Browsing by Author "Van der Walt, J. J."
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- ItemCardiac involvement in mixed connective tissue disease : a fatal case of scleroderma combined with systemic lupus erythematosus(Health and Medical Publishing Group (HMPG), 1985-10) Przybojewski, J. Z.; Mynhardt, J. H.; Van der Walt, J. J.; Tiedt, F. A. C.A 27-year-old black woman with cardiac failure, angina pectoris and Raynaud's syndrome is presented. Skin biopsy and barium studies established the diagnosis of scleroderma (progressive systemic sclerosis (PSS)). Systemic lupus erythematosus (SLE) was strongly suggested by the results of immunological studies and increasing severity of renal failure. Because of the possibility of a cardiomyopathy, cardiac catheterization, selective coronary angiography and right ventricular endomyocardial biopsy were carried out but failed to show any histological features of either SLE or PSS. The patient went into progressive renal failure despite immunosuppressive therapy and plasmapheresis and died; consent for autopsy was refused. A final diagnosis of mixed connective tissue disease (MCTD) was made. The salient features of cardiac involvement in SLE, PSS and MCTD are outlined.
- 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.
- ItemHemangiosarkoom van die bors : 'n gevallestudie en oorsig van die literatuur(Health and Medical Publishing Group (HMPG), 1975) Van Zyl, J. A.; Van der Walt, J. J.; Van Zyl, J. J. W.In this case of angiosarcoma of the breast in a 55 yr old woman, the time from treatment to death was 41 mth, compared with 25 mth in collected cases from the literature. The possible value of adjuvant chemotherapy is recalled. In this case Endoxan (cyclophosphamide) was tried in a dosage of 10 mg/kg body weight i.v.
- ItemHypertrophic cardiomyopathy complicated by complete heart block : case report and review of the literature(Health and Medical Publishing Group -- HMPG, 1984-12) Przybojewski, J. Z.; Van der Walt, J. J.; Ellis, G. C.; Tiedt, F. A. C.A 48-year-old man with symptoms of presyncope and congestive cardiac failure had hypertrophic cardiomyopathy (HCM) without obstruction. Complete heart block (CHB), a rare complication of this disease, was preceded by complete left bundle-branch block. Right ventricular (RV) heart failure was a dominant clinical feature but improved dramatically after temporary transvenous RV pacing prompting the insertion of a permanent RV inhibited pacemaker. Repeated ventricular fibrillation was successfully controlled by amiodarone. This is the 7th case of HCM complicated by CHB reported in the literature, and the first in which RV endomyocardial biopsies were undertaken. Two other patients reported in the literature had RV inhibited permanent pacemakers implanted, and a further 2 had atrioventricular sequential pacemakers.
- ItemHypertrophic obstructive cardiomyopathy with pseudo-myocardial infarction pattern. A case report(Health & Medical Publishing Group, 1986-6) Przybojewski, J. Z.; Van der Walt, J. J.; Tiedt, F. A. C.ENGLISH ABSTRACT: A 60-year-old woman with mild hypertension and presumed ischaemic heart disease was followed up over a very long period on account of angina pectoris. Acute myocardial infarction (MI) was suspected on the basis of the history, ECG findings and serum enzyme values, but disproved by radio-isotope investigation. Echocardiography demonstrated features of hypertrophic obstructive cardiomyopathy (HOCM), a diagnosis supported by cardiac catheterization and endomyocardial biopsy (EMB). Histological features of HOCM were absent from left ventricular EMB specimens despite a significant intraventricular gradient, but the right ventricular EMB demonstrated extensive changes of HOCM despite a small intraventricular gradient. Cardiac catheterization excluded previous MI and coronary artery disease. A further interesting feature was the development of congestive cardiac failure, which necessitated modification of her drug therapy).
