Browsing by Author "Du Toit, D. F."
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- ItemAcute abdomen in a patient with situs inversus : a case report(Health and Medical Publishing Group -- HMPG, 1986-02) Du Toit, D. F.; Greeff, M.The case of a man with situs inversus who presented with acute abdomen is reported. Acute left-sided appendicitis was considered before operation, but at laparotomy an omental abscess of unknown aetiology was drained. The appendix, localized in the left iliac fossa, was removed but was normal on histological examination.
- ItemApplication of irradiation as an immunosuppressive agent(Health & Medical Publishing Group, 1987-04) Du Toit, D. F.; Heydenrych, J. J.ENGLISH ABSTRACT: The concept of using total lymphoid irradiation (TLI) for immunosuppression is based on the prolonged and profound immunosuppressive effects observed after TLI in the treatment of patients with Hodgkin's disease. Pre-operative TLI of allograft recipients has been shown to be immunosuppressive when used alone or together with chemical immunosuppression. Fractionated TLI and allogeneic bone marrow injections produce stable chimaerism without graft-versus-host disease in inbred mice, rats and mongrel dogs and transplantation tolerance of skin and cardiac grafts in rats. In the primate, TLI and bone marrow injection result in significant tolerance of liver and kidney allografts. In 1959 sublethal whole-body irradiation was used as an immunosuppressive agent for the first successful related-human renal allografts between non-identical twins. Despite the dangers of myelosuppression, recent clinical experience has shown TLI to be a useful immunosuppressant for organ transplantation, allowing decreased dosage of concomitant immunosuppressive drugs.
- ItemBleeding from varicose veins -still potentially fatal. A case report(Health & Medical Publishing Group, 1985-02) Du Toit, D. F.; Knott-Craig, C.; Laker, L.A 57-year-old woman was admitted to hospital with spontaneous profuse haemorrhage from a small acute varicose ulcer of the left leg. She was in shock, semicomatose and anaemic because of blood loss. The haemorrhage was easily controlled by elevating the leg, applying compression bandages and administering a blood transfusion. The patient made an uneventful recovery.
- ItemCongenital choledochal cyst : a case report(Health and Medical Publishing Group (HMPG), 1986-07) Du Toit, D. F.; Warren, B. L.A congenital choledochal cyst presented as an upper abdominal mass in a non-jaundiced woman; at laparotomy total cystectomy was performed and biliary enteric continuity re-established by a hepaticojejunostomy Roux-en-Y anastomosis.
- ItemCost of breast preservation surgery for cancer(Health & Medical Publishing Group, 1992) Smit, B. J.; Liebenberg, T. J.; Du Toit, D. F.[No abstract available]
- ItemEndovascular aortic aneurysm repair by a multidisciplinary team : lessons learned and six-year clinical update(Clinics cardiv Publishing, 2005-02) Du Toit, D. F.; Saaiman, J. A.; Carpenter, J. P.; Geldenhuys, K. M.Background: Endovascular aneurysm repair (EVAR) (using an Federal Drug Association-approved AneuRx® device) compared to conventional surgical repair of abdom inal aortic aneurysm (AAA) previously rendered favourable outcomes regarding post-operative pain, avoidence of laparotomy, and rapid rehabilitation and hospital discharge in high-risk patients, including octagenarians. Objectives: To assess the safety, reduction in aneurysmrelated deaths, and interim survival data up to 72 months after AAA exclusion by endoluminal endografts (EVAR). Design: We carried out an open, controlled, prospective, multidisciplinary EVAR study for the period 1998 to 2003 (six years). In the earlier part of the study, EVAR was compared with previously published results of conventional open aneurysmectomy surgery. Setting: Heart Unit, Panorama Medi-Clinic, Parow, South Africa. Participants: We recruited adult male and female patients presenting with AAA and fulfilling the inclusion criteria for endovascular repair, as recommended by the consensus 2003 meeting of the Vascular Association of South Africa (VASSA). All patients were offered open surgery as an alternative and were entered into the VASSA EVAR trial registry. Pre-operatively, AAA anatomy was assessed by spiral-computed tomography (CT), and selectively with conventional angiography and intravascular ultrasound (IVUS). Informed consent was obtained in accordance with the recommendations of the Senate of Surgery Paper 2, Ethical Guidelines, Great Britain and Ireland. Patients underwent EVAR by a multidisciplinary interventional team. Interventions: Two hundred and seven adult patients with AAA were assessed. Forty-four of the 207 (21.2%) were excluded from EVAR because of irreversible comorbid factors and complex aneurysm morphology. One hundred and sixty-three patients (78%), with a mean age of 70.7 years (range 60−91 years), underwent EVAR (1998−2003). Five patients were lost to follow-up (3%). Median AAA diameter was 56.9 mm and ASA ratings were I, 1.2%; II, 15.9%; III, 57%; IV, 22.6%; and V, 2.4%. EVAR was performed in high- and low-risk categories of both sexes. Most patients were in ASA groups III and IV. Devices deployed: EVAR was performed using a selection of endografts over 72 months − AneuRx® (Medtronic) 47; Talent® (Medtronic) 49; Vanguard® three; Zenith® (Cook) one; Powerlink® (Endologix) 62; and other, one. Results: Thirty-day outcome: successful deployment 99%, primary stent patency 97%, surgical conversion 0.6%, procedural or intra-operative mortality 1.2%, 30-day mortality 4.3%, endoleaks 1.84%, and secondary intraprocedural endovascular interventions 24.5%. Perioperative mortality was 3.1% (one aneurysm related). One patient had suspected endograft infection. Late mortality was 21.4% (35 patients due to co-morbidities, and one was aneurysm related). Follow-up was a median of 28.3 months (range 1−69 months). In 163 patients, two persisting endoleaks (1.2%) were detected. Endotension was detected in 3/163 (1.8%) with average sac increase of 0.8 cm. Conversion to open surgery was needed in one patient (0.6%). Co-morbidities that contributed to late mortality included multi-organ failure, ischaemic heart disease (IHD), cardiomyopathy, renal failure, stroke and cancer. One procedural rupture was fatal (0.6%). Two late ruptures occurred; one was successfully endostented and the other patient died after a failed surgical intervention (0.6%). Endovascular repair of AAA is more expensive than conventional surgery. Introduction of the Endologix stent has reduced operative time from 120 to 60 minutes in un complicated patients. Newer-generation aortic stents allow better control of negative remodeling and stent migration. Conclusion: A multidisciplinary team can safely perform EVAR, with a low 30-day mortality rate in selected patients graded ASA II−IV and with favourable aortic aneurysm morphology. About 22% of patients with AAA are not suited for EVAR. Persisting late endoleaks occurred in 1.2% of the cohort study and were not device specific. Life-long follow-up post EVAR is a prerequisite to detect late device failure, endoleaks and aneurysm-sac enlargement, and to assure the durability of these midterm results. Short-term aneurysm rupture prevention is a predictable outcome in high-risk groups.
- ItemEVAR : critical applied aortic morphology relevant to type-II endoleaks following device enhancement in patients with abdominal aortic aneurysms(Clinics Cardiv Publishing, 2004-08) Du Toit, D. F.; Saaiman, J. A.; Labuschagne, B. C. J.; Vorster, W.; Van Beek, F. J.; Boden, B. H.; Geldenhuys, K. M.Endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) is an established alternative option to conventional surgery for AAA, provided optimal anatomical morphology of the aneurysm sac, neck and outflow exists. In most documented series of EVAR, type-II endoleak occurrence is a universal procedural drawback. This is referred to as the Achilles heel of EVAR. This morphological study, addressing predominantly non-aneurysmal aortic anatomy, reveals the dyssynchronous origins of the renal ostia, ectopia of the superior mesenteric artery and median sacral artery, variations in the length of the infrarenal abdominal aorta, multiple mainstem renal arteries, and the presence of accessory renal arteries (in 13% of cadavers). Such potential vascular anomalies need careful consideration pre-operatively prior to EVAR. In a prospective, clinical study of EVAR in 163 patients over 60 months, using four different aortic stent devices, we demonstrated an intraprocedural type-II endoleak rate, before exclusion, of 3% (5/163). Most were related to patent lumbar arteries. An active policy of intraprocedural aneurysm pressure sac measurement and angiography was used to demonstrate type-I and type-II endoleaks, focusing on the applied anatomy of aortic side branches and variations. Selective intraprocedural coil embolisation and thrombin injection into the sac was utilised to thrombose persisting and large lumbar arteries that predisposed to retroleaks. We recorded a low incidence of persisting type-II endoleaks using this proactive treatment strategy by addressing variant aortic morphology and patent lumbar arteries during EVAR. One aneurysm-related death (0.6%) was observed due to late rupture after EVAR, and a single intraprocedural death was related to unpredictable aneurysm rupture. In conclusion, comprehensive anatomical knowledge of the abdominal aorta and its main collateral side branches, including variations, is a fundamental prerequisite if satisfactory and predictable results are to be achieved after EVAR, especially regarding prevention, diagnosis and treatment of type-II endoleaks. Intraprocedural aneurysm sac pressure monitoring, coil embolisation and the use of injection of thrombin into the aneurysm sac of selected patients is useful in reducing the incidence of post-EVAR type-II persisting endoleaks.
