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Biomedical subjects

J R Botha

Publications and source records attributed to J R Botha.

At least 19 recordsLinked to original sources
PubMed1992

Renal hyperparathyroidism.

The indications for surgical treatment of renal HPT in patients with chronic endstage renal failure are symptomatic disease or failed medical management. The indications for patients who have had a kidney transplant are symptomatic disease and persistent hypercalcemia. It should be noted, however, that the current approach favored in the literature in asymptomatic, mild post-transplant hyperparathyroidism is conservative. Total parathyroidectomy with autotransplantation is the most popular surgical method reported. I have done subtotal parathyroidectomy and reserved total parathyroidectomy for selected patients. My recurrence rate is comparable to that reported. The actual survival rate in our two groups of patients was 58 percent for the dialysis patients and 79 percent for the transplant patients. The actuarial survival rates at 1, 5, and 10 years in the two groups were 95 and 92 percent; 59 and 67 percent; and 32 and 67 percent. The use of diphosphonates and medical rather than surgical control needs further study, as do the long-term effects of conservative treatment of asymptomatic post-transplant hyperparathyroidism.

Actuarial Analysis↗
PubMed1991

The relevance of more sensitive ancillary crossmatch techniques in predicting early cadaver renal graft outcome.

The predictive value of varying levels of antibody activity, its class and antigen specificity in sera of 81 recipients of cadaver renal allografts was evaluated. Recipients for transplantation were selected on the basis of a negative dye uptake T-cell crossmatch, after which the more sensitive 51Cr release technique was employed in a blind study using unseparated donor target cells. Recipient sera with peak panel reactivity and current samples were evaluated before and after reduction with dithiothreitol to destroy the IgM subclass. Double absorption with pooled platelets allowed antibodies against HLA class I antigens to be distinguished from those against HLA class II/non-HLA antigens. Optimal levels of cytotoxicity were established, giving a sensitivity of 73%. Data were assessed in terms of positive predictive value, and showed that conventional T-cell crossmatching is adequate for the primary transplant group, but more sensitive ancillary tests are indicated for regrafts. In this category of patients, IgG antibodies, whether against HLA class I antigens or HLA class II/non-HLA antigens, were highly predictive of early graft loss (positive predictive value 50%-100%). Using this protocol for patient selection, 1-month graft survival would have improved from 73% to 96%.

Adolescent↗
PubMed1990

Escherichia coli O157:H7 haemorrhagic colitis. Report of the first South African case.

Escherichia coli O157:H7, although recognised 15 years ago, has only become a significant pathogen since 1982 when two outbreaks of haemorrhagic colitis due to this organism were described in the USA. Since then, numerous such outbreaks have been reported. Recent experience with a patient presenting with E. coli O157:H7-induced haemorrhagic colitis is described. The main features, pathological findings and investigations are described and the principles of management outlined.

Aged↗
PubMed1989

Time-dependent changes in serum gastrin measurements after parathyroidectomy.

A prospective study involving 7 patients with primary hyperparathyroidism and hypergastrinaemia was conducted to assess the time-dependent change in serum gastrin value before and after parathyroidectomy and to determine at which postoperative stage persistent hypergastrinaemia may be indicative of an associated gastrinoma (Zollinger-Ellison syndrome). Five of the 7 patients had hypergastrinaemia in the early postoperative period. One patient had a strikingly high serum gastrin level pre-operatively (1,500 pg/ml). The mean serum gastrin value declined to within the normal range 6 weeks after parathyroidectomy, except in 1 patient who had a gastrinoma. It is concluded that hypergastrinaemia in patients with primary hyperparathyroidism should only be considered significant if pre-operative gastrin levels are strikingly supranormal and/or levels fail to normalise by the 6th postoperative week.

Adult↗
PubMed1987

Hypercalcaemia in the Johannesburg Hospital. Differential diagnosis and physician awareness of primary hyperparathyroidism.

A 1-year retrospective study of all serum profiles of patients with hypercalcaemia analysed at the Johannesburg Hospital was carried out to ascertain the causes of hypercalcaemia and physician awareness of primary hyperparathyroidism. Hypercalcaemia was found in 560 subjects (2.9% of 19,200), but in 147 of these (26%) this was not confirmed by repeat estimations. Malignant tumours were the commonest cause (38.4%) and accounted for the most severe hypercalcaemia (mean serum calcium 2.93 mmol/l). Renal disease resulted in significant hypercalcaemia, at times requiring parathyroidectomy. Drug-associated hypercalcaemia was usually mild and reversible on drug withdrawal. Although primary hyperparathyroidism occurred in 21.3% of cases, overall physician awareness of the disease was poor (39%). 'Incidental' profile hypercalcaemia (P less than 0.005) and hypertension (P less than 0.005) were frequent presenting features in this study. Renal disease (P less than 0.001) occurred infrequently.

Calcium↗
PubMed1987

Renal retransplantation. The Johannesburg Hospital experience.

Between 1968 and 1985 108 renal retransplants were performed at Johannesburg Hospital; 102 patients received a second, 5 patients a third, and 1 patient a fourth kidney. The actuarial graft survival at 1 and 5 years is 52.8% and 40.5%. All retransplanted kidneys were obtained from cadaver donors. Factors that influence second graft survival are the period of survival of the previous graft, the use of cyclosporin A, the level of pre-sensitisation determined by preformed antibodies, the original disease (in particular diabetes and analgesic nephropathy) and the patient's sex. The results of retransplantation are not significantly different from those found in patients with first allografts; hence retransplantation is justified in those individuals whose previous donor kidney has ceased to function.

Adolescent↗
PubMed1987

Outcome of renal transplants with impaired renal function at 6 months.

At 6 months after kidney transplantation 59 adults with impaired renal function were divided into three groups according to their serum creatinine level: group I 150-199 mumol/l; group II 200-299 mumol/l; and group III greater than or equal to 300 mumol/l. These patients were followed up for 5 years or to graft loss when it became apparent that the eventual outcome was related to the degree of renal impairment at 6 months. Age of donor and age of recipient did not have a bearing on the eventual outcome nor did the frequency of acute tubular necrosis or rejection episodes. Patients with severely impaired renal function with serum creatinine levels greater than or equal to 300 mumol/l have a poor outlook but there are no particular prognostic features on which to base a forecast for the individual patient.

Adolescent↗