Biomedical subjects
Publications and source records attributed to G A Decker.
A 45-year-old white woman was found on selective superior mesenteric artery angiography to have an aneurysm arising in an aberrant hepatic artery. The aberrant hepatic artery originated from the superior mesenteric artery, and was the only artery supplying the liver. The aneurysm was excised and continuity of the aberrant artery was restored by insertion of a short segment of autogenous long saphenous vein.
Cyproheptadine hydrochloride was administered orally at 0.1 to 0.2 mg/kg/day to 16 dogs with allergic pruritus. No dog improved. Polyphagia was observed in 4 dogs (25%).
Twenty dogs with atopy or idiopathic pruritus were treated in a double-blinded clinical trial with computer-randomized and computer-generated sequences of 4 fatty acid-containing products: evening primrose oil, cold water marine fish oil, DVM Derm Caps, and EfaVet. Each dog received each product for a 2-week period. Five of 20 dogs (25%) had a good-to-excellent reduction in their level of pruritus with at least 1 of the products: evening primrose oil (2 dogs), DVM Derm Caps (1), EfaVet (1), DVM Derm Caps and cold water marine fish oil (1). Only 1 dog experienced a side effect (loose stools). Clinical response to fatty acid supplements appeared to be quite individualized, and independent of age, breed, sex, weight, duration of disease, specific diagnosis, or number of positive intradermal test reactions.
Most series dealing with external gastrointestinal fistulas cover experience of many years and include a heterogeneous sample of fistulas. We present our experience with 117 cases of postoperative external alimentary tract fistulas treated since 1980. Only fistulas caused by anastomotic leaks and operative injury to bowel are included. The overall mortality rate was 37%. The fistulas are classified into four types: type I-abdominal, esophagus, gastroduodenal (mortality rate, 17%); type II-small bowel (mortality rate, 33%); type III-large bowel (mortality rate, 20%), and type IV-all sites associated with a large abdominal wall defect (mortality rate, 60%). The main cause of death was intra-abdominal infection. Seventy-six percent of the patients required further operations. We conclude that despite the availability of all modern diagnostic and management facilities, postoperative external gastrointestinal fistulas treated during the 1980s continue to represent a surgical "disaster." Only prevention and improved methods in the management of the associated intra-abdominal infections could improve the results.
Experience with 43 patients with gastrointestinal fistulas associated with a large abdominal wall defect is presented. The overall mortality rate was 60 per cent; 37 per cent in patients who underwent the primary procedure in the home unit and 74 per cent in those from elsewhere. An average of five operations per patient was performed. The abdominal wall defect developed spontaneously as a consequence of postoperative peritonitis in 24 patients (mortality rate, 71 per cent) and was created intentionally as a part of the 'open management' in 19 cases (mortality rate, 47 per cent). Errors in management were identified in 63 per cent of the patients and this adversely influenced the outcome. Patients with this condition should be referred early to tertiary care facilities where diversion of the intestinal leak away from the defect, prompt control of the associated intra-abdominal infection and adequate handling of the defect itself can be performed.
The introduction in the late 1970s of potent and effective anti-ulcer drugs revolutionised the medical treatment of peptic ulcer disease and modified the indications for surgical management. Since, as far as we were aware, there had been no previous detailed evaluation of the pattern of surgery for peptic ulcers in this country during the modern era of ulcer therapy, we decided to look at our experience since 1980.
The first surgical audit from a South African teaching hospital is presented. During a 1-year period (1987) 1,725 patients were treated in a 60-bed unit (29 patients/bed/yr). Eighty per cent of admissions were emergencies; 1036 operative procedures were performed (45% emergency operations). Aspects of workload, utilisation of beds, pattern of admission and operations are discussed. The audit indicated that a surgical unit in an urban teaching hospital for white patients serves mainly as an acute surgical facility.
Four cases of suture-line dehiscence occurring during acute postoperative pancreatitis are presented. The possible causative role of the pancreatitis in the pathogenesis of these leaks is discussed.
In a prospective study of 22 patients with diffuse peritonitis managed by the method of electively staged multiple laparotomies, the abdomen was left open in 9 patients. The patients were selected on the basis of the severity of their intra-abdominal infection: only massive faecal peritonitis, postoperative peritonitis and pancreatic abscesses were included. These amounted to only 9 per cent of all patients with intra-abdominal infection treated over a 2-year period. Up to seven re-operations were required per patient. In view of a high mortality rate of 32 per cent, the superiority of this aggressive management strategy over conventional methods is not fully established.
A technique for easy and bloodless dissection of fat laden intestinal mesentery, both small and large, has been described. This technique can also facilitate Roux-en-Y reconstruction in the obese patient.
A case of colitis cystica profunda, the patient presenting with haematochezia and a rectal mass, is reported. The clinical and pathological features of this condition are discussed, and the difficulty in distinguishing this lesion from the much commoner rectal neoplasms is emphasised.
Acute lesions of the epiploic appendages are rare. We present 4 cases of torsion of an appendix epiploica. Aspects of this condition and its complications are discussed.
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A case of colonic perforation complicating a benign gastrocolic fistula is presented. Only 2 similar cases have been previously reported in the English-language literature. Pathophysiology and management are briefly discussed.
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This is a retrospective analysis of 99 patients with perforated peptic ulcer treated in the Department of Surgery at the J. G. Strijdom Hospital over a 6-year period. The incidence of this condition is increasing in our population. The mortality rate for perforated peptic ulcer remains high (12.1%). Forty-three per cent of our patients were suffering from a major medical illness at the time of perforation, with a mortality rate of 25.6%. The mortality rate for relatively fit patients was 1.8%. While more conservative surgery is indicated for high-risk patients, a definitive ulcer operation can be performed safely in patients who are not suffering from a major medical illness. Our selective operative policy is discussed.