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Biomedical subjects

J E Krige

Publications and source records attributed to J E Krige.

At least 19 recordsLinked to original sources
PubMed1992

Therapeutic perihepatic packing in complex liver trauma.

Packing for control of haemorrhage was used in 22 of 294 patients undergoing surgery for liver trauma over a 6-year period. The major indication for packing was transfusion-induced coagulopathy. Sixteen patients had blunt trauma and six penetrating trauma including five gunshot wounds; 19 patients had major right lobe injuries, three left lobe and five also had hepatic vein injuries. Packing provided definitive control of bleeding in 18 patients but four patients had recurrent bleeding due to hepatic artery injury (three) and hepatic vein injury (one); three required further surgery and bleeding was controlled in the fourth by selective hepatic artery embolization. Six patients died and in two of these recurrent bleeding, despite packs, was a contributing factor. Mean blood loss in the six patients who died was 18 (range 10-30) units, compared with 13.1 (range 8-30) units in survivors. Packs were removed from the 16 survivors at laparotomy at a mean of 3.1 days after insertion; six patients rebled during pack extraction and were successfully repacked. Major morbidity occurred in 12 of the 16 survivors. Seven patients developed intra-abdominal sepsis following packing, one of whom died. Therapeutic liver packing provides life-saving control of hepatic bleeding which is frequently aggravated by coagulopathy. This approach permits resuscitation in an intensive care unit and subsequent planned relaparotomy for retrieval of packs and further intervention as necessary.

Adolescent↗
PubMed1992

Prospective, randomized study comparing amoxycillin-clavulanic acid and cefamandole for the prevention of wound infection in high-risk patients undergoing elective biliary surgery.

The efficacy of amoxycillin-clavulanic acid for prevention of postoperative wound infection was compared with that of cefamandole in 150 patients at risk for infected bile while undergoing elective biliary surgery in a prospective, randomized study. The two groups were comparable for age, sex, risk factors, operative procedures and positive bile cultures. Similar numbers of patients had an uncomplicated postoperative course (amoxycillin-clavulanic acid 70%; cefamandole 73%). Four patients in each group developed wound infection. The incidence of postoperative pneumonia, urinary tract infection and number of days (+/- SD) in hospital (amoxycillin-clavulanic acid 10.1 +/- 4.7; cefamandole 9.7 +/- 5.6) were similar. The efficacy of amoxycillin-clavulanic acid and cefamandole in preventing wound sepsis in high-risk patients undergoing biliary surgery was similar. Economic considerations may favour the use of amoxycillin-clavulanic acid.

Adolescent↗
PubMed1992

Closed degloving injuries: results following conservative surgery.

Closed degloving wounds are uncommon but important injuries because they may be overlooked in the multiply injured patient and, if not treated correctly, may give rise to significant morbidity. This prospective study reports the results of a conservative surgical management policy in 16 patients with closed degloving wounds treated during a 1-year period in a tertiary referral center. Motor vehicle accidents caused most of the injuries, 69 percent of which occurred on the lower limb. The extent of injury ranged from 2 to 12 percent (mean 4.9 percent) of the total body surface area. The diagnosis of closed degloving wound was missed at initial assessment in one-third of patients. A uniform management policy with drainage of the degloved area through a small incision followed by compression bandaging was applied. The volume of blood and necrotic fat evacuated ranged from 15 to 800 ml (mean 120 ml). One patient with necrotic skin initially had excision and primary wound closure performed. Delayed necrosis occurred in one patient in whom extensive degloving occurred and effective compression could not be applied. Ultimate flap viability using this technique was excellent, since only 1 of 16 patents required skin grafting.

Accidents, Traffic↗
PubMed1992

The treatment of esophageal varices.

The etiology, the geographic variation in pathology, and the level of hepatic reserve all affect the prognosis in patients with bleeding from esophageal varices. Acute variceal bleeding requires emergency treatment. The options include pharmacological therapy, balloon tube tamponade, and urgent sclerotherapy used singly or in combination. Immediate sclerotherapy at the time of the initial diagnostic endoscopy is the preferred treatment. Those in whom sclerotherapy fails should be subjected to more major surgery. Patients presenting after a variceal bleed has been controlled should be considered for definitive long-term treatment. The main options are repeated sclerotherapy, a portosystemic shunt, or a devascularization and transection operation. All patients should be evaluated for liver transplantation prior to therapy. Repeated sclerotherapy is widely recommended, with many groups reserving major surgery as a salvage procedure if sclerotherapy fails. Pharmacological therapy remains under review. Prophylactic treatment prior to a variceal bleed should probably be restricted to controlled trials.

Arteries↗
PubMed1991

Delay in the diagnosis of cutaneous malignant melanoma. A prospective study in 250 patients.

The extent and consequence of patient and professional delay in the diagnosis and treatment of 250 consecutive patients with primary cutaneous malignant melanoma was investigated. Mean total delay from the onset of observed change in a melanoma to appropriate therapy was 11.1 months. The major component of delay (9.8 months) was patient related. Seventy-nine (31.6%) patients waited more than 6 months before seeking medical attention. Few patients recognized early melanoma, and 46% responded only to late features (i.e., ulceration or bleeding). Inappropriate professional delay (misdiagnosis or observation without specific action) occurred in 30 consultations (12.4%) and resulted in a further 1.3-month mean delay in treatment. No correlation (r = 0.027) was found between delay in diagnosis and thickness of melanoma for the study population overall. A significant relationship (r = 0.2087; P less than 0.05) was found between longer lag time and advanced disease in 92 patients with nodular melanoma. Asymptomatic melanomas incidentally diagnosed during routine skin surveillance were significantly more favorable (mean depth, 0.89 mm) than symptomatic melanoma (1.76 mm; P less than 0.01). These data suggest that future public education campaigns should emphasize early signs of melanoma and that professional programs should stress routine skin surveillance and prompt referral of suspicious lesions for diagnostic biopsy.

