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Biomedical subjects

J Terblanche

Publications and source records attributed to J Terblanche.

At least 109 records · Page 6Linked to original sources
PubMed1988

Rigid versus fiberoptic endoscopic injection sclerotherapy. A prospective randomized controlled trial in patients with bleeding esophageal varices.

During a 3-year period (June 1981-July 1984), 70 patients who presented with an endoscopically proven variceal bleed were randomized to receive either fiberoptic injection sclerotherapy (FIS, 36 patients) or a rigid scope technique (RIS, 34 patients), using ethanolamine oleate as the sclerosing agent. After discharge, patients entered into a chronic injection sclerotherapy program. Control of the acute bleeding episode (FIS, 91%, RIS, 95%) and the first hospital admission mortality (FIS, 34%, RIS, 44%) were similar. Eradication of varices was achieved in 16/19 and 13/16 cases in the two respective groups of patients who survived longer than 3 months, and only 2 of these patients (both of whom were in the RIS group) had a further major variceal bleed. The overall complication rate per injection was significantly lower in the FIS group (p less than 0.005). Twenty-six patients (14 FIS, 12 RIS) were alive at the end of the 4-year trial period. Of the total of 44 deaths, only 3 were not associated with a bleeding episode. Only five of the 29 patients who had their varices eradicated died during the trial period (median follow-up of 16 months). FIS has become the preferred method of treatment at the Groote Shuur Hospital, particularly in the long-term management of these patients. The procedure is safe, does not require a general anesthetic, and in long-term management, most patients can be treated on an outpatient basis. RIS should be reserved for the difficult recurrent acute bleeder, where the more controlled situation with a rigid scope under general anesthesia may provide safer and more effective sclerotherapy. The study stresses the importance of achieving eradication of all varices to prevent rebleeding and its attendant high mortality.

Esophageal and Gastric Varices↗
PubMed1988

Hepatic stimulator substance in extracts from regenerating porcine liver. Basic physiochemical properties.

Previous studies in rats and dogs have implicated the liver as the source of some of the factors which are responsible for its regeneration. In the present study extracts from regenerating and normal livers were infused into the portal vein of pigs after a 15% partial hepatectomy. Thymidine kinase activity was measured on the 3rd and 4th days as an index of liver regeneration. An intraportal infusion of extracts from regenerating, but not normal, livers resulted in an increased regenerative response. The response was dose-related. The stimulator substance was stable when stored at -20 degrees C and could be precipitated by absolute ethanol.

Animals↗
PubMed1988

A porcine model for the study of liver regeneration.

A technique of 65% partial hepatectomy in the pig is described. Thymidine kinase activity and mitotic index were used as indices of liver regeneration. Thymidine kinase activity increased from a baseline value of 1526 +/- 256 to a maximum of 23992 +/- 4966 dpm/mg protein on the third day after partial hepatectomy. The mitotic index also increased from 0-13.3 +/- 1.66 on the third postoperative day. The indices of regeneration remained unchanged after sham operation.

Animals↗
PubMed1988

The role of U tube palliative treatment in high bile duct carcinoma.

Twenty-one patients with cholangiocarcinoma at the confluence of the main right and left hepatic ducts were referred to our professorial surgical unit between 1968 and 1982. All were evaluated, treated, and documented prospectively with follow-up to mid 1986. No lesion was deemed resectable. The U tube palliative bypass developed during the course of the study was used in 14 patients, and its role in treating high bile duct carcinoma was evaluated. Histologic confirmation of the diagnosis was obtained in 71% of patients. Seven patients received additional treatment with radical radiotherapy. The 30-day overall hospital mortality rate was 19%. The 1- and 2-year survival rates were 57% and 33%, respectively. The quality of survival was usually good. The need for centralized referral and treatment of these difficult patients is stressed. The case against radical resection for this lesion is presented. It is concluded that radical resection is seldom possible, and therefore the U tube palliative procedure is advocated in most patients.

Adenoma, Bile Duct↗
PubMed1987

Unresectable fibrolamellar hepatocellular carcinoma treated with intra-arterial lipiodolised doxorubicin. A case report.

Hepatocellular carcinoma is often an aggressive tumour and, if unresectable, carries a poor prognosis, especially in the presence of jaundice. We report on a jaundiced patient with an unresectable fibrolamellar hepatocellular carcinoma treated with intra-arterial lipiodolised doxorubicin (Adriamycin). The initial response of the patient has been encouraging. This form of therapy deserves further evaluation in patients with unresectable hepatocellular carcinoma.

Adult↗
PubMed1987

Primary sclerosing cholangitis: biliary drainage and duct dilatation.

