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Biomedical subjects

J Terblanche

Publications and source records attributed to J Terblanche.

At least 145 records · Page 8Linked to original sources
PubMed1984

Liver blood flow after partial hepatectomy in the pig.

The role of liver blood flow in liver regeneration remains controversial. This study in 17 pigs documents the total hepatic blood flow, and portal and arterial components measured with an electromagnetic flowmeter, the portal pressure, and the cardiac output for 6 days after partial hepatectomy (PH) or sham operation. There was a twofold increase in total flow immediately after PH which rose to three- to fourfold by the second postoperative day. Thereafter values decreased but remained elevated above preoperative values; no similar increase was noted in sham animals. The increase in flow was both absolute as well as relative to the proportion of liver remnant remaining. The portal component increased from 74 +/- 3% preoperatively to 84 +/- 3% (P less than 0.05) on the second postoperative day, and portal pressure was apparently increased. These changes in flow precede the previously documented maximum regeneration response between Days 3 and 4. The factors resulting in the increased flow may be responsible in part, for regeneration.

Animals↗
PubMed1984

Sclerotherapy for bleeding esophageal varices.

Patients with endoscopically proven variceal bleeding that continues despite conservative management require invasive emergency measures to stop hemorrhage and improve survival. Injection sclerotherapy is the simplest and most effective means currently available. The relative merits of the various techniques and sclerosants remain controversial.

Combined Modality Therapy↗
PubMed1984

Transhepatic changes in insulin and glucagon following partial hepatectomy in the pig.

In this study, glucose levels decreased after partial hepatectomy in the pig. This was associated with a decrease in insulin and an increase in glucagon levels. An added dextrose infusion resulted in hyperglycemia and appropriate responses in insulin and glucagon. Insulin clearance remained unchanged and glucagon extraction by the liver was decreased after partial hepatectomy. Changes in insulin and glucagon after partial hepatectomy appear to be related to the changes in blood glucose rather than the regenerative process.

Animals↗
PubMed1984

Are acid and pepsin reduction the only effects of highly selective vagotomy. Evidence of changes in tissue levels of gastrin, prostaglandins and lysosomal acid hydrolases in an experimental ulcer model.

Using the bile duct ligated (BDL) pig as a model of experimental peptic ulceration, a study was made of the effects of highly selective vagotomy (HSV) upon basal and stimulated acid and pepsin secretion, tissue levels of n-acetylglucosaminidase, prostaglandins (PgE2) and gastrin, and gastric venous plasma gastrin. In addition to reducing basal acid and pepsin output, HSV was found to return towards normal the elevated tissue prostaglandin and depressed antral gastrin levels after BDL. In addition, it was observed that gastric juice specimens were markedly viscid. It is suggested that there may be effects of HSV other than acid and pepsin reduction which require attention.

Acetylglucosaminidase↗
PubMed1984

Endoscopic laser endarterectomy.

The effects of the Neodymium YAG laser on atheroma have been examined in human cadaver aortoiliac arteries and in normal porcine vessels. YAG laser is effective when used to ablate atheroma in an air environment and can be used successfully through the vascular endoscope. When atheroma were treated in the saline solution environment necessary for vascular endoscopy, the laser was less effective. Laser-treated areas of porcine arteries were not thrombogenic. Severe laser damage was easily recognized by blanching and marked elevation of the initma and consistently resulted in late aneurysm formation. ELE is feasible and further investigation is warranted.

Air↗
PubMed1983

Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. A five-year prospective controlled clinical trial.

The role of sclerotherapy in long-term management after oesophageal variceal bleeding was assessed by comparing repeated sclerotherapy by means of a rigid oesophagoscope in 37 patients with control medical management in 38 patients. Varices were eradicated in 21 of the 22 patients analysed (95%) in the sclerotherapy group, but recurred in 13 of the 21 patients (average 21.5 months). Varices persisted in 13 of 14 surviving controls. The sclerotherapy patients had fewer recurrent bleeds than control patients (43 versus 73); the majority occurred before variceal eradication and were mild. However, there was no difference in survival in the two groups. The commonest cause of death was liver failure (37 patients). 32 complications occurred in 24 patients during 258 injections. Repeated sclerotherapy failed to improve survival in this trial, although varices were eradicated and recurrent variceal bleeds were prevented with adequate follow-up.

Acute Disease↗
PubMed1983

An ischemic basis for biliary strictures.

Three case reports reflecting a probable ischemic basis for biliary strictures are presented. A stricture occurring after biliary-enteric anastomosis following low division of the bile duct and another after relatively low division of the bile duct are explained on the basis of the tenuous blood supply to the supraduodenal bile duct from above. It is postulated that these strictures could have been avoided had the bile duct been divided at a higher level originally and had adequate back-bleeding from the transected upper bile duct been checked prior to performing the anastomosis. The stricture in the third patient probably occurred because the damaged duct segment was used for the anastomosis. The stricture could probably also have been avoided by higher transection of the duct.

