Fakulteit Geneeskunde, Universiteit van die Oranje-Vrystaat ...

Fakulteit Geneeskunde, Universiteit van die
Oranje-Vrystaat: Akademiese Jaardag,
20 - 21 Augustus 1992
Abstrakte
'N ONTLEDING VAN DIE OORSAAK VAN STERPTES
BY BORSKANKER.
RS du ~oit*, J ~illemse* en L Goedhals+.
Departemente chirurgieX en Onkoterapief,
Fakulteit Geneeskunde, Universiteit van
die Oranje-Vrystaat, Bloemfontein.
Inleidinq:
Metastatiese siekte is die algemeenste en
belangrikste oorsaak van dood by
borskanker. Dit is egter nie alom bekend
hoeveel pasiente aan ander "natuurlike"
oorsake sterf nie.
Doelstellinq:
Om die sterfteprofiel van pasiente met
bewysde borskanker te bepaal ten opsigte
van oorsaak as gevolg van siekte en
sonder siekte en dit te korreleer met
stadium van siekte asook ouderdom van
pasient by diagnose.
Pasiente en Metodes: . 1 -
Kliniese notas is retrospektiewelik
nagegaan van pasiente wat gesterf het met
gediagnoseerde borskanker. By a1 hierdie
pasiente is die presiese oorsaak van dood
evalueer asook die metastatiese profiel
by dood. Die ouderdom asook stadium van
siekte by diagnose van a1 die pasiente
moes bekend gewees het vir insluiting in
die studie.
Resultate :
Bv 343 ~asiente was alle inliqting vir
i;sluiti& in die studie - bekend.
~etastatiese siekte was die oorsaak van
dood by 252 gevalle (74%). By die 81
(24%) gevalle wat dood is aan ander redes
was 55 (16%) totaal skoon by dood en 26
(8%) het we1 onderliggende siekte gehad.
Die belangrikste nie-metastatiese redes
vir sterftes was kardiovaskulGr 623,
respiratories 26% en nefrologies 7%. Hoe
vroeer die stadium van siekte, hoe beter
was die kans dat die pasient aan In nie-
metastatiese rede gesterf het, naamlik
Stadium I = 36%, 11 = 27%, I11 = 26%, IV
= 5%. Hoe jonger die pasient by
diagnose, hoe swakker was die kans om aan
In nie-metastatiese oorsaak te sterf,
naamlik c50 jaar = 10%, 50-70 jaar = 22%,
>70 jaar = 45%.
Gevolatrekkinq:
1. In Beduidende aantal pasiente (24%)
met borskanker sterf aan
"natuurlike" oorsake .
VOL 82 DECEMBER 1992 443
SAMJ
2. In Pasient se kans om aan
"natuurlike" oorsake te sterf
korreleer direk met die stadium van
siekte maar omgekeerd met die
ouderdom by diagnose.
3. Die ~ardiovaskul~re, respiratoriese
en nef rologiese stelsels is
verantwoordelik vir + 95% van alle
"natuurlike" oorsake van dood.
Opsomminq:
Hierdie studie bevestig die huidige
tendens om ouer pasiente met vroee
borskanker minder aggresief te behandel.
EWEKANSIGE KLINIESE STUDIE NA DIE ROL VAN
ILEOSTOMIE NA PROKTOKOLEKTOMIE EN ILEO-
ANALE RESERVOIRPROSEDURE
S.P. ~robler*, K.B. Hosie. M.R.B. Keighley. Departments of
Surgery. University of Birmingham. United Kingaom &
University of the Orange Free State, South Africa .
Doel. 'n Ewekansige kliniese proef het die voor- en nadele
van 'n tydelike ileostomie na proktokolektomie en ileo-anale
reservoirprosedure ondersoek.
Metodes. Van 59 pasiente wat 'n gestandardiseerde operasie
oor 'n periode van 36 maande ondergaan het, is 45 tot die
studie toegelaat. Na voltooing van die ileo-anale reservoir is
die pasicnte ewekansig vir tydelike proksirnale lusileostomie
(n = 23) of geen ileostomie (n = 22) toegewys.
Resultate. Die twee groepe was vergelykbaar in terme van
basislynkenmerke soos ouderdom en ondediggende
siektetoestande. Die operasieduur (mediaan) was 160 minute
vir die reservoirprosedure met ileostomie asook 45 minute vir
die latere ileostomiesluiting in vergeleke met 150 minute vir
die reservoirprosedure sonder ileostomie. Geen sterftes het
voorgekom nie. 12 pasiente het ileostornie-verwante
komplikasies ontwikkel (diaree-5; stomale retraksie-3;
enterokutanefistel-l ; dermobstruksie-3; stomale breuk-2).
Lekkasie van die ileo-anale anastornose het slegs in twee
pasiente voorgekom, een in eke groep. Die pasient sonder
beskermende ileostomie het 'n vedengde en gekompliseerde
postoperatiewe verloop gehad. Ileo-anale stenose het in 5
pasiente in die ileostomiegroep voorgekom teenoor slegs 1
pasient sonder ileostomie. Die voorkoms van sepsis,
dermobstruksie en ontstekiig van die dundermreservoir
("pouchitis") was soortgelyk in die twee groepe. Die mediane
totale hospitaalverblyf was 23 dae in die ileostorniegroep
teenoor 13 dae by diegene sonder ileostomie (p~0.01
Wilcoxon analise) .
Slotsom. Hierdie studie dui op 'n lae risiko van bekkensepsis
na ileo-anale reservoirprosedures. Die weglating van 'n
proksirnale ileostomie het die sepsisrisiko in 'n geselekteerde
pasientegrcep nie betekenisvd vermeerder . -nie. Die
lusileostomie op sigself het verskeie komplikasies velsoorsaak.

DIE MIRURGIESE HANTEZUNG VAN
PANRREAsKOPiURsINoon : K ~ O V E R S I ~
ASPERfE.
JJ Basson, RS du Toit, CJC Nel : Departement
Chirurgie, VOVS . p
Pankreaskopkarsinmm het gewoonlik 'n swak
prognose. Die chirurgiese hantering moet gemik
wees op optimale terapeutiese gewin met
minimale gepaardgaande morbiditeit en
mortaliteit, Kontroversie bestaan steeds oor
die optimale galwegdreinasie vir obstruktiewe
geelsug en die roetine gebruik van 'n
profilaktiese duodenale omleiding om
maaguitgangobstruksie te voorkom.
DOEL VAN DIE STUDIE:
Die studie is onderneem om ons ondervinding met
die chirurgiese hantering van
pankreaskopkarsinmm in die algemeen te
evalueer . Palliatiewe prosedures, met klem op
die bogenode kontroversies, is krities
evalueer .
PSI- EN -DES:
Alle pasi&te met 'n diagnose van
pankreaskopkarsinmm wat tussen 1985 en 1990 in
Universitas en Pelonomi Hospitale opgeneem is,
is ingesluit- Kliniese notas is vir die
versameling van data gebruik. Pasiente wat
chirurgie ondergaan het, is retrospektief in
drie groepe verdeel. Groep I sluit pasiente met
resekteerbare tumore in; groep I1 is pasiente
met lokaal gevorderde siekte en/of maligne
limfnodes en groep 111 sluit alle pasiente met
metastases in. Groep 111 is verder onderverdeel
in drie subgroepe. Groep IIIa : pasiente met
lewer en verafgele6 metastases; groep IIIb :
pasiente met slegs askites (insluitend
peritoneale metastases) en groep IIIc :
pasiente met beide askites en ander metastases.
'n Operatiewe cholangiogram is gedoen by alle
pasiente met onresekteerbare tumore en
obstruktiewe geelsug. In Cholesistojejunostomie
(CCJ) is gedoen as die vlak van obstruksie >
2cm van die oarsprong van die sistiese buis was
en 'n choledochojejunostomie (CDJ) is in a1 die
ander gevalle gedoen . In Duodenale omleiding is
gedoen by gevalle waar tekens van
maaguitgangobstruksie teenwoordig was.
RESULTATE:
Die studie sluit 165 pasiEnte (94 mans en 71
vroue) in. Die gemiddelde ouderdom van die
groep was 65 jaar (verspreiding : 34 tot 91
jaar) . Dertien persent (n = 22) was terminaal
met opname en het geen aktiewe behandeling
ontvang nie. Vier en tagtig persent (n = 138)
het vir chirurgie gekwalif iseer. Slegs 7% (n =
9) het resekteerbare tumore gehad (groep I) en
'n pankreatikoduodenektomie is vir a1 die
pasiente gedoen met 'n gepaardgaande
mortaliteit van 22%. Die mortaliteit van
palliatiewe chirurgie in die algemeen was 21%
(n = 129). 'n Lae mortaliteit van 2% (n = 69)
het in groep 11 voorgekom. In groep IIIa (n =
36) was die mortaliteit 17% terwyl die
mortaliteit 79% en 100% in groep IIIb (n = 19)
en IIIc (n = 5) onderskeidelik was. Herhaling
van obstruktiewe geelsug het in 3% (2/78) van
pasiente met *n CCJ voorgekom. Almal was egter
terminaal en het geen verdere chirurgie benodig
nie. Geen profilaktiese du male omleiding is
gedoen nie en slegs 6% ) van pasikte het
later 'n dudenale omleiding benodig.
0-:
1 . Pankreaskopkarsinoora presenter laat in
die verloop van die siekte.
2. Indien pasiente god geselekteer word,
kan palliatiewe chirurgie met 'n lae
mortrilitiet van 2% ui tgevoer word.
Askites dra by tot 'n hoe mortaliteit en
. . behoort ' n kontraindikasie tot
C - palliatieue chirurgie te wees .
9
. Die CCJ is 'n effektiewe galwegdreinasie
en in slegs 3% van pasiente het 'n
herhaling van obstruktiewe geelsug
voorgekom.
4. 'n Profilaktiesae duodenale omleiding is
in die meerderheid van gevalle n ic nodig
nie. -
WHAT HAPPENS TO OUR PATHNl% WITH
VITREOUS ~ LOSS?
M Schultz, .Department of Ophthalmology, University of
OFS
Ekpulsive suprachoroidal haemorr e aside, the loss of
vitreous is the most serious comp "k 'cation of cataract
surgery. Our retrospective study evaluates comrtively
the mechanisms and ement of vitreous m. The
visual outcome and 7 etioogy of reduced vision are
analysed and a strategy for improvement is
PATIENTS AND METHODS: Our recor ?lor*' of 1 215
cataract extractions performed at the National Hospital,
Bloemfontein, between January 1987 and Decemhr
1991, were studied and 41 cases of vitreous loss were
identified. An analysis was made of the surgical
technique employed, intra-ocular lens implantation, predisposing
factors, the mechanisms of complications, the
post operative visual acuity, secondary complications and
the pattern of follow-up.
RESULTS: Comphcated posterior chamber lens
placement causing wtreous loss was conspicuous in our
study. Primary anterior chamber lens implantation was
implicated in poor visual outcome. Although 90 % of
patients obtained excellent post-operative visual results,
secondary complications directly related to vitreous loss
was responsible for poor results in the remaining 10 %.
An unsatisfactory attern of follow-up was evident.
~~N~uI~KNv: L study confum~ vitreous loss as tbe
most common visually detrimental complication of
cataract surgery. It focuses attention on several
previously unsus cted weaknesses and points to a
number of logi car avenues for the further improvement
of as yet excellent over-all visual results.
'N PROSPEKTIEWE STUDIE IN OOGTROUMA
GEDURENDE 1991 BY PELONOMI HOSPITAAL
J du T Vos, Departement Oftalmologie, UOVS,
Bloemfontein
Omdat trouma 'n p t
lading op ons Departement
plaas, het ons 'n stu&e gedoen om 'n trouma profiel daar
ts stel.
Alie pasiznte met 'n besering van die oog of adneksae is
in die studie ingesluit.
Die regteroog was btrokke in 403 % van beserings en
die linkeroog in 56,7 %. In 3 % van gevalle was beide &
beseer. Die ouderdomme het gewissel van 1 tot 88 jaar.
Ongeskoolde werkers was betrokke by die meeste
oogbese~gs. 80 % van beserings het in mans voor e-
kom. Pasitnte met oo beserings het gemiddeld 2 L
geneem om by die m&ek te rapporteer. Ongelukke
was algemeen in kinders en be'aardes en aanrandings
meer algemeen in die intermeditre ouderdomsgroepe.
Oogliabeserhgs het die grootste persentasie van die
beserings uitgemaak. Visie van slegter as 20/200 was in
60 % van beseerdes teenwoordig met die eerste besoek.
Relatief tot soortgelyke oorsese studies, is die aanfal
oogbese~jp wat evalueer is baie minder, maar dte
graad van trouma was baie erger.

ABNORMALE PLAATJIE EN PLASMA VETSUUR-
SAMESTEMNG VAN PASleNTE MET MUTE
MlOKARDlALE INFARKSIES
F l t , M Weman PN Badenhorst, Departement
l&%ogie, UOVS, ~foemfontein.
Plaatjies spel 'n baie belan rike rol b die ontwikkeling
van artene trombose, wa? vqder & let tot akute
miokardiale infarksies (MI). Di word ook algemeen
aanvaar dat plaatjies 'n belangrike rot speel by
aposkleyose, onafhyklik van ander faktore soos rook,
hpertens~e en enetiese faktore. Pla?jks van pasiente
met familiGle %ipercholesJerolemie, n toestand wat
geassosieerd is met 'n hoe voarkoms van aterosklerose
en S trombqtiese komplikasies, is hipersensitief vir sekere
t~aa~e-agonste en produsey r k verhoo de
oeve@h@e Wqboksaan A*. [M was-daq ook die 6681
van hlerd~e studre om te be~aal of hierd~e funkslonele
veranderinge gekop I kan ' word am 'n . defektiewe
~laatiiemembraan. E hierdie doe1 moes d~e ~lasma-,
bw6l as die pl~iemembraanvetsuursamestdling vari
pasiente met akute. miok~diale infarksie be
vergelyk word met dte van n gepaarde nomae P groep en
vryvvllhgers.
EDTA-Moed van 15 siente met akute miokardiale
infak5ie en 20 ouderd%ms-, save1 as gesla sgepaarde
ulyunll~gers IS versamel. Die bloed :S gekolle5eer .b:nne
ure na aanv~g van die mlokar'de ~nfarks~e. hp~ede
IS ui be~de plaatyes en plasma geekstraheer volgens dre
bekende Folch-metode. Die monsters is verseep en
gemetileer volgens die metode van Morrison en Smith. Die
vetsuurrnetidesters is met behulp van gasvloeistof-
chromatografie geskei en geidentifiseer. Die resultate is
U$ edruk of as relatiewe persentasies, of as nanogram of
mtkgram vetsuur milliliter plasma of as nanograrn
vetsuur per rnitjoen pgtjii.
VOL 82 DECEMBER 1992 &S
SAMJ c,
INHIBISIE VAN ARTERICLE TROMBOSE DEUR 16N7C2, U1 die resuttate
'N MONOKLQNALE ANTlLIGGAAM TEEN
Myk dii dat die plasma van pasilinte met
DIE M1 meer vetsure as norrnale plasma bevat Daar was
GLIKOPROTEXN IIb/IIIa RESEPTOR-KOMPLEKS OP statisties betekenisvolle verskille tussen verskeie van die
DIE PLAATJIEMEMBRAAN.
versadigde, mono-onversadi . e en poli-onversadigde
Lam rech HF Kotz6, PN Badenhorst, M Meirin V van vetsure van die twee roe*. b plasma. van die MI grwp
k'k'&clanyn Departement Hematologie, &o.v.s., en normale gmep f~et deseifde relattewe persentawe
Bloemfpntein en 'Sentrum Trombose en Vaskul&e versadigde vetsure bevat, terwyl plasma van norrnale.
Favorsmg, K.U.L., Leuven, Bel~e.
persone relatief meer poli-onversad'gde vetsure bevat het
as die van iGnte met MI. Verrassend er was die
pie antitrombotiese effekte van 16N7 'n monoklonale bevinding
gntiliggaam, is in 7 bobbejane getoets. 16 3
&? die plaatjiemembraan van%l pasi$nte
7C2 blokkeer die minder vefsure as die kontrole. groep beyat. Die relattewe
binding van fibrinogeen aan sy gliko roteien (G ) g /ma persentasle versadlgde en poll-onversad~ de vetsure was
re? tor qp @e memb- van ge&veerde res qn ook h&r by die normale groep in verge&ng met die MI
int&=er m- wfplaatjie aggregaslq v o ~ am ~ &e 9roeP.
mtltrpmbmese e .ek te kwant@eer IS 'n smthasie-kamera
ebd om d~e neerle van In-l11 em rkte Di is duidelik uit bogen~mde resuttge dat die p!asma- en
%loedplaatjies op Dacrom vaswere prosteFes (0,?cmS) te plaa ~evetsuursamestell~ng van paslente met mlokardlale
meet. Die pro:tese is as 'n verlengstuk m- 'n permanent mnfar!sies verskil van die van 'n gepaarde kantrle roe
ingeplante arteno-veneuse fistel geplaas 15 mute nadat 0,3 Die presiese bydrae van herdie verskille, t8 %
mg per kg 16N7C2 intraveneqs ingespuit is. Die neerlegging yenaarnde abnormaliteke in pbtjiefunksie van pasiente
van gemerkte plaa ies IS w 2 uur emeet, waarna &e me MI, moet egter nog verder ondersoek word.
rostese weer.venvy a" er.& en bloedvloei%eur die pennanente
&tel herstel a. Om &e langterm~ effqkte op trombase te
bep*, is daar 24 en 48 uy na be +deh weer 'n-prostese
m &e -1 ge laas en Le plaatJieneerl%wg w 2 uur
gemeet. voor pking van die prostese is die m ntm laatjiea~gasierespom
o ADP en kolageen; die. bloei&d; en
sto m e (m, h en m gemet. V eo mute na
behan%?kg was 5727% van &e G Zma. reseptore
geblokkeer met 16N7C2; na 24 48 en 78uur was &e waardes PLAATJIE EN PLASMA VETSUURPROFIEL VAN
onderskeidelik 46*5%, 3227d en 1825%. Op die dag van PASICNTE MET SLE.
behandeling is daar feitlik geen plaatjies op die prostese
neergel8 me. Na 24 uur was plaatjie neerlegging nog met JM de W F Cloete en PN Badephorst
on eveer 79% ge- beer en-na 48 uy mef ongeveer 65.%. D@iE%t Hemtolope, Fakulteit Geneeskunde, UOVS
BYE am geen + +tro a Tgasle het na msputm~,aasgewnd
egasie IS na uur no met on eveer o en na 48 Sistemiese lupus eritematose (SLE is 'n outo-immuunsiekte
ongeveer 25% ge-&beer. g~ en mute na wat oep veelwl'% van e orgaip aantasting
ins uiting was die bloei d verlen na 202 r"
L veroorsaak. 'n Sekere
minute (kontrole
e paslente onWel spontane trombose
= 0,2 minute n? Z& was floeityd wser normaal. Die berieel en/of veneus). Die gomtptiese neiging h geko pel
aP'IT PT en h IS me dew behandeh met 16N7C2
&e aanwesighe~d van %oe
beTn&ed niq. 'n Bolq inspuitin van 1&70 inhibeer =osfoli iedantili aamvlakke (aFa). Nie alle asiente met
laat~ie funksie dus effehef w tot 63 uur sonder dat stolhng h& a~a-vhe on&el trombose rue en ander Paktore moet
geipvloed wqrd. 16N7q kan gebw word w lan em dus ook betrokke wees. 'n Verandering in die
an&trombobew temple aangesien plaatjie-&& vetsuursamestelh van die laatjiemembraan in SLJ3
trombusvorming geinhibeer word
pasiente kan 'n sn&er wets w & interaksie men plaatjie~
en aFa.
Navorsers het onlangs aan etoon dat die konsentrasie van
Tromboksaan B2 (hoofs& dew laatjiegeproduseer) baie
verhwg was in plasma vaq S& pasiente w?t qnlangs
trombose-gehad het. Die bevmdm ondentem. he lupotese
dat plaatjies belangrik is in die tromLtiese nei g.. Voord?
enige gevolgtrekkmgs ten opsi e van moonge mterakse
wen aFa en 'n veranderde p& 'iemembraan gernaak kan
moqt die vetsuursimest&mg van &e plaatji4-
mem ram m alle SLE paslente-pagegaan word en moet &t
vergelyk word met normale plaatjles.
Die doe1 van die studie was om die plasma en
plaat'iemembraap vetsuursamestelling van SLE pasiente te
vergt!lYk met &e vano'n ouderdoms- en
kontrole gr EDTA bloed a venamef?%-g%~&
pasiegte en?& konpole per- Plaatjie. k p!asma en
!i.+pe-arm l~ma IS deur mddel van senAgasie verkry.
epied ekstr&ie van &e plaatjies en plasma IS volgens &e
klassieke Folch metode gedoen Die monsters is daama
verseeg en emetdeer volgens Morrispn and Srmth se metode.
On eestenkxerde vetsuurbepahgs IS volgens Pace Asaak se
mefode edoen. Vetsuur metielesters is geskei en
gekwant&eer dew middel van gaschromatografie.
Resultate het getoon dat plasma van SLE pasiente minder
totale vetsure as normale lama bevat. Daar was statisties
belangrike veqkille in die &nsent@e van soqmige van. die
plasma versa& de,-,mono-owersxbgde en pob-onversa&gde
vetsure. he pfaa~~emembraan van SE paslente het meer
vewe, venadi sowel as goli-onveqdig, as. nowe laatJas bevat baar W? statis belaqgnlre venue m &e
fonsentrasie van somge van be plaatpemembraan vetsure
tussen die twee groepe. Normale plasma het 'n hoer
koqsentrasie on eesten£iseerde vetsure as plasma van SLE
pauente eha8. Die konygasie vaq verskeie
ongeeste&erde vetsure het statlsoes betekenwol men
die wee verskil. Normale .-plaatjies het meer
ongete&oeF eer e vetsure bevat as plaatpes van SLE paslente.
Uit die resultate is dit duidelik da; die plasma- en plaatjievetsuursamestelhg
van SLE paslente en normale persone
verskil. Die verswe mag .belq@ wees in die patogenese
van somrmge van &e komphkas~es van SLE.