- ItemExtracranial internal carotid artery aneurysm : a case report(Health & Medical Publishing Group, 1984) Du Toit, D. F.; Van Zyl, J. A.; Laker, L.; Groenewald, J. H.A patient with an asymptomatic, right-sided internal carotid artery aneurysm is reported. The entity was accurately located and diagnosed pre-operatively by utilizing a duplex ultrasonographic scanner. Treatment comprised aneurysmectomy and restoration of arterial continuity by autogenous venous grafting. The patient recovered without the occurrence of any sequelae.
- ItemGastric haemorrhage in a patient with neurofibromatosis : a case report(Health & Medical Publishing Group, 1987) Du Toit, D. F.A 54-year-old woman with upper gastro-intestinal haemorrhage, neurofibromatosis and an underlying schwannoma of the stomach is presented. Gastroscopy and barium meal examination revealed the presence of a submucosal gastric tumour with overlying ulceration. A Billroth II gastrectomy was performed with complete excision of the tumour; histologically this was revealed as a schwannoma of undetermined biological activity.
- ItemHepatic abscess in a patient with polycystic liver disease : a case report(Health and Medical Publishing Group (HMPG), 1985-04) Du Toit, D. F.; Van Schalkwyk, P.; Laker, L.A patient with a liver abscess and underlying polycystic renal and liver disease is described. The liver abscess was diagnosed on the clinical findings and accurately localized by ultrasonography. Tube drainage and antibiotic administration resulted in a rapid recovery. The polycystic liver disease, which was previously undiagnosed and asymptomatic, was an unexpected finding at laparotomy.
- ItemIntra-ocular concentration-time relationships of subconjunctivally administered gentamicin(Health & Medical Publishing Group, 1991) Van Rooyen, M. M. B.; Coetzee, J. F.; Du Toit, D. F.; Van Jaarsveld, P. P.Eighty-nine patients scheduled for cataract removal or lens implantation were divided randomly into three groups. Each received 5, 10 or 20 mg gentamicin subconjunctivally at times varying between 0,2 and 19 hours pre-operatively. At surgery a sample of aqueous humour was obtained and analysed for gentamicin concentration. The data for each group were subjected to non-linear regression analysis to fit an open one-compartment pharmacokinetic model with first-order kinetics. A statistically acceptable fit was obtained. The average values of the pharmacokinetic parameters obtained from the single doses were used to simulate multiple-dose kinetics. The average target intra-ocular gentamicin concentrations and dosage interval were specified in the computer program, which subsequently allowed calculation of the dose required. This allowed the construction of a simple linear nomogram that can be used to read off the dose needed for handling specific clinical situations.
- ItemIntrahepatic gallstones : a case report(Health & Medical Publishing Group, 1985) Du Toit, D. F.; Retief, A.; Laker, L.A Coloured woman was admitted to hospital with a 3-day history of acute right upper abdominal pain, nausea and vomiting. Acute cholecystitis was confirmed by biliary imaging using technetium-99m. An acutely inflamed gallbladder and two pigment stones in the common bile duct were removed. There were numerous retained gallstones in biliary radicles of the right hepatic duct; attempts to dislodge these by saline flushing failed. An extended choledochotomy with further exploration of the intrahepatic radicles also failed to remove the incarcerated stones. Biliary enteric drainage was achieved by choledochoduodenostomy and short-term postoperative progress was uneventful.
- ItemLeft paraduodenal hernia with acute abdominal symptoms : a case report(Health and Medical Publishing Group (HMPG), 1986-08) Du Toit, D. F.; Pretorius, C. F.A 22-year-old man with an incarcerated left para-duodenal hernia is described. Symptoms included nausea, vomiting, cramp-like abdominal pain and obstipation. A clinical diagnosis of mechanical small-intestinal obstruction was made on the history, examination, and abdominal radiographic findings. At laparotomy successful manual reduction was achieved, resection was not required and the patient made an uneventful recovery.
