Browsing by Author "Du Toit, H. J."
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- ItemAetiology of pulmonary dysfunction in total hip replacement operations: The influence of nifedipine on the factors involved(Health & Medical Publishing Group, 1987-05) Du Toit, H. J.; Macfarlane, C. M.; Taljaard, J. J. F.; King, J. B.; Cooper, R. C.ENGLISH ABSTRACT: Patients undergoing total hip replacement surgery who developed pulmonary dysfunction (PD) demonstrated evidence of a complement activation and increased thromboxane A2 (TXA2) synthesis. In a double-blind study nifedipine (Adalat; Bayer-Miles) was shown to inhibit complement activation and TXA2 synthesis and thus appears to offer protection against PD.
- ItemAnaesthetic management of cerebral artery aneurysms at Tygerberg Hospital, 1980-1982(Health and Medical Publishing Group -- HMPG, 1984-05) Erasmus, F. R.; Du Toit, H. J.; Rose-Innes, A. P.Forty-seven patients were operated on for intracranial artery aneurysms at Tygerberg Hospital, Parowvallei, CP, between January 1980 and December 1982. Problems related to anaesthesia which are peculiar to this condition and the solution thereof are outlined. The importance of meticulous anaesthetic management in the successful recovery of these patients, the majority of whom are young and in the productive phase of their lives, is stressed. A plea is made for increased awareness, early diagnosis and surgical intervention to decrease the high mortality rate associated with this lethal condition.
- ItemEarly recognition of pulmonary dysfunction during intramedullary orthopaedic surgery(Health & Medical Publishing Group, 1982) Du Toit, H. J.; Erasmus, F. R.; Taljaard, J. J. F.Peri-operative partial arterial oxygen tension (Pa(O2)) was monitored in 20 patients undergoing total hip replacement. Three distinct groups emerged on analysis of the arterial oxygen tensions. In group I there was no initial decrease in Pa(O2) but it rose above baseline level towards the end of the procedure. In group II there was a distinct fall in Pa(O2) during the acetabular and femoral stages of the operation. On termination of the procedure Pa(O2) had returned to baseline levels. In group III Pa(O2) values were significantly lower than those in group II during the acetabular and femoral stages and decreased further at the end of the procedure. One patient in group II and 6 in group III developed postoperative pulmonary dysfunction. A progressive deterioration in Pa(O2) during hip replacement without recovery at end of the procedure indicates that the patient is likely to develop postoperative pulmonary dysfunction.
- ItemThe effect of ventilatory patterns on prostacyclin (PGI2) synthesis in the lung(Health & Medical Publishing Group, 1984) Du Toit, H. J.; Erasmus, F. R.; Macfarlane, C. M.; Taljaard, J. F.; Shephard, E. G.; King, J. B.; De Klerk, A. J.Prostacyclin (PGI2) appears to be synthesized in the lungs of man and experimental animals. It has been stated that PGI2 must be regarded as a local hormone that inhibits platelet adhesion to vessel walls only very close to the site of synthesis. The wide range of normal values given for PGI2 may be related to the sensitivity and exclusiveness of the different assay techniques used. In animals, hyperventilation increases PGI2 synthesis by the lung, but in agreement with other authors we demonstrated that hyperventilation did not influence PGI2 synthesis in man. We used a radio-immunoassay technique to estimate PGI2 levels.
- ItemEffects of nifedipine on the peri-operative ECG, as determined by continuous Holter monitoring : a double-blind study(Health & Medical Publishing Group, 1986-03) Du Toit, H. J.; Weich, H. F. H.; Weymar, H. W.; Przybojewski, J. Z.A double-blind study was performed on 50 elderly patients undergoing hip-replacement surgery under general anaesthesia; 26 were given nifedipine and the remaining 24 placebo to determine effects on the continuously monitored (Holter) ECG during the 4 peri-operative days. Drugs were only administered during the latter 3 days of the observation period. Surgery was performed on the morning of the 3rd day. A striking feature was a high incidence of arrhythmias in both groups of patients, a finding previously documented in both 'normal' and elderly people. A decrease in ST-segment changes was expected in the nifedipine-treated patients. An unexpected finding, therefore, was the lack of protection against cardiac ischaemic changes in the nifedipine-treated patients compared with the placebo patients. Interpretation of the ST segment as seen in the Holter-monitored ECG remains controversial. We have no clear explanation for the lack of protection against ischaemic changes. The effects of profound vasodilatation produced by nifedipine in elderly patients subjected to major surgery, general anaesthesia including administration of enflurane, and a variable amount of blood loss in the postoperative period may be important factors. In conclusion, one should perhaps be cautious of nifedipine administration under these circumstances.
- ItemMethylprednisolone and the adult respiratory distress syndrome(Open access journal, 1984-06) Du Toit, H. J.; Erasmus, F. R.; MacFarlane, C. M.; Taljaard, J. J. F.; King, J. B.; De Klerk, A. J.; Elk, E.Total hip replacement was carried out on 22 patients under general anaesthesia. Of these, 10 were pretreated with methylprednisolone (30 mg/kg); 1 of these developed the adult respiratory distress syndrome (ARDS) and had high levels of thromboxane B2 (TXB2) 5 minutes after fixation of the femoral prosthesis and at the end of the operation. The other 12 patients served as controls; 5 of them developed ARDS and had statistically significant higher TXB2 levels than the other 7 control patients who remained well. All patients who did not develop ARDS had low TXB2 levels. TXB2 and β-thromboglobulin levels followed the same trend and there was good correlation (r = 0.6806; P < 0.01) at the end of the operation in the control group patients who developed ARDS. There was no statistical difference in 6-keto-PGF(1α) levels between the patients who developed ARDS and those in the control group who remained well. Steroids reduce arachidonic acid metabolism by inhibiting the release of substrate for cyclo-oxygenase and lipoxygenase activity. Patients prone to ARDS thus benefit from methylprednisolone administration.
- ItemQuadriplegia following venous air embolism during posterior fossa exploration : a case report(Health & Medical Publishing Group, 1983) Du Toit, H. J.; Rose Innes, A. P.; Le Roux, D.; De La Harpe, C. P.A frequent complication of posterior fossa exploration with the patient in the sitting position is venous air embolism. Spinal cord deficits following such a mishap have rarely been reported. We report a case in which a patient who suffered venous air embolism developed quadriplegia from the C6 level. The mechanisms of passage of air into the arterial system are discussed.