Adult↗
PubMed1982

Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial.

57 patients with obstructive jaundice were randomly allocated to surgery with preoperative external biliary drainage (29 patients) and without preoperative external biliary drainage (28 patients). 22 patients ultimately underwent laparotomy after a mean of 11.7 days of drainage and 25 had surgery without preoperative drainage. The postoperative complication rate was low and similar in both groups but complications associated with the drainage procedure were substantial. Perioperative mortality was 4/28 (14%) in the drainage group and 4/27 (15%) in the non-drainage group. There seems to be no advantage associated with routine preoperative external biliary drainage before surgery for obstructive jaundice.

Acute Kidney Injury↗
PubMed1982

The stimulatory effect of a partially hepatectomized auxiliary graft upon the host liver. Observations on the regenerative response in orthotopic and heterotopic grafts.

Transplantation of an intact or partially hepatectomized auxiliary liver graft has been shown to result in a marked regenerative response (as measured by thymidine kinase activity and mitotic index) in the donor liver, apparently associated with rejection. This response was also transmitted to the host (portacaval-shunted) liver which showed a four- to sixfold increment in regenerative response. Livers transplanted by conventional orthotopic techniques also showed a marked regenerative response. The control groups of animals which were subjected to portacaval shunt, portacaval transposition or liver autografting showed a minimal regenerative response. The regenerative response after orthotopic transplantation is an original observation of great relevance to the overall response to liver grafting and may help partly to explain the variable responses to the procedure.

Animals↗
PubMed1981

Carcinoma of the pancreas at Groote Schuur Hospital, 1975-1979.

One hundred and seven patients underwent laparotomy for carcinoma of the pancreas at Groote Schuur Hospital, Cape Town, during the years 1975-1979. Less than 3% of this group had tumours suitable for curative operations and 27% had advanced disease that precluded even palliative surgery. Although 2 patients are 5-year survivors, the overall prognosis for patients with carcinoma of the pancreas is poor; the average length of survival after diagnosis ranges from 3 to 6 months. Improvement in these dismal statistics may come with earlier diagnosis and accurate selection of patients for curative operations. Although ultrasonography, endoscopic retrograde cholangiopancreatography and other techniques speed diagnosis, most patients with this disease will remain candidates for palliative operation only.

Aged↗
PubMed1981

Obstructive jaundice in pancreatitis.

Twelve patients with obstructive jaundice as a direct result of pancreatitis or its complications are described. The value of ultrasonography in the diagnosis of this condition is stressed. The criteria for surgical intervention and the operation of choice are discussed.

Adult↗
PubMed1981

Hepatic sequelae of congestive cardiac failure. Evidence for a liver lesion in patients in whom cardiac function has been restored to normal.

In order to test the hypothesis that clinical and biochemical features of liver disease due to cardiac failure regress upon relief of cardiac decompensation, 38 patients with constrictive pericarditis were studied before and after pericardiectomy for periods ranging from 1 week to 25 years. All patients were judged to be free of clinical evidence of heart failure. Hepatomegaly was present in 10 of the 38 patients studied. Of the patients studied 1-25 years after operation, 96% had elevated serum levels of total and conjugated bilirubin. The percentage Bromsulphalein (BSP) retention at 45 minutes was abnormal in all 29 patients studied 1 year or more after surgery. There was no significant correlation between the level of bilirubin or the percentage BSP retained when these were compared with the pre-operative height of jugular venous pressure, degree of pulsus paradoxus, duration of symptoms or degree of hepatic congestion. Our study reveals that the liver lesion of cardiac failure persists for up to 25 years after restoration of normal cardiac function.

Adolescent↗
PubMed1981

Acute bleeding varices: a five-year prospective evaluation of tamponade and sclerotherapy.

In a five-year study of massive upper gastrointestinal hemorrhage, 143 patients had esophageal varices diagnosed on emergency endoscopic examination. Seventy-one patients had active bleeding from varices and required Sengstaken tube tamponade during at least one hospital admission. The remaining patients included 33 with variceal bleeding which had stopped and 39 who were bleeding from another source. Sixty-six of the former group of 71 patients were referred for emergency injection sclerotherapy. These 66 patients were followed prospectively to August 1980, and had 137 episodes of endoscopically proven variceal bleeding requiring Sengstaken tube control followed by injection sclerotherapy during 93 separate hospital admissions. Definitive control of hemorrhage was achieved in 95% the patients admitted to the hospital (single injection 70%; two or three injections 22%). The death rate per hospital admission was 28%. No patient died of continued variceal bleeding, and exsanguinating variceal hemorrhage no longer poses a major problem at our hospital. The combined use of initial Sengstaken tube tamponade followed by injection sclerotherapy has simplified emergency treatment in the group of patients who continue to bleed actively from esophageal varices, despite initial conservative treatment.

Acute Disease↗