- ItemLow-velocity gunshot injury of the abdominal aorta managed by debridement and re-anastomosis : a case report(Health & Medical Publishing Group, 1986-01) Du Toit, D. F.; Greeff, M.Penetrating injuries to the abdominal aorta are highly lethal despite increasing numbers of reports of successful treatment. A case of survival after a 0,25-calibre gunshot wound of the abdominal aorta is presented. The patient, a young male, also had associated injuries to the liver, stomach and jejunum. He was managed by vigorous resuscitation, emergency laparotomy, aortic debridement and end-to-end re-anastomosis. He was discharged from hospital on the 12th postoperative day.
- ItemPancreatic transplantation in a patient with severe insulin resistance : a case report(Health & Medical Publishing Group, 1988) Du Toit, D. F.; Heydenrych, J. J.; Coetzee, A. R.; Weight, M.A 22-year-old white woman with insulin-dependent diabetes mellitus of 20 years' duration and advanced secondary complications underwent pancreatic transplantation for severe insulin resistance and rapidly progressive nephropathy. Resistance to all forms and strengths of subcutaneously administered insulin had necessitated almost permanent hospitalisation for the previous 10 years. Short-term improvement of the endocrine and metabolic status was achieved by initial segmental and subsequent whole pancreatic transplantation.
- ItemRectus sheath haematoma - a complication of anticoagulation therapy : a case report(Health & Medical Publishing Group, 1983) Du Toit, D. F.; Maritz, J.; Loxton, A. J.; Groenewald, J. H.A right-sided rectus sheath haematoma developed during heparin therapy for deep vein thrombosis. Computed tomography of the abdomen provided accurate pre-operative images of the size and extent of the haematoma, and surgical evacuation thereof resulted in uneventful recovery.
- ItemSplenic rupture caused by a cricket ball. A case report(Health & Medical Publishing Group, 1987-06) Du Toit, D. F.; Rademan, F.ENGLISH ABSTRACT: A 14-year-old boy presented with a ruptured spleen after being injured by a cricket ball during a match. A typical picture of splenic rupture with intra-abdominal haemorrhage was evident on admission to hospital. At emergency laparotomy splenorrhaphy was not feasible because of a deep hilar laceration and splenectomy was performed.
- ItemTakayasu's disease : a report of 3 cases(Health & Medical Publishing Group, 1985) Du Toit, D. F.; Warren, B.; McCormich, M.; Laker, L.Three patients with Takayasu's disease are described. In 2 cases aortography demonstrated an occlusion of the great vessels at the origin of the arch of the aorta. In 1 patient there was concomitant aneurysmal dilatation of the brachiocephalic trunk. Common and internal carotid artery stenosis occurred in 1 patient and was associated with hemiplegia and blindness. All 3 patients had constitutional symptoms and signs of the disease as well as markedly elevated erythrocyte sedimentation rates; 2 patients had moderate clinical responses to steroid administration in the short term and 1 developed bilateral calf vein thrombosis, which responded satisfactorily to conservative management.
- ItemTraumatic superior mesenteric arteriovenous fistula(Health & Medical Publishing Group, 1987-05) Du Toit, D. F.; Rademan, F.ENGLISH ABSTRACT: In a case of traumatic superior mesenteric arteriovenous fistula resulting from a stab wound in the abdomen clinical signs of high-output cardiac failure or portal hypertension were absent. Selective angiography was useful in confirming and locating the fistula. The patient made a good recovery after resection of the aneurysm and fistula and insertion of a prosthetic graft.
- ItemThe Zollinger-Ellison syndrome : a case report(Health & Medical Publishing Group, 1985) Du Toit, D. F.; Louwrens, H.; Esterhuizen, N.; Falck, V. C.; Du Toit, L. B.A vagotomy and antrectomy was performed on a 15-year-old boy with malignant gastrinoma for emergency control of massive upper gastro-intestinal haemorrhage from a large posterior penetrating duodenal ulcer in the presence of jejunal ulceration and liver metastases. Hypergastrinaemia was confirmed by elevated serum gastrin levels. In the short term postoperatively the patient's disease has been controlled with oral cimetidine. Although controversy continues over the efficacy of cimetidine in the management of gastrinomas, medical treatment should be considered as an alternative to total gastrectomy in children with malignant gastrinomas because they are often slow-growing, indolent and compatible with long survival.