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Biomedical subjects

D F du Toit

Publications and source records attributed to D F du Toit.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Perspectives in the clinical application of pancreas transplantation in the diabetic].

Until June 1983 a total of 280 human pancreatic transplantations had been performed world-wide. Until July 1983, 57 were functioning (22%), 11% for more than 12 months. During the past 5 years a steady increase in the number of segmental transplants has been observed. In most cases simultaneous transplantation of pancreas and kidney was performed (144 cases), in 65 cases the pancreas was transplanted metachronously after kidney grafting, and in 64 cases pancreatic transplantation was performed alone. Currently, segmental or whole pancreatic transplantation is the favoured procedure. Islet transplantation has been disappointing because of the difficulty in procuring sufficient numbers of islets from an adult pancreas followed by immunological destruction of the transplanted islets. Most pancreas grafts have been procured from cadavers, but the favoured segmental technique allows living related donors to be used. After rejection the graft does not always have to be removed and exogenous insulin administration may be resumed, either permanently or until re-transplantation can be accomplished. Life-long immunosuppression is needed after transplantation and currently pancreatic allograft survival rates for cyclosporin (CSA) and azathioprine-treated patients have been similar. The longest survival of a living diabetic recipient with a functioning pancreas is 5 1/2 years. Some authors have recently claimed improvement and stabilization of impaired nerve conduction and diabetic retinopathy after pancreatic transplantation.

Diabetes Mellitus, Type 1↗
PubMed1986

The application, mechanism of action and side-effects of immunosuppressive agents in clinical transplantation.

The conventional agents (azathioprine and steroids) have been the mainstay or organ allograft immunosuppression for the past 20 years. The main drawback of the immunosuppressive agents at present in use is that they act nonspecifically with sequential general depression of the immune system. The introduction of cyclosporin, an undecapeptide of fungal origin, which selectively inhibits T-cell-dependent immuno-reaction has made a significant impact on organ allograft survival rates. Clinical application has been complicated because of renal or hepatotoxicity. Thoracic duct drainage is of historical interest but the use of antilymphocyte serum, despite its chequered history, has recently been shown to be safe and effective in cadaver kidney transplant recipients. There has also been a resurgence of interest in the use of total lymphoid irradiation as an immunosuppressive agent. The introduction of xenogenic monoclonal antibodies with anti-T-cell specificity opened a new era in clinical immunology and OKT3-PAN has emerged as a powerful major immunosuppressive agent with low toxicity.

Graft Rejection↗
PubMed1986

Congenital choledochal cyst. A case report.

A congenital choledochal cyst presented as an upper abdominal mass in a non-jaundiced woman; at laparotomy total cystectomy was performed and biliary enteric continuity re-established by a hepaticojejunostomy Roux-en-Y anastomosis.

Adult↗
PubMed1986

Budd-Chiari syndrome. A report of 3 cases.

Three patients with the Budd-Chiari syndrome are presented. This is a rare condition characterized by hepatomegaly, progressive and refractory ascites, distension of the abdominal wall veins, abdominal pain and leg oedema. These features are attributed to congestion of the liver and portal hypertension. The condition has been notoriously difficult to treat medically. Surgical measures are directed towards relieving the liver congestion and lowering pressure in the portal system by portal-systemic shunting operations. In some cases refractory ascites may be treated by peritoneovenous shunting with a Le Veen shunt. In a select group of patients orthotopic liver transplantation has proved to be worth while.

Adolescent↗
PubMed1986

Acute abdomen in a patient with situs inversus. A case report.

The case of a man with situs inversus who presented with acute abdomen is reported. Acute left-sided appendicitis was considered before operation, but at laparotomy an omental abscess of unknown aetiology was drained. The appendix, localized in the left iliac fossa, was removed but was normal on histological examination.

Abdomen, Acute↗
PubMed1986

Low-velocity gunshot injury of the abdominal aorta managed by debridement and re-anastomosis. A case report.

Penetrating injuries to the abdominal aorta are highly lethal despite increasing numbers of reports of successful treatment. A case of survival after a 0,25-calibre gunshot wound of the abdominal aorta is presented. The patient, a young male, also had associated injuries to the liver, stomach and jejunum. He was managed by vigorous resuscitation, emergency laparotomy, aortic debridement and end-to-end re-anastomosis. He was discharged from hospital on the 12th postoperative day.

Adult↗
PubMed1985

[Gas gangrene: A discussion of 3 cases and review of the literature].

Three patients with gas gangrene of the lower limbs are presented. In 2 of the 3 patients gas gangrene developed after lower-limb amputation, indications for amputation being atherosclerotic and diabetic gangrene. In the third patient associated leukaemia was diagnosed. All 3 patients presented with the typical clinical manifestations of gas gangrene. Clostridium perfringens was isolated from the affected leg in each patient. The current application of surgery and hyperbaric oxygen therapy in the treatment of gas gangrene is discussed.

