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Biomedical subjects

J Terblanche

Publications and source records attributed to J Terblanche.

At least 127 records · Page 7Linked to original sources
PubMed1986

Venous anatomy of the lower oesophagus in portal hypertension: practical implications.

The venous anatomy of the lower oesophagus and upper stomach in man was studied using high resolution resin casts obtained from ten fresh cadavers. Four layers of veins were identified in the oesophagus of both normal and portal hypertension patients. Intra-epithelial channels drained into a superficial venous plexus which connected to larger deep intrinsic veins. Both the superficial plexus and the deep intrinsic veins communicated directly with their counterpart veins in the stomach. Perforating veins connected the deeper veins with the adventitial plexus, the fourth layer. In patients with portal hypertension all of these veins were significantly dilated. Typical large oesophageal varices arose from the main trunks of the deep intrinsic veins which communicated directly with gastric varices. This study clarifies the anatomy of oesophageal varices and may explain why sclerotherapy is usually effective. The venous communications are probably partly responsible for the recurrence of varices after sclerotherapy.

Adolescent↗
PubMed1986

Sclerotherapy in acute variceal bleeding: technique and results.

The current Cape Town management policy for patients with suspected acute variceal bleeding includes vasopressin infusion 0.4 units/minute, and emergency diagnostic endoscopy. Sengstaken balloon tube tamponade is reserved for patients with active variceal bleeding at the time of emergency endoscopy. Only these patients have early emergency sclerotherapy. The results of the Cape Town five-year prospective evaluation of sclerotherapy with the rigid Negus oesophagoscope using general anaesthesia are presented. We conclude that the combined use of balloon tube tamponade and sclerotherapy has markedly simplified the management of patients with variceal bleeding at our institution. The preliminary results of the 2-year analysis of our ongoing prospective randomised controlled clinical trial comparing the above technique with a new combined paravariceal and intravariceal sclerotherapy technique using a fibreoptic endoscope without anaesthesia are presented. We conclude that both techniques successfully control acute variceal bleeding in the majority of poor-risk patients, but that the rigid scope has some advantages, particularly in those few patients who rebleed at the time of injection. We currently recommend a standard portacaval shunt or a devascularisation and transection procedure for the rare failures of sclerotherapy. Controversial areas of sclerotherapy are reviewed, and a new treatment policy for acute variceal bleeding is proposed on the basis of our experience and a review of the literature.

Acute Disease↗
PubMed1986

For how long can the liver tolerate ischaemia?

In this study the ability of the normal liver to tolerate normothermic ischaemia was assessed. The survival rate in pigs after 3, 6 and 12 h of normothermic hepatic ischaemia was 71, 46 and 0%, respectively. A patient who survived after inadvertently being subjected to 90 min of normothermic hepatic ischaemia is also presented. These findings suggest that the 'safe period' for liver blood flow occlusion could be extended beyond 1 h.

Animals↗
PubMed1986

Transplantation. The liver.

Liver transplantation has been described as one of the most difficult of surgical operations. But in a few major centres throughout the world good results follow this procedure and patients otherwise condemned to an early and miserable death can enjoy a happy life once more.

Adult↗
PubMed1985

Axillofemoral bypass. A 2-decade experience reviewed.

A retrospective study of axillofemoral bypass performed at Groote Schuur Hospital over a period of 2 decades was undertaken to analyse the results and to re-examine current criteria for patient selection. During this period 109 patients underwent surgery. The primary indication was critical ischaemia (in 88% of cases). Operative mortality was 6,4%. Graft thrombosis and sepsis were identified as the major reasons for graft failure. Overall graft patency at 3 years was 43% and at 5 years 30%. Successful graft thrombectomy improved the overall cumulative patency rate at 5 years to 43%, and patient survival in the same period was 56%. Modern advances in the assessment of anaesthetic risk together with improved postoperative intensive care have allowed more patients who in the past would have been considered candidates for axillofemoral bypass to undergo direct aortic reconstruction. While the results of axillofemoral bypass are inferior to those of aortic grafts, the technique remains a valuable method of limb salvage for the poor-risk patient and a life-saving treatment for aortic graft sepsis.

Adult↗
PubMed1985

Mortality and morbidity after anterior lesser curve seromyotomy with posterior truncal vagotomy for duodenal ulcer.

A survey has been performed of the mortality and morbidity of anterior lesser curve seromyotomy with posterior truncal vagotomy in the elective treatment of chronic duodenal ulcer. There was one death in a series of 605 patients due to a myocardial infarction, an operative mortality of 0.16 per cent. There was no case of ischaemic necrosis of the lesser curvature or fundus of the stomach. Eleven patients had symptoms of delayed gastric emptying (1.7 per cent) and seven of these underwent a drainage procedure (1.3 per cent). Postoperative dumping did not occur, significant diarrhoea was present in two patients (0.33 per cent). This operation is relatively simple, quick and extremely safe to perform. It is suggested that the more widespread use of this type of elective surgery for duodenal ulcer might reduce the mortality from the condition.

Chronic Disease↗
PubMed1985

A review of injection sclerotherapy--the Cape Town experience.