*
446 VOL 82 WEEMBER 1992
SAMJ
DLE PLCLNOSE~~ SWANGEBI~TAPSTOETS: 'n
OMERSOEK NA DIE KORRELASZE TUSSEN SERUM EN
URIENAS MEDL4
MiiUer FR*, Tait M, Thorn G, Schall R, Faher lU
Departement Obstetric eo G i s , Geaeskmde Faidkit,
Universiteit van die OraqSe Vrystaat, Bloemfobteir, SuiAMra
Inleiding: Meuslike chorioniese gonadotropien (Ha) bestaan uit Wee
non-kovalentgebonde subeenhede, waarvan die PHCG-sllbeeoheid
struktureel uniek is. Die teenwoordigheid van BHCG m die mien vom die
basis van baie hedendaagse swangerskapstoetse. Die aigemeerste sykamerswange~skapstoets
wat deesdae gebruik word, is die lateks6kwietoets.
waarvan Phmse& h vombee1d is. Dit km koosentrasies van 1500 tot
3000 Im HCG in die urien opspoor en word in die BloemfooteioSe
opZeidin&~hospitale onder andere gebruik om psi- me1 h vermDedelike
ektopiese swangerskap vir sonografie te sif. Omdat die Phnm&toets
egter mien benodig om uitgevoer te word en die pasibt 'n -1 blaas nodig
het vir sonografie, sou 'n sykamertoets op serum m piaas van urieo van
wade kon wees.
- Doel: Om die waarde van die Pld-toets te ondersoek waneer
serum in plaas van urien gebruik word orn dit uit te voer.
Metode: Vir 'n tydperk van drie weke is uriemonsters versamel by
. pasicnte met 'n geskiedenis van arnenoree en waar die ldiniese vermoede
bestaan bet dat die pasiEnt swanger mag weeS. PasiEnte waarvan
urienmonsters nie beskikbaar was nie of met bloed kontamincer was. of
waarvan die serum- enlof urienmonsters meer as 24 uur oud was, is nie in
aanmerking geneem nie. Van elk pasient wat aan die insluitingskriteria
voldoen het, is urieo eo 5 m1 gatolde bloed versamel. Een druppel van die
urien is vir die uitvoer van die Planasec@-tocts gebruik. Die bloed is
afgeswaai en een druppel serum is gebruik om 'n Phme&-toets uit te
vow. Die res is na Biochemie gestuur vir serum+HCG-bepalings
Resultate: 28 pasiente het aan die projek deelgenaem. b 10 gevalle was
die PHCG, soos deur die laboratorium bepaal, positief. Die laboratniiumtoetsuitslae
is as die "goue standaard" aanvaar. Die sewtoets wa5 in alle
gevalle positief. Die urientoets het in.9 gevalle 'n ware positief getoon, in 1
geval 'n vals positief en in 1 geval 'n vals negatief. Om die
metingsooreenkoms tussen die twee toetse te bepaal is kappa (~kstatistiek
aangewend. Die ooreenstemmingstoets tursen die urientoets m die
laboratoriumbepaalde PHCG het K = 0.84 gelewer, wat dui op goeie
ooreenstemming. Die ooreenstemmingstoets tussen die senuntoets m die
laboratoriumbepaalde BHCG het K = 0 gelewer, wat beteken dat daar geen
ooreenstemmlng tussen die twee toet% bestaan me.
Semitiwiteit en spesifiitek
* Urientoets: Semtlwiteitr 9/10 = 9056; 90% V1 61% tot
Spesdlitelt: 17/18 = 94%; W% V1 76% tot 99.7%
* SerumuKts:Sens~t~wlteit: 10/10 = 100%; 95% V1 74% tot 10%
Spesdiite~t: 0118 = 0%; 95% V1 0% tot 15%
Indien dle sensitlwiteit en dle spesKiiteit van die lwee toetse met mekaar
vergelyk word deur mlddel van die K-toets, word K gelyk aan 0 gevlod, met
'n kansverhoudmg ("Odds Ratio") van 0.
Gevol&&king: Sew kan me m die plek van urieo amgewend word m
dle uitvoer van d~e PhusedB swangetskapstoe2s me, waarskphk as
gevolg van non-spesifieke binding met LH se a-subeenheid en prdeiie
(SODS bv. albumien) in die sew.
A COMPARISON OF HEMODYNAMIC DATA OBTAINED
BY BIOIR@EDANCE VERSUS lliERMODLUTION
METHODS
*L SKEAD J Diederieks, G J&
~epartwat df~aaestbesi~~, U.O.F.S.
The golden standard thermodilution method of obtainin k
hemodvnamic data has associated morbidity and mortality .
A ne\; non-invasive method using &rack electrid
bioimpedance (TEB)2 could be usey during coronary artery
bypass graft (CABG) surgery. Ttus S* determined the
.agreement between TEB and thermoddution values of
- ardiac index (cr),. stroke vohune index (SV) and systemic
-,vascular resistance 1nde.x (SW) for Merent ardiac outputs
*- . in open and closed chest conditions during CABG surgery.
Permission for the S was obtained fiom the U.0P.S.
ethical committee. In "", 1 patients undergoing CABG surgery
cardiac output was determined with a thermodilution
technique (SwanGanz catheter in iulmonary artery) and
TEB (external electrodes on both si es of the thorax m the
rni- lipe at xiphisternum level and on both sides at the
base of the neck). The electrodes measure changes in
electrical bioimpedance caused by the flow of blood through
the thorax. S five paired samples were obtained with an
open chest and '2- 9 paired samples with a closed chest Using
both methods, measurements were taken simultaneously for
CI, SVI and S W To determine the agreement between
the two methods7 intraclass correlations were calLulated by
using analysis of variance that took into account the number
of patients as well as the number of measurements per
pahent.
Sam le A includes all data and shows a r correlation for
a &r for SW and good fa SVRl (Ta. However, this
group included a patient with a very large left ventricular
aneurysm. The aneurysm could have affected the TEB
measurements. All data from this patient were excluded
from sample B which shows a ood correlation for SVI and
S W but only fair correlation for CL Agreement was good
for SW in the open chest but only fair for the closed chest
while agreement for SVRI was good in the open and closed
chest.
Table of correlation toe-nts
SampkA SampleB
open Closedopen Closed
0.42 0.60 0-69 0.73
0.65 0.64 0.81 0.71
0.85 0-80 0.88 086
This study shows that a reasonable to good correlation for
CI, SW and SVRI exists between the TEB and
thermodilution methods for dete 7 cardiac outw when
no or a small aneurysm is present. owever, the extreme
Werences obtained in one patient with a large
suggest that other factors my deem the values o b x Y
the TEB method unreliable. There were no marked
differences between the open and closed chest
measurements.
1. Robin, ED: The Cult of the Swan-Ganz Catheter. Int
& Crit Care Digest, 1986, V01.5, No.l:18.
2. Bernstein, DP: Continuous non-invasive real-time
monitoring of stroke volume and cardiac output by
thoracic electrical bioimpedance. Crit Care Med,
1986, Vo1.14, No.1&898.
DIE ARBCHIDONSUURPIETABOLISME IN PLAATJIES
VAN UREMIESE PASIBNTE MET VERLENGDE
BLOEITYE -
B F Botha, F C ~loet~', P N ~adenhorst*,
Afdeling Nefrologie. Dept Hematologie,
UOVS, Bloemf ontein.
Somige uremiese pasiente ontwikkel 'n
bloedingsneiging wat bydra tot morbiditeit
en mortali teit . ' n Verlaging in tromboksaan
A, produksie in uremiese plaatjies is een
van die oorsake van die abnormale
plaat jiefunksie . ~ i e verlaagde tromboksaan
AZ produksie word veroorsaak deur 'n defek
in die plaat j ies se arachidonsuurmetabolisme.
Hierdie def ek is
praksimaal tot die siklo-oksigenase stap in
die arachidonsuurmetabol i sme gelee .
Arachidonsuur (Aa) word deur arachidoniel
KoA-sintetase in die plaat j iemembraan
ingebou. Die hipotese is dat die
aktiwiteit van arachidoniel KoA-sintetase
verlaag is by die uremiese pasiente.

Die doel van die studie is die andersoek
van die Aa-metabolisme in uremiese
plaatjies.
Metodes: Bloed van 10 uremiese pasiente
met verlengde bloeitye op permanente hemo-
dialise en 10 normale persone is geana-
liseer. Vetsure in die plasma en plaatjies
is met behulp van gaschromatografie bepaal.
Die aktiwiteit van arachidoniel KoA-
sintetase is bepaal deur die inbouing van
radioaktiewe Aa in die fosfolipiede van die
plaatjie te meet. Die vetsure is met hoe
verrigting vloeistofchromatografie geskei
en die radioaktiwiteit met behulp van 'n
vloeimeter bepaal. Die vrystelling van
arachidonsuur uit die plaatjies is bepaal
deur siklo-oksigenase met ETYA te inhibeer
en dan die Aa-konsentrasies in die
supernatant en plaatjiemembrane te bepaal.
Resultate: Uremiese plasma bevat beteke-
nisvol hoer konsentrasies totale en
ongeesterifiseerde Aa. Uremiese plaatjies
bevat betekenisvol laer konsentrasies van
Aa. Die aktiwiteit van arachidoniel KoA-
sintetase is beduidend laer in uremiese
plaatjies. Die defek in die aktiwiteit van
arachidoniel KoA-sintetase kan in normale
plaatjies geynduseer word deur inkubasie in
uremiese plasma en . die defek in
ensiemaktiwiteit kan herstel word word deur
inkubasie in normale plasma. Die
vrystelling van Aa uit uremiese plaatjies
is normaal.
Gevolgtrekkings: Die verlaagde Aa-konsen-
trasie in uremiese plaat j ies word veroor-
saak deur 'n defek in die aktiwiteit van
arachidoniel KoA-sintetase. Die vrysteling
van die Aa uit die uremiese plaatjies is
normaal . Die verlaagde tromboksaan A2
produksie in uremiese pasiente met
verlengde bloeitye word veroorsaak deur 'n
verlaagde Aa-konsentrasie in die plaatjies.
DIE ONYIKKELING VAN 'N NIE-LNDRINCENDE
FARMrLKODRVAMZESE ONDERRIGMODEL VIR VOOR-
GRAADSE MEDLESE STVDENTE
Miillw P, Hattingh 4 Miiller FO, S&U R, Barnard HC.
Departement Fannakdogie, Fekulteit CenegkuiuJe, UniverJiteit van
die Oraqie-V- Bloemfonteln, Suid-APrika
Inleiding en doek Die doe1 van hierdie projek was om 'n praktige- onderrigmodel
met betrekking tot geneesmiddel-wisselwerking te ontwikkel deur
furosemied-geinduseerde nafriurese as ma~tstaf te geb~ik. Die farmake
dinamika k& sodoende op 'n nie-indringende wyse vcrgcstslp word.
PotensiW vlakke van geneesmiddel-wisselwerking is geidentifiseer en
verskeie middels is in kombinasie met furosemied toegedKa om die
interaksies te demonstreer. Maaglediging is versnel dew die toediening van
metokloprmnied en vertraag deur propmrtellien. Cholesnrmien is aangewend
om absorpsie vanaf die maagdermkanaal te veminder. Misie
van die aldostemonrespoas is deur knptopril teweegebnng en hhbise van
prastagWiensintese deur iRdome&%ien. Plasebo is as konmle toeeen.
Metode: Agttien jong, gesonde manlike en vroulike vrywilligers he3 aan 'D
plasebo-beheerde, gerandomiseerde, W-fase oorkmisstudie deeigeneem.
Behandelings is as volg toeged~en:
A. Lasd (furosemied) 40 mg 1 uur M plasebo Pkta m kapsuk)
B. Lasixm 40 mg 1 uur na 75 mg IndocidCO (indornetaslen) op die proef
dag en 12 me vantevore
C. LasixB 40 mg 1 uur na 25 mg Capotd (kaptopd), plus 25 mg
Capten@ 3 ure na Lasix@-mname
D. LasixB 40 mg saam met 9g Questran@ (cholestiramlen)
E. Las- 40 mg 1 uur na 20 mg Maxolon@ (metoklopramied)
F. Lass 40 mg 1 uur na 30 mg Pro-Banthin& @ropantehbcomied)
VOL 82 DECEMBER 1992 447
OD proefdae is urien op die volgende tye versamel: 0-1 uur, 1-2 uur, 2-3
I&-3-4 uur, 4-5 uur, 5-6 uur m 68 uur na Lasix@-inname.
Resultate:
Gemiddelde Gemiddelde Gemiddelde
Mandeling:
hxx@ + ...
(SD) totak
urienvolume
uitgeskei oor 8
(SD) totale
wi&e
natriurn-
(SD) totale
uridre kaliumuitskeiding
oar
uur (ml) uitskeiding oor
8 uur (mrnol)
8 uur (mmol)
A. Plasebo 2255(431) 179(,55) 39( 9)
B. Indocia
C. &poten@
1793(498)
=wc“v
1@%56)
202(W
30(10)
4V7)
1372(555) 67(51) 21(10)
~holekrarnien en indoiaetasien het natriu- klinies en statisties
betekenwol onderdruk. Propantelien het (rniskien onvewags) 'n klinies
en statisties betekenisvolle versterking van furosemied-geindtiseerrte
natriuwe vemorsaak, rnoontlik as gevolg van verhoogde intragastriese pH.
Kaptqd het h klinies waameembare verhoging in natriurese veroorsaak.
MetnWoprcUnied het geen noemenswaardige effek op furosemiedgeindlt~eerde
natriurese g W nie.
GevolgtreWdng: Die gebruik van furosemied-ge-museerde natriurese as
maatsraf vlr die demwtraue van middel-middelwisselw~ op 'n nieindringeode
wyse is potensieel bmikbaar in die ond-g van vowgraadse
mcdh studente.
LAPAROSKOPIESE CHOLESISTEKTOMIE - VROEe
ONDERVINDING IN IN OPLEIDINGSHOSPITAAL.
SM Smit, GF Ferreira, RS du Toit, R
Barry, CJC Nel. Departement Chirurgie,
UOVS , Bbemf ontein.
DOEL: Die doel van die studie was om
vas te stel of laparoskopiese
cholesistektomie (Le) voldoen aan die
vereis tes gestel vir minimaal
ingrypende chirurgie nl verminderde
PY~I verminderde post-operatiewe
komplikasies en verkorte
hospitaalverblyf.
PASI~NTE EN METODES: Alle pasiente wat
tussen Aug 1991 en April 1992 tot
Universitas Hospitaal toegelaat is met
simptomatiese galsteensiekte en geen
kontra-indikasies vir chirurgie gehad
het nie, is ingesluit in die studie.
Die operasie is onder algemene narkose
uitgevoer volgens die beskryfde 4
trogar tegniek van Cuschieri en ~erci'.
In Nasogastriese buis en urienkateter
is in elke geval passeer en direk post-
operatief verwyder .
RESULTATE: 60 pasiente is ingesluit,
12 mans en 48 vroue. Die gemiddelde
ouderdom was 53,5 jaar. Operatiewe
probleme is in 18 gevalle ondervind wat
insluit bloeding vanaf sistiese
arterie, galblaas perforasie,
choledochus besering en verklewings.
In 4 gevalle is In intra-operatiewe
cholangiogram uitgevoer wat normaal
was. In die reeks moes daar in 8
gevalle tot oop cholesistektomie
oorgegaan word. Die gemiddelde
narkosetyd was 85 minute en die

448 VOt 82 DESEMBER 1992
SAMJ
gemiddelde operasie tyd 40 minute.
Post-operatiewe komplikasies sluit in 1
pasient met erge onverklaarde buikpyn
wat binne 12 uur opgeklaar het. Een
pasient is in die post-operatiewe
tydperk oorlede aan In beroerte. A1
die pasiente was binne 12 uur mobiel en
het binne 24 uur In normale saaldieet
gevolg . Post-operatiewe pyn was
minimaal. Die gemiddelde post-
operatiewe hospitaalverblyf was 38 uur
(die omskakelings uitgesluit). Die
meeste pasiente kon binne 8 dae weer
terugkeer na hulle werk.
GEVOLGTREKKING: LC beantwoord aan die
vereistes ges tel vir minimaal
ingrypende chirurgie. Om die
komplikasiesyfer laag te hou moet die
chirurg opgelei wees in laparoskopiese
tegnieke en disseksie moet met
versigtigheid gedoen word.
~a~aroscopic biliary surgery 1 990.
Alfred Cuschieri and Georqe Berci.
L -
- - .r - - . . .
-. c-.
i
THE ENIGMATIC RELATION BElWEEW TRAUMA AND
SEPSIS: BACTERIAL TRANSLOCATION - A
MYTH. AN EPIPHENOHKNON OR TREATABLE
SYNDROME? A PIL#l' STUDY
SJA Smit, EJ Theron, CJC Nel, S v Riet H
v Wyk, F vd Watt, SS ant sol, R schal12 -
Department of Surgery, Department of
~icrobiolo~~ l Department o f
Biostatistics 1 , UOFS, Bloemfontein
Aim : The use of animal models to
evaluate bacteremia in shock creates a
problem of interpretation. The dog, for
example, has a normal bacteremic
splanchnic circulation. The
investigation of bacterial translocation
in the shocked patient frequently gives
opposing results as noted by recent
studies. (Rush confirmed and Moore
questioned). Thus a prospective clinical
study was done to determine the incidence
as well as the character of bacteremia in
shocked patients.
Patients and methods: Fifteen acutely
shocked patients were assessed. None of
them had received antibiotic prophylaxis.
Aerobic and anaerobic blood cultures were
taken on admission. The specimens were
procured under sterile conditions from a
selected site.
Results: The incidence of positive blood
cultures was 47%. Two groups of patients
were distinguished. Patients with a
systolic BP >70mmHg (40% of the study
group) had a 17% incidence of positive
blood cultures whereas patients with a
systolic BP

Resultate word in die ondemtaande tabel aangetoon :
I Mans I Vrouens I I
I Pieksistoliese
vloeisnelheid
Minimum
diastoiiese
vloeisnelheid
(cmisek)
Gemiddelde
vloeisnekid
(cmisek)
Mans
- 30,7 (s=8,71)
Vrouens
-24,6 (S= 8,75)
KOSTE-EFFEKTIEWE KLINIES-FARHAKOLO6IESE SliQIES
B.H. Heyer. Hoechst-Navorsingseenheid, Dept.
Farmakol ogie. UOVS
In die lig van die toenemende aantal kliniese
studies wat in ons fakulteit teen vergoeding in
opdrag van firmas uitgevoer word is dit belangri k
dat kennis geneem word van koste faktore by die
uitvoer van studies en van die belang van koste uit
die oogpunt van die opdraggewer.
Innoverende werk in die farmaseutiese areld is
riskant, tydrowend en baie duur. Slegs 0.1% van
nuwe entitei te berei k ooit die mark.
Ontwi kkel ingskoste van nuwe middel s word slegs in
'n 1/4-1/3 van produkte verhaal . Talle groot
maatskappye verkry 50% van hulle verkope uit 1-3
middels. Die gemiddelde ontwi kkel ingskoste van een
nuwe mi&del het astronomies toegeneem van 51.2 mil .
in 1962 tot $231 mil. in 1990. Die tyd nodig vir
ontwikkeling van 'n nuwe geneesmiddel is 12 jaar.
Dit tesame met hoe koste het groot renteverliese
tot gevolg.
BEPERKING VAN KOSTE VAN KLINIESE STUDIES: Die
eenvoudigste benadering is om die koste verbonde
aan 'n studie in sy komponente af te breek en te
besluit of elke komponent verminder kan word.
Voorbeeld: Die kwotasie vir 'n studie met 4 fases
in 36 vrywilligers wat in elke fase vir 10 dae 'n
nuwe geneesmiddel ontvang en waari n
farmakokinet iese asook verdraagsaanheidsverander-
likes gemeet word, is R6 340 per vrywill iger per
fase of R228 240 vir die hele studie. Dit is nodig
VOL82 DECEMBER 1992 449
SAMJ
M die aantal herhalings van hematologie, chemiese
patologie en urine ondersoeke na te gaan en te
bepaal of dit verminder kan word, sonder prysgawe
van noodsaaklike data. Dit geld ook vir bepalings
van hormone, fisiese ondersoeke en EKG's. Oorweeg
ook of proef persoomvergoedi ng beperk kan word,
asook of die aantal bepalings van die konsentrasie
van die middel verminder kan word. Dit mag oorweeg
word on te bespaar op statistiese en far-
makoki net i ese berekeni nge en versl aggewi ng , maar
dit met in gedagte gehou word dat swak statistiek
'n hele studie kan verongeluk. In genoesde
voorbeeld kan sowat R30 000 bespaar word, met die
risiko dat die studie nie statisties lewensvatbaar
sal wees nie, en later herhaal met word.
EFFEKTIWITEIT VAN STUDIES: Om die regte ding te
doen en M dinge reg te doen is hier ewe belangrik.
Tydsduur vandat opdrag gegee is tot voltooiing van
die studie is 'n uiters belangrike koste faktor.
Die regte studies moet gedoen word en hierdie keuse
moet vooraf in 'n algemene strategie vasgeld word.
Om dinge reg te doen is kardinaal, want dit verhoed
dat 'n studie herhaal met word.
Oosonmend: Van die kant van die opdraggewer is dit
belangrik dat professionele mense met baie ervaring
en 'n goeie naam gekies word om die studie uit te
voer. Hulle sal goeie raad kan gee aangaande
beplanning, protokol le, goeie kl iniese en
laboratoriumpraktyk, uitmuntende statistiese
analise en verslaggewing. Sulke studies sal nie
herhaal hoef te word nie en sal op enige plek in
die wdreld aanvaarbaar wees.
DIE ROL VAN DIE ARBEIDSTERAPEUT IN DIE
ONTWW(EL1NG EN BEDRYF VAN DIE
D C Nienkemper
Kinderinligtingsentrum
Dept. Pdatrie en Kindergesondheid, U.O.V.S.
Die doe1 van die studie was om te bepaal wat die rol van die
arbeidsterapeut by die Bloemfontein Kinderinligting-
sentrum (ELKIS.) is.
Die BXIS. is gesetel in die Dept. Pediatrie van die Fakulteit
Geneeskunde van die Universiteit van die Oranje-Vrystaat
en funksioneer as 'n onafhanklike eenheid Vie die
departement en die Universiteit.
Op 'n prospektiewe wyse is 145 persone van die O.V.S. en
Nhpstreek wat van die dienste gebruik maak, in die
studie ingesluit. Die vraelys aan die ouers is dew middel
van onderhoudvoering uitgevoer.
Daar is vasgestel dat die ouers (48%) 'n behoefte het aan
en leiding ten opsigte van korrekte
ers op hul mylpaal ontwikkeling. A1
die ouers was positief oor die dienste en van mening dat hul
behoefies deur die BXIS. bewedig word.
Daar is tot die gevolgtrekking gekom dat die
arbeidsterapeut met haar keMis oor s ~ en l ontwikkeliig 'n
defnitiewe rol het in die ontwikkelmg en bed$ van 'n
Kinderinligtingsentnun.
Dit is duidelik deur die studie dat Kinderinligtingsentra 'n
rol as onderstemingsdiens in die gemeenskap het. Met die
kennis wat ingewin is oor die behoeftes van die ouers wat
aan die stu&e deelgeneem het, kan die BXIS. in die
toekoms 'n groot rol speel in die totale primere
gesondheidsorg plan in Bloemfontein en omliggende ara

