Browsing by Author "Krige, J E J"

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    Biochemical and immunohistochemical charterisation of mucins in 8 cases of colonic disease - a pilot study
    (Health and Medical Publishing Group, 2007) Chirwa, N; Govender, D; Kahn, D; Mall, A; Tyler, M; Kavin, B; Goldberg, P; Krige, J E J; Lotz, Z; Hunter, A
    Objectives: To characterise mucins in cancer of the colon and compare these with controls using stringent biochemical measures to avoid endogenous proteolysis. Design: Crude mucus scrapings were collected from 12 specimens obtained by colectomy. Specimens from 3 traumatic colectomies and 1 sigmoid volvulus were used as controls, and compared with 6 specimens from colons resected for adenocarcinoma and 2 irradiated colons. Subjects: The median age of the 4 female patients was 76 years (range 49 - 82 years), and of the 8 male patients 46.5 years (range 16 - 74 years). Results and conclusions: The crude mucus scrapings in the 9 specimens ranged in weight from 353 mg to 7 697 mg (median 4 928 mg). The median of purified mucin in the 9 specimens was 0.72 µg/mg wet weight of scraped material. Eight samples gave non-extractable pellet material, and were treated with DTT to reduce disulphide bonds for further analysis. One of these 8 pellets was resistant to reduction and had to be digested with papain before analysis. Only 5 of these pellets had mucin. Gel filtration and SDS-PAGE (sodium dodecyl sulphate polyacrylamide gel electrophoresis) analysis revealed different populations of mucin based on size and extent of degradation. Western blotting and immunohistochemical analysis confirmed the presence of MUC2 in all samples, MUC5AC in 2 and MUC5B in 5 diseased specimens. Immunohistochemical analysis showed that there was no MUC1 in the normal specimens, MUC1 apoprotein MUC1 core) in 2 cancer specimens and MUC1 in 1 cancer specimen. Histochemical analysis showed that normal tissue expressed neutral and acidic mucins and diseased specimens predominantly expressed acidic mucins. The electrophoretic behaviour of MUC2 in sigmoid volvulus was different from that in cancer of the colon.
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    A cost analysis of operative repair of major laparoscopic bile duct injuries
    (2015) Hofmeyr, Stefan; Krige, J E J
    Major bile duct injuries occur infrequently after laparoscopic cholecystectomy but may result in life-threatening complications. Few data exist about the financial implications of bile duct repair. This study calculated the total inhospital costs of operative repair in a cohort of patients who underwent reconstruction of the bile duct after major ductal injury sustained during laparoscopic cholecystectomy. A prospective database was reviewed to identify all patients referred to the University of Cape Town Private Academic Hospital between 2002 and 2013 for assessment and repair of major laparoscopic bile duct injuries. The detailed clinical records and billing information were evaluated to determine all costs from admission to discharge. Total costs for each patient were adjusted for inflation between the year of repair and 2013. Forty four patients (33 women, 11 men, median age 48 years, range 30 - 78) underwent reconstruction of a major bile duct injury. First time repairs were performed at a median of 24.5 days (range 1 - 3662) after initial surgery. Median hospital stay was 15 days (range 6-86). Mean cost of repair was R215 711 (range R68 764 - 980 830). Major contributors to cost were theatre expenses (22%), admission to intensive care (21%), radiology (17%) and specialist fees (12%). Admission to a general ward (10%), consumables (7%), pharmacy (5%), endoscopy (3%) and laboratory costs (3%) made up the balance. The cost of repair of a major laparoscopic bile duct injury is substantial due to prolonged admission to hospital, complex surgical intervention and intensive imaging requirements.
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    Departments of surgery in South Africa - legacies of the past, challenges for the future
    (2004) Krige, J E J
    Among the most important constituencies of the South African Journal of Surgery are its readership and contributing authors. The needs and interests of our readers are being addressed in several ways. A new feature in this and the following issues of the Journal is a review highlighting one of the academic departments of general surgery in South Africa. Each of the eight heads of department has been invited to introduce and record the achievements and talents of his department in a remit that includes a synoptic background and biographical detail of previous opinion leaders and staff who have made seminal contributions to clinical surgery, teaching and research in South Africa. Within the brief are current research directions, registrar development, the thrust of undergraduate teaching and future prospects and challenges for surgery in that environment. Professor Brian Warren is the first to take up the gauntlet.