Sclerotherapy is currently used to treat acute variceal bleeds and also in the long-term management after a variceal bleed. The technical variants and results of sclerotherapy in both settings are reviewed and compared with alternative surgical treatment options. Sclerotherapy has become an accepted therapy for acute variceal bleeding. In Cape Town it is used in combination with the Sengstaken tube. A preliminary analysis of an ongoing trial comparing a rigid scope technique with a fibreoptic scope technique provides support for the use of the rigid scope in acute variceal bleeding. The place of repeated sclerotherapy in long-term management has become controversial. Varices can be eradicated and repeated variceal bleeds markedly reduced, but its role in improving survival requires further clarification.

Acute Disease↗
PubMed1985

The "divided stomach"--a model for separate acid and alkali collection in the pig.

Bile duct ligation (BDL) in the pig results uniformly in fatal oesophago-gastric ulceration which appears to be related to hypersecretion of acid. The presence of bile in normal porcine gastric juice may interfere with studies of acid secretion. The present studies were conducted in pigs with the stomach divided into two separate pouches (proximal and antral) which allowed individual collection of acid or alkali secretion. In normal pigs, division of the stomach resulted in a 30-50% decrease in secretion, rather than any increase in measureable acid. In BDL pigs, there was an 8- to 15-fold increase in alkali collection by antral pouches which may have been in response to acid hypersecretion, or merely duodenal or pancreatic juice reflux. No normal pigs with divided stomachs developed significant ulceration suggesting that such ulcers were not related to exclusion of bile from the stomach. It is proposed that a total gastric fistula may be used in the pig for studies of acid secretion, and that the model with divided stomach may be used for assessment of the effects of secretagogues or hormones upon individual acid or alkali secretion.

Alkalies↗
PubMed1985

Healing of the bile duct anastomosis after transverse choledochotomy or transplantation of the liver in the pig.

A comparison was made in pigs of the tensile strength of the bile duct anastomosis after simple dochotomy and after hepatic autograft or allograft. It appears that tensile strength returned to normal levels within 15 days of simple dochotomy and indeed rose past normal at 50 days, but that after either form of hepatic grafting, tensile strength did not reach normal levels even by 50 days postoperation.

Animals↗
PubMed1985

Subtotal cholecystectomy: for the difficult gallbladder in portal hypertension and cholecystitis.

An easy, safe, and definitive operation for the "difficult gallbladder" is described and has been termed subtotal cholecystectomy. Eighteen patients underwent subtotal cholecystectomy during a 30-month period, which constitutes approximately 7% of cholecystectomies performed at our institution. The indications were cholecystitis with severe fibrosis or inflammatory changes that prevented safe dissection in Calot's triangle in 11 patients and portal hypertension in seven patients (liver cirrhosis [two patients] and segmental portal hypertension caused by chronic pancreatitis [five patients]) to prevent massive blood loss from the gallbladder bed. The operation entails leaving the posterior wall of the gallbladder attached to the liver and securing the cystic duct at its origin from within the gallbladder with a purse string technique. The latter obviates the need for dangerous dissection in Calot's triangle. Control of bleeding from the remaining gallbladder edge is greatly facilitated by the use of a running suture after each stage of piecemeal excision of the gallbladder. All patients survived the operation and wound infection occurred in only two patients (11%). One patient required a laparotomy 1 month after surgery for adhesive small bowel obstruction related to the remaining gallbladder wall and site of a liver biopsy. No patients have so far developed postcholecystectomy symptoms (median follow-up 12.2 months; range 3 to 31 months). Subtotal cholecystectomy is a definitive operation that prevents recurrent gallstone formation, as no residual diseased gallbladder mucosa is left in continuity with the biliary system. It provides a simple, safe option in patients in whom cholecystectomy could be hazardous.

Aged↗
PubMed1985

Changes in specific immunoglobulins after various forms of portal diversion in the rat.

This study was designed to investigate further the hyperglobulinaemia which followed portal or splenic venous diversion but not mesenteric venous diversion. It was observed that levels of IgG and IgM were elevated from 3-6 weeks after portacaval shunt, portacaval transposition or splenacaval shunt. IgA levels were increased after all forms of portal venous diversions including after mesentericocaval shunt. The failure of levels of IgG and IgM to rise after mesocaval shunting suggests that some component of splenic venous blood may regulate the ability of the reticulo-endothelial system of the liver to respond to antigenic influences.

Animals↗
PubMed1984

Abdominoperineal resection of the rectum for carcinoma at Groote Schuur Hospital, Cape Town, 1971-1982.

Abdominoperineal excision of the rectum remains the accepted treatment for the majority of lower rectal adenocarcinomas. Despite advances in surgery and anaesthesia, survival has not improved over the last 40 years. Over a 12-year period the overall 5-year survival rate for patients undergoing abdominoperineal excision for adenocarcinoma of the rectum at Groote Schuur Hospital, Cape Town, was 39%. The incidence of complications associated with the operation remains high (36%). The major causes of morbidity still originate in the urinary tract and the perineal wound. Further techniques which may improve the overall survival are briefly reviewed.

Adenocarcinoma↗