650 VOL 82 DESEMBER 1992
SAMJ
AM)LESCENTS WITH LEARNING DISABILITIES AND
THE MASTERY OF LIFESKILLS NEEDED IN THE
WORKPLACE
Jeanne Pretorius, N Coetzee, J Du Preez, S J Serfontein, C
Vivie~ Demrtment of Occu~ational Therapy, UOFS
child& whh learning disabaties receive tlieir education in
special schools where the emphasis is on practical subjects
such as weldin panelbeating, plumbing, hairdressing, office
management, k ome management, etc. It was established
that the children are well able to meet the job demands
after leaving school, but are unable to comply with the
social demands. The p se of this study was to determine
which of the social lifesxneeded in the workplace present
the biggest problems, to the children still busy with their
schoohg.
Three questionnaires were designed in order to test
knowledge, attitude and skill in terms of twelve carefully
selected lifeskills. Situational descriptions were used to
evaluate attitude and skill, and a multi-choice questionnaire
for the testing of knowledge. A sample taken at random
from the a, b and c classes from standard 6, 7 and 8 were
subjected to the tests. The results showed the following:
1. Extremely high percentages of the goup as a whole
have got problems with the lifeslulls being tested.
They score better on the knowledge test than on
attitude and skill. The handling of conflict, making
decisions and the handling of criticism seems to be
the biggest problems.
. There are very slight differences in the scores of the
standard 6, 7 and 8 groups respectively. The four
biggest problems in each standard are basically the
same, only in a different order.
3. Overall the grou s from the c-classes had lower
scores. and there P ore bigger problems with most of
- *
the lifeskills.
In order to lace these kids successfullv in anv kind of iob,
they must 6e able to com ly with s&al no&, relatd to
other people in an accepta g le way and handle tricky social
situations. In light of the above results it is clear that it is
extremely important to teach the learning disabled child the
social lifeskills needed in the workplace, as it seems as if
these skills do not develop through the normal
developmental processes. The reason for this might be
because most of these children come from economically
deprived areas.
THE INCIDENCE OF COINFECIION WITH HTLV-I IN
HIV-l SEROPOSITIVE PATIENTS WITH NEUROLOGIC
COMPLICATIONS
E. van der Rvsc MS. Smith; k Pretorius
Department of Virology; UOFS Bloemfontein, South
Africa
Human immunodeficienq virus 1 (W-1) and human
T-lymphotro ic virus type I =V-I) infections share
common risf: factors that include sexual contact, vertical
transmission and transfusion of contaminated blood or
blood products. Both HIV-1 and HTLV-I are endemic in
South Africa and coinfedon might not be uncommon. Both
HIV-1 and HTLV-I are associated with neurologic
abnormalities. HIV-1 can cause a wide range of neurologic
complications, including myelopathy. HTLV-I is the
etiologic agent of tropical spastic paraparesis (TSP).
AIM : To determine the seroprevalence of anhies
against IFlZV-I among HIV-1 seropositive patients with
neurolo 'c complications, and to investigate the role of
HTL+v-~ in the neurologic complica~ons of HIV-l
seropositive patients.
PATIENTS AND METHODS : Fifty HIV-1 seropositive
patients with neurologic complications were selected. Their
sera were tested for antiies against HTLV-I with a
commercial enzyme linked immunosorbent assay (ELISA)
test kit. e- and sex-matched control groups
3
consisting of 50 h thy HIV-1 seronegative patients and 50
HIV-1 seropositive patients without neurologic
complications were also tested.
RESULTS : Seven of the 50 (14%) HIV-1 seropositive
patients with neurologic com lications had anties
against HTLV-I, while 1/50 (277 o of the HIV-1 seropositive
patients without neurolo 'c complications had antibodies
against HTLV-I @=0.03$ None of the healthy HIV-1
seronegative patients tested positive for HTLV-I antibodies.
CONCLUSIONS : The incidence of coinfection' with
HTLV-I in HIV-l sero sitive atients with neurologic
complications is high, an&hL.V-fmight play an important
role in the neurologic complications found in HIV-1
seropositive patients.
DUPLEX SONOGRAPHY OF CAROTID ARTERIES IN
DIABETICS
J. Brunova, Department of Internal
Medicine, University of the Orange Free
State, Bloemfontein
Macrovascular complications are the
commonest cause of death in diabetics. In
order to detect the extend of
atherosclerotic changes in diabetic
patients, duplex sonography of the carotid
and femoral arteries was used.
PATIENTS AND METHODS: We investigated 107
newly diagnosed diabetic middle-aged men
using Toshiba, SSA, 270A Sonolayer Alpha.
The presence of arterial atherosclerotic
changes was correlated with levels of serum
triglycerides, cholesterol, HDL-cholesterol
and immunoreactive insulin in diabetic
patients.
RESULTS: Minimal atherosclerotic changes of
the arteries were present in 23% of
patients; 20 - 4-% stenosis were present in
18% of diabetic patients. Arterial stenosis
more than 40% of diameter was present in
2,7% of patients. Atherosclerotic plaques
were found mainly 'in the internal carotid
artery. Severe stenosis of the femoral
artery was found in 3,8% of patients, but
almost 50% of patients had atherosclerotic
changes. A correlation was found between
the prevalence of carotid artery
atherosclerosis and the level of serum
triglycerides, total cholesterol/~~L
cholesterol ratio and levels of
immunoreactive insulin in diabetic
patients.
CONCLUSION: 1. The ultrasonography is
useful in diagnosis of the early
atherosclerotic changes.
2. The higher levels of triglycerides,
t.otal cholesterol/^^^ cholesterol ratio and
higher levels of immunoreactive insulin
were risk factors for carotid artery
disease in newly non-insulin dependent
diabetes mellitus.

PHENYTOIN INTOXICATION, CEREBELLAR
ATROPHY AND SO CALLED STANDARD
DOSAGE IN SOTY.
CH van d Meyden , AJ ICrugerl, T D e villiers2,
F0 ~ulle3. epartments of Neurology , ~adiolod,
Pharmacoloz UOVS, Bloemfontein
AIM: Diiscription of phenytoin (DPH) toxicity,
cerebellar atrophy and their relation to dosage in the
Sotho.
METHOD: Patients presenting with both DPH toxicity
and cerebellar atrophy on computer tomography of the
brain at the Pelonomi hospital e ilepsy clinic between
the 1st of January 1991 and the &th of February 1992
are descriid. The number of DPH intoxications and
their dosages were calculated for the period 1st June
1989 to 31st December 1991 at the same clinic.
RESULTS: Seven young mentally handicapped
patients (5 Sotho) with tonic clonic convulsions were
identified of which 2 showed severe, 3 moderate and 2
mild degrees of cerebellar atrophy. The episodes of
DPH intoxication were prolonged in 6, repetitive in 4
and associated with a dosage of DPH lOOmg tds in 6
During 7,475 outpatient visits 55 instances
DPH mtoxication were noted of which 36
occurred at a dosage of 300mg or less per day.
CONCLUSION: The close temporal association
between DPH intoxication and the onset of sustained
clinical cerebellar deficit su ested a causal
relationship. The hypotheses of a%igher incidence of
DPH toxiaty in the Sotho compared to the Caucasian at
a so called standard DPH dosage of lOOmg tds may
relate to a lower weight status or a slower genetic
oxidative metabolism. Awareness of these preventable
complications is mandatory.
DIE EFFEK VAN PIMOBENDAN OP ISCHEMIESE
MIOKARDIUM
Diedefieks CP Herb$, N Uys, J B-r. De artement
kesteslolodc. B~ofisb em proefdmeenhekf UOVS,
Blpx$onte%,
Ber&e stu&e ondersoek die effek van pimobendan o
miokardiale funksie wanneer 'n area van die linker ventrik3
met krities beperkte bloedvloei ischemies gernaak is deur 'n
verhoogde konsentrasie halotaan.
Na remedikasie met 0,8 =/kg morfien intrampkulCr, is
*
narfose by 7 Beagles mber met 15 k bopentmn
jntraveneus, en in stapd gehou me? 0,s-13% otaan tydens
mnstnunentasle. Mer ventnk@re en .aorta druk,
bloedvloei in die stwende aorta en Mer antenor afdalende
koronere arterie dishil tot die tweede perforerende tak, en
streeksfunksie in die apks en basis van die linker ventdel
is emeet en data met n rekenaar versamel. 'n Mikrometer-
befieerde lus om die linker afdalende koronere arterie,
onmiddellik distaal tot $e vloeimeter is gebruikpm kritiese
mnko0rpnggvan bloedvloei te verkry. ha chlrur e s 'n yr
stabherq teen 0,7% halo- met nodl e koronere
bloedvloel foe elaat en toe kontrole hemodmamese leslngs
versamel. Atiese inper yan vl~i na die linker
ventrikulere apeks is aange % l-gs herhaal, en
halot- tpe verrpeerder na??,2% waarna verdere
hemodmarmew lesmgs venamel S.
m /k is intraveneus toe edip en data versamel Pimobendaq, na F:
12.26.25, 35, 45, en d mute. Da@ is vemrk met
vanansie-se yr herhaalde mebngs en 95%
vertrouensmtervalle s bereken.
Daar we geen. verslegting v*. globale- of streekj
hartfunksie met &e aanbnn van lrntres beperkte bloedvloe~
me. Verho g na 12%%a19taan he$ elei tot matige
ischeme m gapex verhogmg m post-s1st&ese verkortmg)
en de ressie van obale en streeksmiokardiale funlcs~e
(tabelf Pimqben d het globale- (+e/dt, tabel) en
streeks- (helhg van a X en bass se druk/lengte
verhou+ng) kontr+iliteIS" verwg. Honvel statistics
onbedwdend, het pmbendan gelei tot 'n neiging om perifere
vasku!&re weerstand te vemder en slagvolume en
hartmtwerp te vermeerder 500s gesien aan 95%
vertrouensmte~alle
VOL 82 DECEMBER 1992 451
SAMJ
(/mi4
MAP 89 (9). 67 (6) 64 (8) S6 (10). 53 ((U)*
(-W)
dP/dt 1440 (W)* l(L30 (230) 1400 (170). 1410 (110). l460 (140).
(mmW=k)
QaSS 24 (7). 17 (5) 17 (8) 18 (9) 17 (8)
%S Basis 16 (6). 17 (7) 21 (8). 18 (6) 21 (8).
LADEDL 105 (1.9). 11.1 (2.3) 10.7 (22p 9.8 (13). l03 (W*
(-1
Waarde. is Gemiddeld(SD), p

452 VOL 82 DESEMBER 1992
SAMJ
DIE IMPAK VAN STERIUSASIE AS GEBOORTE-
BEPERKINGSMETODE IN SEKERE DELE VAN DIE
ORAN JE VRYSTAAT
J D N a n G JV'DeptObsteW&enGinekolog'i,UOVS
Manlike en vrolllike sterilisasies is weeldwyd die mees algemene
metode van kontrasepsia Deur verbeterde tegnieke kan dii Mndag as
'n -we onder W e verdowing uitgevoer iwrQrd met 'n he
~orko&'van komplikasies en newe Sterilii is 'n
eenmdige en pemranente rnetode - hasgenoemde is waarskynlik ook
diigroatstenadee4.
Me doe1 van die sWe was om te be@ wat die gemiddekle
ouderdom en parteit was van vrouens wat dew die s t e r i l i i van
dieDepartementObstetrieenGii mdelevandieOVSvirdie
tydpedc 1988 tat 1991, onder lokaie verdowing gesterllii is.
Me ppukb was pasiiinte in dele van die 0 V S op wie .ntenml
laparoskopiese sterili llitgevoer is Mnaf l988 tot 1991.
SWst&ke is verkry vanaf die Bloernfordeinse Sbeekskantoo~ van die
-van Nashaie Gesondheid en Bevdkingsontwikkelii
Dieresultatewasasvdg:
'n Totad van 4 485 vroue is in die 4 iaar gesterili. Die gemiddekle -
ouderdom w&s 35.25 jaar en die geid& pariteit 4.9.
GEVOLGTAW(ING: Sterilii was in die tvd verd uitaevoer OD
ouer pasi&te wat waamky@k nie meer so f&el is nie.- Km&indi
vk scmmige metodes, byvoorbeekl die kombii, is
moonUii ook 'n rede waarom sterili-es aanbeveel word in hierdie
pasilinta Met 'n pariteit van 2 5 speel sterilisasie waarskynlik nie 'n
graot rd h die vennhdering van die gebooctesyfer nie.
AANBEVEUNGS: SWlisasie behooft sy vdwaardige plek in te neem
as 'n k v e . Daar sal gekyk moet word na metodes om
vmwns van 'n her pariteit vir sterilii te motiveer. Woubare
omkeerbare konbasepsie vir die jong fertiele vrou wat bar
swangerskappe wil uitstel of spasieFtr is steeds uiters belangrik en moet
nk wwaarlaos word ten koste van sterilii nie.
LYMPHOGRAPHY IN LYMPHATIC
AND CHYLE STASIS
Dr J Bruna Department of Diagnostic
Radiology, University of the Orange Free
State / Universitas Hospital,
Bloemfontein.
Lymphography is used in the diagnosis of
lymphatic and chyle stasis.
The involvement of lymphatics by
metastases, filariasis, retroperitoneal
fibrosis, anomalies and advanced
malignant lymphomas are the main causes
of lymphatic stasis.
Lymphography demonstrates not only the
changes in lymph nodes, but also abnormal
lymphatic circulation.
The collateral lymphatic circulation
depends on to ographic localization of the
lymphatic o g struction and on the
anatomical variation of the lymphatic and
venous systems.
Both typical and non-typical lymphatic
pathways are found in malignancy and
filariasis. This paper deals with the typical
lymphatic collaterals (parietal, perivisceral
and subcutaneous) and non-typical
lymphatic pathways such as lymphovenous
com~nunications, internal lymphatic
fistulae and extravasation.
This finding is very important from the
surgical, physiotherapeutical and
pathophysiological points of view. -
SIR EN GRAAD VAN ALKOHOL
NOODGEVHLLE
M de Villiers
Dept Huisartskunde
-n Opname van bloedalkoholvlakke is gemaak
van 500 pasignte wat die Pelonomi
noodgevalle afdeling besoek het.
Die doe1 van hierdie studie was om te
bepaal wat die omvang en patroon van
alkohotverbruik by hierdie pasignte is.
Uit die 500 pasignte wat getoets is, was
daar 25% wat *n positiewe bloedalkoholvlak
gehad het.
Die insidensie van positiewe alkoholvlakke
het oor naweke tot 94.3% gestyg.
Na analise van die data, het dit onder
andere getoon dat oor naweke 53% van die
pasihte na die trauma afdeling verwys is.
Van hierdie pasignte het positiewe
bloedalkoholvlakke gehad.
Daar is oak gevind dat die persentasie
geintoksikeerde pasisnte wat weekliks be:
soldig word, feitlik 100% meer is as die
geintoksikeerde pasiente wat maandeliks
betaal word.
Na aanleiding van die bevindinge word
enkele aanbevelings voorgestel.

RIsIgOF- m KORONeBeVATSIEklE IN U LANDELZgE
EN W SFEDEddKE OBANlEvaYSTABTSE S W q BEVOLKpG
WE. m A. M- M. Steyn, G. Joabert , K Steyp , GM.
~DJ~Weich.Departement~Geneeslnmde, ~fd&g
Bimtatistieken MedieseNa * 3.
AGTERGROND EN -WPPZE.- Die voorkoms van ko&Mtsielde
@VS) is steeds laag onder die swart bevolkiag van Suid-m Min
bevokiagsgebaseerde idigtbg is beskikbaar omtrent die voorkoms van
kardiovashEre risikofaktore m die swart bevow van die RSA en
derhalwe is hierdie studie ondernee~a
METODES: Qwatpa is gekies as die hdelike en Mangaung as die
stedelike gebied. Die teikengroep het bestaan nit p n e van 25 jaar en
ouer. Die voorkoms van die volgende kardiovaskulbe risikofaktore is
bepaal: bloeddruk, Serumlipiede, rook, 1'- -in&ks, middelheupomtrek-verhoudiag
@lW) en diabetes mellitus.
RESULTATE: Agthonderd drie en vgftig respondente Mnuit Qwaqwa en
758 respondente vannit Mangaang het aan die stndie Die
voorkoms van hipertensie (na ouderdam en na die
be~lkiagsstrulduur) was 345% in Qwaqwa en 303% in Mangaung en
het gestyg met toenemende ouderdom. Insgelyks was die voork01~ van
diabetes meltitOS 4.7% m die Qwaqwa-bevolkiag en 6.0% m die
Maugaung- bevolking. Die rook van meer as 10 sigarene per dag was baie
meer algemeen onder mans as onder vrouens. Obesiteit was veral
algemeen onder vrouens en die piek-voorkoms was 543% onder
Mangaung vrouens in die 45-54 jaar groep. Die gemiddel& MHV vir alle
ouderdoqoepe vrouens het OS Oorsiqy. Totale serum chalwerol in
die h& risiko kategorie was teenwoodig in 125% en 6.0% van Qwaqwa
en Mangaung mans mspdttkwelik in die 25-34 jaar ouderdomsgroep. Die
wree~~~temmende syfess vir matige risiko hipercholesterolemie was 34%
en 448% en het afgeneem met toenemende ouderdom.
GEVO-G: Weinige verskille in die ris?rofakto'pro&l van die
twee bemlkings kon aangetoon word. DrastieSe maatr&ls sal getref moet
word om die riskofaktorprofiel van die swart bevolking te verbeter om
&nde die ontstaan van KVS en ander chroniese lewensstyltoestande
te probeer verhoed.
DIE VERLOOP EN UITKOMS VAN SWANGERSKAPPE
SOOS VERWEK IN DIE REPRODUKTI EWESORGEENHEID,
UNIVERSITAS HOSPITAAL, BLOEMFONTEIN
Wessels PH, Wessels M, Van Drimelen M
Reprodukt iewesorgeenheid, Departement
Obstetrie en Ginekologie, UOVS ,
Bloemfontein.
DOEL: Die doe1 van hierdie studie was om
ondersoek in te stel na die verloop en
uitkoms van swangerskappe wat na
infertil iteitsbehandel ing in die plaasl i ke
Infertil i tei tskl iniek verwek is.
STUDIE-ONlHERP: 'n Retrospektiewe studie i S
uitgevoer op data soos verkry per
telefoniese navraag aan die pasiCnte self.
PASIGNTE: Ses en tagti g opeenvol gende egpare
wat na behandel ing in die p1 aasl i ke eenheid
swanger geraak het, is deur die ondersoekers
ondervra. 'n Retrospektiewe anal i se i S
hierna gedoen van die data verkry.
Spesi fieke aandag i S aan kompl i kasies tydens
swangerskap en die verlossing self geskenk.
VOL 82 DECEMBER 1992 453
SAMJ
RESULTATE: Van die 86 swangerskappe het 15
geaborteer, 61 was enkel voudi ge
swangerskappe en 10 (14%) was meerlinge.
Vier en veertig seuns (54%) is gebore
teenoor 38 dogters (46%). Bykans die heffte
van alle swangerskappe is deur middel van 'n
kei sersni t verl OS (49%) Geen
noemenswaardige intrapartum komplikasie is
gevind nie.
GEVOLGTREKKING: Die uitkoms van swangerskap
na infertil i tei tsbehandel ing het oor die
algemeen gunstig voorgekom en het goed met
die van die algemene populasie vergelyk.
Geen oormatige be1 adi ng op verl oskundige
sowel as op neonatale gesondheidsdienste is
waargeneem nie. Dit is egter so dat hierdie
pasihte meer angstig oor hul swangerskap en
die verloop daarvan is, en dat dit
waarskynlik ook 'n invloed op die
verloskundige het. Vandaar die besondere hoe
kei sersni tsyfer .
DIE LIPOTROPIESE EAEK VAN INDOOL-
VERBINDINGS
AJ van Rensburg en FA MGller
Departement Geneeskundige Fisiologie, Universiteit van
die OVS, Bloemfontein
Uit die literatwr blyk dat daar deur verskeie navorsers,
uit verskillende weefseltipes, 'n verbinding / verbindin s
gekstraheer is wat lipotropiese effekte besit. Hiercfe
verbinding(s) is tot op hede nog nie geidentifiseer nie.
So is die bestaan van 'n sogenaarnde 'lipocaic" (wat vet
uit lewer mobiliseer), in 1939 reeds gepostuleer.
Waarnemings in ons laboratorium dui daarop dat die
metaboliete van triptofaan 'n invloed mag M op die
mobilisering van vette uit verskillende weefseltipes.
Aangesien daar destyds min bekend was oor die bestaan
van triptofaan en sy metaboliete, is dit waarskynlik dat
hierdie verbindings in vr-e eksperimente onwetend
ge6kstraheer kon gewees het.
Urine van normale rotte, onder vastende en normale
voedingstoestande, is versarnel en indoolverbindings is
get%tmheer. Die opbrengs is met behulp van
dunlaagchromatografie geskei. Die verskillende verbind-
ings is by lewer- en vetweefsel gevoeg, en die weefsel is
in Krebs-Ringer-bikarbonaatbuffer geinkubeer. Na
inkubasie is die vry vetsure in die buffermedim,
gekwantifiseer.
Dit wil voorkom asof hierdie verbindings groot
hoeveelhede vetsure uit beide die lewer a&
vetweefsel, mobiliseer. Hierdie uitgesproke lipotropiese
effek van indoolverbindings kan dus moontlik sekere
onduidelikhede rondom "lipocaic", asook ander
lipotropiene, opklaar.
"--