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    Endoscopic injection sclerotherapy in the treatment of bleeding oesophageal varices in patients with portal hypertension due to alcohol-induced cirrhosis : an assessment of acute control of bleeding, prevention of recurrent bleeding and prognostic factors predicting early variceal rebleeding and death
    (2009) Krige, J E J; Bornman, P C; Kahn, D
    The ideal treatment of portal hypertension and bleeding varices should be universally effective, safe, easy to administer and inexpensive. Currently no such treatment exists and the surgeon or physician is obliged to select the most appropriate intervention from a menu of currently available therapeutic options, none of which is ideal or applicable to all patients. The rational treatment of oesophageal varices depends on a clear understanding of the risks of rebleeding and the response to each specific intervention. The selection of the correct and appropriate intervention is critical and requires a comprehensive understanding of the relative efficacy and safety of each treatment compared to other competing options. In addition, the chosen intervention requires detailed knowledge of the criteria underpinning the correct selection of patients for treatment in order to maximize the therapeutic benefits of the appropriate choice while minimising the side effects of the treatment. The optimal management of bleeding oesophageal varices therefore requires a full appreciation of portal, gastric and oesophageal venous collateral anatomy, the pathogenesis and haemodynamic consequences of variceal bleeding and the utility of each available therapy at specific stages in the natural history of portal hypertension (Henderson 1998).
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    The new DEAL - a novel technique using a double-entry access loop to facilitate bilateral intrahepatic biliary access for complex intrahepatic stones
    (Health and Medical Publishing Group, 2006) Krige, J E J; Beningfield, S J
    The management of patients with primary intrahepatic stones may be complex as the natural history is frequently complicated by further episodes of cholangitis after initial treatment because of residual or recurrent intrahepatic stones or strictures.1 Curative segmental or lobar hepatic resection of atrophic segments and diseased ducts is possible in only the 20% of patients with localised stones or strictures.2 Complete stone removal by resection is therefore not feasible in the majority of patients with bilateral lobar stones and strictures. Patients who subsequently develop cholangitis pose a major operative risk if secondary biliary cirrhosis, portal hypertension or the atrophy-hypertrophy complex has occurred.3 Treatment of recurrent stones and strictures via the percutaneous transhepatic biliary route is successful in only 70% of patients.3 In order to avoid these hazards, to reduce the incidence of incomplete operative stone removal and to facilitate extraction of recurrent intrahepatic stones, we have used a multidisciplinary approach in complex hepatolithiasis, combining resection of atrophic liver segments with a modified hepaticojejunostomy incorporating permanent access for interventional radiological procedures via a jejunal access loop.
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    New paradigms in the management of complicated peptic ulcers the final requiem for vagotomy?
    (2004) Bornman, P C; Krige, J E J
    The need for elective peptic ulcer surgery has diminished dramatically over the last two decades with the successful prevention of ulcer recurrence by effective Helicobacter pylori eradication therapy.
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    Pancreatic pseudocysts
    (2006) Apostolou, C; Krige, J E J; Bornman, P C
    Improvements in imaging studies and a better understanding of the natural history of pancreatic fluid collections (PFCs) have allowed the different types to be clarified. Stratification of PFCs into subgroups should help in selecting from the increasing current available treatment options, which include percutaneous, endoscopic and surgical drainage. Percutaneous catheter drainage is safe and effective and should be the treatment of choice in poor-risk patients, and for infected pseudocysts related to acute pancreatitis. Endoscopic drainage should be the first management option in suitable pseudocysts related to chronic pancreatitis, if the necessary expertise is available. The high success rate and current low morbidity of elective open surgery mean that it is still the standard of management in this disease. Laparoscopic approaches are gaining favour, predominantly in drainage of collections in the lesser sac, and long-term data are awaited. The precise application of this modality will need to be critically compared with the low morbidity of mini-laparotomy, which is the current standard after non-operative treatment fails in these patients. It is essential to clearly stratify the different types of pancreatic pseudocysts, in particular with relation to acute or chronic pancreatitis, and perform a valid comparison of the different treatment modalities within groups. In this capacity a precise and transparent classification may provide valuable answers, in particular relating to optimal management according to pseudocyst type.
