Research Articles (General Internal Medicine)
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- ItemAbnormal serum lipoprotein levels as a risk factor for the development of human lenticular opacities(Clinics Cardiv Publishing, 2003-04) Meyer, D.; Parkin, D.; Maritz, F. J.; Liebenberg, P. H.Aim: To determine whether an association exists between the different plasma lipoprotein constituents and the prevalence of lenticular opacities in dyslipidaemic subjects. Methods: Adult patients (n = 115) of both genders were included if their fasting total serum cholesterol concentrations exceeded the 95th percentile of normal or their serum low-density lipoprotein (LDL) : high-density lipoprotein (HDL) ratios exceeded 5. Patients were excluded if they suffered from any condition known to cause, or predispose them to, elevated lipoprotein levels or lenticular opacification. Lenticular changes were assessed by means of a slit-lamp through the fully dilated pupil. Results: An extremely strong association (p < 0.0001) was found to exist between HDL cholesterol levels and the development of lens opacities. Below an HDL-C level of 1.5 mmol/l subjects had a seven-fold higher calculated probability of falling in the lens opacity subgroup than those with HDL-C levels above 1.5 mmol/l [odds ratio = 7.33 (95% CI = 2.06–26.10; p = 0.001)]. An equally strong association was found between high (>5) LDL:HDL ratios and the development of lens opacities (p < 0.0003). The risk of falling into the cataract subgroup if the individual’s LDL:HDL ratio exceeded 5 was 2.35 (95% CI = 1.09–5.04; p = 0.014). Conclusions: This study strongly suggests that an association exists between low levels of HDL cholesterol and high LDL:HDL ratios on one hand and the development of adult lens opacification on the other.
- ItemAcute coronary thrombus formation after stress testing following percutaneous transluminal coronary angioplasty : a case report(Health and Medical Publishing Group -- HMPG, 1985-03) Przybojewski, J. Z.; Weich, H. F. H.Successful percutaneous transluminal coronary angioplasty (PTCA) was performed on a 37-year-old white man with an isolated 95% right coronary artery stenosis who initially presented with type II unstable angina. Submaximal treadmill stress testing was not carried out before PTCA, but testing 3 days after PTCA was strongly positive without accompanying symptoms of myocardial ischaemia. Some 30 minutes after this test the patient experienced severe precordial pain with features of a hyperacute transmural inferior myocardial infarction. Immediate coronary arteriography delineated fresh thrombus related to the previous PTCA site. Intracoronary thrombolysis with streptokinase was successful, revealing an underlying severe stenosis at the PTCA site. PTCA was not repeated, nor was emergency coronary artery bypass grafting (CABG) performed. This is the second such case documented in the literature; the first patient failed to respond to intracoronary thrombolysis with streptokinase and was submitted to emergency CABG. The possible underlying pathophysiological mechanisms are discussed. We believe that the late thrombus formation was directly related to submaximal stress testing after successful PTCA, and recommend that testing to assess the efficacy of PTCA be deferred until at least 1 month after the procedure to allow for completion of the healing process.
- ItemAcute renal failure in the medical ICU still predictive of high mortality(Health and Medical Publishing Group (HMPG), 2009) Friedericksen, D. V.; Van der Merwe, L.; Hattingh, T. L.; Nel, D. G.; Moosa, M. R.Background. We aimed to determine the outcome and certain predictors of outcome for acute renal failure (ARF) in the medical intensive care unit (ICU) at Tygerberg Hospital. Method. We conducted a retrospective, single-centre cohort study over 12 months comprising all patients admitted to the medical ICU with all causes of renal failure or who developed renal failure following admission to the ICU. Results. Of 198 medical patients admitted to the ICU, ARF occurred in 46 (23.2%). The leading cause of ARF was acute tubular necrosis. The ICU mortality for ARF patients was 47.8%, compared with 17.5% in ICU patients without ARF. Acute haemodialysis was performed in only 17.3% of the 46 ARF patients. Using Cox proportional hazard regression, we found that mean duration of stay (p<0.001), acute physiology and chronic health evaluation II (Apache II) score (p<0.001), mechanical ventilation (p<0.01), dialysis (p<0.04) and multiorgan failure (p<0.05) affected survival time. Conclusions. We found that ARF is still associated with a high mortality rate and longer duration of stay, higher Apache II score, and need for mechanical ventilation; dialysis and presence of multi-organ failure were indicators of a higher mortality rate.