454 VOL 82 DESEMBER 1992
SAMJ
ARBOVIRUSSE EN HUL GEASSOSIEERDE MUSIi.
VEKTORE IN DIE WESTELIKE ORANJE-VRYSTAA'I
R van Staden, MS. Smith (Dept Virologie); T.C. de K.
der Linde (Dept Dierkunde-Entomologic), U(
Bloemfontein.
Arbovirusse word deur bloedvoedende arthropods vek:
waarvan muskiete die belangrikste is, oorgedra.
Gedurende die somer en herfs van 1974175
buitengewoon baie reen oor die grootste gedeelte van 5
Afrika geval. Oor die droe Karoo, westelike Kaapprov
en die Oranje-Vrystaat het dit gunstige toestande vir
aanwas van muskiete geskep. Die gevolg was dat 'n g
epidernie van Sindbis, Wes-Nyl en Wesselsbron in die
van die land uitgebreek het. 'n Episoonose
Slenkdalkoors het in groot dele van die land voorgekor
die eerste gevalle van mortaliteit by die mens is aangete!
Die doe1 van die projek was om die ekologie van se
muskietspesies en hulle vektorpotensiaal te onders
Muskietpoele bestaande uit 1 tot 55 muskiete, gegroe
volgens spesie en versamel vanaf 1989 tot 1991, is vir
teenwoordigheid van arbovirusse deur inokulasie in '
selkulture in vitro ondersoek.
Drie van die 200 poele wat getoets is, was positie
arbovimsse. A1 drie poele was positief vir Slenkdalkl
vims soos bepaal deur neutralisasietoetse. Die feit d.
min virusse gelsoleer is, mag te wyte wees aan die fei
1989 en 1990 besondere droe jare was. Hierdie studie I
ook bewys dat Slenkdalkoorsvirus in die afwesigheic
siekte by die mens en dier we1 in die natuur sirkuleer.
'N EENVOUDIGE MEETMETODE VIR DIE
RUIMTELIKE VERSPREIDING VAN DIE
ENERGIESPEKTRUM VAN ,#E VERSTROOIDE
GAMMASTRALE VANAF 'N mTc PUNTBRON IN
WATER
DE Serfontein, CP Herbst, A van Aswegen, MG Liitter
en PH Pretorius.
Dept. Biofisika, UOVS, Posbus 339, Bloemfontein.
Compton verstrooiing benadeel die beeldkwaliteit en
die akkuraatheid van kwantifisering in
sintillasiekamerabeelde, waarmee sekere
siektetoestande in Kerngeneeskunde gediagnoseer
word. Om verstrooiingskorreksietegnieke te evalueer is
dit noodsaaklik om die energiespektrum van die
verstrooide fotone by elke punt in die beeld sowei as die
untverspreidingsfunksie (PSF) van die verstrooide
rotone, te ken. Daarom was die doel van hierdie studie
om bogenoemde twee groothede te meet en om dan
hierdie i-ng te gebruik om die kanaalverhouding
(KV) verstro "n skorreksietegniek te evalueer.
Metode: 'n puntbron is in 10 energievensters
van 2% elk, wat die normale 20% energievenster dek,
gebeeld. Dit is herhaal. Sodoende is die totale PSF in
eke energievenster bereken. Die totale PSF is toe
geskei in sy primere en verstrooide komponente, deur 'n
eksponensiele passing op die stertgedeelte (sle~
verstrooiing) te doen, en dit terug te ekstrapoleer na die
brongebied waar primere en verstrooide komponente
saarn voorkom. meruit is die primere PSF verkry.. Die
ener 'espektrum van die verstrooide fotone kon
bere en word. Die algoritme vir die KV is toe op
hierdie inligting toegepas en sodoende is 'n skatting van
die verstrooide PSF verkry, wat toe vergelyk is met die
ware verstrooide PSF. Die totale aantal verstrooide
fotone, sowel as die totale aantal primere fotone is ook
bereken en hieruit is die verstrooiingsfraksie bereken,
wat vergelyk is met resultate van Monte Carlo
sirnulasies uit die literatuur.
Resultate: Die gemete verstrooiingsfraksie van 462 2
0,09 vergelyk goed met die Monte Carlo resultaat van
456. Die KV-verstrooiingskorreksie oorskat die
verstrooiing ver van die bron, teyl dit die naby aan
die bron onderskat.
Gevolgtrekking: Die getoetste meetmetode is akkuraat
en eenvoudig om toe te pas en aangesien die
dataverwerking gemaklik op 'n persoonlike rekenaar
edoen is, is dit 'n goedkoo alternatief vir die
%erekenin@-intensiewe Monte 8 arlo simulasies. Die
resultate van die meetmetode het sekere tekortkorninge
by die KV-verstrooiingskorreksietegniek aangetoon en
daar kan dus nou gepoog word om 'n verbeterde
weergawe van hierdie tegniek te ontwikkel.
'N VERGELYIUNG TUSSEN ESMOLOL EN NATRIUM
NI'I'ROPRUSSIED VIR DIE HANTERING VAN
HIPOTENSIEWE NARKOSE
C Lkbenberg, J Diederieks, R Schall, A Stassen
Departemente Aaestes'ilogie en Biistatistiek, U.O.V.S.
Die doel van hierdie studie was om die effektiwiteit,
veiligheid en neweeffekte van natrium nitroprussied (NW)
en esmolol te vergelyk warmeer hierdie middels ebruik
word om hipotensie tydens nark- te induseer. %wintig
pasitnte wie almal oor, neus en keel of plastiese chirurgiese
prosedures ondergaan het, is bestudeer. A1 20 pasitnte was
ASA 1 of 2 mans of nie-SW er vroue tussen die
9
ouderdomme van 18-60 jaar. asiEnte met kliniese
betekenisvolle kardiale, pulmonale, renale of hepatiese
siektes is uitgesluit. Proefpersone het ingeligte slmftelike
toestemming gegee vir deelname aan die studie.
Groep 1 het 'n bolus normale soutoplossing gevolg deur 'n
infusie van 03% kg/min NNP ontv Die infusietempo is
eke 5 min in dremente van O,s&- verhbog tot 'n
maksimum van 5 /kg/min of tot &e teiken emene
arteritle bioedmbu?~~~) van 80 -g bereik is. &roep 2
het 'n bolus esmolol van 5OO&ig onwan$ gevolg deur 'n
infuus van 15Opg/kg/mh Laasgenoemde a eke 5 rnin in
idmemente van 5Opg/kg/min verhoog tot 'n maksimum van
35Opg/kg/miu of 'n GAD van 80mmHg bereik is.
Harttempo en perifere sumtofversadigiug is deurentyd
gemonitor.

Daar was 'n neighg om die teikenbloeddruk ' er met
plNP as met em0101 te bereik, -=tiewe
wolgtrekldngs kon nie op die klein getalle edoen word nie.
baa~ was egter mreenkoms tussen csm~lof en in die
iyd wat dit geneem het om bloeddruk by die teikenwaarde te
]IOU (tabel). Dit word toegeskryf aan tagifilakse, waarvwaarvoor
bekend is.
NNP ESMOUlL verskil 9546Vergonens
interval vir die
verska
ndbt 3 min 103 min 73min -20 tot 1
GAD
m-m
Qd tot l0 min 125 min 2,!5 min -13 tot 8
GAD
80mmHg
yir >3 min
h 7 uit 10 gevalle is die teikenbloeddruk bereik met
i , S&-lmin-1 NNP of minder en in 9 uit 10 evalle is die
met 25-lmin-1 of min%r esmolol.
Tagkude IS beskou om teemoordig te wees indien die
verskil tussen die gemene hartqmd tydens die 7de tot a te
minuut periode van die infusie en die eerste minuut meer as
was. Ses pasiEnte in pep 1 het 'n
gehad teenoor geen pasiEnte in groep 2
suurstofdesaturasie of ander newe-
effekte is in enige van die groepe gemerk nie.
mltiple Endocrine Meoplasia Type 2B:
Report of a 13 year old female
WF Mollentze, S Jansen, R Barry, M Koning,
J Kuyl, A Kruger, M Wolfaardt, H Pelser, L
Wolmarans, C Nel, J Rossouw, R de Lange
Bloemfontein MEN Study Group, OFS
The clinical findings of a patient with
multiple endocrine neoplasia type 2B (MEN
2B) are presented. Hypotonia was present
at birth. At age 10 years the mother
noticed a lump in the girl's neck.
Subsequent lobectomy and histology lead to
the diagnosis of medullary carcinoma of the
thyroid, and MEN 2B. A total thyroidectony
was performed one year later and thyroid
hormone replacement therapy instituted.
She was then referred to our study group
for follow-up investigations. The patient
was the only affected member of the family.
On examination she displayed the typical
phenotype of MEN 2B. A combined calcium
chloride / pentagastrin calcitonin
stimulation test was performed. The basal
serum calcitonin concentration was 124
pg/ml and the maximum -stimulation
concentration 762 pg/ml. rf"I MIBG scan
of the neck was performed and activity
noted in the suprasternal area. Re-
exploration of the area of interest was
undertaken and some residual thyroid tissue
was removed. No clinical metastases were
noted on operation. Repeat calcitonin
stimulation testing revealed a basal serum
concentration of 123 pg/ml and a 9 minute
concentration of 1310 pg/ml. These results
indicated subclinical metastases.
VOL 82 DECEMBER 1992 455
SAMJ
AMBULATORY BLOOD PRESSURE M0NFM)RING IN
MILD TO MODERATE HYPERTENSION TREATED
WITH A L ONGANG NISOLDIPINE TABW
FORMULATION
F0 Miiller*, HG bus, DP Myburgh, LH Opie, C Rosendorff, P
Sareli, DJV Weich
South African Multi-Centre "ANCHOR" Study
*Department of Pharmacology, Faculty of Medicine, University
of the Orange Free State, Bloemfontein. South Africa
Non-invasive ambulatory monitoring of blood pressure
(ABPM) was employed to assess the 24-hour profile of blood
pressure in 137 out-patients aged 20 to 74 years (mean 52.4)
with mild to moderate arterial hypertension and normal day-
night activity cycles The technique was further used to measure
the blood pressure response to nisoldipine (NIS), a
dihydropyridiie calcium antagonist. This was a 10 week
(including a 4-week run-in period), multicentre, randomized,
placebo controlled, parallel group comparison of once daily
(mane) NIS 'CoatCore' (long-acting formulation) 10mg 20mg
and 30mg, conducted from January through December 1990 in 5
centres. Baseline (week 4) ABPM showed that all the patients
had circadian curves of established arterial hypertension.
Variables calculated from ABPM Mean values (standard
deviation). Diastolic blood pressure = DBP; Systolic blood
pressure = SBP.
Me= (SW
change (0-24) in
SBP (mm Hg) at
week 10 from
barelioe
Mean (SD) SBP
(mm Hg! (0-24)
at week 10
NIS 1bg
0 0 0
-5.2(55)
88.7(73)
-9.2(96)
138.6
(12.4)
NIS %g
-9.q.1)
83.475)
-15q115)
1373
(115)
NIS 3 bg
-8.q7.2)
833(7-6)
-1431 1.9)
h this population, clinically acceptable blood pmswe lowering
by NIS 'CaatCore' over a -our period was demonstrated
over the entire dose range. Heart rate was not influenced at any
dose level and adverse drug reactions were negligible.
Verhoogde- sekretoriese aktiwiteit en die
mikrotubulere netwerk van B-selle van die pankreas
A Crous, AM de Beer, EJ Visser 81 LJ Duyvene de Wit
Depte. Geneeskundige Fisiologie en Anatomiese
Patologie, Universiteit van die OVS, Bloemfontein
'n Funksionele mikrotubul8re stelsel as intrasellulQre
organel is essensieel vir volgehoue insulienvrystelling uit
B-selle van die pankreas . Die doe1 van die ondersoek
was om die organisasie van sitoplasmiese mikrotubuli
tydens verhoogde sekretoriese aktiwiteit te monitor.
h-

$56 VOL 82 DESEMBER 1992
METODES: Rot-eilandweefsel is in vivo asook in vitro
met glukose gestimuleer waarna weefselmonsters
geneem is om beide fases van die insulien-
vrystellingsrespons te verteenwoordig. Elektron-
mikrograwe (x40 000) van individuele B-selle is in
montage saamgestel ten einde vdledige selprofiele teen
h06 vergroting te konstueer. Deur morfornetriese analise
is die totale sowel as regionale verspreiding van
mikrotubuli vir elke betrokke sel bepaal.
RESULTATE: Mikrotubuli was nie ongeorden in die
sitoplasma versprei nie, dog in 'n spesifieke
verspreidingspatroon georganiseer. Onder bade
ornstandighede was die mikrotubulQre verspreidings-
digtheid in die subplasmalemma-area relatief her as in
die perinukldre gebied. Hierdie verspreidingspatroon
het gedurende die eerste (vinnige) fase van glukose
gestimuleerde insulienvrystelling, onveranderd gebly.
Gedurende die tweede (volgehoue) vr)fstellingsfase het
'n verskuiwing in die mikrotubulere verspreiding
plaasgevind. Die persentasie mikrotubuli in die
perinukldre en subplasmalemma-areas is onderskeidelik
her en laer aangepas. Geen betekenisvolle verandering
het in die sentrale sitoplasma voorgekom nie. Die totale
mikrotubulQre inhoud van die selle het deurgaans
konstant gebly.
GEVOLGTREKKING: Uit die resultate word afgelei dat
vrystelling van sekresiegranules geposisioneer digby die
selmembraan, geen modulasie in die mikrotubuldre
stelsel verg nie. Volgehoue vrystelling van insulien (wat
aktiewe transport van sekresi ranules vanaf die Golgi-
area na die selmembraan vere3 word egter verged van
o5nskynlik doelgerigte organisatoriese veranderinge in
die mikrotubuiQre sisteem. Sekretoriese aktiwiteit kan
dus verhoog, terwyl die selluldre tubulien-mikrotubulus
ewewig (mikrotubulQre inhoud) nie gewysig word nie.
FANCONI ANAEMIA - A CLINICAI+ CYTOGENETIC
AND MOLECULAR GENETIC INVESTIGATION OF
SOUTH AFRICAN FAMILIES
T. Pears04 l, M woIfaardt1, c.pnga2, S. Jansen
1 ,
C.Math .
1. Division of Human genetics,
2. De t. of Paediatrics, UOFS, Bloemfontein,
3. 9 edical and Molecular Genetics, Guy's hospital,
Fanconi Anaemia (FA) is a rare autosod recessive
genetic disorder showing progressive bone marrow failure,
and various phenotypic abnormalities. The lymphocytes
show an increased sensitivity to the clasto enic agents
diepoxybutane (DEB) or mytomycin C (MM&, measured
as chromosomal aberrations. The latter is used to confirm
the clinical diagnosis of FA homozygotes, but
heterozygotes and non-carriers cannot be idenbfied.
The gene(s) which are mutated in this disorder have not
been identified, but a defect in some aspect of DNA repair
is suspected. Mann et al have suggested that FA is
genetically hetero eneous, with one FA gene being located
on chromosome &U.
FA patients were identified according to their clinical,
haematologic and cytogenetic appearance. Results
obtained from the above criteria are m accordance with
the literature. Molecular results shown firm roof for the
existence of genetic heterogeneity in FP A but less
convincing evidence with respect of gene localization.
RFLP- AND PCR-ANALYSIS OF MEN 1 FAMIIdES
H.F. F.n, U Wolfaardf S. Jansen, W.F. MnllencrP.,
R H. Pelser, L Wolmaram, R delLange, CJ-C.
4 , M er, RV. Thakker
Faculty of Med~cine, U%, B1oemfontein
1. Hammersmith Hospital, London
Familial multiple endocrine neo lasia type 1 (MEN 1) is
an autosod dominant disorgr characterized .by the
combined occurrence of tumors of the oids, the
pancreas, and the pituilifuy. Previously m ter , we used
three Restriction fragment length polymo hism m)markers
to detect gene carriers for &l. This
technique is time-consllmin& especially when results are
required with ur ence. As an alternative, the
chain reaction (h)-technique was used, yie p"lwer= ding faster
and better results.
Three RFLP markers and two sets of PCR primers were
used to detect gene carriers in MEN 1 farmlies. Results
obtained with W-merkers, PCR-primers and
biochemical screening, were compared
I~STIOATION OF A POSSIBLE
ImRACTION BETWEEN WARFARIN AHD
SFEPPIROME
N de la Rey, BH Meyer, FO Miiller,
HG Luus,
PN ~adenhorst+, E ~renke**
Departments of Pharmacology and
~aematolo~~+, University of the
Orange Free State, Bloemfontein,
%$public of South Africa.
Hoechst AG, Frankfurt, Federal
Republic of Germany
Introduction
Cefpirome (HR 810) is a new
cefotaxime-like cephalosporin of the
third generation for parenteral use.
It has a broad spectrum of activity
and is active against bacterial
strains which are frequently
resistant to third generation
cephalosporins. In view of the fact
that many patients have to take oral
anticoagulants on a regular basis and
that many drugs interact with
anticoagulants, the question arose
whether cef pirome may elicit
detrimental effects due to
interaction with warfarin.
Aim
The aim of the study was to assess
the effects of cefpirome on the
pharmacodynamics of warfarin.
Methods
Fourteen healthy male volunteers
participated in this randomised,
placebo-controlled, cross-over study.
Cefpirome (l g v.) or placebo was
given twice daily, on a randomised
basis, from Day 1 through 6 of each

phase. On Day 3, a single dose of
25mg warfarin was administered
grally . Blood samples for
c3etermination of prothrombin time
(PT) and factors 11, V11 and X
activity were taken before and 12,
24, 36, 48, 72, 96, 120 and 144 hours
after medication of warfarin. A
piash-out period of 14 days was
allowed between warfarin doses.
Results
Mean values
Warfarin Uarfarin Point
& +olacebo +cef~irome estimate (Cl#
PT (Day.sec) 117 113 97 (93 - 102)
factor 11

