaval shunt or a side-to-side narrow diameter polytetrafluoroethylene graft between the portal vein and vena cava). In long-term management of patients after a variceal bleed the currently favoured treatment is repeated sclerotherapy. However, failures should be identified early. We define failures as patients who present with varices that are either difficult to eradicate by sclerotherapy or who have repeated life-threatening variceal bleeds during the course of repeated injection sclerotherapy. Such patients should have either a portal-to-systemic shunt or a transection and devascularisation operation. Further controlled trials are required to define the specific indications for the individual forms of therapy. Prophylactic treatment for varices that have not yet bled is unjustified at present.

Esophageal and Gastric Varices↗
PubMed1988

Partial hepatectomy and liver regeneration in pigs--the response to different resection sizes.

Liver regeneration has been extensively studied in the rat and dog models but pigs have seldom been used. They resemble man closely in their omnivorous diet and their gastroenterological and endocrinological responses. This paper describes techniques of 15, 50, 65, and 70% partial hepatectomy in the pig. Thymidine kinase activity and mitotic index were used as indices of liver regeneration. The timing and events of the regenerative response in the pig compared favorably with other animal models and the maximum regenerative response occurred on the third postoperative day, irrespective of the size of the partial hepatectomy. The 15% partial hepatectomy, which shows a minimal response to resection, provides a suitable "primed" model for the study of stimulatory substances.

Animals↗
PubMed1988

The effect of hepatic devascularisation in the pig upon the energy charge and ketone ratio.

This study describes the effects upon various functions of the porcine liver, especially the energy charge, after ligation of the hepatic artery or diversion of portal venous blood either with or without revascularisation by arterial or vena caval blood. Energy charge was significantly reduced for up to 2 days after arterial ligation but by 7 days was showing a return towards normal. Levels of adenosine triphosphate were affected most. The ketone body ratio was well maintained. A sharp elevation in levels of aspartate aminotransferase was noted at 2 days but had returned towards normal by 7 days while the prothrombin index and plasma fibrinogen tended to fall. There were inconsistent changes after portal diversion. These data indicate that the hepatic arterial, rather than portal venous inflow is important in the maintenance of porcine hepatic energy charge. This fact has physiological implications, and there is also an important application in the field of liver transplantation, where it may be that the ischaemic liver should be rearterialised first rather than after revascularisation with portal venous blood.

Adenosine Diphosphate↗