- ItemAcute respiratory arrest in status asthmaticus. A report of 2 cases(Health & Medical Publishing Group, 1982-10) Whitelaw, D. A.ENGLISH ABSTRACT: Respiratory arrest is a rare but serious complication of status asthmaticus. Two such cases, which were closely associated with the use of intravenous steroids, are reported. Possible causes for the sudden deterioration of patients in status asthmaticus are discussed.
- ItemAdenosine deaminase activity - more than a diagnostic tool in tuberculous pericarditis(Clinics Cardiv Publishing, 2005-06) Reuter, Helmuth; Burgess, Lesley J.; Carstens, Machteld E.; Doubell, Anton F.Aim: To improve the understanding of factors that influence adenosine deaminase (ADA) activity in large pericardial effusions. Methods: A prospective study was carried out at Tygerberg Academic Hospital, South Africa. Patients underwent echocardiographically guided pericardiocentesis. ADA activity, as well as biochemistry, haematology, cytology, and in some cases, histology, were determined. Human immunodeficiency virus (HIV) status was assessed in all patients. Results: Two hundred and thirty-three patients presented to Tygerberg Hospital with large pericardial effusions requiring pericardiocentesis. Tuberculous pericarditis accounted for 162 effusions (69.5%). An ADA cut-off level of 40 U/l resulted in a test sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic efficiency of 84.0%, 80.0%, 91.0%, 66.0% and 83.0%, respectively. Pericardial exudates with an ADA activity ≥ 40 U/l were associated with increased total leukocyte and neutro - phil counts. Patients with tuberculous pericarditis and ADA ≥ 40 U/l also had increased lymphocyte counts. Pericardial ADA activity < 30 U/l was associated with severe depletion of CD4 cell counts in HIV-positive patients. ADA levels were higher in cases with histological evidence of granulomatous inflammation than in cases with serofibrinous pericarditis. Conclusions: An ADA cut-off level of 40 U/l results in best diagnostic test results. ADA production appears to be influenced by factors associated with the antituberculous immune response.
- ItemThe adult respiratory distress syndrome in association with diabetic keto-acidosis: A case report(Health & Medical Publishing Group, 1987-04) Botha, J.; Van Niekerk, D. J. T.; Rossouw, D. J.; Stewart, R. I.ENGLISH ABSTRACT: A 41-year-old man presented in stupor, with ketoacidosis and acute severe respiratory failure. He had a history of alcohol abuse and had been on insulin therapy for diabetes secondary to chronic pancreatitis for 11 years. The condition was rapidly progressive and the patient died within 5 hours of presentation of profound hypoxia and hypotension despite aggressive therapy. Autopsy confirmed the clinical diagnosis of 'shock lung'. None of the more commonly associated precipitating factors of adult respiratory distress syndrome could be detected clinically or at autopsy and the pathogenesis of the condition remains elusive.
- ItemAlterations of bone and mineral metabolism in diabetes mellitus : Part II. Clinical studies in 206 patients with type I diabetes mellitus(Health and Medical Publishing Group -- HMPG, 1987-07) Hough, F. S.This study reports a 22% prevalence of significant cortical osteopenia in 206 patients, aged 7 - 20 years, with established insulin-dependent diabetes mellitus (IDDM). A parallel decrease in trabecular bone mass was also noted. Bone loss was more evident in males (16%) than in females (6%) and was rare before 10 years of age (3%). No relationship between bone loss and the duration of diabetes, degree of metabolic control or diabetic complications was apparent. Delayed skeletal maturation did not account for cortical thinning, and the mean bone age of osteopenic diabetics was similar to that of non-osteopenic diabetics. There was no significant correlation between HLA-antigen frequency and the predisposition to diabetic osteopenia. Metabolic alterations comparable with previous findings in the chronically diabetic rat were documented in IDDM. The data documented are consistent with the conclusion that IDDM results in intestinal hyperabsorption of calcium, absorptive hypercalciuria, phosphaturia, hypomagnesaemia, hyperphosphatasaemia, and decreased circulating parathyroid hormone levels. These alterations in mineral metabolism may relate to the decrease in cortical and trabecular bone mass observed in patients with IDDM.