Adolescent↗
PubMed1991

Simplified hepatic resection with the use of prolonged vascular inflow occlusion.

Ten consecutive patients scheduled to undergo liver resection were studied prospectively with the use of a standard protocol, which included routine vascular inflow occlusion to reduce blood loss and blood transfusion requirements. Fibrin sealant was sprayed on the raw liver surface, and abdominal drainage was not performed. No deaths occurred, and the postoperative course was remarkably smooth. The normothermic liver ischemic times of 30 to 122 minutes (mean, 73 minutes) were well tolerated. The amount of blood transfused was reduced to a mean of 2 U (range, 0 to 4 U). The occurrence of infected intraabdominal bile collections in two patients with preexisting biliary tract infection suggested that abdominal drainage should be performed in such patients. Vascular inflow occlusion is recommended for all liver resections.

Adult↗
PubMed1991

Colonic complications after toxic tribal enemas.

Tribal enemas obtained from traditional healers are used widely in Southern Africa for a variety of indications. Inclusion of injurious substances such as potassium dichromate may cause serious colonic and renal complications. Nine such patients, in seven of whom chromate use was confirmed, presented after a mean delay of 7.3 days. All patients had bloody diarrhoea and vomiting and three underwent major colonic resection, requiring a total of ten procedures. One patient suffered mechanical perforation of the rectum, with subsequent necrotizing fasciitis, necessitating rectal excision. Eight patients had acute renal failure and seven required dialysis. One patient died. At follow-up one patient has chronic renal failure and only three are completely well. Although local medical practitioners are aware of the problem, the challenge of preventing harmful cultural practices remains.

Acute Kidney Injury↗
PubMed1991

Accurate intraoperative transhepatic U tube placement.

Cholangiocarcinoma of the main hepatic duct junction is best treated by curative resection, although this is not often possible as most lesions are associated with local infiltration, portal vein invasion or metastases. For unresectable lesions, we advocate the use of a wide bore U tube followed by radiotherapy. Placement of the U tube must be accurate and meticulous. This paper describes a simplified method allowing accurate intraoperative transhepatic U tube placement.

Adenoma, Bile Duct↗
PubMed1991

Conservative surgery for trauma to the pancreatic head: is it safe?

The results of conservative operative management (involving no pancreatic resection) for 13 patients presenting with trauma to the pancreatic head over a period of 10 years were reviewed. Seven patients with injury of the pancreatic head without duodenal or ductal involvement made an uneventful recovery after simple drainage. The average hospital stay was 6.7 days. The remaining six patients with either duodenal (four patients) and/or ductal involvement (five patients) developed 22 major complications. One of these patients died of multiple organ failure, and the rest had an average hospital stay of 43 days. Injury of the vena cava was noted in five patients, but was not significantly associated with additional morbidity or mortality. Although simple drainage of pancreatic head injuries is associated with a low mortality, there is an unacceptably high incidence of complications if either the duodenum or pancreatic duct is involved. The authors recommend that simple drainage be restricted to patients in whom neither of these structures is injured.

Adult↗
PubMed1991

Long-term management after variceal bleed--the current role of sclerotherapy.

While injection sclerotherapy has been accepted as the treatment of choice for acute variceal bleeding, its role as a definitive long-term treatment modality has not yet been clearly defined. This paper will critically analyse the current status of this technique, now widely used, and a comparison will be made with conventional medical management. The review will be based on the 10 years' Cape Town experience and the published series on this subject. A long-term management strategy will also be discussed.

Acute Disease↗
PubMed1990

Bacteremia after injection of esophageal varices.

Elective sclerotherapy for esophageal varices produces bacteremia in 4% to 53% of patients. The clinical importance of this phenomenon is uncertain. This study was undertaken to re-assess the incidence and clinical relevance of post-sclerotherapy bacteremia. Blood cultures were taken prior to and at 5 min and 4 h after endoscopy in 50 patients for whom sclerotherapy was planned. In the 41 patients in whom varices were injected, positive cultures were obtained 5 min after sclerotherapy in only 4 patients (10%) and all but 1 patient had other possible causes of bacteremia. After 4 h, all blood cultures were sterile. No infective complications were identified. Bacteremia appears to be an infrequent and transient event after elective sclerotherapy. Only patients with prosthetic heart valves or endocardial abnormalities require antibiotic prophylaxis.

Adult↗
PubMed1990

Malignant melanoma of the external ear.

Twelve patients with primary melanoma of the external ear were treated during a 10-year period. Ten patients were males. Median melanoma depth was 2.1 mm and seven patients had lesions deeper than 2 mm. Eight of 12 lesions were either Clark level IV or V. Six patients had wedge excisions of the primary lesion and all developed recurrent disease (local: three). Six patients underwent wide excision and none developed local recurrence. All patients with primary disease less than 2 mm are alive. Only two of seven patients with lesions deeper than 2 mm have survived. The definitive excision for melanoma of the ear should encompass wide margins despite the cosmetic consequences. Lesser procedures inevitably lead to local recurrence. Melanoma deeper than 2 mm penetration on the ear in our series had a poor prognosis.

Adult↗