Biomedical subjects
M Hopley
Publications and source records attributed to M Hopley.
Prevalence and clinical manifestations of disseminated Mycobacterium avium complex infection in South Africans with acquired immunodeficiency syndrome.
In a sample of 100 hospitalized human immunodeficiency virus-seropositive black South African patients with CD4 cell counts of <100 cells/mm(3), the point prevalence of disseminated Mycobacterium avium complex infection was 10%, in contrast with other African studies that report that the infection is uncommon. The point prevalence of Mycobacterium tuberculosis was 54%. The clinical and laboratory features of these patients were largely unhelpful in detecting M. avium complex; the BACTEC blood culture (Becton Dickinson) was the only reliable method.
An African community-based chronic ambulatory peritoneal dialysis programme.
BACKGROUND: The reasons for failure of continuous ambulatory peritoneal dialysis (CAPD) are varied. Against a background of mass poverty, poor resources, and the cheaper cost of CAPD it is the primary choice of dialysis. The aims of this study were to determine infection rates and document factors responsible for CAPD failure. METHODS: We report a prospective study in a large African tertiary hospital and its community based satellite clinics. Infection rates as well as factors that may influence them were studied. Sites of infections were documented and causes of CAPD failure recorded. All patients qualifying for dialysis from January 1998 to July 1999 were included. RESULTS: Eighty-four patients were enrolled. There were 55 males and 29 females. The mean age was 39+/-10 (range 16-71) years and mean duration on dialysis at the end of the trial period was 17 months. The peritonitis rate was one episode every 27.9 patient months. Attrition to haemodialysis occurred in 16.6% of patients (n=14) and loss to follow-up in 29.8% (n=25). Fourteen patients regained renal function or were transplanted. Peritonitis appeared to be related to a poor BAD-C score (Bara Adapted Dialysis Compliance), i.e. combination of clinical status and clinic visits (P=0.07). The odds ratio for failure of CAPD with peritonitis was 5.3 times higher (confidence interval (CI) 1.7-17.1; P=0.0085). A low BAD-C score was a significant indicator of CAPD 'failure' (P=0.0001). The natural turnover rate of patients was 46%. Home conditions, employment, and education levels did not correlate with CAPD 'failure'. CONCLUSION: The peritonitis rate and aetiology are similar to the developed world. Socioeconomic factors did not appear to play a role in peritonitis rates or CAPD failure.
The peritoneo-saphenous shunt for palliation of refractory ascites.
OBJECTIVE: To describe a safe surgical technique for the management of refractory ascites. PATIENTS AND METHOD: Two preterminal patients with respiratory compromise caused by refractory ascites had the long saphenous vein transected at mid-thigh and anastomosed to the peritoneum in the region of the internal inguinal ring. This allowed direct drainage of the ascitic fluid into the vascular system (peritoneosaphenous shunt). RESULTS: The procedure was performed successfully on two patients. The first patient, with cirrhosis, was leading a normal lifestyle without diuretic use at 7 1/2 months' follow-up. The second patient, with cirrhosis and multifocal hepatoma, was fit enough for discharge without medication. CONCLUSION: The peritoneo-saphenous shunt deserves further evaluation as a novel and safe surgical technique for the management of refractory ascites.
Multiple endocrine neoplasia type 2A in a black South African family.
The genetic abnormality of multiple endocrine neoplasia type 2A (MEN 2A) has recently been elucidated. Over 95% of families with MEN 2A have an identifiable mutation of the RET proto-oncogene on chromosome 10. This report describes a black South African woman with MEN 2A in whom a mutation of the RET proto-oncogene was identified. Current genetic knowledge and recent changes in clinical practice are presented, with specific reference to the other family members found to be carrying the mutant RET gene.
Recovery of renal function in Black South African patients with malignant hypertension: superiority of continuous ambulatory peritoneal dialysis over hemodialysis.
OBJECTIVE: To describe recovery of renal function (RC) in Black South African patients with primary malignant hypertension (MHT) and end-stage renal failure, according to the type of dialysis provided. DESIGN: A retrospective analysis of the records of 31 patients with MHT. SETTING: A university-based, large tertiary-care hospital and its community-based satellite continuous ambulatory peritoneal dialysis (CAPD) clinics. PATIENTS: Only patients with renal failure caused by MHT and who were on dialysis between January 1997 and June 2000. There were 11 patients on peritoneal dialysis (PD) that regained renal function; 11 patients on hemodialysis (HD), none of whom recovered renal function; and 9 patients on PD who did not recover renal function during the same time period. OUTCOME MEASURES: The groups were investigated for variables that might predict RC. RESULTS: Peritoneal dialysis compared with HD was highly significant as an indicator of RC (p < 0.0001), with 60% of patients on PD regaining renal function, versus 0% on HD. Median time to recovery was 300 (150 -365) days. There was no significant difference in decline of mean arterial pressure (MAP) between the groups; MAP declined significantly in all groups (p = 0.00002). All groups received similar drug therapy. In the RC group, initial MAP, kidney size, and urine output tended to be higher and creatinine lower (p = not significant). Dialysis adequacy was similar in the different groups. CONCLUSIONS: This retrospective study suggests there may be benefit from PD as the primary form of dialysis when patients have MHT as a cause of their renal failure. Possible predictors of RC include blood pressure control, initial MAP, initial serum creatinine, initial urine output, and kidney size. Time should be allowed for RC before transplantation is undertaken. Prospective studies are needed to confirm the benefit of CAPD in patients with MHT.