- ItemAnterior myocardial infarction with coronary thrombus formation secondary to acute coronary vasospasm: A case report(Health & Medical Publishing Group, 1986-11) Przybojewski, J. Z.; Vogts, B. C.; Myburgh, D. P.ENGLISH ABSTRACT: An acute myocardial infarction in a young man when there was no fixed atherosclerotic lesion in the coronary arteries is reported. Soon after the myocardial infarction the patient was shown to have thrombosis in the anterior descending branch of the left coronary artery but this later disappeared. In view of recurrent angina pectoris, provocation tests were undertaken with ergometrine maleate, cold pressor and hyperventilation. Both the drug and the hyperventilation provoked coronary spasm accompanied by angina pectoris but no EGG evidence of ischaemia.
- ItemAtrial fibrillation - an old problem and an old solution(Health & Medical Publishing Group, 1992-04) Whitelaw, D. A.ENGLISH ABSTRACT: Atrial fibrillation (AF) is a common arrhythmia affecting approximately 0,4% of the adult population. Prevalence rises to 2 - 4% in individuals over 60 years of age. There are many causes of AF, rheumatic heart disease being one of the more prominent. The combination of rheumatic heart disease and AF is associated with a 17-fold increase in the rate of cerebrovascular accidents compared with the rate in those individuals who do not have valvular disease and who are in sinus rhythm.
- ItemBeginsels onderliggend tot die nuwe curriculum van die geneeskundige fakulteit van die Universiteit van Stellenbosch(Health & Medical Publishing Group, 1973) Brink A. J.After thorough preparation a new curriculum for the training of medical practitioners was framed. The new syllabus aims at accomplishing the greatest degree of integration and coordination, to accentuate the principles of medicine and to stimulate further self education. Four basic subjects are completed at the end of the 1st year, two at the end of the 2nd year, and two after the first semester of the 3rd year. No further examinations are conducted over the next 2.5 yr. At the conclusion of the 5th year, an examination stressing theory is taken, and in the 6th year another, stressing practical and clinical efficiency; and after this the M.B. Ch.B. is awarded. At the end of the 7th year an evaluation is made.
- ItemBensarazid with L dopa in the treatment of Parkinson's disease(Health & Medical Publishing Group, 1974-02) Van Wieringen, A.ENGLISH ABSTRACT: A short review is given of the pharmacokinetics and pharmacodynamics of the decarboxylase inhibitor Ro 4-4602. The results obtained in 20 patients using this drug in combination with L dopa, are described. Reduction in the total dosage of L dopa by 1/6 to 1/10 the single preparation gave marked relief of nausea. The induction period of the dosage was smoother, and an optimum dose could be reached sooner with earlier signs of improvement in comparison with the single drug.
- ItemBeta-blockers and the treatment of hypertension : it is time to move on(Clinics Cardiv Publishing, 2007-12) Wiysonge, Charles Shey; Volmink, Jimmy; Opie, Lionel H.Existing solid scientific evidence with hard outcome data should be the basis for treatment guidelines, and where such evidence is lacking, we must invest in research. A case in point is the initiation of antihypertensive treatment with a beta-blocker. Beta-blockers are pharmacological agents that block the action of endogenous catecholamines on beta-adrenergic receptors, part of the sympathetic nervous system which mediates the ‘fight or flight’ response.
- ItemBinneaarse radio-isotoop angiografie karotis-kaverneuse fistels(Health and Medical Publishing Group (HMPG), 1975) Van Heerden, P. D. R.; Rose Innes, A. P.; Klopper, J. F.The use of intravenous radio isotope angiography in 3 cases of unilateral carotid cavernous sinus fistula is described. The lesion gives a characteristic image pattern distinguishable from that of arteriovenous malformation in this region. An abnormal registration of intense radioactivity is seen in the early phases, accurately localised to the cavernous sinus, with a distinctive sigmoid shaped configuration. Rapid disappearance of this accumulation of isotope follows, accompanied by a paradoxical apparent increase in blood flow to the ipsilateral hemicranium. This is attributed to the massively arterialised venous drainage. This technique of demonstrating the cerebral circulation dynamically is considered a valuable diagnostic supplement to the static scintiscan and to conventional roentgen arteriography in this lesion.