- ItemInterstitial lung disease. Part I. A multidisciplinary approach to the diagnosis and assessment of disease activity(Health & Medical Publishing Group, 1980) Joubert, J. R.; Rossouw, D. J.; Van der Walt, J. J.The value of alveolar lavage as an investigative technique was determined in patients with interstitial lung disease. Alveolar cytology was related to defined histopathological degrees of disease activity found in transbronchial biopsy specimens. The degree of disease activity as assessed by these two techniques was compared with radiological evaluation. Adequate specimens of lung tissue for histopathological evaluation were obtained by transbronchial biopsy in 95% of the subjects during the first procedure and diagnostic histopathological changes were found in 60% of the patients. In the evaluation of disease activity, the lymphocyte-macrophage (L-M) ratio and, to a lesser extent, the total alveolar cell counts correlated well with graded histopathological changes of activity. A graded radiological evaluation of activity was accurate in 14 out of 17 patients, but in 3, extreme cellular disease was not recognized. Alveolar cytological examination can be employed as a supplement to the biopsy technique for increased accuracy in the initial and follow-up evaluation of active interstitial lung disease. An approach combining transbronchial biopsy, alveolar lavage and radiography, provides a safe and accurate alternative to open lung biopsy in most patients for determining the aetiology and degree of activity of interstitial lung disease.
- ItemMitral valve prolapse complicated by acute cerebral embolism, arrhythmias and painless myocardial infarction : a case presentation and overview(Health & Medical Publishing Group, 1984) Przybojewski, J. Z.; Tredoux, J. G.; Van der Walt, J. J.; Tiedt, F. A. C.A case of 'primary' mitral valve prolapse is documented. The patient was admitted with right-sided hemiplegia of sudden onset, probably caused by a cerebral embolus from the mitral valve. He also had a painless transmural inferior myocardial infarction (MI) of indeterminate age which was diagnosed electro cardiographically and on left ventricular cine angiography. Since selective coronary arteriography delineated the absence of fixed obstructive atherosclerotic disease, and since coronary vasospasm could not be provoked with the ergonovine (ergometrine) maleate test, it is further postulated that a coronary embolus from the abnormal mitral valve apparatus was responsible for the painless MI. A percutaneous right ventricular endomyocardial biopsy specimen displayed findings not indicative of a 'cardiomyopathy'.
- ItemPatogenese van murale trombi idiopatiese kardiomiopatie(Health and Medical Publishing Group (HMPG), 1975) Van der Walt, J. J.Hearts from 32 patients with idiopathic cardiomyopathy were examined postmortem. A comparative morphological study of the human hearts and of hearts from cardiomyopathic hamsters, rabbits and baboons indicates that severe cardiac dilatation with intracavitary stasis and abnormal turbulent blood flow are the most important factors in the pathogenesis of mural thrombi in idiopathic cardiomyopathy.
- ItemPrimary cardiac amyloidosis : a case presentation(HMPG, 1980-05) Przybojewski, J. Z.; Daniels, A. R.; Van der Walt, J. J.A young man with primary cardiac amyloidosis presented clinically as a case of 'restrictive' cardiomyopathy with an initial diagnosis of constrictive pericarditis, probably of tuberculous origin. Cardiac catheterization showed features compatible with restrictive cardiomyopathy or constrictive pericarditis but pericardial biopsy was negative. Percutaneous right ventricular endomyocardial biopsies established amyloid infiltration of the myocardium, but rectal, tongue and liver biopsies were all negative for amyloidosis. Benze-Jones protein was absent from the urine. Serum electrophoresis, and bone marrow examination all failed to detect possible multiple myelomatosis as a cause of secondary amyloidosis. Respiratory function tests showed a restrictive picture, probably secondary to chronic congestive cardiac failure. Thus, this case is the second example of primary cardiac amyloidosis in the world literature which has been diagnosed by right ventricular endomyocardial biopsy. Phonocardiographic features of early aortic valve closure are reported for the first time in amyloid restrictive cardiomyopathy. Since tuberculous constrictive pericarditis is an important cause of cardiac disease in this country, with effective therapy, the authors stress more frequent use of endomyocardial biopsy as a safe diagnostic tool to exclude other similar disease states. The patient was offered the possibility of a cardiac transplantation in view of the localized nature of his disease, but refused. He now continues to respond unsatisfactorily to antifailure therapy with, presumably, a poor prognosis.