458 VOL 82 DESEMBER 1992
SAMJ
2 D~~INI van aFstewa indien bekend.
S Toesrandtyderrrlaastebesoek. HG Lu F0 Miiller, DP Myburgh, LH Opie, C
km P Sneli, YK D Weich F Baaa and J
m k e m * a ~ i W p m~ e
gesterf het sonder dab die hospitaal in kennis gestel is as& modike
vemuishg mst anafgelewerde telegramme. Baumann
Die mdtab van die stud& was as vdg: South African Multi-Centre "ANCHOR* Study.
pasiente %) was F Department of Pharmacology, University of the OFS,
waatvan
Bloemfontein RSA
32 143.8 %) binne 6 maande
15 i20.5 %j m 6 - 12 maande
l4(19.l%)nal tot2jaar
20 (19.2 %) Is oorlede : 11 (55 %) binne 1 jaar
~(40%)
m1-2jaar INTRODUCIION: Nisoldipine is a new calcium channel
%) het nog Hewe gehad blocker belonging to the same chemical group as
nifedipine. It has been under clinical investigation for its
ha
G E V O L G ~ ~ me met
senrikskarshoom (70.2 %) was m 6 jaar veriore vir opvdg. Die swak anti-angina and antihypertensive effects since '1981. Many
oprdg het tot '- dat die- W koste behandeling van
V nie optimaal deur padhte benut word nie. Hie
bevindhgs hw emstige bnplikasies in vir mvorsing oor hierdie
studies- have failed to demomtrate control of blood
'N ANALISE VAN NIE
DIAGNOSTIESE RiiNTGEN
OPNAMES
C Barnard Departement Diagnostiese
Radiologie, Universteit van die
Oranje- Vrystaat / Universitas
Hospitaal, Bloemfontein.
Die doel van die pmjek was om die
volgende te be@
1) Perxntasie en koste van films wat
agv. 0-e
beeldkwaliteit weggegooi word
2) Oorsake vir onaawaarbare
beeldhualiteit
MEIODE: 'n Analise van die
weggooifilms is &a& oor 'n
periode van vier weke uitgevoer. Die
aantal films per ondersoek gebruik en
weggegooi is dew die radiograaf wat
die ondenoek gedoen het,
aangeteken.
RESULTAAT: 'n Totaal van 8 5%
films is gebtuik waarvan die volgendf
weggegooi is: 2 463 films agv
-bare beeldkwaliteit, 3T
6lms &&v. donkerkamedoute en
toe- op X-straalapparaat 28.61%
van radiogra6ese opnames word ag.v.
0-e beeldkwaliteit herbal.
Die totale persentasie film wat
weggegooi 4 was 31,61% wat 281%
vierkante meter film is, met 'n
filmkoste van R6 035.17.
Te bi5 beelddigtheid: 21.76%
Te lae beelddigtheid : 2229%
Posisionering : 3678%
Beweging : Z8%
Pr-ring : 138%
Ander : 14,98%
GGVOKTREKKING: Die totaal van
31,61% film wat weggegooi is, is
onaanvaarbaar hoog en bring die
geskane koste op meer as R70 000 per
jaar te staan Daar bestaan nie 'n
norm vir 'n aanvaarbare penentasie
fib wat weggegooi word nie, maar 'n
aanvaarbare persentasie vir 'n
Departement waar geen vorm van
kwaliteitskon!mle toegepas word nie,
is in die omgewing van 12% 'n
Dringende behoefte vir 'n
kwaliteitskontrole pmgmn en
indiensopleiding is geidentifiseer om
die persentasie film wat weggegooi
word, te verminder.
pressure for 24 hours with a single daily dose of
nisoldipine in an ordinary tablet formulation. A new
galenic formulation of nisoldipine, the longer acting
nisoldipine coat-core (NE) tablet, is now being
investigated for once daily treatment of patients with
hypertension and angina.
AIM The main objective of this study was to compare the
antihypertensive effect and safety of three daily doses of
NIS, namely lhg, 20mg and 30mg with placebo in
patients with mild to moderate hypertension (baseline
supine diastolic blood pressure of between 95 and 1 l4 mm
Hg).
STUDY DESIGN: Following a four-week single-blind
placebo run-in period, 208 patients (2 were not evaluable)
from 7 centres were randornised to either placebo (n=58)
for six weeks, NIS lOmg (1149) for 6 weeks, NIS l0mg
for l week and NIS Uhng (n=51) for 5 weeks, or NIS
l0mg for 1 week and NIS 30mg (n=48) for 5 weeks.
Patients visited the clinic at weeks -4, -2,O (baseline), 5 4
and 6 during which trough supine and standing blood
pressure and supine heart rates were measured. The supine
diastolic blood pressure @BP) at the last valid visit was
the main efficacy criteria
RESULTS: Efficacy: The mean difference (95%
confidence interval) of "m-PIA" in the change from
baseline of supine DBP was
-3.2 mm Hg (-5.9 to -0.5 mm Hg) between PIA and NIS
lhg
-6.7 mm Hg (-9.3 to -4.0 mm Hg) between PLA and NIS
20mg
-8.0 mm Hg (-10.7 to -5.3 mm Hg) between PLA and MS
3bg
There were 17% responders (patients in whom supine
DBP dropped by at least 10 mm Hg, or who had a supine
DBP of 90 mm Hg) in the PLA group, 35% in the NIS
lOmg group, 47% in the NIS 2Omg group and 63% in the
NIS 30mg group.

fhfcty analysis: The percentage of patients experiencing
at least one adverse event in the PLA, NIS 10mg NIS
-g and NIS 30mg groups was 4096,41%, 30% and
M% respectively. The most fkequently reported adverse
event was headache.
CONCLUSION: Nisoldipine coatcore at dosages of
'-g and 30mg once daily was effective as compared to
placebo in reducing blood pressure in patients with mild to
moderate hypertensions. The effect of the lOmg dose was
smaller. The study confirmed that nisoldipine, in these
dosages, is a safe and well-tolerated agent; the incidence
md severity of adverse events were commensurate with
other antihypertensive agents.
STAFF RADIATION DOSES DURING SEVEN YEARS
IN A NUCLEAR MEDICINE RADIOPHARMACY.
SE Jansen, A van Aswegen, CP Herbst, MG Utter and
Biophysics and Nuclear Medicine Departments,
University of the Orange Free State, Bloemfontein,
South Africa.
Data on radiation doses to staff in the radiopharmacy
and nursing staff responsiile for injecting radionuclides
were gathered for seven years. In addition to the
compulsory dosemeters issued monthly by the South
African Bureau of Standards' Radiation Protection
Service (RPS), radiation doses received on the hands
and whole body were monitored by lithium fluoride
thermoluminescent dosemeters (TLD) every week. The
workload (number of patient studies each year) and-the
estimated amount of Tc-99m received per month were
also established. The highest total radiation dose
received in any one year by any one person was 22353
mSv on the hands, and 1020 mSv and 837 mSv to the
whole body dependent on the dosemeter used. The
radiation doses to staff were well within the limits
prescni this is attributed to the practice of
maintaining a high awareness of radiation safety and
meticulous training and rotation of staff in the
radiopharmaq.
VOL 82 DECEMBER 1992 459
SAMJ
'N VERGELYKING VAN DIE
BEELDINGSEIENSKAPPE VAN ITERATIEWE EN
TERUGPROJEKSIE TOMOGRAFIESE
REKONSTRUKSIE TEGNIEKE D.M.V. OWK
ANALISE
H Naude. C.P. Herbst, A van Aswegen, MG Utter.
Dept Biofisika, UOVS, Posbus 339, Bloemfontein.
Enkelfotonemissietomografie beelde wat dew middel
van iteratiewe tegnieke gerekonstrueer is besit beter
kwantitatiewe eienskappe as beelde wat met die
- teruwrojeksie tegnieke verkry is. Die doe1 van die
stu&e was om ook die kwalitatiewe eienskappe van
iteratiewe en terugprojeksie rekonstruksie tegmeke met
mekaar te ver elyk deur van ontvanger
waarnemingskenmerf (OWK) analise gebruik te maaL.
'n Standard breinfantoom is met 99q~ gevul.
Vullingsdefekte is ewekansig o 5 verskillende posisies
veroorsaak. 'n Totaal van 30 a 1 normale en 45 normale
areas is gebruik. 64 beelde is tomografies deur 360
grade versamel en d.m.v. beide die iteratiewe en
terugprojeksie tegnieke op 'n SUN werkstasie
gerekonstrueer. Die moontlike abnormale areas is
visueel volgens 'n 5 punt skaal gegradeer en gebruik om
OWK krommes te genereer.
Die resultate toon am dat die iteratiewe tegnieke
beelde lewer met struktuur wat met di6 van planare
beelde ooreenstem. Die oppervlaktes onder die OWK
krommes vir die iteratiewe tegniek was 495 en die
volgens die terugprojeksie 0,936 wat daarop dui dat
beter resultate met die iteratiewe tegnieke verb word.
Iteratiewe rekonstruksie word dus aanbeveel waar dit
prakties moontlik is.
"h VERGELYKING OM DIE EFFEKTIWITEIT VAN h
ULTRASONIESE NEBULISEERDER EN h AeRObOL=
SISTEEM DEUR MIDDEL VAN ISOTOOPINASEHING
TE BEPAAL. "
R.Y. van den Berg , E. Fourie. A. Haarhoff.
D. Knekemoer, Departement F isioterap ie .
Die doe1 van die studie is om die "Meda=
snn i c Scn ior Drugnebul izer" --- ultra=
snnissc nebul iseerder met die "Resp i-Neb"
--- akrnsnlsisteem te vergelyk deur middsl
van die inaseming van isotope.
15 Proefpersone bo 20 jaar, van fnigs
geslag, met normale longfunksies sonaer
enige longpatologiek is gebruik. Elkc
proefpersoon is vir 10 minute met dis
Medasnnic genebuliseer en na h week met
die Respi-Neb. In albei gevalle is h op=
lnssing van isotope en saline gebruik. h
Posterior statiese beeld van twee minute
is direk na nebulisering van elke pro$f=
personn geneem, waarna die isotoopdistri=
busie van albei longe op die rekenaar
vasgel? is deur gebruik te maak van die
garnmakame ra .
Uit die resultate is h hoogsbeduiaenae
verskil in effektiwiteit tussen aie twee
apparate. verkry wat daarop dui aat die
"Medasonic Senior Drugnebul izer" meer
effektief is as die "Respi-Neb".
.
7

460 VOL 82 DESEMBER 1992
SAMJ
DRUGS IN SPORT: RESULTS OF THE PAST 6
YEARS OF DOPE TESTING IN SOUTH
AFRICA
P J Van Der Merwe, H S% Kruger
Department of Pharmacology
University of The Orange Free State
Bloemfontein
Screening procedures were performed on 2066 urine
specimens collected from competitors in 17 different sports
during the period 1986 - 1991. Samples were tested for-the
presence of stimulants, narcotics and anabolic steroids by gas
chromatography and gas chromatography/mass
spectrometery.
Drugs classified as forbidden substances by the International
Olympic Committee were detected in 113 (5,5%) of the
samples Fencamfamine was the stimulant detected most
frequently and 19-nortestosterone the anabolic steroid
detected most frequently. The ephedrines as a group
accounted for 35 (31,0%) of the urine samples containing
banned substances.
This high incidence of the use of banned substances indicates
that the dope testing program to curb their use by competitors
in sport, should continue and be expanded to other sports.
RISIKOFAKTORE VAN KORONeRE
HARTVATSIEKTE.
GRAAD, INSIDENSIE EN DIE INVIDED VAN
LEWENSWYSE DAAROP
A de Wad, MS Calitz*. Departement Farmakologie, UOVS
Departement Huisartskunde, UOVS
Inkicaing
Die insidensie van miokardiale hfarksie onder die Suid-
Afrikaanse bevolking is ontstellend hoog en die bestuder@ van
die betrokke risikofaktore is van Lardinale belang.
Docl
Hierdie studie is onderneem om 'n aanduiding te verkry van die
insidensie van die onderskeie algemene risikofaktore en om vas
te stel tot watter mate deelnemers gemotiveer kan word om hul
lewenswyse so aan te pas dat die graad van die risikofaktore
verminder kan word
Metode
Ecn honderd, klaarblyklik gesonde manspersone, tussen 40 en
45 jaar in 'n stedelike omgewing is ondersoek vir risikofaktore
van kom6re hartvatsiekte naamlik hipercholesterolemie,
hipertensie, familiele geskiedenis van koronSre hartvatsiekte,
fiksheidsgraad, oormassa en rookgewoonte. Die resultaat van
eke deelnemer se ondersoek is visueel aan horn met behulp van
'n rekenaarprogram wat vir dik doel ontwikkel is, voorgestel en
die deelnemer is gemotiveer om risikofaktore, Mien
teenwoordig, te elimineer, of om sy lewenswyse so aan te pas
dat die graad van 'n betrokke risikofaktor verminder kan word.
Die betrokke persone is na vedoop van een maand
geherevalueer.
Resultate
Dit is bevind dat daar by %% van die proefpersone ten minste
een van bogenoemde risikofaktore teenwoordig was 60% van
die proefpemne kon met aanpassing in hul lewenswyse 'n
verandering in die graad van risikofaktore te weeg bring.
PLAATJIEFUNKSIE, STOLLING EN FIBRINOLISE IN
PASIENTE OP CHRONIESE PERITONEALE EN
HEMODWSE
V. yan Wvk, H.F. Kotzt, P.N. Badenhorst, KC. Alexander
en -B.P. Botha
Departement Hematologie en h eme Geneeskunde.
Abnormale bloedin$neigings is algemene komplikasies by
pasiente met chromese nierversakin . Ten spyte hieman is
aterosklerose steeds een van die hookorsake v-
by hierdie pasiente. Die doel van hierdie studie was om
hkmostase iolledig te ondersoek in pasiente met cluoniese
nierversaking (CNW. Plaatiiefunksie, stolling en fibrinolise
is gemeet. viertien ~~vpasi~nte (kreaeen opruiming
< lOml/min), is in die studie ingesluit. Sewe asiente was op
chmniese ambulatoriese peritoneale dialise [CAPD) en 7 op
instandhoudingshemodialise (HD). Die gemidelde
plaatjietelling van die CAPD-pasiente was 288+55x109/1,
Hb: 9.8?1.9g/dl en plasma-urelm en keatinien
202 2mmol/l en 988 ?261pmol/l onderskeidelik Die
gemiddelde plaatjietehg van die HD-pasiente was
189+45x109/1 Hb. 8.8? 1.5g/dl ea plasma-ureum en -
kreatinien 28 2 71ll11lol/l en 1101 i 570umol/l onderskeidelik.
Die resultate word gegee as die mediaan (Med.) en
reikwydte (R.W.).
Meting CAPD HD Normaal
Med. R.W. Med. RW. Med. R.W.
Bloeityd(minute) 75 3.7-20.0 55 3.0-10.0 5.0 35-7.0
W%) 155 105-265 4.0 15-8.0 75 1.0-15.0
SPAV 0.B 0.664.83 089 0.78-0.96 0.91 081-1.0
Plasminogeen(%) 116 94-U5 101 70-120 % 82-108
&~ntiplasmien(%) 116 68-143 94 80-1l3 105 W107
p'4I@/min) 0.0 0.0-9.0 25 0.0-35 15 0.0-5.0
t-PA(E/&) 9 4-14 3 1-10 5 110
SA =. Spontane Agppk
SPAV = Sikulerende plaatjie aggregaat verhoudiag
PT = Protromb'intyd
F+lT = Par&% tromboplastien tyd
PAI = Piasminoga aldmeerder inhibeerder
t-PA = Weefsel plasminogeen aldiveerder
In vitm-aggregasiestudies het getoon dat plaatjies van beide
die asiEntgroepe meer sensitief was vir laer konsentrasies
AD%. Die bloe~tye van veral die CAPD pasiente was effens
verleq. Dit was egter nie klinies betekenisvol nie, en kan
ook me toegeskryf word aan die verlaagde plaatjiefunksie
nie. Dit kan egter moontlik gedeeltelik toegeskryf word aan
anemie. Die plaatjie-hiprreaktiwiteit kan klinies belae wees aangeslen hierdle pasiente 'n h& insidensie van
aterosklerose en kardiovaskulEre siekte het. Dit wil ook
voorkom asof die CAPD-pasiEnte 'n groter kans het om
aterosklerose te ontwikkel as die HD-pasiEnte.

-
geinedre E Otto A.C. Dun M.
~kpartmenf of Nudear Medicine Bloemfonteia.
Stable labem of polydonal immunoglobulin with Tc 9hn can be done in a
simple, relatively ;.expensive and safe manner. Rislrs of dLed handiing of
blood are reduced and the procedure is less time consuming.
-fhe purpose of this study was to compare the effectivity of the two above-
flentioned techniques to localise ' " ation.
f-Zteen patients with a h@yobabillity of a localized inflammatory process
Mere examined with a Tc - HMPAO white cell study. On completion of
tbe study written consent was obtained from each and a Tc . whrdonal .
1g~studywasdonewithin48ho~~~ofthefirststu~.
Results are summarized in Table l.
'ABLE 1.
AREA OF I NO. OF PT.
INFECIlON CELLS
POS/NEG
SKELETAL 5 4 1
ABDOMINAL 5 2 3
PULMONAL 5 4 1
Comparative images of the different techniques will be displayed.
CONCLUSION-,
Tc 99~labe~ed white blood cells showed better ability to detect and localise
inflammatory processes in the lungs.
Although the two techniques showed good comparison for detection of
abdominal infedions the target-to-background ratio was consistently lower
with labelled IgG.
Both techniques showed reasonable efficacy for deteding peripheral skeletal
inflammatory disease
DIE EFFEK VAN VWTRAAGDE SKEIDING VAN
BJXEDWONSTERS OP KREATINIEN OPRUIHING
H.J. van Wvk, A.J. Groenewald, H. Viljoen
Serum kreatinienkonsentrasies en
kreatinienopruiming word algemeen in die
kliniese praktyk gebruik om glomerul&re
funksie te beoordeel. Daar is egter baie
analitiese en pre-analitiese faktore wat
plasma kreatinien en kreatinienopruiming
minder geskik maak vir hierdie doel. Van
die pre-analitiese faktore sluit ondermeer
onakkurate kolleksies en veranderinge in
plasma kreatinienkonsentrasies met verhoogde
inname van protexne in. Onlangse
literatuurstudies toon dan ook In styging
van kreatinienkonsentrasie met tyd, indien
serum nie van selle geskei word nie.
Die doel van ons studie was dan om die effek
van vertraagde skeiding van monsters op
VOL 82 DECEMBER 1992 461
SAMJ
kreatinienopruiming te bepaal. Urine en
bloed is by gesonde persone (n=4)
gekollekteer asook bloed by 'n groep
pasiente (n=10) met chroniese nierversaking.
Serum is op tye 0-, 24-, 48- en 72 uur na
kolleksie, van die selle geskei en
kreatinienkonsentrasie daarna bepaal. Die
urine is vir periodes 0-, 24- en 48 uur na
kolleksie geanaliseer. Kreatinien is d.m.v.
'n roetine kinetiese Jaffe metode op 'n
Technicon DAX~ analiseerder bepaal .
Urine kreatinienkonsentrasies het tussen O-
en 48 uur na kolleksie stabiel gebly. Serum
kreatinienkonsentrasies in normale persone
het egter In styging van f 25% (piek
verandering by 48 uur van tussen 23 - 40
umol/l) getoon. Kreatinienopruimings vir
normale persone het gevolglik na 48 uur 'n
gemiddelde daling van 25,28 ml/min p <
0.01 (19,6 - 32,7 ml/min) getoon. Indien
bloed egter in 'n yskas by 1'C gehou word,
het hierdie daling in kreatinienopruiming
nie voorgekom nie. Serum
kreatinienkonsentrasies , van pasiente met
chroniese nierversaking (reikwydte 300
umol/l - 1200 umol/l) het egter geen
betekensvolle verandering na 48 uur getoon
nie .
In hierdie studie is aangetoon dat
interfererende substans(e) vanuit die
bloedselle vrygestel word wanneer serum vir
24- tot 48 uur in kontak met bloedselle bly.
Hierdie effek is klinies betekenisvol op
plasma kreatinien en kreatinienopruiming van
persone met normale nierfunksies. Bloed vir
kreatinienopruirning moet dus dadelik
afgeswaai, of in 'n yskas gestoor word,
tydens voltooiing van 'n 24 uur urien
kolleksie.
THE EFFECT OF BODY POSTURE ON THE RATE OF
GASTRIC EMFTYING IN ADULTS
*F TEOM, J DIEDERICKS, MJ UNGERER, P KRUGER, CP
HERBST, DJR DU MIT
Department of Anaesthesiology and Biophymcs, UOFS
Conflicting studies have been published regarding
gastric emptying and body posture.l.2 The purpose
of this investigation was to determine if position
does make a difference to the rate of gastric
emptying and to determine the least time necessary
for fasting in a supine adult awaiting surgery.
The study was done with consent of the UOFS
ethical committee for human research. Gastric
emptying studies were done in both the sitting and
left lateral lying positions. The latter position was
chosen because anatomically it is the least ideal
position for gastric emptying. Ten healthy adult
volunteers were used. On different occasions, at
least a week apart, they received either 200ml radio
active marked orange juice or a radio active marked
light breakfast consisting of a muffin and a poached
egg. The radio active marker used was 3mCI 99mTc
colloid. Gastric content was measured with a gamma
camera immediately after ingestion Icontrol) and
then everv 30 minutes until radio activity was less
than 10% (20ml) of the original activity. T-tests for
comparison at individual time points between sitting
and lying measurements were done. The emptying
times of sitting and lying values were compared,
using 95% confidence intervals.