A further extension of the U-tube technique is described in the treatment of six patients with primary sclerosing cholangitis who developed progressive jaundice and recurrent biliary sepsis. All six patients had operative intrahepatic duct dilatation and U-tube placement. Three patients in addition had a Roux-en-Y hepaticojejunal anastomosis. Five patients are improved and are well after a median follow-up period of 56 months. Two patients have had the U-tube removed electively. Three patients with progressive disease required further percutaneous catheter dilatation of intrahepatic strictures via the U-tube tract. Application of the technique permits evaluation of the biliary system by tube cholangiography and provides access in complex cases for repeated therapeutic intrahepatic stricture dilatation.

Adult↗
PubMed1987

Injection sclerotherapy in adult patients with extrahepatic portal venous obstruction.

Thirty-nine adult and teenage patients with extrahepatic portal venous obstruction (EHPVO) were treated with injection sclerotherapy. There were 22 males and 17 females with a mean age of 27 years (range 12-69). Oesophageal varices were eradicated in 33 patients after seven injections (range 1-17) over a mean of 14.5 months (range 1-48). Fewer injections were needed to eradicate varices in older patients. Variceal bleeding occurred on 13 occasions in 9 patients before eradication of varices and on 4 occasions in 4 of the 33 patients in whom varices had been eradicated, with a mean follow-up of 44 months (range 3-105). There were no deaths during the study period. Complications, mostly of a minor nature, occurred in 25 patients and included injection site leak in 5, stenosis in 7 and mucosal ulceration in 23. We conclude that injection sclerotherapy is the treatment of choice in patients with EHPVO.

Adolescent↗
PubMed1987

Giant hepatic hemangiomas: diagnostic and therapeutic dilemmas.

This report describes four cases of surgically treated giant hepatic hemangiomas which illustrate some diagnostic and therapeutic difficulties encountered in the management of this condition. An important diagnostic triad has emerged, which should alert the physician to the possibility of a complicated hepatic hemangioma: the clinical signs of an acute inflammatory liver process contrasted with a normal white blood cell count and liver function tests. Hemangiomas of the left lobe were either missed or poorly demonstrated on selective hepatic angiographic examination, and in two patients the diagnosis was made only at the time of laparotomy. Hepatic resection was successfully performed in all patients; there was minimal morbidity and none of the patients died. In two patients with multiple hemangiomas, only symptomatic or easily resectable lesions were removed. All patients are alive and well; three have been followed up for more than 5 years. We conclude that resection in asymptomatic cases should be carried out only in those cases that require a diagnostic laparotomy and in those where the lesion is easily resectable. The majority of patients with symptomatic and complicated tumors should undergo resection, but even in these patients continued conservative treatment is appropriate when the risk of major resection outweighs the small risk of live-threatening bleeding.

Adult↗
PubMed1986

Limitations of multiple injection sclerotherapy sessions for acute variceal bleeding.

Sixty-six patients with active bleeding (127 episodes) from oesophageal varices treated by balloon-tube tamponade followed by injection sclerotherapy with a rigid endoscope were followed up for at least 1 year and analysed to determine whether the number of acute injection sessions during each hospital admission (87) or any other known parameter of liver function, e.g. Child's grading, affected the outcome. Definitive control of bleeding was achieved with one or two injections during 75 of these admissions (86%) with a mortality rate of 21%. However, the mortality rate in those patients who received three or four injections was 66% and reached 89% when Child's category A patients were excluded. It is concluded that the mortality rate in poor risk patients becomes unacceptably high when more than two injection sessions are required during a single hospital admission. Other methods of treatment, such as emergency portacaval shunting or devascularization procedures, should be instituted in the small subgroup of patients whose variceal bleeding is not controlled by two injection sessions.

Esophageal and Gastric Varices↗
PubMed1986

Prospective controlled trial of transhepatic biliary endoprosthesis versus bypass surgery for incurable carcinoma of head of pancreas.

53 patients with obstructive jaundice due to incurable carcinoma of the head of the pancreas were randomly allocated to percutaneous transhepatic placement of a permanent biliary endoprosthesis (PTE) or bypass surgery. After exclusions 25 patients in each group were treated. Technical success was achieved in 21 patients (84%) in the PTE group and 19 (76%) in the surgery group. The incidence of postprocedural complications (PTE 7, surgery 8) and 30-day mortality (PTE 2, surgery 5) were similar. Recurrent jaundice occurred more often in the PTE (8/21) than the surgery group (3/19). Duodenal obstruction developed in 3 patients in the PTE group. Although the initial median postprocedural hospital stay was significantly shorter in the PTE than the surgery group, the difference was no longer significant when readmissions for blocked endoprosthesis and gastric outlet obstruction were taken into account. There was no difference in the median survival time in the two groups (PTE 19 weeks, surgery 15 weeks).

Aged↗