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    The role of endoscopic retrograde pancreatography in the management of pancreatic trauma
    (2012) Thomson, David Alexander; Krige, J E J
    Background: Endoscopic retrograde pancreatography (ERP) has various applications in the diagnosis and management of pancreatic trauma. The utility of ERP in pancreatic trauma presenting to a level 1 equivalent trauma centre was analysed. Methods: Patients who sustained pancreatic trauma and underwent ERP were identified. Patient demographics, mechanism of injury, time to presentation, diagnostic modalities, associated injuries, clinical management, endoscopic interventions and their timing, surgical treatment and patient outcomes were recorded. Results: Forty-eight patients with pancreatic trauma were referred for ERP after blunt (26), gunshot (15), or stab (7) injury. The average time from injury to ERP was 38 days (range 2 – 365). An ERP visualized the duct in 47 patients. Twenty-four patients had a pancreatic fistula, 12 patients had a main pancreatic duct stricture or cut-off and 10 patients had a pseudocyst. Endoscopic interventions were pancreatic duct sphincterotomy (15), pancreatic duct stent (7) or pseudocyst drainage (6). Ten patients demonstrated minor injuries and no interventions were performed. One patient had a normal pancreatogram. Ten patients required pancreatic surgery following ERP (distal pancreatectomy n=6, pancreaticojejenostomy n=3 and cystjejenostomy n=1). One patient unable to tolerate ERP had a distal pancreatectomy. Conclusion: The majority of ERPs were performed post surgery or after a delayed presentation. Diagnostic success was high and in conjunction with therapeutic interventions 77% of patients avoided surgery for their pancreatic complications. ERP is an effective tool in the delayed management of the local complications of pancreatic trauma.
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    Taking the tension out of portal hypertension
    (Health and Medical Publishing Group, 2009) Krige, J E J
    Bleeding from oesophageal varices is the most serious complication of portal hypertension and accounts for most cirrhosis-related deaths. A quarter of high-risk cirrhotic patients with liver decompensation who present with a first major variceal bleed die as a consequence of the bleed. After control of the index bleed, there is a 70% chance of rebleeding with a similar mortality if further effective treatment is not given. Mortality is related to several factors, including failure of rapid control of initial bleeding, early rebleeding, presence and severity of underlying liver disease and functional hepatic reserve. Optimal emergency management requires an efficient and organised team to provide accurate initial assessment of the patient, effective resuscitation, rapid endoscopic diagnosis, successful intervention with control of bleeding, and prevention of early rebleeding as well as the anticipated complications of liver decompensation including spontaneous bacterial peritonitis, progressive liver and renal failure and hepatic encephalopathy. The modern management of acute, persistent variceal bleeding is therefore best accomplished by a skilled, knowledgeable and well-equipped team that can offer the full spectrum of treatment options.
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    The management of complex pancreatic injuries
    (2005) Krige, J E J; Beningfield, S J; Nicol, A J; Navsaria, P
    Major injuries of the pancreas are uncommon, but may result in considerable morbidity and mortality because of the magnitude of associated vascular and duodenal injuries or underestimation of the extent of the pancreatic injury. Prognosis is influenced by the cause and complexity of the pancreatic injury, the amount of blood lost, duration of shock, speed of resuscitation and quality and nature of surgical intervention. Early mortality usually results from uncontrolled or massive bleeding due to associated vascular and adjacent organ injuries. Late mortality is a consequence of infection or multiple organ failure. Neglect of major pancreatic duct injury may lead to life-threatening complications including pseudocysts, fistulas, pancreatitis, sepsis and secondary haemorrhage. Careful operative assessment to determine the extent of gland damage and the likelihood of duct injury is usually sufficient to allow planning of further management. This strategy provides a simple approach to the management of pancreatic injuries regardless of the cause. Four situations are defined by the extent and site of injury: (i) minor lacerations, stabs or gunshot wounds of the superior or inferior border of the body or tail of the pancreas (i.e. remote from the main pancreatic duct), without visible duct involvement, are best managed by external drainage; (ii) major lacerations or gunshot or stab wounds in the body or tail with visible duct involvement or transection of more than half the width of the pancreas are treated by distal pancreatectomy; (iii) stab wounds, gunshot wounds and contusions of the head of the pancreas without devitalisation of pancreatic tissue are managed by external drainage, provided that any associated duodenal injury is amenable to simple repair; and (iv) non-reconstructable injuries with disruption of the ampullary-biliary-pancreatic union or major devitalising injuries of the pancreatic head and duodenum in stable patients are best treated by pancreatoduodenectomy. Internal drainage or complex defunctioning procedures are not useful in the emergency management of pancreatic injuries, and can be avoided without increasing morbidity. Unstable patients may require initial damage control before later definitive surgery. Successful treatment of complex injuries of the head of the pancreas depends largely on initial correct assessment and appropriate treatment. The management of these severe proximal pancreatic injuries remains one of the most difficult challenges in abdominal trauma surgery, and optimal results are most likely to be obtained by an experienced multidisciplinary team.