Browsing by Author "King, J. B."

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    Aetiology of pulmonary dysfunction in total hip replacement operations: The influence of nifedipine on the factors involved
    (Health & Medical Publishing Group, 1987-05) Du Toit, H. J.; Macfarlane, C. M.; Taljaard, J. J. F.; King, J. B.; Cooper, R. C.
    ENGLISH ABSTRACT: Patients undergoing total hip replacement surgery who developed pulmonary dysfunction (PD) demonstrated evidence of a complement activation and increased thromboxane A2 (TXA2) synthesis. In a double-blind study nifedipine (Adalat; Bayer-Miles) was shown to inhibit complement activation and TXA2 synthesis and thus appears to offer protection against PD.
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    The effect of ventilatory patterns on prostacyclin (PGI2) synthesis in the lung
    (Health & Medical Publishing Group, 1984) Du Toit, H. J.; Erasmus, F. R.; Macfarlane, C. M.; Taljaard, J. F.; Shephard, E. G.; King, J. B.; De Klerk, A. J.
    Prostacyclin (PGI2) appears to be synthesized in the lungs of man and experimental animals. It has been stated that PGI2 must be regarded as a local hormone that inhibits platelet adhesion to vessel walls only very close to the site of synthesis. The wide range of normal values given for PGI2 may be related to the sensitivity and exclusiveness of the different assay techniques used. In animals, hyperventilation increases PGI2 synthesis by the lung, but in agreement with other authors we demonstrated that hyperventilation did not influence PGI2 synthesis in man. We used a radio-immunoassay technique to estimate PGI2 levels.
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    Hodgkin's disease and acute promyelocytic leukaemia : a case report
    (Health & Medical Publishing Group, 1980) Rosenstrauch, W. J. C. J.; Van der Merwe, A. M.; King, J. B.
    A case of Hodgkin's disease is reported in which acute promyelocytic leukaemia developed within 5 months of initiation of chemotherapy. Only 3 other cases, possibly of a similar nature, were found in the literature; these had occurred 15, 77, and 226 months respectively after the initial diagnosis of Hodgkin's disease.
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    Methylprednisolone and the adult respiratory distress syndrome
    (Open access journal, 1984-06) Du Toit, H. J.; Erasmus, F. R.; MacFarlane, C. M.; Taljaard, J. J. F.; King, J. B.; De Klerk, A. J.; Elk, E.
    Total hip replacement was carried out on 22 patients under general anaesthesia. Of these, 10 were pretreated with methylprednisolone (30 mg/kg); 1 of these developed the adult respiratory distress syndrome (ARDS) and had high levels of thromboxane B2 (TXB2) 5 minutes after fixation of the femoral prosthesis and at the end of the operation. The other 12 patients served as controls; 5 of them developed ARDS and had statistically significant higher TXB2 levels than the other 7 control patients who remained well. All patients who did not develop ARDS had low TXB2 levels. TXB2 and β-thromboglobulin levels followed the same trend and there was good correlation (r = 0.6806; P < 0.01) at the end of the operation in the control group patients who developed ARDS. There was no statistical difference in 6-keto-PGF(1α) levels between the patients who developed ARDS and those in the control group who remained well. Steroids reduce arachidonic acid metabolism by inhibiting the release of substrate for cyclo-oxygenase and lipoxygenase activity. Patients prone to ARDS thus benefit from methylprednisolone administration.
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    A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part I. Clinical features
    (Health & Medical Publishing Group, 1985) Van Eeden, P. J.; Joubert, J. R.; Van de Wal, B. W.; King, J. B.; De Kock, Annamarie; Groenewald, J. H.
    Crimean-Congo haemorrhagic fever (CCHF) is a rare disease in South Africa. From 1981 to September 1984, 8 sporadic primary cases were reported. An outbreak of CCHF in a large university hospital is described; of 8 patients diagnosed 2 died (the index and a secondary case). Four patients were seriously ill and 2 had a mild illness. Problems were encountered in diagnosing the disease, which presents initially with influenza-like symptoms, differing only in severity from influenza. However, petechiae and other manifestations of a bleeding tendency distinguished it from influenza in the later phase of the disease. Special investigations, especially those revealing leucopenia and thrombocytopenia, were critically important in early diagnosis. The dilemma of handling this highly contagious disease is that definite virological diagnosis is time-consuming and is conducted in only one high-security laboratory 1600 km distant. A further case was admitted 3 months later from a different locality and confirmed virologically but no secondary cases could be confirmed or traced.
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    A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part II. Management of patients
    (Health & Medical Publishing Group, 1985) Van Eeden, P. J.; Van Eeden, S. F.; Joubert, J. R.; King, J. B.; Van de Wal, B. W.; Michell, W. L.
