SUNScholar - Browsing by Author "Du Toit, D. F."

Browsing by Author "Du Toit, D. F."

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Acute 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.
Aneurysm of the splenic artery - a controversial entity. A case report
(Health & Medical Publishing Group, 1983-01) Du Toit, D. F.; Theron, J. C.; Groenewald, J. H.
ENGLISH ABSTRACT: The case of an asymptomatic, calcified, arteriosclerotic, intact splenic artery aneurysm in a 60-year-old woman is presented. The diagnosis was confirmed by selective coeliac arteriography and the aneurysm was successfully resected with preservation of the spleen.
Application 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.
Bleeding 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.
Bolus obstruction of the intestine : case reports
(Health and Medical Publishing Group -- HMPG, 1985-06) Knott-Craig, C. J.; Du Toit, D. F.; Van Schalkwyk, P.; Van Rensburg, L. C. J.
Two cases of intestinal obstruction caused by peaches are reported. In the first case steamed dried peaches were eaten by a 56-year-old woman who had undergone a Billroth I gastrectomy 18 years previously, while in the second case canned peach halves were swallowed whole by a 75-year-old edentulous man. The cases both typify the usual clinical setting of bolus obstruction, certain aspects of which are discussed. The responsibility of the attending practitioner to advise his high-risk patients with regard to their diets is emphasized.
Buerger's disease. A case report and review of the literature
(Health & Medical Publishing Group, 1984) Du Toit, D. F.; Maritz, J.; Klompje, J.
A case of thrombo-angiitis obliterans (Buerger's disease) in a 30-year-old man is reported. Irremediable gangrene necessitated amputation of both legs, and distal amputation of the fingers and thumb of the right hand.
Congenital 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.
Cost of breast preservation surgery for cancer
(Health & Medical Publishing Group, 1992) Smit, B. J.; Liebenberg, T. J.; Du Toit, D. F.
[No abstract available]
Deep-vein thrombosis in pregnancy : a case report
(Health & Medical Publishing Group, 1985) Du Toit, D. F.; McCormich, M.; Laker, L.
The incidence of thrombo-embolic complications in pregnancy varies between 2 and 5 per 1 000 deliveries. Deep-vein thrombosis (DVT) is classically associated with pulmonary embolism and chronic venous insufficiency, which are leading causes of maternal morbidity and mortality. An accurate diagnosis of iliofemoral or calf vein thrombosis should be confirmed by either Doppler ultrasonography, impedance plethysmography or ascending phlebography. Full-dose continuous intravenous heparin for 5-10 days is the established method of therapy for acute DVT and pulmonary embolism occurring during pregnancy or in the puerperium. Thereafter, long-term treatment with self-administered subcutaneous injections of heparin in low doses is feasible and effective. During pregnancy. coumarin administration results in embryopathy as it readily crosses the placenta; it should be avoided until after delivery. In view of its safety and effectiveness, low-dosage intravenous heparin or heparin by subcutaneous injection seems to be the anticoagulant of choice for the expectant mother.
Early postoperative pancreatic endocrine function after segmental and pancreaticoduodenal allotransplantation in nonimmunosuppressed primates
(1987) Du Toit, D. F.; Heydenrych, J. J.; Smit, B.
In this study we evaluated the short-term hormonal effects of segmental and whole pancreatic allotransplantation on the glucose intolerance produced by hemipancreatectomy in the primate. In hemipancreatectomized animals without grafts the K-values were reduced to 0.6 ± 0.05, plasma insulin increased from 27.5 ± 2.5 to 63.5 ± 6.3 μU/ml, and glucagon levels declined from 252 ± 29.9 to 216.5 ± 33.0 pg/ml. Hemipancreatectomized segmental allograft recipients rendered K-values of 0.79 ± 0.05, plasma insulin increased from 19.98 ± 3.43 to 66.0 ± 17.03 μU/ml, and glucagon release declined from 395.6 ± 63.0 to 226.2 ± 37.6 pg/ml during IVGTT postoperatively. Hemipancreatectomized, pancreaticoduodenal allograft recipients rendered K-values of 0.82 ± 0.1, results not significantly different from hemipancreatectomized or segmental allograft recipients. Plasma insulin increased from 29.5 ± 4.0 to 186.0 ± 25.0 μU/ml, and glucagon release declined from 1,087.0 ± 31.6 to 656.0 ± 12.7 pg/ml. In summary, segmental pancreatic allotransplantation could not, in the short-term, restore the reduced K-values and hypoinsulinaemia in hemipancreatectomized primates to that of normal, unstressed controls. Although K-values of hemipancreatectomized recipients were not significantly improved, whole pancreas transplantation resulted in improved insulin release and hyperglucagonaemia during IVGTT when compared to segmental allograft recipients. The unexpected findings of hypoinsulinaemia and hyperglucagonaemia in both transplant groups may only reflect a function of the stressed state of the animals in the immediate postoperative phase.
Endovascular 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.
Ethics, litigation and teaching of anatomy
(Health & Medical Publishing Group, 2003) Du Toit, D. F.
Curriculum time devoted to teaching human gross anatomy in medical and dental schools has diminished to accommodate new knowledge and other disciplines. Systembased curricula have replaced classic anatomy teaching on a regional basis. ‘Wet labs’ have disappeared and the electronic media has taken the place of the anatomist.
EVAR : 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.
Extracranial 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.
Gangrene of the hand and forearm after inadvertent intra-arterial injection of pyrazole : a case report
(Health & Medical Publishing Group, 1985) Du Toit, D. F.; Sunshine, M.; Knott-Craig, C.; Laker, L.
A case of gangrene of the hand following inadvertent intra-arterial injection of a pyrazole derivative (Tomanol) is presented. Gangrene of the hand and superficial sloughing of the distal arm necessitated a forearm amputation. Because of the serious sequelae, precautions must be taken to avoid inadvertent intra-arterial injections and due consideration must be given to the anatomical variations of the brachial artery and its branches in the cubital fossa.
Gasgangreen : 'n bespreking van 3 gevalle en literatuuroorsig
(Health & Medical Publishing Group, 1985) Du Toit, D. F.; Pretorius, C. F.; Esterhuizen, N.; Du Toit, L. B.
Three patients with gas gangrene of the lower limbs are presented. In 2 of the 3 patients gas gangrene developed after lower-limb amputation, indications for amputation being atherosclerotic and diabetic gangrene. In the third patient associated leukaemia was diagnosed. All 3 patients presented with the typical clinical manifestations of gas gangrene. Clostridium perfringens was isolated from the affected leg in each patient The current application of surgery and hyperbaric oxygen therapy in the treatment of gas gangrene is discussed.
Gastric 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.
Hepatic 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.
Hydatid cyst of the pancreatic tail : a case report
(Health & Medical Publishing Group, 1984) Du Toit, D. F.; Loxton, A. J.; Laker, L.; Dreyer, J. F.
A case of calcified hydatid cyst of the pancreatic tail is presented. The ultrasonographic and computed tomographic features of the lesion suggested the presence of a cystadenoma or a calcified hydatid cyst. Computed tomography proved the most useful investigation and accurately localized the lesion. A distal pancreatectomy and splenectomy were performed because on the basis of the results of pre-operative investigations and macroscopic operative findings, carcinoma of the pancreatic tail could not be ruled out with certainty. The patient made an uneventful recovery.
Intra-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.

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