- ItemC Louis Leipoldt and his sexual orientation(Health & Medical Publishing Group, 2005) Kannemeyer, J. C.[No abstract available]
- ItemCan we predict and/or prevent type I diabetes?(Health & Medical Publishing Group, 1990) Sandler, MalcolmThe highest risk for the development of type I diabetes resides with first-degree relatives of the diabetic proband, this risk being in the order of 2.9%, 6.6% and 4.9% for parents, siblings and children of the proband, respectively. The major genetic markers associated with the development of insulin-dependent diabetes mellitus (IDDM) is the possession of the HLA alleles DR3/DR4 and more recently the absence of aspartate in the 57th position on the beta-chain of the HLA DQ gene (HLA DQ beta Asp 57 negative). The most important auto-immune marker for predicting preclinical IDDM is the presence of high titres (greater than 40 Juvenile Diabetes Foundation units) of islet cell antibodies (ICA), while the finding of insulin auto-antibodies (IAA) is a good predictive marker in children less than 5 years of age. The presence in a susceptible individual of ICA plus IAA is a better predictor of impending IDDM than the presence of either of these two markers alone. Antibodies which precipitate an islet membrane protein (MW 64K) are highly sensitive and specific markers of preclinical IDDM. The presence of 64K antibodies may well be the most important predictive marker of impending IDDM in the future. The progressive decline of the first phase of insulin secretion in response to an intravenous glucose challenge is associated with the onset of IDDM within 18 months. Of the immunotherapeutic agents at present used in clinically manifest IDDM, azathioprine has been shown to be ineffective in increasing the remission phase, while the value of nicotinamide is controversial.(ABSTRACT TRUNCATED AT 250 WORDS)
- ItemClinical characteristics of and prognosis in acute transmural anterior, transmural inferior and non-transmural myocardial infarction : a comparative retrospective study(Health & Medical Publishing Group, 1985) Van Rensburg, C. J.; Przybojewski, J. Z.; Soolman, J.This retrospective study was undertaken to determine whether there was any difference in the clinical characteristics of and prognosis in white patients admitted to the Intensive Coronary Care Unit (ICCU) at Tygerberg Hospital with acute non-transmural, transmural anterior and transmural inferior myocardial infarction (MI). The three groups were carefully matched, taking into consideration the possible influence of previous MI and congestive cardiac failure (CCF). There were 187 patients with nontransmural MI, and 176 with transmural anterior and 209 with transmural inferior MI. Patients with acute transmural anterior MI had the worst prognosis while at the ICCU, at 3-months' follow-up and at long-term follow-up (mean 22,2 months). This group had the greatest frequency of CCF, cardiogenic shock, acute pericarditis, ventricular premature beats, ventricular tachycardia, left anterior hemiblock and complete left bundle-branch block and the highest mortality. Acute transmural inferior MI was responsible for the highest frequency of ventricular fibrillation in the ICCU and had a worse prognosis than non-transmural MI. Acute non-transmural MI resulted in the highest incidence of early and late myocardial re-infarction; although death in the ICCU was least frequent, mortality among this group had increased dramatically by 3 months' follow-up. Hence, acute non-transmural MI is not benign and an unstable period exists for 3 months thereafter. Because of this, more aggressive diagnostic measures should be instituted during this period in order possibly to improve prognosis in this group. It would appear that this is the first such study undertaken in South Africa.
- ItemClinical trials in South Africa : need for capacity building and training(Health and Medical Publishing Group (HMPG), 2010) Burgess, L. J.; Sulzer, N. U.