    During the outbreak of Crimean-Congo haemorrhagic fever (CCHF) at Tygerberg Hospital 8 patients were diagnosed positive. CCHF was diagnosed in another patient several months later. The treatment of these 9 cases is outlined. When it became evident that CCHF could present with a spectrum of severity, treatment was adjusted according to each patient's requirements. The essential components consisted of correction of haematological abnormalities combined with hyperimmune serum; the latter is particularly important for the severely ill patient with no antibodies to CCHF. The antiviral agents ribavirin and interferon were used but evidence to substantiate their application in future cases was inconclusive. Interferon was discontinued because of severe side-effects, many of which simulated the clinical features of CCHF. Objective improvement after corticosteroid treatment was noted in only 1 patient, but some of her symptoms could have been due to a transfusion reaction. Antibiotics were not routinely used. The 2 patients who died were diagnosed late, did not receive hyperimmune serum, and eventually developed multi-organ failure. The course of CCHF can probably be modified if the diagnosis is made early, if antiserum is given, and if the haematological abnormalities are promptly corrected.
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    A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part III. Clinical pathology and pathogenesis
    (Health & Medical Publishing Group, 1985) Joubert, J. R.; King, J. B.; Rossouw, D. J.; Cooper, R.
    Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in 8 patients; 7 were staff members at Tygerberg Hospital who had been infected by a patient in whom the disease had not initially been diagnosed. Two patients, the initial case and a staff member, died and 4 became seriously ill. The immunopathogenesis of CCHF appears to be multifactorial. Certain features were common to all patients - leucopenia, thrombocytopenia, elevated liver enzyme values and low serum total protein levels. Ultrastrucutral changes in and around skin capillaries, including intracytoplasmic endothelial tuboreticulated bodies, were found. Virus-like particles were found on electron microscopy. Important individual factors related to prognosis were identified. The patients who survived all mounted a good antibody response, and manifested no coagulation defect extensive enough to explain the haemorrhagic tendency. In the patients who died no evidence of antibody production was detected; both developed diffuse intravascular coagulation and in 1 evidence of immune complex formation and complement consumption was found. Hepatorenal failure and cardiovascular collapse characterized the terminal period. Early clinical recognition of CCHF with specific attention to factors amenable to treatment may vastly improve the prognosis.
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    A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital. Part IV. Preventive and prophylactic measures
    (Health & Medical Publishing Group, 1985) Van de Wal, B. W.; Joubert, J. R.; Van Eeden, P. J.; King, J. B.
    During the Crimean-Congo haemorrhagic fever (CCHF) outbreak at Tygerberg Hospital a particular problem existed: a simultaneous influenza epidemic complicated the screening of contacts because of its very similar clinical picture to that of early CCHF. The methods of identifying and screening contacts are described. Of 459 listed CCHF contacts, 7 (1.5%) developed the disease; 6 were contacts of the index case and only 1 a contact of a secondary case. Two of the 7 CCHF patients had no direct contact with the index case; this caused a great concern about the dissemination, despite the otherwise full protective measures. Four of 46 blood contacts (8.7%) and 3 of 9 needle contacts (33%) developed the disease. Prophylactic interferon therapy had to be discontinued because of side-effects mimicking the symptoms of CCHF. Ribavirin was used prophylactically in 6 of the 9 inoculation contacts. One of the patients on ribavirin had a mild clinical course while 5 others who received the drug developed neither clinical CCHF nor antibodies to the virus. Two of the 3 needle contacts not treated with ribavirin had a severe clinical course. One contact with needle inoculation and 42 proven blood contacts who had not received ribavirin did not become infected. No firm conclusion can therefore be made about the protective value of prophylactic ribavirin.
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    Severe rhesus iso-immunization successfully treated with apheresis and azathioprine : report of 2 cases
    (Health & Medical Publishing Group, 1986) Odendaal, H. J.; King, J. B.; Oosthuizen, O. J.
    Two patients are described in whom previous fetal loss had occurred due to rhesus (Rh) disease. In both patients apheresis was performed from a gestational age of 25 weeks in an attempt to remove excessive antibodies. In addition, production of new antibodies was suppressed by the administration of prednisone and azathioprine. A reduction in the antibody titres was accomplished although this was not reflected by a marked decrease in amniotic fluid bilirubin levels. The patients were delivered at gestational ages of 32 and 33 weeks since fetal lung maturity had then been demonstrated. Both babies were surprisingly little affected by the Rh disease and only one exchange transfusion was necessary for each. Neonatal follow-up for 2 years and 1 year respectively revealed no fetal abnormalities.
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    Severe staphylococcal infection with pneumonia treated by plasmapheresis and plasma exchange. A preliminary report
    (Health and Medical Publishing Group -- HMPG, 1980-11) King, J. B.; De Vaal, J. B.
    Three cases of extremely severe staphylococcal infection are reported. All 3 patients were treated by plasmapheresis and fresh plasma or fresh-frozen plasma replacement, and all made a steady recovery. In all 3 cases blood culture for Staphylococcus aureus was positive, 1 patient had osteitis, and 1 signs of spinal cord compression by an infectious process (an abscess). It is thought that the above-mentioned procedures may offer a useful additional line of therapy for desperately ill patients with staphylococcus infections.