General Internal Medicine

Permanent URI for this community

https://scholar.sun.ac.za/handle/10019.1/161

Browse

Now showing 1 - 20 of 165

Abnormal 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.
Acute 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.
Acute coronary vasospasm secondary to industrial nitroglycerin withdrawal : a case presentation and review
(Health and Medical Publishing Group -- HMPG, 1983-01) Przybojewski, J. Z.; Heyns, M. H.
A Black employee exposed to industrial nitroglycerin (NG) in an explosives factory presented with severe precordial pain. The clinical presentation was that of significant transient anteroseptal and anterolateral transmural myocardial ischaemia which responded promptly to sublingual isosorbide dinitrate. Despite being removed from exposure to industrial NG and receiving therapy with long-acting oral nitrates and calcium antagonists, the patient continued to experience repeated attacks of severe retrosternal pain, although transient myocardial ischemia was not demonstrated electrocardiographically during these episodes. Cardiac catheterization revealed a normal myocardial haemodynamic system and selective coronary arteriography delineated coronary arteries free from any obstructive lesions. An ergonovine (ergometrine) maleate provocative test failed to elicit coronary artery spasm, although this was undertaken while the patient was on nitrate and calcium-blocker therapy. Clinical records of previous significant constrictive pericarditis (probably due to tuberculosis) with resultant abnormalities on the ECG complicated the diagnosis. Evaluation was further hindered by the known 'variant pattern' seen on the ECGs of members of the Black population. We postulate that this patient's clinical features were a direct result of severe vasospasm affecting the left coronary artery; it is also strongly suggested that withdrawal from contact with industrial NG precipitated this potentially lethal coronary vasospasm. The role played by industrial NG in ischaemic heart disease is reviewed, as well as the importance of the 'normal variant pattern' in the assessment of cardiac disease in Black patients. As far as we are aware this is the first time that the use of the ergonovine maleate provocative test has been documented in the industrial NG withdrawal syndrome.
Acute myocardial infarction with a non-diagnostic electrocardiogram : case presentation and overview
(Health and Medical Publishing Group -- HMPG, 1983-12) Przybojewski, J. Z.; Gilburt, S. G. M.
The clinical presentation of a young hypertensive White man with acute high lateral non-transmural myocardial infarction (MI) is documented. This diagnosis was established on the grounds of a history of chest pain, elevated serial serum enzyme levels, technetium-99m pyrophosphate ('hot-spot') scintigraphy, exercise thallium-201 ('cold-spot') scanning, left ventricular cine angiography and selective coronary arteriography. Daily resting 12-lead ECGs failed to demonstrate unequivocal features of acute non-transmural subendocardial MI. The diagnostic difficulties facing the clinician in a case of acute MI associated with a non-diagnostic ECG are stressed, and the ECG features of acute subendocardial MI are reviewed.
Acute 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.
Acute 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.
Adenosine 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.
The 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.
Alterations 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.
Alterations of bone and mineral metabolism in diabetes mellitus. : part I. An overview
(Health and Medical Publishing Group -- HMPG, 1987-07) Hough, F. S.
A critical review of the literature leads to the conclusion that alterations of bone and mineral metabolism occur both in diabetic patients and in animals with experimentally induced insulin deficiency syndromes. The coexistence of juvenile insulin-dependent diabetes mellitus (type 1) and radiological evidence of decreased bone mass (osteopenia) appears to be firmly established. Available data support the view that these patients have an increased propensity to skeletal fracture. Adult-onset, non-insulin-dependent diabetic populations, more heterogenous as regards the type of diabetes, the therapy and the presence of complications or coexistent disease, are characterised by subpopulations with either a decreased, a normal or an increased bone mass. The pathogenesis of diabetic osteopenia is multifactorial. Data obatained from studies employing appropriate animal models of chronic insulin deficiency indicate that various metabolic and hormonal abnormalities may be involved.
Anterior 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.
Ascaris lumbricoides and allergic asthma. A new perspective
(Health & Medical Publishing Group, 1979-10) Joubert, J. R.; De Klerk, H. C.; Malan, C.
ENGLISH ABSTRACT: Infestation of humans with the parasite Ascaris lumbricoides may induce high total serium IgE levels, but the influence of this immunogenic respone on allergic asthma has not been defined. In this study, the specific antiparasitic IgE-mediated response as determined by skin-prick testing was related to the incidence of allergic asthma in Ascaris-infested patients. A limited number - 17% of the non-allergic controls and 51% of the allergic asthmatics - had a clinically detectable immunogenic response to the parasite. The predicted incidence of asthma was significantly higher than the observed incidence in the subjects in whom the Ascaris skin test was positive. This was not found in subjects in whom the Ascaris skin test was negative. Inhalation of Ascaris antigen induced asthmatic reactions in 7 of 8 patients who were Ascaris-positive on skin testing, but not in the negative controls. The groups of patients who repond immunogenically to parasite infestation need to be defined, as they may be predisposed to allergic diseases such as asthma.
