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Biomedical subjects

S van der Spuy

Publications and source records attributed to S van der Spuy.

12 recordsLinked to original sources
PubMed1991

Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy in the management of suspected gallstone pancreatitis.

An approach to suspected gallstone pancreatitis based on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) was adopted in 1976 and was followed in 29 patients. ERCP became the routine method of early biliary tract assessment when gallstone pancreatitis was suspected on clinical and biochemical grounds, and further management was based on ERCP findings. If calculi were detected in the common bile duct (13 cases) ES was performed; when calculi were confined to the gallbladder (12 cases) cholecystectomy was advised; and if no calculi were detected on ERCP (4 cases) investigations were continued. ERCP proved to be a reliable guide to management, while ES provided safe and effective symptomatic relief when choledocholithiasis was present, and prevented recurrence of pancreatitis even when the gallbladder remained in situ.

Acute Disease↗
PubMed1991

Cholangiography and endoscopic sphincterotomy in the management of severe acute gallstone pancreatitis discovered at diagnostic laparotomy.

Seven patients with gallstone pancreatitis discovered at diagnostic laparotomy did not undergo definitive biliary surgery because it was considered hazardous in the presence of severe acute pancreatitis. The procedures carried out at operation in these cases included cholecystectomy and T-tube drainage (2 patients) cholecystostomy drainage (3 patients), and closure of the abdomen without drainage (2 patients). Direct cholangiography was carried out postoperatively in all cases. The biliary drain was used for this purpose in 5 patients, and endoscopic retrograde cholangiopancreatography was performed in 2. All patients were found to have calculi in the common bile duct and were successfully managed by endoscopic sphincterotomy (ES) without complications or mortality. ES therefore appears to be a safe and effective method of avoiding difficult and hazardous biliary surgery in the presence of severe acute pancreatitis.

Acute Disease↗
PubMed1981

Endoscopic sphincterotomy in the management of gallstone pancreatitis.

The presence of pancreatitis does not constitute a contraindication to endoscopic sphincterotomy in the management of common duct calculi. On the contrary, experience with 10 cases of gallstone pancreatitis suggests that endoscopic sphincterotomy can be carried out safely with little disturbance to the patient, and that it greatly simplifies the management of these cases. In the frail and elderly patient little further may be required.

Adult↗
PubMed1980

Cimetidine in the treatment of herpesvirus infections.

In August 1977 a patient developed herpes zoster just before she commenced a course of cimetidine (Tagamet; Smith, Kline & French) for a chronic gastric ulcer. She experienced both rapid relief of the ulcer symptoms and, rather unexpectedly, dramatic relief of the herpetic pain and rapid disappearance of the eruption. On the basis of this observation cimetidine was prescribed to 21 patients with herpes zoster. The results continued to be encouraging in all but 3 patients. The trial was therefore extended to other herpesvirus infections. In all but 1 of 7 patients with herpes labialis the blisters were aborted, and in 1 patient with herpes keratitis the result was also encouraging, the attacks being markedly shortened in duration and reduced in frequency. The results of this preliminary trial warrant a systematic scientific inquiry into the potential role of cimetidine in the treatment of hypesvirus infection, as well as a study of the mechanisms involved.

Adolescent↗
PubMed1979

The relationship between juxtapapillary diverticula and biliary calculi. An endoscopic study.

A systematic prospective endoscopic study of the incidence of juxtapapillary diverticula in a variety of digestive disorders was undertaken in the Surgical Clinic at the Provincial Hospital, Port Elizabeth. The findings were related to conditions commonly encountered. The following frequency distribution was found: 33 diverticula out of 164 patients associated with gallstones (20.1%); 15 out of 668 patients not associated with gallstones (2.2%); 1 out of 39 patients with pancreatitis (2.6%); and 3 out of 146 patients with gastric ulcer (2.1%). No diverticulum was noted in 111 patients with duodenal ulcer. These findings suggest that juxtapapillary diverticula are nearly 10 times more common in patients with gallstones than in patients without. There is evidence to suggest that these diverticula tend to precede the gallstones. It is conceivable that juxtapapillary diverticula may predispose to gallstones. Alternatively, both conditions may be manifestations of another underlying disorder as yet to be defined.

Adult↗
PubMed1978

Peritoneoscopy in the management of breast cancer.

Peritoneoscopy has been recommended by the Combined Breast Clinic at the Provincial Hospital, Port Elizabeth, since 1975, mainly to confirm or exclude metastatic involvement of the liver. Experience with 27 procedures is reviewed. Peritoneoscopy is shown to be a useful aid in the staging and management of selected cases of breast cancer. Positive findings, confirmed by histological examination, were recorded for 5 patients. Negative findings in 22 patients were equally helpful, and were found to be reliable, in that none of these patients had evidence of liver involvement during the follow-up period, while in 5 patients there was evidence of metastases elsewhere.

Breast Neoplasms↗
PubMed1978

Biliary ascariasis--endoscopic aspects. Report of 4 cases.

Retrograde cholangiography was carried out in 4 small children with suspected roundworm infestation of the biliary tree. An adult-sized side-viewing fibre-optic duodenoscope was employed, and a general anaesthetic was given in each case. Roundworms were frequently seen protruding from the papillary orifice when biliary infestation was present. Cannulation of the duodenal papilla was shown to be eminently feasible in these small children, whose average weight was 12,4 kg. The degree of infestation and the response to vermifuge therapy could be determined with precision by retrograde cholangiography. It is suggested that this procedure has a place in the management of the complicated case of biliary ascariasis, and that it should certainly be considered when surgery is contemplated.

Ascariasis↗
PubMed1978

Endoscopic retrograde cholangio-pancreatography (ERCP) in children.

ERCP was successfully carried out 6 times in 4 children with suspected round worm infestation of the biliary tree. A general anaesthetic was given in all cases, and an adult duodenofibrescope was used. Early experience indicates that the procedure is feasible and of value even in small children weighing 12 kg. As in adults, ERCP should be considered whenever a precise outline of the pancreato-biliary system is required, and when infusion cholangiography fails to give the desired information.

Anesthesia, General↗
PubMed1977

The role of mastectomy in locally advanced breast cancer.

The role of mastectomy in locally advanced breast cancer remains to be established. Experience at the Breast Clinic at the Provincial Hospital, Port Elizabeth, strongly suggests that mastectomy improves local control. The addition of mastectomy to a basic regimen of radiotherapy and adjuvant chemotherapy now forms the basis of a prospective clinical trial.

Adult↗
PubMed1977

Endoscopic sphincterotomy. A preliminary report.

Early experience with endoscopic sphincterotomy in 13 patients is recorded. Sphincterotomy was successfully carried out in 11 patients. The only complication noted was a haemorrhage in 1 case, for which the patient required 1 unit of blood. Routine endoscopy and extraction of residual calculi by means of a balloon catheter or Dormia basket have not been practised. Instead, an expectant policy is being put to the test, and patients are followed up chiefly by means of intravenous cholangiography. The anatomical basis of endoscopic sphincterotomy is discussed in detail, and a plea is made for standard terminology.

Adult↗