The gastrid'emptying rate for orange juice is faster
in the sitting than in the lying position lp

M)UBLEBmRANM)BfrzEDcaOSSOVERTRIAC
OF NocmRNAL TaEOPHYLUNE
SUPPLEMENTATION OF A TWICEDAILY
SUsTAINED-aELEASETHEOPEYLLlNET~m
FORMULATION. MV-Middle, F.O.Miiller, RSchall Dept.
of Pharmacology, University of the Orange Free State,
Bloemfontein, RSA
Theophylline chmnotherapy of asthma dictates that the
highest plasma theophylline concentrations (PTO is needed
during the early morning hours when bronchoconstriction and
risk of lifethreatening asthma is greatest To investigate the
response to nocturnal supplementation of a 12hdy regimen
of a specific sustained release theophylline (SRT) formulation
(Nuelin SAR) with a non-sustained release theophylline elixir
(NSRT), marketed as Nuelin LiquidR, a prediction equation,
established for addition of th'e NSRT in healthy volunteers,
was used in sixteen asthmatic patients who were diurnally
active between 06hOO and 23h00, during the South African
spring of 1991. During the run-in phase the patients were
stabilized on individual Nueli SAR doses necessaq to
maintain a steady state PTC of 8-10 Wml. The treatment
regimens were Nuelin SAR 12hurly plus evening
administration of either placebo or Nuelin LiquidR. The
Nuelin LiquidR dose was determined individually to arbitrarily
raise the early morning PTC to 18 &m1 (upper end of
therapeutic range), by means of the prediction equation. The
11 day trial included two 24 hour inpatient periods during
which PTC and lung functions were obtained 2-hourly. The
mean average (standard deviation) early morning PTC and
lung function variables for the period Olh00-05h00 were as
RATKS
Placebo N.eti. %
PTC lrglhl 8.6(27) 1730.7) 206
PEF vs 'fi(L6) UP) 110
1 3.1 (1.4) 3.4 (1.2) 114
m25-75% l/S ZO(1.9 =(L3 123
FVC I 4.7 (1.3 5.0 (m 10s
90% confidence interval Nuelin SAR + Nuelin
Nuelin SAR + Placebo
90% CI*
The prediction equation proved reliable for this specific
SRT/NSRT combination. The incidence and severity of
nocturnal bronchOCOIlStriction in asthmatics can possibly be
attenuated by supplementing a 1241ourly Nuelin SAR regimen
with nocturnal Nuelin LiquidR.
Key words
asthma, chronotherapy, theophylline, prediction equation
PLASMA CELL MORPHOLOGY AND FATJY ACID PROFILE
OF A SKULL PLASMACYTOMA
L iouw*, A-M. ~n~elbrecht* and F. cloete;
Of Anatomy and Cell Morphdogy and Department *-
f-laematology, University of the O.F.S., MerhxB~ n.
The major objective of this study is to present the fatty acid
profile of neoplastic odls in a skull plasmacytoma, h a
patient with underiying systemic myelomatosis. Emphasis is
placed on the relative of linoleic acid, in
m-on wim -a cSSology, as an
~feafwetorevealthedegreedmalignancyfor
hs not so common case. .
%
VOL 82 DECEMBER 1992 463
SAMJ
PATIENTS AND METHODS: Roubine P-
i-: histocytdog'i gi in-7 marrow
examination; metastabjc bone suyey; serum
electrophoresis and immunoelectrm. Fatty acids
from samples (n=6) were e m according to a
modification of the dassic Folsch-method and the methyl
esters were prepared according to the method of Morrison
and Smith. Idmtkith and calculation of the teldtive
percentagefattyacidmethylesterswerebasedonthe
retention times of known standards.
RESULTS: The prm skull
plasmacytomamorphology,
as a mature plasmacytic skuH plasrnacytoma
morphology. The fatty adds detected were: palmitiC acid
(C16:O = 25.06%); stearic acid (C18:O = 10.75%); oleic
acid (C18:lrS = 38.89%); vaccenic acid (C18:ln7 =
2.57%); linoleic acid (C18: 2n6 = 17.84%); arachidonic acid
(CB: 4-16 = 3.54%) and dihomo-gama lindeic acid (CB:
31-16 = 0.74%). Compared to linolac acid levels in &Went
human tumor entjbes with high grade malignancy, a
significantly h i level of lindeic acid occured here.
CONCLUSIONS: It is postulated that the relative percentage
of linoleic acid, in correlation with plasma cell morphology
and our hypothesis: that higher levels of linoleic acid reveal
low-grade mali nancy, while low levels of linobii acid reveal
high grade dgnancy; is reprBsBntativB as a level for lour-
grade malignancy in this skull plasrnacytoma at the time of
investigation. Further investigation is needed to vatidate this
phenomenon for plasmacytomas.
PHYSICAL PROPERTIES OF A HYDRODYNAMIC
EQUATION APPLICABLE TO THE
BLOEMFONTEIN CLINICAL INTERSTITIAL
HYPERTHERMIA TECHNIQUE (BCIICT).
G. A. palmer*, J. Duvenagem, and G. J. Van
Huyssteen+. 3partments of Paramedical !!kiences,
Technikon OFS , Biophysics, University of the Oran
F= Statem and Omotherapy, National ~ospital?
Bloemfontein, South Afkica.
Clinical results indicate the importance of the BCIHT in
the treatment of cancer. A physical model (PM) of the
BCIHT, of which hydrodynamics play an integral part, is
essential in order to optirnize the BCIHT
technologically, to obtain the required hyperthennic
protocol and quality control, and to evaluate the
accuracy of numerical models necessary for quantitative
thermal dosirnetry.
A hydrodynamic flow rate equation (HFRE) was
theoretically derived from first principles utilizing
hydrodynamic equations by Euler, Bernoulli, Darcy,
Weisbach, Hagen and Poiseuille.
The HFRE, as well as the experimentally measured
hydrodynamics (EMH) of the BCIHT, verify that the
flow rate increases linearly as a function of the number
of arrays utilized (N), and that Reynoldr diameter
number, Re - 2 382 if N = 29, causing turbulent flow
in the in- ant outlet manifolds.
The HFRE can be incorporated into a computer
program to form part of a global PM of the BCIHT. It
contains the hydrodynamic s stem parameters of the
BCIHT, which can be mod' 2 ed to suit and enhance
specific types of treatments. Significant physical
hydrodynamic applications are easily obtained from the
equation. The HFRE compares favourably with the
EMH of the BCIHT, which will be presented.

464 VOL 82 DESEMBER 1992
SAMJ
'N 24 UUR-PROFIEL VAN BAWE SEROTONIEN-
KONSEHTRASlES IN MENSLIKE SERUM
EH de Wet, WE en JMC Oosthuizen
Departement Geneeskundi Fisiologie, Universiteit van
die Oranje-Vrystaat, Bloem 8" ontein
INLEIDING: Serotonien (5-HT) is 'n indoolverbinding en
'n metaboliet van triptofaan. Dit ageer multipotent as
neuro-oordragstof / neuromoduleerder / hormoon /
voorlopersubstans van metoksi-indoolverbindings
(byvoorbeeld melatonien). Die sirkadiese sekresie-
patroon van melatonien is welbekend. Alhoewel sirka-
- diese fluktuasies in sentrale weefselserotonien-
konsentrasies reeds aangetoon is, ontbreek inligting met
' ' l - betrekking tot sirkadiese fluktuasies van serotonien-
! -. - konsentrasies in plasma- / serum ("perifere" serotonien).
DOEL: Die doe1 van die studie was om vastte stel of
sirkadiese fluktuasies in rnenslike serumserotonien-
konsentrasies ("perifere" serotonien) voordoen. Die
bepaling van plasmakonsentrasies van 5-HT is oorweeg,
vir logistiese oorwegings laat vaar.
pfionsentrasies, onekonomies)
MATERIAAL EN METODE: Veneuse bloedmonsters vir
die bepaling van serumserotonienkonsentrasies is uurliks
tydens 'n aaneenlopende periode van -24 uur, van vyf (5)
normaalgesonde mans, bekom. Hormoonkonsentrasies
is vervolgens, volgens 'n aanvaarde radio-immuun-essai-
prosedure gevalueer.
RESULTATE: Resultate van die studie toon duidelik 'n
bifasiese patroon van sekresie met prominensies tussen
06:00 en 10:00, asook 18:OO en 2200 onderskeidelik.
(Hierdie tendense strook nie met die sirkadiese
sekresiepatroon van enige van die metaboliete van 5-HT
nie.)
GEVOLGTREKKING: Dit wil dus voorkom asof 'n
"outonome" sirkadiese sekresie atroon vir "perifere"
serotonien we1 ook vwrkom. Uitgreiding van d~e studie
word tans onderneem. (n =5 + n = 15)
A RETROSPECTIVE PROFILE OF,CARDIAC
ANAESTHESIA FOR 1990 AT A TEACHING HOSPITAL
IN BLOEHFONTEIN
*JJ REYNEKE. WL Rabe
Department of Anaesthesiology and
Biophysics, U.0.F-S, BLOEMFONTEIN
This survey Is an analysis of peri-
operative data of 378 patients admitted for
coronary artery bypass surgery andjor valve
replacement. The purpose was to compare
the morbidi tv and mortality of traditional
anaesthesia with different low dcsaqe
opiate 'supplements with the conce~t of
different high dosage opiates wlus
supplements for amnesia or further
analgesia
THE HETHOD consisted of a collection of
data which mav had influenced the course of
the operation and peri-operative outcome.
tiorbiditv and mortality factors included
post operative number of davs in the
cardiothoracic intensive care unit or in
the ward. Further incidents or
complications were evaluated and calculated
aaainst- a diaital scale and added to the
morbidity score. Anaesthetists decided
lndividuallv on monitoring- premedication.
induction agents. tvpes and dosages of
oplates used. Patients with mlssinp
records or vague information were excluded.
The objective parameters included age,
mass, operation time, bypass time, aorta
cross clampins time, and types and dosaoes
of different opiates. . These parameters
were compared with peri-operative morbidity
and mortality.
RESULTS :
NOETALITY HOEEIDITY
CEOUP PATIENTS fOST OF DlYS SPENT IN UOSPITAL
1-318 1-18 3DAYS 4DlYS SDAYS - 6DlYSt
FENTANYL
SUFENTA
HORPHINE
268
58
10
13f4,81
315,2)
2f20)
10f3:91
-
66!25,91
11f20)
l(12.51
79f311 100
19f34.5) 25
3f37.51 4
EXCLUDED 42
CAUSES OF DEATH:
1. Surgical .......................... 3
2. Low cardiac output ................ 8
3. Fatal arrhvthmlas .................
4. Cerebral lnfarction ...............
5. Pulmonarv embolism ................ 1
6. OrSan failure. (mu1 tl') sepsis .....
REMARKS-:-
1. There was no correlation between anv
of the above-mentioned parameters and
mor tall tv .
2. The tvpe and dose of anaesthetic had
no effect on outcome of the operation
done.
3. No patient in the SUFENTA arouo was
discharged from hospital before the
FOURTH oost operatlve dav.
4. Patients in the FENTANYL qrou~ were
discharged as from the THIRD ~ost
operative dav.
DIE EFFEK VAN NALOKSOON OP BASALE
SEKRESIE VAN RENDORFIEN EN LEUSIEN-
ENKEFALIEN
EH HC Barnard, R Schali, *MS Bornman en
JMC ~osthu'izen
Departemente Geneeskundige Fisiologie, Chemiese
Patolwie en Farrnakoloaie. Universiteit van die Oranie-
~ryst&t, Bloemfontein lasbok 'Departement ~rologie,
Universiteit van Pretoria, Pretoria
INLEIDING: Sekresie van endogene opioiede (Rendorfien
/ leusienenkefalien), wat wrsprong neem uit
prwpiomelanokortien, word deur biologiese negatiewe
terugvoermeganisrnes, eksogene faktore asook sekere
farrnakologiese agense gemoduleer. Naloksoon ('n
suiwer opioiedreseptorantagonis) vertoon in terapeutiese
doserings, ~ egend affiniteit vir mu-opioiedreseptore.
Die affiniteit wr delta-reseptore is waarskynlik weglaatbaar
laer.
DOEL: Die doe1 van die studie was om die effek van
intravenellse toediening van 0,4mg naloksoon op die
bade sekresie van Rendorfien asook leusienenkefahen
vir 'n periode van 4 uur, te evalueer.

~AERIAAL EN METODES: Elf normaalgesonde, man-
like vrywilligers is, in 'n enkeldosering, gerandomiseerde
oorkruisstudie met 'n plasebofase, as proe rsone aan-
gewend. Veneuse bloedmonsters vir die E paling van
plasma-B-endorfien- en -leusienenkefaiienkonsentrasies
(R.1.A.-prosedures), is !JurIiks tussen 06:00 en 10:00 van
proefpersone bekom. Kovariansie-analise is vir statistie-
se verwerking van data gebruik.
RESULTATE: Naioksoontoediening verlaag plasma-&
endorfienkonsentrasies statistics beduidend en fisio-
logies relevant sonder om leusienenkefaliensekresie te
be1 nvloed.
GEVOLGTREKKINGS: 'n Moontlike verklaring vir die
effek van naloksoon op Sendorfiensekresie, is dat mu-
reseptorblokkade, r ulerende negatiewe terugvoer-
rneganismes aktiveery potensieer. 'n Verklaring vir die
gebrek aan effek op leusienenkefaliensekresie, is dat die
aangewende dosis van naloksoon waarskynlik te laag
was om merkbare effek op delta-reseptore (hoe
leusienenkefalienaffiniteit) uit te oefen.
PLASMAMELATONIENKONSENTRASIES AS ADDI-
SIONELE BIOCHEMIESE MERKER VIR OVULASIE
EH de Wet, EJ Wilson, BH Meyer en JMC Oosthuizen
Departemente Geneeskundige Fisiologie en Farmako-
logie, Universiteit van die Oranje-Vrystaat, Bloemfontein
INLEIDING: In die kliniese praktyk word pro esteroon-
konsentrasies (tydens die geprojekteerde lutegee fase) as
indikator van ovulasie gebruik. Fasespesifieke ftuktua-
sies in sekresie van verwante geslagshormone (asook
melatonien), tydens die menstruele slklus / ovulasie, is
bekend. Kontroversie bestaan egter steeds oor die ver-
band / interaksie tussen erkende geslagshormone en
melatonien. Uit beskikbare inligting wil dit voorkom asof
resiproke sekresiepatrone van melatonien en lutropien
gedurende ovulasie voorkom.
DOEL: Die doe1 van die studie was om plasma-
melatonienkonsentrasies (op grond van resiproke
prestasie tot lutropien), -as addisionele biochemiese
merker vir ovulasie te evalueer.
MATERIAAL EN METODE: Veneuse bloedmonsters, vir
die bepaling van - plasmamelatonienkonsentrasies, is
daagliks (Dag 12 tot en met Dag 16 van die menstruele
siklus) op dleselfde tyd, van ses (6) normaalgesonde
vrouens (ouderdom 18 tct 48 jaar), bekom.
Omgewingsbsligting was deurgaans r 350 Lux.
Bykomstig is bloedmonsters vir die bepalin van serum-
progesteroonkonsentrasies op dag 21 van e ke proefper-
soon bekom. Horrnoonkonsentrasies is vervolgens, vol-
gens aanvaarde radio-immuun-essaiprosedures gekwan-
tifiseer.
RESULTATE: Resultate van hierdie studie toon 'n
rominente nadir in midsiklus plasmamelatonienf:
onsentrasies aan in proefpersone 1, 2 en 6. Geen
opmerklike basislynverskuiwings in plasmamelatonienkonsentrasies
van oroef~ersone 3. 4 en 5 kon vir die
spesifieke sik1~i.s ' uitgew* word nie.
Serumprogesteroonkonsentras~es vir proefpersone 1 en
6 strook met verwagte postovulasie waardes.
GEVOLGTREKKING: Gesien teen die agtergrond van
die waarskynlike fisiologiese verband tussen lutropien en
rnelatonien (asook die resuitate van hierdie bepekte
studie), wil dit voorkorn asof plasmamelatonien-
konsentrasies we1 klinies sinvol in geselekteerde gevalle,
as misionele biochemiese merker vir ovulasie
aangewend kan word.
B
VOL 82 DECEMBER 1992 465
SAMJ
Verspreiding van sekresiegranules in gestimuleerde
B-selle van die pankreas
AM de Beer en A Crous
Dept. Geneeskundige Fisiologie,
Universiteit van die OVS, Bloemfontein
Glukosestimulasie van 5selle veroorsaak 'n toename in
insulienvrystelling gevdg dew 'n nadir, waarna die
tempo van vrystelling weer toeneem en vir die duur van
stimulasie vdgehou word. lnsulienvrystelling geskied by
wyse van die eksositose van sekresiegranules. Die
insulienkonsentrasie in die bloedplasma is gevolglik 'n
funksie van die beskikbaarheid van granules in die
omgew~ van die selrnembraan. Die doe1 van die
onder was orn die regionale verspreiding van
sekresiegranules in die sitoplasma tydens glukose
gestimuleerde insulienvrystelling morfornetries te bepaal.
METODE: Glukose gestimuleerde eilandweefsel is na 2,5
min., 53 min., M min., 30 min. en 72 uur fikseer en vir
elektronmikroskopie voorberei. Sekresiegranules is op
elektronmikrograwe geidentifiseer en hul voorkoms in
die omgewing van die sdkern en selmembraan
morfornetries bepaal. Granules in die res van die
sitoplasrna is ook in berekening gebring.
RESULTATE: Kort na aanvang van stimulasie (23 min.)
neem die voorkoms van sekresiegranules in die
omgewinf van die selmembraan skerp af. In die res van
die &top asma was geen verandering te bespeur nie.
Met volgehoue stimulasie het die granule verspreidings-
digtheid in hierdie area geleidelik toegeneem om na 30
minute die verspreidings trwn van ongestimuleerde
selle aan te neem. Efs na langdurige glukose
stimulasie word sodanige verspreiding gehandhaaf.
BESPREKING: Instandhoudim van 'n normale
granuulverspreidingspatroon in -die B-selsitoplasma,
tvdens volaehoue insulienvrvstellina. toon dat die status
duo van 8e granuulpopul&ie gekndhaaf word deur
insuliensintese en -vrystelling. Die aanvanklike
verandering in die verspreidingspatroon van die
sekresiegranules word direk in verband gebring met die
fasiese aard van insuliertsekresie. Die morfometriese
waarnemings toon dat selfs :n geringe afnarne in
sekresiegranules in die subplasrnalemrnagebied die
verd tot insuliensekresie beduidend beperk.
AN AUTOMATED HIGH PERFORMANCE LIQUID
CHROMATOGRAPHY METaOD FOR THE
DETERMINATION OF CEFETAMET IN PLASMA.
KJ Swart, I van Heerden and HKL Hundt
Dept of Pharmacology & Farmovs Institute of Clinical
Pharmacology and Drug Development, UOFS,
BLOEMFONTEIN.
Introduction
Cefetamet is the main metabolite and active form of the oral
cephalosporin antibiotic cefetamet pivoxyl. Cefetamet pivoxyl
is very unstable in plasma and it is rapidly converted to
cefetamet. Cefetamet plasma concentrations are therefore
determined since no cefetamet pivoxyl concentrations can be
determined unless special precautions are taken.
Aim
Our aim was to develop an automated HPLC method for the
determination of cefetamet in a large number of plasma
samples.

Method
To -1 plasma was added 50qtl water- Extractions were
done by a Gihn SPEC (Automatic Sample Preparation with
Extraction CoIumn~) system using Varian Bond Elut (1-&
C18 packing) extntction columns Each column was
canditioned with methand followed by 0-lM HQ just befiore
use. The plasma mixbm was loaded onto the column and
washed with lml 0.1M HCI. lk analytes were eluted with
30qrl methanol, the eluate mixed with 30qrl water and lm
injected onto the HPLC column.
Chromatography was performed in the reverse phase mode on a
Waters Novapak (38, 4p, 150x3-9 mm stainless steel column
with a mobile ppbse consisting of sodium &ate buffer and
acetonitiile (9223) (pIlt=3.9) and the analyta detected by a
Hewlett-Packard W detector at Ui5 nm.
Results
Calibration curves were to at last ~ glml for &tarnet,
with a limit of quantification set at 0.1-1 (CV% of 13.8 at
O.O!X?&ml)-
Concl*n
The method was sensitive enough to determine ccfetamet
cancentrations in plasma samples for up to 12 hours after a
single 500mg ceft%amet pivoxyl oral dose. An internal standard
was not used sime the extraction, elution and injection was
done by the ASPEC system with excellept precision and
aqwacy.
ANTIBIOTIC CROSSRESI~ANCE EN PSELIDOMO&lS
AERUGINOSA.
-
M M Theron, M J de Kock, Department of Medical
Microbioh. Universitv of the Orange - Free State,
~loemfont&
Elevated &lactam antiic resktmxe in hospital isolates
of Gram negative organhs is often attributed to a single
factor (altered pemcillin-bindiag oteins [PBP], &
inttctivatim- a iqte4tyr L is widely
believed that cross-resstance results fmm hype reduction
of s p e c i ~ c E-lactamases ~ l mediated& mufatcd
chromosomal g e or ~ from &lactamases mediated by
conjugative plasxmds aspired in hospitals The level of &
lactamase resistance relates to the amonnt of enzyme
roduced and to the kinetics of the activity of the e-e.
%l,rmeabiLity is manifested by high nmimrl inhiiltmy
concentration (MC) values in the absence of&-.
METHODS: Minimal inhibitory -ns of she
antibiotics for 252 isolates were determined by the agar
dilution method. Semiquantitative substrate rdes of
crude Bhctamaa preparations were determinex!for 47 of
these isolates.
The magnitude of cross-resistance in Ikhmmzs
was assessled by comparison of the MICs of the
EEEF&nrn amia Quunitartrr measures of
cross-resistanct were determined over the 6nn range of MIC
values of the different 5~1tiiiotics.
RESULTS: Chs-resistance was demonstrated between
pairs of antibiotics tested. Imipenem, sbolwing m, cross-
resistance with any of the 6-lactam antibiotks, was the only
exception. RLactamase acthi was not &monstrsted in
r~isolates&~>
F&=N: Tbk indicates that resistance d cr--
resstame to the &lactans studied are doe to both the
praduction of &hcUmass and impefmeability of the outer
membrane.
NUMERICAL ANALYSIS OF SEMI-QUANTITATIVE &
LACTAMASE SUBSIRATE PROFILES.
M J de Kock, M M Theron, C J van Rensburg, Department
of M d d Microbiology, University of the Orange Free
State, Bloemfontein.
Semiquantitative substrate profiles of Rlactamases from
l18 Gram negative bacterial strains (in& 20 reference
Rlacmmases producing strains) were recor 2
METHODS Strains were grouped according to their
substrate profiles using mean m e cluster analysis and a
similarity measure based on the degree of overlap between
traces.
Z-Depe- they were produced, & on the bacterial strains by which
profiles were divided into
seven major group.
The first group contained profiles of B-lactamases produced
by Adnetobacter strains and two reference B-lactamases
(OM-3 and OXA-4). The second group consisted of B-
ktamaws h m PseudoinroMs aemghma and one reference
Rlactamase (ROB-l). Group 3 was a small mixed group of
Rlactamases from Xmtthomoma maltophilia, Pseudornonas
aerugirtosa and a reference Blactamase (SW-2). The
remaining X~homonas Rlactamases formed a loosely
grou (group 4), distinct from all the other
=Group !exclusiveb contained rofiles derived from
reference Blaetlmaws (RE-l, PS&, PSE-3, OXA-6
TEM-1, TEM-2, --l, 0-1, HMS-1, SW-1, TLE-i
and OXA-7) and plasmid mediated &lactamases from
Bloemfontein hospitals. Group 6 repreygted seven &
lactamases from Pseudontollcls and one reference &
lactamase (OXA-2). Group 7 contained two subgroups, the
first subgroup from lasmid mediated Rlactamases and the
second subp gom standard (OXA-I,
OXA-5 and P&-l). Subgroups and dusters could be
delineated in aIl lar er groups.
ONCLUSION: h approach to anal of fi-lactmme
substrate rofiles offers a valuable tool ~epidemiologid
surveys OF &L.ldamases present in different bacteria and
environments.
AN AUTOMATED HIGH PERFORMANCE LIQUID
CHROMATOGRAPHY METHOD FOR THE
DEIERMINATION OF ~ ONAZOLE IN PLASMA
KJ Swart. JC van der Merwe and HKL Hundt.
Dept of Pharmacology & Farmovs Institute of Clinical
Pharmacology and Drug Development, UOFS,
BLOEMFONTEIN.
-
Iatrodoetion
Ketoconazole belongs to the mole family of the antifungal
compounds. Although a number of methods exists for the
determination of ketoconazole in plasma they are either
microbiological methods or HPLC methods which are time
consuming, labour intensive and not automated.
Aim
Our aim was to develop an automated HPLC method for the
determination of ketoconazole in a large number of plasma
samples.
. .
Method
To 0Sml plasma was added the internal standard,
perphenazine, and 0Sml 0.01M NaOE Extractions of the
@asma samples were done by a Gilson ASPEC (Automatic
Sample Preparation with Extraction Columns) sy&m. The
L _