- Item'Coronary intimal fibrous stenosis' - early coronary atherosclerosis causing acute myocardial infarction : a case presentation and overview(Health and Medical Publishing Group -- HMPG, 1982-11) Przybojewski, J. Z.; Van der Walt, J. J.A 34-year-old Coloured man had typical angina pectoris which was unresponsive to medical therapy. There was no history of factors predisposing to atherosclerosis apart from moderate cigarette smoking. A resting ECG suggested a previous nontransmural anterolateral myocardial infarction, and a submaximal effort test was strongly positive for myocardial ischaemia. Serological investigation for syphilis was positive, and initially the possibility that coronary ostial stenosis was the cause of his symptoms was strongly considered. Cardiac catheterization and selective coronary angiography showed evidence of an anterolateral myocardial infarction and that there was no coronary ostial stenosis, but total occlusion of the left anterior descending coronary artery (LAD) proximally with retrograde filling from the right coronary artery was revealed. The left circumflex coronary artery also showed some insignificant internal luminal irregularities. The patient was subjected to coronary artery bypass graft (CABG) surgery with saphenous grafts to the proximal LAD as well as its first diagonal branch. Proximally the LAD was a firm fibrotic cord; biopsy specimens were taken from this as well as part of the adjacent myocardium and aorta. The artery showed severe fibrous proliferation of the intima without any calcium or lipid deposits, which would have been expected with atherosclerosis, as well as an organized thrombus. There were no signs of cardiovascular syphilis. The patient made quite a dramatic recovery with disappearance of the angina and improved results on submaximal stress testing. A month later cardiac catheterization showed improved segmental anterolateral contractility of the left ventricle as well as patency of both CABGs. Some 3 months postoperatively he again complained of angina, which gradually worsened on treatment. Stress testing again showed significant ischaemia and a second postoperative cardiac catheterization 10 months after surgery showed both CABGs to have occluded. The patient, who is on medication, is being followed up. A pathological diagnosis of early coronary atherosclerosis was made. This lesion has been previously termed 'coronary intimal fibrous stenosis' as the authors concerned did not believe that it was due to coronary atherosclerosis. Ours is the third such case documented in the literature. Reference to earlier literature on coronary atherosclerosis confirms that this histological picture is in keeping with the early phase of this disease. The 'classic' features of coronary atherosclerosis may not have been evident on account of the patient's dietary habits, which may prove to be the important pathological differentiating feature in our White and Coloured population groups.
- ItemCutaneous reaction to zinc - a rare complication of insulin treatment. A case report(Health & Medical Publishing Group, 1989) Sandler, M.; Jordaan, H. F.A diabetic patient presented with furunculoid lesions at the sites of insulin injections. These lesions were diagnosed as representing a manifestation of a cutaneous reaction to the zinc component of an intermediate-acting insulin. The differential diagnosis of furunculoid lesions in insulin-dependent diabetic subjects is discussed.
- ItemDie Rehabilitasie van Pasiente met Serebrovaskulere Ongelukke(Health & Medical Publishing Group, 1978) Van W-Van Der Colf, C.; Wicht C. L.; Willers E.A rehabilitation programme for patients with cerebrovascular accidents is outlined. The effectiveness of this programme was assessed in 220 patients transferred from Tygerberg Hospital to Goodwood Aftercare Hospital during the past 4 years. They were accepted after the acute phase and when the strokes were completed. The results of rehabilitation were judged by evaluating activities of daily living, namely eating, washing and dressing, and factors such as mobility and use of an affected hand, sphincter control, and ability to communicate. Other factors used to evaluate the rehabilitation programme were complications during treatment and eventual placing of the patients. Of 130 patients (72.6%) who were bedridden on admission, 62 (34.6%) could walk unaided and 46 (25.7%) could walk with aid after discharge. Thus, 108 patients (60.3%) could walk, either with or without aid. Thirty-six patients (20.1%), in whom stroke rendered their upper limbs useless, regained the use of their hands. On admission 90 patients (50.2%) were incontinent of urine, and 82 (45.8%) were faecally incontinent. On discharge the figures were 45 (25.1%) and 29 (16.2%) respectively. Dysphasia was present in 56 patients of whom 24 (37.5%) improved on therapy. Thirty-eight patients were admitted with dysarthria, of whom 26 (68%) either recovered or improved. On admission 35 of the survivors (19.6%) could eat independently, and on discharge 121 patients (67.6%) could eat unaided. Only 17 patients (9.5%) were independent as far as washing and dressing were concerned, but on discharge 77 (43%) could wash and 75 (41.9%) could dress without aid. During the rehabilitation phase 41 of the 220 patients admitted (18.6%) died. Deep venous thrombosis occurred in 28 patients (12.7%) and clinically diagnosed pulmonary embolism in 4 (1.8%). Urinary tract infections presented a problem in patients with indwelling catheters. Reactive depression was a major problem. Subluxation of the hemiplegic shoulder occurred in 32 patients (17.6%). No new decubitus ulcers developed. On discharge 29 of the 114 patients who returned to their previous homes needed some form of help. Thirty-one were placed in old-age homes with nursing care and 9 in private nursing homes. A total of 25 were admitted to institutions for chronically ill or terminal-care patients.