- ItemPrimary cardiac amyloidosis : a review of the literature(HMPG, 1980-05) Przybojewski, J. Z.; Daniels, A. R.; Van der Walt, J. J.A review of the literature on primary cardiac amyloidosis is presented. Its differentiation from constrictive pericarditis, both on clinical and hemodynamic grounds, is outlined. The importance of antemortem endomyocardial biopsy in establishing a definitive diagnosis of this relatively rare condition is stressed. Finally, an updated overview of the classification and immunological pathogenesis of this disease is given.
- ItemProgressive familial heart block type I : clinical and pathological observations(Health & Medical Publishing Group, 1991) Van der Merwe, P.-L.; Rose, A. G.; Van der Walt, J. J.; Weymar, H. W.; Hunter, J. C.; Weich, H. F. H.Progressive familial heart block type I (PFHB-I) is an autosomal inherited disease. It was previously postulated that the disease is limited to the cardiac conduction tissue. The presentation of a patient with dilated cardiomyopathy focused on the possibility that this might be part of PFHB-I. This observation led to routine echocardiographic examination of patients with complete heart block, who belonged to PFHB-I families, and another 5 cases with signs of dilated cardiomyopathy were identified. This is the first time, to our knowledge, that the histological picture of PFHB-I has been described. From these case reports it is clear that in the presence of a dilated cardiomyopathy the prognosis in PFHB-I tends to be poor.
- ItemPseudoxanthoma elasticum with cardiac involvement : a case report and review of the literature(HMPG, 1981-02) Przybojewski, J. Z.; Maritz, F.; Tiedt, F. A. C.; Van der Walt, J. J.A young Black man with many features of pseudoxanthoma elasticum (PXE), confirmed by skin biopsy, complained of classic angina pectoris, decreasing effort tolerance, and palpitations. Clinically he was in severe congestive cardiac failure which was confirmed by echocardiography and cardiac catheterization, investigations which indicated the presence of a 'congestive' cardiomyopathy. Selective coronary arteriography showed normal epicardial vessels. Antemortem endomyocardial biopsy in this condition is described for the first time in the literature. This showed abnormal light microscopic and electron microscopic features. It is postulated that the predominant cause of congestive cardiac failure and angina pectoris in this disease is a diffuse arteriopathy secondary to elastic fibre dysgenesis, involving the small intramural coronary vessels ('small-vessel disease'). Hitherto it has been accepted that the endocardial changes have been most important in the pathophysiology. A review of the literature as it applied to cardiac involvement in PXE is undertaken.
- ItemRupture of sinus of Valsalva aneurysm into both right atrium and right ventricle : a case report(Health and Medical Publishing Group -- HMPG, 1983-04) Przybojewski, J. Z.; Blake, R. S.; De Wet Lubbe, J. J.; Rossouw, J.; Van der Walt, J. J.A young man had a congenital sinus of Valsalva aneurysm originating from the right coronary sinus, complicated by fistulas draining into both right atrium and right ventricle, as well as congenitally abnormal aortic valve with mild aortic insufficiency. His dramatic clinical presentation, with the sudden appearance of severe biventricular cardiac failure unresponsive to intensive medical therapy, was an important clue to making the correct pre-operative diagnosis. The use of non-invasive techniques, such as phonocardiography and M-mode and two-dimensional echocardiography, is highlighted. Full cardiac catheterization was employed to define the cardiac pathophysiology. This was one of the few cases documented in which a catheter could be passed from the aorta into the right ventricle via the fistula connecting these two chambers. The fistulas were closed and the aortic valve replaced. Postoperative investigations confirmed the success of corrective surgery. As far as we are aware this is the first documented case of successful repair of a congenital sinus of Valsalva aneurysm rupturing into both the right atrium and right ventricle, accompanied by aortic insufficiency.