ASPEC was programmed to condition each Varian Bond Elut
(lOOmg, C18 packing) extraction column with methanol
followed by 0-01M NaOH just before use. The plasma mixture
was loaded onto the extraction column and washed with lml
0.01M NaOH. The analytes were eluted with 30qrl methanol
the eluate mixed with air and a l0qrt aliquot automatically
injected onto the HPLC column.
Chromatography was performed in the reverse phase mode on a
Waters Novapak C18 4p, 150~3.9 mm, stainless steel column
with mobile phase consisting of methanol, water, acetic acid
pnd triethylamine (750+250+5+5) @H=6.0), and the analytes
detected by a Shimadzu W detector at 242nm.
Rcwlts
Calibration curves were linear to at least M m 1 for
ketoconazole. The limit of quantification was set at 0.12Clg/ml,
a level at which the analyte could still be detected with good
precision and accuracy (CV% of 6.6 at 0.162 Mml, and CV%
of 23 at O.O82pg/ml.
Conclusion
This method was sensitive enough to determine ketoconazole
concentrations for up to 12 hours in plasma samples after a
single UlOmg oral dose. Determinations can be done 24 hours
of the day since the extraction, injection, chromatography and
dab reduction are completely automated.
AUTOMATED ANALYSIS OF CEFACLOR IN PLASMA
BY HIGH PERFORMANCE LIQUID
CHROMATOGRAPHY.
KJ Swart, T Malherbe and HKL Hundt
Dept of Pharmacology & Farmovs Institute of Clinical
Pharmacology and Drug Development, UOFS,
BLOEMFONTEINNTEIN
Introduction
Cefaclor is a cephalosporin antibiotic with a broad antibacterial
spectrum against Gram-positive and Gram-negative bacteria
Cefaclor is very unstable in solutions above pH=4.5 and
degrades rapidly at room temperature. Existing methods were
not automated and did not control the temperature of the
samples during extraction.
Aim
Our aim was to develop an automated HPLC method for the
determination of cefaclor in a large number of plasma samples
mder conditions which ensured the stability of the analyte.
Method
Plasma (0.5ml) was immediately acidified with 0.51111 0.1M
&Cl after blood collection and centrifugation. Before
extraction, cefalexin was added as internal standard and the
mples loaded into a temperature controlled rack at O'C in a
Gilson ASPEC (Automatic Sample Preparation with Extraction
Columns) system. Extraction was done on Varian Bond Elut
(lOOmg, C18 packing) extraction columns Each column was
tonditioned with methanol followed by 0.1M HCI just before
W.
VOL 82 DECEMBER 1992 467
SAMJ
The plasma mi.mue was loaded onto the extraction column and
washed with lml 0.1M HCl. The analytes were eluted with
300@ methanol, the eluate mixed with 20qrl water and SW1
automatically injected onto the HPLC column.
Chromatography was performed in the reverse phase mode on a
Bihoff Spherisorb ODS II, 4p, 125x4.6mm stainless steel
column with mobile phase consisting of sodium citrate buffer
and acetonitrile (W8) @H=3.8). The analytes were detected by
a Shimadzu UV detector at 265nm.
Results
Calibration curves were linear to at least 281rglml for cefaclor
with a limit of quantification set at OSqrglml (CV%=12 at
0.4&g/ml).
coacwn
This procedure provided us with a method that was sensitive
enough to determine cefaclor plasma levels for 10 hours after a
single 5OOmg oral dose. Determinations can be done 24 hours
of the day since the extraction, injection, chromatography and
data reduction are completely automated. The stability of the
analyte in the plasma samples is ensured by the addition of acid
shortly after sample collection and by keeping the samples at
K befoie analysis.
'N ONDERSOEK NA DIE INSIDENSIE VAN EKTOPIESE
SWANGERSKAPPE NA WEETOORDRAG IN DIE
BLOEMFONTEINSE REPRODUKTIEWESORGEENHEID
Wessel S PH, Sournbassis E, Venter D
Reprodukt iewesorgeenhe id, Departement
Obstetrie en Ginekologie, UOVS,
Bloemfontein.
DOEL: Die doe1 van hierdie studie was om vas
te stel of Gameetoordrag, soos in die
p1 aasl i ke eenheid aangebied, met 'n
verhoogde insidensie van ektopiese
swangerskappe geassosieer is.
STUDIE-ONTWERP: 'n Retrospektiewe studie is
ui tgevoer op a1 l e ektopi ese swangerskappe
wat vanaf 01 Januarie 1985 tot 31 Desember
1990 in die Universitas Hospitaal
gediagnoseer en behandel i S.
PAS18NTE: A1 le pasiente met ektopiese
swangerskappe, wat by die p1 aasl i ke
Infertil iteitskl iniek behandel is, is
geidentifiseer. Hulle kl iniese data is
noukeurig nagegaan en die oorsaak van hul
infertil itei t asook die tipe behandel ing wat
hull e ontvang het, i S geidenti f i seer. Geen
ektopiese swangerskap wat na behandeling by
die plaaslike kliniek ontstaan het, is oor
die hoof gesien nie.
---
- ,
-
-- i

F - -
,
: 8
p- - p
I r 468 VOL 82 DESEMBER 1992
9, *:
SAMJ
RESULTATE: In die periode is 55
swangerskappe deur middel van gameetoordrag
verwek teenoor 360 swangerskappe met ander
behandel ingsmetodes. 'n Totaal van 17
ektopi ese swangerskappe i S gedi agnoseer.
Slegs 3 ektopiese swangerskappe het na
gameetoordrag ontstaan teenoor 14 na ander
behandel ingsmetodes. Die waarskynl i kheid om
'n ektopiese swangerskap te ontwikkel is
5'45% na gameetoordrag en 4'10% na ander
behandel i ngsmetodes . Geen statisties
betekenisvol le bf kl inies betekenisvolle
vers ki l kon waargeneem word ni e .
GEVOLGTREKKING: Die risiko om 'n ektopiese
swangerskap na gameetoordrag in die
plaaslike eenheid te ontwikkel is nie
betekenisvol ho@r as na enige ander
behandel ingsmetode nie.
I&? - im SP~~~~LPMIDDEL vt~ 1y
W D~WIESE
PASISAT MET W BILATERALE N W PARALISE
M van Vuuren
DepL Arbeidsterapie - Pefonomi Hospitaal
Die pasii5ni het 'n bilaterale N W paralise opgedoen, na 'n
SkedeIbasisfraktum.
Om 'n hulpmiddel te ontwerp wat eet en spraak verbeter.
- sykw
'n Aksienavo~ode is gebruik aangesien 011s bier met 'n
unieke geval te doen het en so 'n tipe hulpmiddel nog nie
voorheen ontwerp is nie.
Metode 1 'n Statiese spalk is gemaak van temoplastiese
materiaal wat oor die pas%?& se ken pas en met vier
BesPrtaat 1 Die spalk het sy lip effektief geeleveer, maar as hy
sy l$ dilateer kon die spalk nie die onderlip weer outomaties
eleveer sodat die mond toegaan nie.
Mecoae 2 'n Diaamiese S@ is gemaak, die leerbandjiies by
metode l is met rek vervaag.
lkdtaat 2 Die hoelr waarken die kragte van die rek trek ;as
nie groat genoeg om die mond outomaties toe te maak nie.
Metode3 Diehaekewaartesndiekraetetrekisveranderenso
ver moontlik laudreg opmekaar m& sodat die trekhag op
die onderlip superioraraslits verhoog.
Redtaat 3 Die mand kon outomaties toemaak. Die
hdpzddel het egter nie in posisie gebly nie.
Metode 4 Die hulpmiddel is versterk dew 'n kopstuk gedeelte
by te voeg.
Resnltaat 4 Die hulpmiddel kon in posisie bly en was
k(hglletiesaaaMarbaar.
Metode 5 lbm hulpmiddek is gemaak. Die een, wat vir
spraakdoeleindes ontwerp is, is uitgevoer met watteersel om
druksere op die ken te voorkom. Die ander een was sonder die
watteersel en vir ee& e e t e bed&
Resubat 5 Die hdpmiddel was effektief.
' .
'n ICosmetiese hnlpmiddel is ontwerp wat onafhanklikheid
'teweeg gebring het ten opsig&e van spraak en eet.
DIE MVII3ED VAN ~IOlCSIDAN!L' VITAMIN
AAmmLLING WENS MOKARDIALE
ISGELZIE/RKPEWUSIE.
H van Jaarsveld, Jn Kuyl, DW Alberts
Departement Chemiese Patologie, UOVS ,
Bloemf mtein
Produksie van suurstofradikale tydens
miokardiale isgenie/ reperfusie is
gedeeltelik verantwoordelik vir die
mitochondriale beskadiging wat waargeneem
word. Lae molekul&re gewig yster (MY) tree
as katalis op om die minder reaktiewe
suurstof spesies (OZ-, H20 ) om te skakel na
die baie toksiese hidroksfelradikaal (OH. ) .
Antioksidante is molekule soos vitamien C,
a-tokoferol en B-karoteen wat
suurstofradikale inaktiveer en onskadelik
stel. Die doel van hierdie studie was om te
bepaal of antioksidant aanuulling
mitochondriale beskadiging tydens isgemie
reperfusie kan venninder. Drie
eksperimentele groepe is ondersoek naamlik:
1) rotte wat geen addisionele vitamiene
ontvang het nie: 2) rotte wat B-karoteen en
a-tokof er01 ontvang het vanaf speenouderdom;
en 3) rotte wat B-karoteen, a-tokoferol en
vitamien C ontvang het vanaf speenouderdom.
Hitochtmdriale f unksie, LMMY en a-tokof er01
is bepaal. Beide die suplementasie groepe se
mitochondriale funksie het 'n verbetering
getoon ten opsigte van die kontrolegroep
tydens isgemie en reperf usie , alhoewel die
LlMY uitermate verhmg was. a-Tokoferol was
betekenisvol hoer in hide suplementasie
groepe, maar die groep wat slegs 8-karoteen
en a-tokof er01 ontvang , het *n a-tokof er01
konsentrasie van ongeveer dubbel die van die
groep vat ook vitamien C aanvulling gekry
het. Die groep wat nie vitamien C ontvang
het nie se a-tokof er01 konsentrasie het
egter vinnig uitgeput tot 'n konsentrasie
laer as die groep met vitamien C aanvulling.
Ons km dus tot die gevolgtrekking dat
aanvulling van antioksidant vitamiene we1
miokardiale isgemie/reperfusie besering tot
'n mate verminder (ten spyte van 'n
verhoogde LHNY) en dat vitam~en C nodig is
on die vitamien E konsentrasie in stand te
hou .
-. .
.- .
* .- -. .
- -
' A 1 -
'N VERGELYEFCNDE STUDIE TUSSEN El23
TIROIED-OPNAMES SOOS BEPAAL MET 'N
SINITIUSIETELLEI EN GAMMA-KAMERA
TEGNIEK
J. van der Wath, H Naudi, M Utter.
Departemeut Kemgeneeskunde, Bloemfontein.
l231 is teoreties die optimale spoorder om die tirozed te
bestudeer. Beelding en kvcrantifisering van invangs kan
as 'n enkele prosedure gdoen word Dit is voordelig
Iwz standaard invangsbepalings wat aLfsonderlik met 'n
sintillasieteUer gedoen moet word en tydrowend is.
Die doel van hierdie studie was om invangs soos bepaal
met 'n gamma-kamera tegniek te vergelyk met 'n
sintillasietellertegniek ms beskryf deur Chervu et al.
60 P dnte is bestudeer en die resultate word in al die
@eke en tabeile saamgevat. Volgens hsgenoemde
a daar we1 'n baie goeie korrelasie tussen die
sintillasietellertegniek en die Gamrna-kamera tegniek.
.-?!
-

13ETA-LACMM AND QUINOLONE RESISTANCE:
13EFORE AND AFIER.
PI. Botha, W. de Kock, UU Theron, 7
I partment of Medical Microbiology, University of the
(hnge Free State, Bloemfontein.
~n ~ ~mfotein hospitals most antimicrobid agents were
freely available for therapy. Resistance to second and third
line drugs inmased sharply during 1990. This wa~ @i'b~ted to ~ ~U~~UOUS use. Reduction of the selective
pressure on the emergence of resistance became imperative.
19 policy was instituted, restricting the prescription of B-
@dam aad quinolone agents to consultants serving on the
Adiiotic Subcommittee.
lk aim of this study was to detect change in resistance
profiles of four Gram negative pathogens, after restriction
bad been enforced for a period.
The restriction policy came into effect on 5 June 1991. The
iesistauce profiles of the four pathogens against three
aminoglycosides and the six restricted antimicrobial agents
were studied for a period of six months prior to and after
this date. The first period was utilized to document existing
profiles and then compared with the second to detect
changes. For each organism and antimicrobial agent the
number of sensitive and resistant isolates in the two periods
were compared and tested for significance by the chi-square
test.
In general, resistance in Universitas Hospital decreased. In
Pelonomi however it was noted that resistance to some
drugs increased. Exceptions were noted: The resistance of
P~ltuwlc~s significantly increased to piperacillin in
Universitas Hospital. At Pelonomi a significant decrease in
resistance to cefotagime was observed in MebsieIla.
These results show that only restriction of prescriid
antimicrobial agents does not totally alleviate the selective
pressure producing increased ltos~comial resistance.
Judicious use of antimicrobial agents should prolong the
efficacy of individual drugs. An established hospital regime
for antimicrobial therapy would contniute greatly towards
autailing resistance. The simultaneous reinforcement of
hospital hygiene should enhance this effect.
DIE GEBRUIK VAN DIE POLIMEBASE
EE'ITINGREAKSIE VIR DIE AANTONING EN DIREKTE
'IIPERING VAN HERPES SIMPLEX VIRUS IN
SEREBROSPINALE VOG, MOND-, KEEL EN
GENITALE DEPPERS
HMM P i MS Smith, E vd Ryst
Die ontwikkeh van effektiewe antivirale terapie teen
Herpes simplex wrus (HSV) infeksies genoodsaak die vroeC
diagnose van HSV infeksies. Toetse wat gebruik word om
die aanwesigheid van HSV in Wese monsters aan te toon,
kan nie altyd met sukses aangewend word om 'n vr& en
gkkurate diagnose te maak nie.
bOEL VAN DIE STUDIE: Die doel van die studie was om
die sulcsesv011e toepassing van die polirnerase kettingreaksie
KR) vir die gelyktydige aantoIung en ti ring van HSV
g NA in serebrospiuale vog (SSV), mod-, P eel- en genitale
deppqrs feevalueer. .
. . ., L
PASIENTE EN METODES: Die polimerase kettingreaksie
(PKR) is eers toegepas op HSV tipe 1 (HSV-1) en HSV tip
2 (HSV-2) DNA, wat verkry is vanaf VERO selle wat
eihfekteer is met kliniese monsters waaruit HSV-l en
&V-2 onderskeidelik geisoieer is en tipering uitgevm b
mbv fluoressiengemerkte tip-spesifieke monoklonale
antiliggame. Twee SSV monsters, twee monddeppers, twee
keeldeppers en twee genitale de pen van pasiEnte met
HSV-1 of HSV-2 letseh h met &e PKR get- .vir die
teenwoordi eid van HSV DNA. Hierdie monsters reeds
positief verG vir die teenwoordigheid van HSV dmv virus
~solasie. Deur gebruik te maak van een a1 emene opgaande
8 %
voorloper en twee ti -spesifieke af aan e voorlopers van
23 baslsse elk, is & e h van die SV tip 1 (HSV-l) en
tipe 2 (HSV-2) DNA polimerase geen gearnplifiseer om
produkte van verslcillende groottes te produseer. Die
Southern klad tegniek is gebruik om die identiteit van die
geamplifiseerde produk te bevesti dew gebruik te maak
van 'n peiIer wat spesifiek is vir beide HSV-1 en HSV-2.
RESULTATE: Produkte van verwagte groottes (469 en
391bp vir HSV-l en HSV-2 onderskeidelik) was op 'n
ethidiumbromied gekleurde gel sigbaar en bevestig die
spesifisiteit van die PKR toets. A1 agt die monsters is
positief getoets vir die teenwoordigheid van HSV-1 of HSV-
2 DNA.
SAMEVATTING: Die ampHhsie van W e DNA dmv
PKR was gen sensitief en c k vir die
van F i n bogenoemde as monsters.
EZ'Truik te mask van die mie voorlopers, was dit
moon& am gelyktydig dieHSV stam te tipeer.
PHGRMACOKINETICS AND COMPARATIVE
BIOAVAILABILITY STUDY OF
EM Moeilnicka, M van Dyk, HKL Hundt, FO Miilter, R Schall,
LW Brown
Farmovs Institute, University of Orange Free State, Bloemfontein
Maprotiline belongs to the second-generation antidepressants and
represents the goup of tetracyclic compounds.
=.
. 3 A
+ t
.
i .
I -
*%
l f i
F >:-
n
-.3
A-,
-.
Maprotiiie has been used for treatment of mild to severe ,- c -. +
depression for many years but the phannacokinetic data both in : id '
healthy volunteers and patients with depre-sj~n are poorly
- -+d
documented.
.
_
-"
For the present study we used 20 healthy white males. Th~s
single-blind, singledose, randomized, cross-over study with a 21
day wash-out period. The volunteers received two different tablets
of 75 mg maprotiline HCI: products A and B, according to the
randomization schedule. The study was approved by the Ethics
Committee of the UOFS, Bloemfontein.
.Q
r:. 4
' i
4 ,
9,
2 . 1; . - .
e
Maprotiline was assayed by high performance liquid
I r:
chromatography in plasma samples collected over a 12 day period.
The pharmacokinetic variables of the products were comparable
was a - - f
and the respective means for LudiomiP and the generic product
were as follows: C,: 13.4 and 13.7 nglml; T,: 6.7 and 7.7 2
hours; AUC$-oo: 788 and 821 ng.h/ml; tin: 36.3 and 37.1 hours.
*
The presented data are not in agreement with previously published
L
results. t
emm l -92/vc L
I:
f
\ --
- r'
. *

