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Biomedical subjects

P C Bornman

Publications and source records attributed to P C Bornman.

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

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↗
PubMed1992

Intraperitoneal abscess after laparoscopic cholecystectomy.

A case is presented of small bowel obstruction due to an intra-abdominal abscess as a complication of stones left behind during laparoscopic cholecystectomy. It is suggested that a concerted effort be made to remove all stones spilled in the peritoneal cavity and that a therapeutic course of broad-spectrum antibiotic be instituted.

Abscess↗
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

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

Pseudomonas septicaemia after endoscopic retrograde cholangiopancreatography--an unresolved problem.

Over a 6-month period 5 patients with obstructive jaundice developed Gram-negative septicaemia, all within 48 hours of undergoing endoscopic retrograde cholangiopancreatography. The sepsis proved fatal in 3 patients, despite prompt decompression of the obstructed biliary system. In all cases the organism responsible was Pseudomonas aeruginosa and the source of infection appeared to be a contaminated water-bottle attached to the endoscopic apparatus. This report highlights the importance of disinfection techniques and reviews the present situation in respect of antibiotic prophylaxis.

Aged↗
PubMed1990

Simple closure of perforated duodenal ulcer: a prospective evaluation of a conservative management policy.

One hundred and thirteen consecutive patients admitted with a perforated duodenal ulcer over a 5-year period (1978-82) and treated by simple closure have been followed prospectively over a median period of 43 months. Patients were divided into two categories according to their previous history of dyspepsia; group 1 (66 patients) with a chronic history of more than 3 months and group 2 (47 patients) where there was no history of dyspepsia or a history of less than 3 months duration. The follow-up periods were similar (group 1, 44 months; group 2, 43 months). The overall recurrence rate was 42 per cent and to date only 14 per cent of the total group of 113 patients have required a definitive operation. The incidence of ulcer recurrence was higher in group 1 than in group 2 in terms of total recurrence (group 1, 50 per cent; group 2, 32 per cent) and patients requiring further surgery (group 1, n = 14, 21 per cent; group 2, n = 7, 15 per cent). Five of these 21 patients required an emergency procedure for haemorrhage or reperforation (group 1, n = 2; group 2, n = 3). There were no significant differences between the 5-year predictive recurrence rate or the requirement for definitive surgery between the groups. Five of the 27 patients currently on medical treatment have required maintenance treatment while the remaining patients receive active treatment for a mean of 20 per cent of the time since they developed recurrent ulceration. These results support continuation of our 'wait and see' policy following simple closure of perforated duodenal ulcer, even in patients with a history of chronic dyspepsia.

Adult↗
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

Endoscopic sclerotherapy.

Various sclerotherapy techniques have proved successful in the management of acute variceal bleeding and in long-term control of patients after a variceal bleed. We prefer either an intravariceal or a combined intravariceal and paravariceal technique using ethanolamine oleate, but we advocate that individual units utilize the technique with which they have the most experience. The use of an unmodified flexible endoscope has been almost universally accepted. Once active variceal bleeding is diagnosed on emergency endoscopy, immediate emergency sclerotherapy should be performed. When this is not possible, bleeding should be controlled by balloon-tube tamponade with subsequent delayed emergency sclerotherapy after resuscitation. Patients with variceal bleeding that has stopped at the time of the diagnostic endoscopy can either be treated by immediate sclerotherapy or be observed initially and subsequently treated using the long-term management policy of the unit concerned. Over 90% of actively bleeding patients should be controlled using emergency sclerotherapy. Failures are defined as patients who have more than two acute variceal bleeds during a single hospital admission. Such patients should be identified early and treated either by simple staple-gun transection or by an emergency portosystemic shunt. Repeated injection sclerotherapy using a flexible endoscope and the technique with which the group concerned has the most experience is recommended as the primary form of treatment for the majority of patients after a proven esophageal variceal bleed. Repeat injection treatments should probably be performed at weekly intervals until the esophageal varices are eradicated, with follow-up at 6-month or yearly intervals thereafter. Recurrent varices should be treated similarly. Failures of sclerotherapy are defined as patients who have either recurrent bleeds or in whom varices are difficult to eradicate. They require either a portosystemic shunt or a devascularization and transection operation. All patients presenting with cirrhosis and variceal bleeding should be evaluated for liver transplantation; unfortunately, however, few variceal bleeders are candidates for transplantation. Prophylactic sclerotherapy in patients with esophageal varices that have not bled remains unjustified outside of controlled trials. Available trials have produced conflicting data.

Acute Disease↗