- ItemA study of a family with inherited disease of cardiac and skeletal muscle. Part I. Clinical, electrocardiographic, echocardiographic, haemodynamic, electrophysiological and electron microscopic studies(HMPG, 1981-03) Przybojewski, J. Z.; Hoffman, H.; De Graaf, A. S.; Van der Walt, J. J.; Tiedt, F. A. C.; O'Kennedy, A.; Torrington, M.; Lochner, A.; Hewlett, R.A family consisting of parents and their 6 sons were investigated to elucidate the relationship between a hypertrophic cardiomyopathy, musculoskeletal abnormalities and mental subnormality. The proband was diagnosed as having definite hypertrophic obstructive cardiomyopathy and the remaining family members were shown to have a spectrum of hypertrophic non-obstructive cardiomyopathy. Mild muscle weakness was present in 3 sons. All the subjects except for 1 son showed definite signs of electromyographic abnormality, whereas sensory and motor conduction velocities were normal. All the EEGs except for that of the proband were normal. Testicular hypoplasia was present in 3 sons. The inheritance pattern appears to be polygenic autosomal recessive in type. Definite evidence of linkage between hypertrophic cardiomyopathy and HLA awaits further data.
- ItemA study of a family with inherited disease of cardiac and skeletal muscle. Part II. Skeletal muscle morphology and mitochondrial oxidative phosphorylation(Health and Medical Publishing Group -- HMPG, 1981-03) Lochner, A.; Hewlett, R. H.; O'Kennedy, A.; Van der Walt, J. J.; Tiedt, F. A. C.; Hoffman, H.; De Graaf, A. S.; Przybojewski, J. Z.; Torrington, M.Skeletal muscle morphology and mitochondrial oxidative phosphorylation capacity were examined in a family whose members showed varying combinations of mental subnormality, cardiomyopathy and muscle weakness. Light and electron microscopic findings suggested a neuropathic process, while tests of mitochondrial function indicated a state of tight coupling of oxidative phosphorylation, a feature in marked contrast to those in biochemical studies so far reported.
- ItemA study of a family with inherited disease of cardiac and skeletal muscle. Part III. Genealogical considerations and associations with low intelligence(Health and Medical Publishing Group -- HMPG, 1981-03) Torrington, M.; Przybojewski, J.,Z.; Hoffman, H.; De Graaf, A. S.; Hewlett, R.; Lochner, A.; O'Kennedy, A.; Tiedt, F. A. C.; Van der Walt, J. J.A family with inherited cardiac and skeletal muscle disease was also found to have members with low intelligence. The effects of social and environmental conditions upon the behaviour of family members are described, with particular attention to the sociomedical problems created by the combination of a hereditary disease and low intelligence.
- ItemSystemic sporotrichosis. Pulmonary complications of a well-known cutaneous fungal disease : a case report(Health & Medical Publishing Group, 1982) Matthews, H. J.; Joubert, J. R.; Truter, F. C.; Van der Walt, J. J.Pulmonary involvement during Sporotrichium schenkii infection can present as either primary pulmonary or systemic disease. The clinical and radiological features in the primary form closely resemble those of adult-type tuberculosis. On clinical, radiological and histopathological grounds pulmonary involvement during systemic spread can be difficult to distinguish from sarcoidosis. The diagnostic and therapeutic problems encountered in a woman with systemic sporotrichosis infection with pulmonary involvement are described.
- ItemUnstable angina pectoris secondary to multiple calcified coronary artery masses : successful treatment with coronary artery bypass surgery(Health & Medical Publishing Group, 1986) Przybojewski, J. Z.; Barnard, P. M.; Van der Walt, J. J.; Botha, J. A.A 31-year-old doctor's wife suffered from severe unstable angina pectoris (AP) due to two large, heavily calcified masses involving the right coronary artery and the left anterior descending branch of the left coronary artery. The causes of the masses could not be determined with certainty, but in view of the history (which included the ingestion of large quantities of raw boerewors (traditional spiced sausage) and histopathological findings, we believe that they were coronary artery aneurysms which developed secondary to coronary arteritis many years previously. The possibility of echinococcal (hydatid) infection is also discussed. Cardiac surgery entailed total excision of both masses, together with sections of their accompanying coronary arteries which had become fibrotic as a result of the arteritis, and reestablishment of coronary blood flow by the insertion of two saphenous vein coronary artery bypass grafts. Her AP was dramatically relieved and she continues to be asymptomatic without taking anti-anginal drugs.