2
470 VOL 82 DESEMB
p . r A , . T - SAMJ ,;
~ .' ..$*>--G-
. , . .L., . , . . .
DIE INVLOED VAN DIE IIEO-ANALE
RFSERVOIRPRCBJDURE OP DIE MUKClsAJE
FUNKSIE VAN DIE TERMINALE ILEUM-
S.P. pbler*. V.A. Pomn, K.B. Hosie. El. ~avie', N.J.
Birch . M.R.B. Keighley. Departmentof Surgery, University
of the 0ranp;e Free State. South Africa . Dewrhnent of
Doel, Om die mvloed van die ileo-anale mwvoir op die
struktuut en funksie van die slymvlies van die terminale ileum
indiemenstebestwkr.
Metodes. Terminale ileum slymvliesmoasters is ten tye v%
die aanvanklike ileo-anale r e s e r v o versamel ~ en met
seriele mukosale biopsies van die iieo-anale reservoir vergelyk.
Aktiewe mukosale FP-=P M""""
sintetaseaktiwiteit ( E
vermkinge is beaordeel.
l l (GS) en histologiese
Galsoutopname GS aMiwit
bdd45min) (IrrndlhrkJ
1. Reop. ileum(n =39) 12.3 (11-15) 21.5 (17-25)
2. Ileale reservoir;
(a) gedefunksioneerd (n= 18) 8.0 ( 4-12), 8,3 ( 7-18)*
Cb) 1-3 made-
vorige ileostomie (*= l l) 11 .O ( 8-14) 14.0 ( 6-18)*
geen ileostomie (n = 9) 11.2 ( 6-22) 25.0 (14-38)
(c) 2 4 maande-
vorige ileostomie (n=26) 13.7 (1 1-18) 19,4 (14-2)
geen ileostomie (n=13) 13,3(7-20) 20.2(14-27)
Slotsom, Die gedefuoksioneerde ~ m o iopenbar r
vertaagde aktiewe galsoutopname amok GS-aktiwiteit wat tot
drie maande mag neem om tot preoperatiewe vlakke te styg.
Mukosale fuaksie in gevestigde dundemueservoom blyk nie
nadelig beinvloed te wees nie, ten spyte van die wisselende
mate van viueuse atrofie en chroniese inflammatoriese
infiltraat.
EH de Wet, R Schall en JMC Oosthuizen . z5-
Departemente Geneeskundige Fisidogie en Farmako-
logie, Universiteit van die Oranje-Vrystaat, Bloemfontein
INLEIDING: Dit is welbekend dat pineaalkliirfunksie
(rnelatoniensintese / -sekresie) onlosrnaaklik funksioned
gekoppel is aan adrenoreseptwkinetika Daar word
geredelik aanvaar dat spesifiek &reseptore (met nor-
adrenalien as bindmiddel) in hide funksie 'n
prorninente rol vervul. Modulasies aan metdtsi-indad-
produksie na B-reseptorbbkkade lit' ) (prop
nolol) is reeds wyd gsapporteer. $%%%%strydig =
melatonien 4 / 7 ) Daar bestaan egter in &enstelling,
duidelik 'n kortval in ken& / begrip van metdtsi-indod-
produksie onder die invloed van konvensioneie
i mimetika, (isopenalien aangesien fannakologie-
kyi&kasie van hierdie WC/, "onverwagte* negatiewe
resultate (melatonien onveranderd) aplewer. Ulteenlo-
pende venluidelikings word aartgebied orn hierdi
tendens te verantwmd. Meer potente ("onkonvensione-
le") (Skedule 7) simpatomimetika (fendimetrasienbitar-
traat) se effekte 9 pinesalfunksie is egter nog nie in
diepte ondersoek me.
-
4 I .- ,. $.
D&L: 'D@ doel van die studie was om dig effek van
fendirnetrasienbitartraat (ObesarF) (wat adrenerge
neurotrammit&wmstellina Dotensieer / hermname inhi-
beer), op basale pianealos&ffinksie te ebaluek. -~* -=
-* >"$&
MATERlAAL EN METODE: Elf n~rrnaal~esondej-inin
like proetpewne het 'n enkddosering, gerandorniseer-
de oorkruisstudie met plasebotoediining as kontrde,
vdtooi. V e m Moedmortsters vir die bepaling van
plasmamelatonienkonsentrasies (R.I.A.) is asodc
een (1) wrliks gedurende 'n 4 W-periode (06:00 - 10:00)
bekom. Omgewingsbeligting 2 350 Lux
RESULTATE: Resuitate van die studie toon 'n klein
verskil (4%) in gerniddelde hormoonkonsentrasie (AUC).
(Fendirnetrasienbitartraat > plasebo) Die wye 95%
vertrouensintewal bring egter mee dat geen definitiewe
gevolgtrekking met betrekking tot die effek van
fendimetrasienbi op bade metatoniensekresie
gemaak kan word nie. Hierdie resultaat is voarsien.
GNOLGTREKKING: Eenvoudige adrenoreseptor-bind-
rniddelinteraksie verteenwwdig duidelik nie die volfe
spektrum van biochemiese 'gebeure' rondorn funksiona-
liteit van db pinealosiet nie. 06nskynlik is endogene
(natuurlike) (katecholamienvrystelling uit senu-eindes)
adrenoreseptorstimulasie meer effektief in die uitlok van
'n betekenisvolle respons, as ek ne ("meer onnatuur-
like*) stirnulasie (simpatomimeti~ Uiteindelik wil dit
voorkom asof simpatiese tonus ( C / t ) die pi&-
klier, vry van enige eksogene invloed (direkte 6-
reseptorblokkade / -stimukasie), "dryP.
--
m.
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- -:
< $-
..";
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. VERDAGTE VASKUL6RELElSEl.S BY DIE
KAROTIS BIFURgASIE :
ROLVAN DUPLEKS DOPPLEROND~EK
A ~tepbeq *, R Bany , cw ~erfbn~er~n, ~JC
Bill Venter Eenheid vir Vaskuibe Chimrgie, UUOVS,
Bloemfontek
7st % :
, 7
- ,
. X
Hierdie studie is onderneem om die rol van Dupleks
Doppler (DD) in pasiEnte met massas van moontlike
vaskul6re oorsprong by die kamtis bifurkasie
'n DD ondersoek is oor h 3 @ode (1967 - 1991)
uifgevoer op alle pasihte (n = 50) met 'n
kaakhaeknmssa van 'n moontlike vaskul&e oorsprong
Met kliniese ondemoeke is kamtis llggaam tumore in 29
gediagnoseer- PasEnte is volgens die gebruiklike
metode. wat arteriogafie hges1uit het, ondersoek.
DD het karotis liggaam tumore in 11 pasiEnte,
aneurismes in 5, non-vaskul2e letsels in 1, kamtis
pasi~nte-&gposeer. In 23 van die 50 pasihte (46%)
was geen patologie (ontvouinplf em prominente vate) '

DD is 104% akkuraat bewgs dew arteriogafie edof
c&urgie
@dinpp
in die diagnose van die IetseIs Die DD
in die kmtis bgpm more het 'n
ww
bifurkasie gedemonstreer. In die biirkasie
M 'n letsel met eggo's sowel as arteriEie en veneuse
vlmi aanwesig Lae weerstand vloei in die eksterne
urdis erie was teenwoordig in 80% van die pasitnte
*t die MoedwwNSieniag vandie tarnor aandui
PasiEnte met massas van moontlike
vaddi5~ oorsprong by die karotis
bihrkasie behoort eerstens deur middel
van DD ondersoek te word. In 46% sou
Bospitalisasie en verdere ondemoeke nie
nodig wees aie.
ASPECF~~cfodetermincspknLvolumwas~ kwrdiniEaud
seol~dpodmndrtio~witha~daamiaatio.? Spknicvcduweanbc
obtaiDcdin30miaUmthmmakingitapphbkformuhncdinicalusc Itsalso
pDssiMt m gyar spcnic volume dmgcs with certain in-
The obrcnratioa d iaacascd qiak vdumc afta food intake was pmkdy
rcptatssapaitinoata,~~*. ~ p q m c o f ~ ~ w a s t o
~thcsbolhmCDtjOPOd~qmYjYO.
a-dYpnwr~ eoosbndd5matrolaadUtc9sobjccb,AUsub~wcrenilper
osflm22baotkdaypliortothc~~~SPECT~aasQae
*.E - " timd5~9!hTctiacdlddIbtberdiae~,coaaistiagd~
imagcs(21k/ii)wa~.cquircdmal23~128fDLmat IBkstudy-foUwdby
abxeakfaaSubcq~agmsdtamogapsiertudyaasrqvirrduhiag~aqlliritaDplotoeaSpkcnvcdmcdCbothhtpdicsaas&terminedvsingaI
VOL 82 DECEMBER 1532 471
SAMJ
UNOLEIC ACID: A DIAGNOSTIC FEATURE TO IDENTIFY
TUMORS WITH AN AGGRESSIVE GROWTH PATTERN?
L Low*, A-M. En g 1 brecht* and F- *Department
of Anatomy and U Morphology and Department of
Haematology, University of the O.F.S., Bbemionten.
Investigations were inii, based on observsrhons from
preliminary research in our laboratory, to formulate a
hypothesis that high lindeic acid levels are characteristic of
benign neoplastic cdls, while low Iindeic acid levels are
of malignant neoplastk: cells. vs paper
resents evidence in favour of this phenomenon m diirent
man turnors.
PATIENTS AND MHHODS: Tumor biopsies (n=10) of the
brain, prostate and skin were carefully selected,
hiiocytolog'i classified and analysed by capillary gas-
liquid chromatography. Extraction and preparation of fatty
acid methyl esters from 0,129 samples were carried out
according to a known gas-liquid chromatographic method.
Identification and calculation of the methyl esters were
based on the comparison of retention times with known
standards.
RESULTS: The relative percentages of lindeic acid (G18:2)
for the tumors investigated were: benign astrocytoma
(25.45%) aggressive malignant glioblastoma multiforme
(4.03%), benign adenomyomatous hyperplasia of the
prostate (16.24%). malignant adenocarcinoma of the
prostate (4.82%), benign meningothdiomatous meningioma
(20.67%) aggressive malignant atypical meningioma
non-aggressive mal' nant basal carcinoma
15.1 l%), aggressive malignant m (8.25%),
non-ag ressive malignant squamws epithelii carcinoma
(19-748)), aggressive rnaligrmnt squamw epithelial
carcinoma (9.50961, benign dermatofibroma (21.40%) and a
non-aggressive malignant dennatofibrosarcorna protuberame
(1 1 .m). All turn with an aggressive growth
pattemsho~edsigniilowerlev&0flindeicacid.
CONCLUSIONS: The above mentioned results strengthen
our hypothesis. To posii validate our hypothesis,
current investigation is based on easily accessible cervical
tumors for a more statistically significant analytical study.
THE TREATMEIW OF PRIMARY HYPERHIDROSIS BY
IOmPHORESIs
MGL S~ruvt. E Botes. M du Toit. EJ Monk RS du Toit. CJC Nel.
Depts of Surgely and Physiotherapy. UOFS and Unfversitas
Hospital. Bloemfontein.
AIM
musshe emotionally Sulsulated sweaung is socially
unacceptable to most people. We assessed the efRciency of
tapwater kmtophoresis as a treatment modality for prfmary
hyperhidrosts. as well as its acceptabfflty to patients.
l-
4
t

-82 DE! . . - -2
3AMJ
PATIENIS AND METHODS
Patients with hypufildrosis were recruited by zuhms4s and
referrals from general practttfone~~ in the area.
wasdefinedas:
- the inability to write without an extra sheet of paper to
prevent blottfqg by excessive sweaUng
- the necessity to change clothing during the day due to
sweatin€!
- avoidisg hand contact with others
- medical help having been sought for the problem
- special anti-penpirants used.
TECHNIQUE
A simple source of direct current of low voltage and low
amperage was used to give iontophoresis. ~a~ents were
evaluated subjectively according to a persanal score kept by the
patient before, during and after the trealment. Reliance was
placed on cllnical evaluation by therapist and patient.
RESULTS
Patients: Total I8 Hands 15
Male 5 Feet 2
Female 13 Agillae 3
Hands and feet 1
Hands and axllIae 1
IniUalsuccess: 13/14
Dry at 6 wks: 7. Dxy at 2 mo.: 5.
Dry at 4 mo.: 4.
Side-effects: 2 (redness. ikhiwss)
CONCLUSION
We believe that. although iantophoresis does not achieve
permanent relief in primary hyperhidrosis. it is a practical. safe
and simple solution to the problem in patients who are not
prepared to undergo surgery.
YERIFICATION OF A VARYBUG THRESHOLD
EDGE DETECTION SPECl' TECHNIQUE ON
SPLEEN VOLUME: A COMPARISON TO CT
VOLUMES.
P A van Aswegen, M G Utter, C P Herbst,
M G Nel A C Otto.
Departments of Biophysics and Nuclear Medicine,
Umversity of the Orange Free State, Bloemfontein.
The introduction of single photon emission
computerized tomography (SPECT) facilitated
quantitation of organ volume with radionuclide
techniques emp1oying edge detection methods. In
phantom studies we showed that a negative correlation
exists between volume size and threshold value and
proposed a calibration curve to overcome this difficulty.
The aim of this study was to evaluate the accuracy of
volume determination with SPECT against vohunes
obtained from computed tomography (0. Twenty
patients were included in the study. Patients underwent
a radionuclide as well as a x-ray tornogram which were
both reconstructed employing a filtered backprojection
algoritm. CT volumes were calculated from manually
drawn R01 while SPECT volumes were calculated
employing an automated algorithm. A variance in
volume was also determined for SPECT. -Regression
adysis yielded a regression coefficient of 0,996 (y =
097x + 7.07) when comparing SPE

?im= POSTSTRgPTOCOCCAt
Q p l . T I s IN HOSPITALISED
VOL 82 DECEMBER 1992 473
SAMJ
CS---
- Pelser: Dept Paediatrics and Child
last 2 weeks of treatment, resulting in a
total dose of 69 Gy. All patients
received a high proteinlhigh calorie diet
and a special mouthwash (3x daily) to
Health, University of the Oranje Free counteract the expected increased acute
st-ate, Bloemfontein, South Africa
toxicity. All patients completed the
-ION:
accelerated protocol and no feeding tubes
scatistics of our nephrology ward reveal were required. Confluent mucositis
that acute poststreptococcal persisted on average until day 45 then
g~omerulonephritis (APSGPJ) is the single subsided quite rapidly (avg. 15 days).
~ s cammon t renal disease (53%).
@SILTS :
Complete tumour regression occurred in
m e clinical features and course of
16/26 patients (62 %). Of this group 7
these patients were typical of APSGN.
patients developed tumour recurrence 2-9
The majority were 3 to 10 years old,
months after treatment.
with a peak 5 to 6 years. The sex
Consideration must be given to increasing
ificidense was equal. 88% Presented with the total dose to 72 or 74 Gy as it
acute nephritis i.e. hypertension, appeared as if normal tissue tolerance,
oedema and heamaturia. Only 8% based on acute toxicity repair, had not
pzesented with nephrotic proteinuria. been reached.
nnpetigo were diagnosed in 89%. Most of
our patients come from lower socioeconomic
circumstances.
Acute
complications
(hypertensive
eacephalopathy , cardiac and kidney
failure) developed in 18%. Most (55%)
were- discharged within one week ( 55%) . STIKSTOFMONOKSIED VERHOED MITOCHONDRIALE
Of the remainder 35% were hospitalized BESKADIGING AS GEVOLG VAN MIOKARDIALE
for 1-2 weeks and 6,5% 2-3 weeks. Two ISGEMIE/REPERFUSIE.
patients with renal failure remained in
H van Jaarsveld, JW Kuyl, MS Strvdom
Dept. Chemiese Patologie, UOVS, Bloemfontein
hospital for 52 and 53 days. All Miokardiale isgemie en isgemie gevolg dew
patients recovered.
reperfusie lei tot mitochondriale funksie
Antistreptolysin 0 titers was positive beskadiging in die hartweefsel. Verskeie
in 95%, anti DNASE-B and faktore kan hier 'n rol speel onder andere
antihyaluronidase in 80%- At least one die endoteel funksie, wat *n nieof
these test were positive in every trombogeniese oppervlakte verskaf. Die
patient. Serum complement C3c showed a endoteel reageer op verskeie vasoaktiewe
decrease in 91% and C4 24%.
substanse dew endoteel-ontstaande
~ S I O N :
ontspanningsfaktor vry te stel. Die mees
algemeen aanvaarde vorm van endoteel-
Although the prognosis of APSW is good onstaande ontspanningsfaktor is
it is preventable. Improved sosio- stikstofmonoksied (NO), aangesien NO
economic standards leading to reduced bioloqiese eienskappe het wat identies is
skin infections and early treatment aan endoteel-onst&de ontspanningsf aktor .
would reduce the incidence and result in Dit word dan ook as dieselfde substans
considerable savings for the community beskou. Dit is reeds aangetoon dat NO die
and the country as a whole.
nekrotiese area in die hart verminder tydens
isgemie/reperfusie. Die doe1 van hierdie
studie was om te bepaal of NO in staat is om
die mitochondriale funksie (wat as 'n
parameter van intrasellul&-e beskadiging
INITIAL EXPERIENCE WITH ACCELERATED
beskou word) te beskerm teenoor miokardiale
FRACTIONATION IN THE TRKAlWEIW OF HEAD isgemie/repf&f usie besering . Sprague Dawley
AWD NRCK MALIGRANCIES.
witrotte is as proefdiere gebruik. Harte is
gefsoleer. In die eerste groep was die harte
H. Heunis, G van Huyssteen, L Goedhals nie aan isgemie/reperfusie onderwerp nie; in
Dept. Oncotherapy, 'U.O.F.S.,
9roeP I I was die harte aan
Bloemfontein.
isgemie/reperfusie onderwerp, maar het nie
NO ontvang nie; groep I11 is aan
isgemie/reperfusie onderwerp en het NO in
Due to the poor tumour response and high die perfusaat ontvang. Mitochondria is
rate of morbidity after conventional hierna gefsoleer en die funksie is bepaal.
radiation techniques for advanced T3 and Die mitochondriale funksie van harte wat nie
!P4 head and neck cancers, we decided to NO ontvang het nie, het 'n betekenisvolle
investigate a concomitant boost technique beskadiging getoon in vergelyking met harte
Pioneered by the MD Anderson Hospital. wat nie aan isgemie/reperfusie onderwerp is
nie. Die groep wat NO ontvang het se
?'he concomitant boost technique has been mitochondriale funksie was dieselfde as die
Utilized in the treatment of 26 patients van die harte wat geen isgemie/reperfusie
With T3 and T4 carcinomas of the head and ontvang het nie. Ons kom dus tot die
9eck. The protocol involves a treatment gevolgtrekking dat NO we1 in staat is om die
qose of 54 Gy in 30 fractions of 1 -8 Gy miokardiale mitochondriale funksie te
Qaily for 6 weeks. A concomitant small beskerm. Dit dui dan ook die belang van die
tield boost of 1 -5 Gy was given daily (6 endoteel in die beskerming van die
hours after the 1 -8 Gy fraction) for the miokardiuar aan.

474 VOL 82 DESEMBER 1992
SAMJ
CLIHICAL RADIOBIOLOGY OF MALIGHAIOT
- THE HATIOm HOSPITAL
EXPERIENCE.
K, Vorster, G van Huyssteen, L Goedhals
and A Zerwick. Dept Oncotherapy ,
Bloemfontein, U.O.F.S.
Due to the current controversy regarding
the radiotherapy of malignant melanoma, a
retrospective clinical radiobiological
analysis was carried out on 116 lesions
treated at the National hospital between
1966 and 1990.
The vigorous statistical analysis of
radiation effects in both tumour and
normal tissue included frequency
dis ributions, regression analysis; the
5
Chi -test and Fischerrs exact test.
Treatment variables analyzed included
total dose, dose per fraction, treatment
time and field size for various levels of
tumour response. The predictive
abilities of time-dose models (TDF, CRE
and LQ) were also analyzed.
Both dose per fraction and treatment time
influenced the outcome of treatment.
Fractions > 600 cGy were more effective
and radiotherapy should be completed in
21 days. The Bloemfontein melanoma
alphalbeta value is 4,06 Gy and target
ETD for complete response 84,35 Gy. Late
normal tissue effects (necrosis,
fractures and fibrosis) occurred in 14,66
% of the treated lesions.
Iso-effect tables for the fraction range
600 - 900 cGy have been developed
together with the expected normal tissue
effects using SRE and DS values.
CLINICALLY UNEXPECTED PATENT DUCI'US
ARTERIOSUS
A D Bruwer T J van der Meme
Dept. Paediatric Cardiology, UOFS, Bloemfontein
INTRODUCTIONt In four children evaluated for a
cardiac murmur, a patent ductus arteriosus (PDA) was
found 11nexpeetedly.
Although haernodynamically not significant, these
lesions were corrected, three surgically and one by
catheter occlusion as there is a risk for infective
endoearditis.
METHOD: The patients were evahreted clinically, by
ECG, X-ray chest, echocardioeraphieally (colour and
pdsed doppler) and by heart catheterization.
l. CLINICAL
Clinical findings, ECG and chest X-ray changes
indicated the following:
CASES land2 : Innocent murmurs (Still's
murmurs)
CASE 3 : Atrial septal defeet
CASE 4 : Bicuspid aortic valve
2. ECHOCARDIOGRAPHY
An advanced technical laboratories ultnunark 9 system,
capable of eolour as well as pulsed doppler studies,
confirmed the presence of an ostinm seeundum atrial
septal ddeet in case 3 and a bicuspid aortie valve in
case 4. The other hvo patients hearts were structurally
normal. In all four cases abnormal colour flow and
pulsed doppler patterns were seen in the main
pulmonary artery and were interpreted as being due to
PDA flow.
3. CARDIAC CATHETERIZATION
No haernodynamic changes which could be ascribed to
a PDA were found. Anpography, however,
demonstrated a small left to nght shunt through a
ductus arteriosus in all four cases.
CONCLUSION; Echocardiography with colour
doppler is in this situation, a sensitive non invasive
diagnostic aid. Even if not haemodynamically
si@cant, a small PDA can, if not ligated, be
complicated by inlective endocarditis. Although not
cost effective, the use of echocardiography with colour
doppler in the evaluation of children with innocent
murmurs is of value.
CELL PROCESSES AND JUNCTIONS IN SQUAMOUS
EPITHEUAL CELLS OF THE CERVUC
L W,* L Sc$ort4,* AM. Engelbrechf* S. Cooper,'
andLdeWrtt DeparbTlentofAnatomyandCell
Morphology and '~epartment of Anatomical Pathology,
Universii of the O.F.S.. BloemfwMi.
~otphol&kal altdns characteristically occur during
transformation of normal cells to modastic cells. This studv
fowsses on the presence of mothdim cell p-,
presumably as a pielude to cell iniqrationyand ahations in
cell iunctions. characteristic of cell mfi'ttration in carcinomas.
A fairly full &count on filowdia and desmosome numbers,
as W& as desmosome mksurernents, is presented here m
premalignant and malignant squatnous epithelia1 cells of the
Cervix.
PATIENTS AND Mm10DS: Normal tissues, prernaliiant
tissues from cervical intraepithelial neoplasia (CIN It) and
malignant tissues from carcinomas (stage I1 l b) were
prepared for a transmission electron microscopic survey.
Biopsies (n=6) from each grwp were selected. Small
pieces of tissue were immersersmib