Browsing by Author "Van der Walt, J. J."
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- 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.
- 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.
- 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.
- 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.