Browsing by Author "Semple, P L"

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    Intracranial endoscopy
    (Health and Medical Publishing Group, 2006) Figaji, A A; Fieggen, A G; Semple, P L; Peter, J C
    In modern neurosurgery there has been a strong trend towards the use of minimally invasive techniques, one of which is intracranial endoscopy. Endoscopic third ventriculostomy (ETV) is the commonest procedure performed; it is used to treat hydrocephalus caused by an obstruction to the ventricular system anywhere distal to the mamillary bodies of the third ventricle. The obstruction is bypassed by a stoma created in the floor of the third ventricle, allowing cerebrospinal fluid (CSF) to flow freely into the subarachnoid space. Endoscopy can also be used for the fenestration of various intracranial cysts, intraventricular biopsy, the placement and retrieval of ventricular catheters, the removal of small intraventricular lesions, and improved visualisation in microsurgical operations. At Red Cross Children’s Hospital and Groote Schuur Hospital endoscopy has become an indispensable tool in the management of a wide range of neurosurgical conditions. As experience has accumulated worldwide, a better understanding of the benefits and limitations of endoscopy in diverse circumstances has emerged.
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    Outcomes of decompressive craniectomy in adults with severe traumatic brain injury: the Groote Schuur Hospital experience
    (2014) Enslin, Johannes Marthinus Nicolaas; Semple, P L
    Object: The aim of this study was to assess outcome following decompressive craniectomy in adults with severe traumatic brain injury (TBI) in a South African neurosurgical unit. Methods: During a 78 month period (January 2005 – June 2011), 76 patients that underwent decompressive craniectomy for TBI in an attempt to lower raised intracranial pressure (ICP) were reviewed . All were older than 14 years and mass lesions were included. Thirty nine point four percent of the patients sustained blunt, low velocity injuries to the head and 19% were involved in motor vehicle accidents. Unilateral hemi-craniectomies were carried out in 81% of patients and 54 (75%) were done as primary decompressive craniectomies. Survivors were followed up for a period of at least six months and functional outcomes were measured using the Glasgow outcomes score. To simplify outcomes the patients were then dichotomised into outcome groups of good (GOS 4 and 5 ), and poor (GOS 1- 3). Results: At six months follow up 24 patients (33.3%) had a good outcome (GOS 4 or 5) and 48 patients (66.7%) had a poor outcome (GOS 1- 3). 32 patients (44.4%) died (GOS 1). There were 16 survivors in the poor group. Sixty percent o f survivors had a good outcome after decompressive craniectomy. Eighteen patients underwent secondary decompressive craniectomies and 54 (75%) primary decompressive craniectomies. Thirty - five percent of patients that underwent primary decompressive cranie ctomy had a good outcome, versus 38% in the secondary decompression group. Mortality was slightly higher in the primary decompression group (43%) than the secondary group (33%) . Factors that showed significant correlation with outcome were age, admission GCS and good response of ICP to decompressive craniectomy. Complications were encountered in 18% of patients with sepsis being the most common (11%). Conclusion: Decompressive craniectomy was associated with a functional outcome that was better than exp ected in patients with severe TBI and should still form part of salvage therapy in adults with TBI and elevated ICP.
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    The susceptibility of baboons to the novel immunosuppressant, FTY720
    (2000) Semple, P L; Quesniaux, Valerie
    Since there is a major scarcity of donor organs world-wide, the experimental search for human organs has focused on two alternatives; mechanical devices and cross-species transplants. The use of mechanical devices as substitute organs is understandably limited due to complications from trying to duplicate the function of complex organs such as the liver. This has resulted in a renewed interest in xenotransplantation. Organs from non-human primates would arguably be the organs of choice but ethical consideration prevents this. The transplantation of organs from pigs or sheep to humans i.e. xenotransplants, results in hyperacute rejection. The development of immunosuppressive agents such as Cyc1osporine A and Tacrolimus have significantly improved the survival of organ transplants. However, although there is a good 1-5 year survival, the recurrent problem of chronic rejection still remains, and unresponsiveness to allografts has never been induced by these immunosuppressive agents. More importantly, the presence of adverse side effects including immunological complications and drug toxicity e.g. nephrotoxicity, remains a serious problem. Since the drugs currently available for allotransplantation preferably target T -cells, and are therefore unlikely to be sufficient for xenotransplantation where there is a strong B-cell driven response, there is a need for new immunosuppressive agents. FTY720 (2 amino-2-(2-[ 4-octylphenyl] ethyl)-1,3-propanediol hydrochloride), a novel, immunosuppressive drug active in rodent and dog transplantation models, has shown no toxic side effects in pre-clinical studies although no long-term patient studies exist.