Adult↗
PubMed1985

The Zollinger-Ellison syndrome. A case report.

A vagotomy and antrectomy was performed on a 15-year-old boy with a malignant gastrinoma for emergency control of massive upper gastro-intestinal haemorrhage from a large posterior penetrating duodenal ulcer in the presence of jejunal ulceration and liver metastases. Hypergastrinaemia was confirmed by elevated serum gastrin levels. In the short term postoperatively the patient's disease has been controlled with oral cimetidine. Although controversy continues over the efficacy of cimetidine in the management of gastrinomas, medical treatment should be considered as an alternative to total gastrectomy in children with malignant gastrinomas because they are often slow-growing, indolent and compatible with long survival.

Adolescent↗
PubMed1985

[Infection of artificial vascular prostheses. Case reports].

Four patients with prosthetic graft infection are presented. In 3 patients infection occurred in a Dacron aortobifemoral graft. In all 4 patients the infection originated at the femoral anastomoses. In 2 patients the entire aortofemoral graft was removed; one patient died of septicaemia and the other required an above-knee amputation. In 1 patient partial removal of the graft limb proved successful after a femorofemoral bypass using an autogenous venous graft. Above-knee amputation was performed in a further patient after removal of an infected axillofemoral graft. Staphylococcus was consistently isolated from the infected grafts in all the patients.

Aged↗
PubMed1985

Bolus obstruction of the intestine. Case reports.

Two cases of intestinal obstruction caused by peaches are reported. In the first case steamed dried peaches were eaten by a 56-year-old woman who had undergone a Billroth I gastrectomy 18 years previously, while in the second case canned peach halves were swallowed whole by a 75-year-old edentulous man. The cases both typify the usual clinical setting of bolus obstruction, certain aspects of which are discussed. The responsibility of the attending practitioner to advise his high-risk patients with regard to their diets is emphasized.

Aged↗
PubMed1985

Takayasu's disease. A report of 3 cases.

Three patients with Takayasu's disease are described. In 2 cases aortography demonstrated an occlusion of the great vessels at the origin of the arch of the aorta. In 1 patient there was concomitant aneurysmal dilatation of the brachiocephalic trunk. Common and internal carotid artery stenosis occurred in 1 patient and was associated with hemiplegia and blindness. All 3 patients had constitutional symptoms and signs of the disease as well as markedly elevated erythrocyte sedimentation rates; 2 patients had moderate clinical responses to steroid administration in the short term and 1 developed bilateral calf vein thrombosis, which responded satisfactorily to conservative management.

Adult↗
PubMed1985

Syphilitic aortitis. A case report.

A case of syphilitic aortitis with total occlusion of the infrarenal aorta without aneurysmal dilatation is presented. Incapacitating claudication of both legs together with pain at rest necessitated an aortobifemoral bypass operation, which resulted in complete relief of symptoms. Histological examination of the aorta showed atherosclerosis together with characteristic perivascular lymphocytic infiltration of the aortic vasa vasorum.

Arteriosclerosis↗
PubMed1985

Deep-vein thrombosis in pregnancy. A case report.

The incidence of thrombo-embolic complications in pregnancy varies between 2 and 5 per 1000 deliveries. Deep-vein thrombosis (DVT) is classically associated with pulmonary embolism and chronic venous insufficiency, which are leading causes of maternal morbidity and mortality. An accurate diagnosis of iliofemoral or calf vein thrombosis should be confirmed by either Doppler ultrasonography, impedance plethysmography or ascending phlebography. Full-dose continuous intravenous heparin for 5-10 days is the established method of therapy for acute DVT and pulmonary embolism occurring during pregnancy or in the puerperium. Thereafter, long-term treatment with self-administered subcutaneous injections of heparin in low doses is feasible and effective. During pregnancy, coumarin administration results in embryopathy as it readily crosses the placenta; it should be avoided until after delivery. In view of its safety and effectiveness, low-dosage intravenous heparin or heparin by subcutaneous injection seems to be the anticoagulant of choice for the expectant mother.

Adult↗
PubMed1985

Hepatic abscess in a patient with polycystic liver disease. A case report.

A patient with a liver abscess and underlying polycystic renal and liver disease is described. The liver abscess was diagnosed on the clinical findings and accurately localized by ultrasonography. Tube drainage and antibiotic administration resulted in a rapid recovery. The polycystic liver disease, which was previously undiagnosed and asymptomatic, was an unexpected finding at laparotomy.

Adult↗
PubMed1985

Bleeding from varicose vein--still potentially fatal. A case report.

A 57-year-old woman was admitted to hospital with spontaneous profuse haemorrhage from a small acute varicose ulcer of the left leg. She was in shock, semicomatose and anaemic because of blood loss. The haemorrhage was easily controlled by elevating the leg, applying compression bandages and administering a blood transfusion. The patient made an uneventful recovery.

Female↗