The association between tissue non-specific alkaline phosphatase expression and differentiation of mesenchymal stromal cells
(Stellenbosch : Stellenbosch University, 2017-03) Bartlett, Cara-Lesley; Ferris, William F.; Crowther, Nigel J.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine. General Internal Medicine.
ENGLISH SUMMARY: Diseases resulting from the dysregulation of adipocyte and osteoblast differentiation include diabetes type II and osteoporosis. Both adipocytes and osteoblasts are derived from the same progenitor cell type, known as mesenchymal stromal cells (MSCs), which may also differentiate into cells of several mesenchymal lineages. A more detailed understanding of the mechanisms involved in the differentiation of MSCs would provide valuable insight into the underlying causes of, as well as facilitate the development of improved treatments for, diseases related to MSC differentiation dysregulation. Tissue-nonspecific alkaline phosphatase (TNAP) is highly expressed in several tissues including bone tissue, where it has a well-established role in skeletal mineralisation. In recent years TNAP expression has been reported in adipocytes, and has been identified as identical to the stem cell marker, mesenchymal stem cell antigen-1 (MSCA-1). The above findings indicate that TNAP has diverse roles, and may be one of the factors involved in determining the differentiation pathway of MSCs. Previous studies have found that inhibition of TNAP in the mouse preadipocyte cell line, 3T3-L1 resulted in a decrease in lipid accumulation during in vitro adipogenic differentiation, suggesting that TNAP is involved in adipogenesis. In the present study, rat-derived primary MSCs were isolated from bone marrow (bmMSCs) as well as subcutaneous (scADSCs) and peri-renal visceral adipose (pvADSCs) depots, and differentiated in vitro towards either an adipocytic or osteoblastic phenotype. The expression of TNAP was assessed in rat-derived MSCs undergoing both adipogenic and osteogenic differentiation. TNAP expression levels were highest in bmMSCs, followed by scADSCs and pvADSCs, with higher alkaline phosphatase (ALP) activity observed during adipogenesis compared to osteogenesis in all three MSC types. The addition of the reported TNAP inhibitor, levamisole during osteogenesis prevented mineralisation in all MSC types, but had no significant effect on lipid accumulation during adipogenesis. Other reported inhibitors were also examined; Histidine was not successful in reducing lipid accumulation or mineralisation, while Lhomoarginine was able to significantly reduce lipid accumulation in all MSC types. The inhibitor results were not conclusive due to possible off target effects within the cells. Attempts to inhibit adipogenic differentiation by knockdown of TNAP expression in scADSCs using shRNA were not successful, as indicated by the presence of lipid droplets in cells where TNAP-specific shRNA was present. This study also revealed that ALP activity was localised to the membrane of intracellular lipid droplets characteristic of adipocytes, and that the same TNAP mRNA transcript type which is preferentially expressed in bone tissue is also preferably expressed during adipogenic differentiation of bmMSCs and scADSCs, while expression in pvADSCs was below detectable levels. TNAP isoforms differ from one another due to differences in posttranslational glycosylation pattern. Glycosylation differences were observed between bmMSCs differentiated from a naïve state towards an adipogenic, compared to an osteogenic, phenotype. Differences were also observed between scADSCs and bmMSCs when differentiated towards adipocytes. This may indicate that a distinct isoform of TNAP exists in adipocytes. In conclusion, this study confirms earlier findings on the presence of TNAP in adipocytes. Differences in TNAP expression from MSCs isolated from different tissue depots were also discovered. This study provides a characterisation of the role of TNAP in adipogenic differentiation; however, the exact mechanisms remain to be elucidated.
The association between ulcerative colitis and chronic liver disease at Tygerberg Hospital
(Health and Medical Publishing Group -- HMPG, 1982-02) Perold, J. G.; Bezuidenhout, D. J. J.; Erasmus, T. D.; Middlecote, B. D.
Twenty consecutive patients with ulcerative colitis were evaluated at the Gastro-intestinal Clinic, Tygerberg Hospital, with special reference to the biochemical tests and histological findings in the liver. Abnormal liver function tests warrant a liver biopsy, since the underlying liver disease influences the subsequent prognosis and treatment.
Atrial 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.
Auto-amputation of a breast due to ductal carcinoma
(Health and Medical Publishing Group (HMPG), 2008) Van der Bijl, P.
[No abstract available]
Beginsels 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.
Bensarazid 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.
Beta-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.
Binneaarse 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.

Browse

Browsing General Internal Medicine by Title

Results Per Page

Sort Options