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2.
Cardiovasc J Afr ; 22(5): 268-71, 2011.
Article in English | MEDLINE | ID: mdl-21107495

ABSTRACT

We report two rare cases of an anomalous origin of the left pulmonary artery (AOLPA) from the ascending aorta, associated with pulmonary atresia, a ventricular septal defect and a left aortic arch. The cases are unusual because AOLPA is more commonly associated with a right aortic arch and it is more usual for the right pulmonary artery to originate anomalously from the ascending aorta. The pulmonary blood supply to the right lung in both patients was absent and provided instead by major aorto-pulmonary collateral arteries which were stenosed at multiple levels. The AOLPA in both patients originated from the postero-lateral aspect of the ascending aorta just distal to the sino-tubular junction. Only one patient showed the more common association of an unusual aortic arch branching pattern in the form of an anomalous right subclavian artery. Neither patient was in heart failure and the chest X-ray in both revealed differential pulmonary perfusion with prominent vascularity of the left lung. Cardiac catheterisation showed systemic pressures within the anomalous left pulmonary artery. Karyotyping revealed normal chromosomes, and fluorescent in-situ hybridisation done in one patient was negative for chromosome 22q11.2 microdeletion. Both patients have been managed conservatively.


Subject(s)
Abnormalities, Multiple , Aorta/abnormalities , Collateral Circulation , Heart Septal Defects, Ventricular/complications , Pulmonary Artery/abnormalities , Pulmonary Atresia/complications , Pulmonary Circulation , Aorta/diagnostic imaging , Aorta/physiopathology , Aortography , Cardiac Catheterization , Child , Echocardiography, Doppler, Color , Female , Heart Septal Defects, Ventricular/diagnosis , Heart Septal Defects, Ventricular/physiopathology , Humans , Infant , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Pulmonary Atresia/diagnosis , Pulmonary Atresia/physiopathology
3.
SA Heart Journal ; 7(1): 4-9, 2010.
Article in English | AIM (Africa) | ID: biblio-1271315

ABSTRACT

objective: to evaluate paediatric cardiac services in south Africa with respect to referral base; services provided and human resources. study design: A descriptive study design was used. An audit of the referral base; personnel and activity of paediatric cardiac units throughout south Africa was conducted by means of a questionnaire. A specialist from each centre was asked to provide the relevant data. Where accurate data was not available; estimates were provided by practitioners within each centre. results: All identified units participated in the audit. three were private sector units while the other five were primarily public sector units. twenty four paediatric cardiologists; equally distributed between public and private sector units; were practicing in the country as at end 2008; with a further eight paediatricians undergoing training in paediatric cardiology. this is significantly less than the 88 paediatric cardiologists required for the population of south Africa. Eight paediatric cardiac surgeons were operating predominantly on children in public hospitals and five in private institutions. An estimated 1370 operations for congenital heart disease were performed over a one year period; with 800 of these in the public sector. Extrapolating from accepted estimates of congenital heart disease incidence; this represents conservatively; less that 40of operations required for the population. Additionally; only 26of the estimated 114 simple transposition of great arteries born annually were operated on; indicating serious deficiencies in the ability to adequately detect and intervene in serious congenital heart disease presenting in the neonatal period. conclusion: the infrastructure and resources to detect and manage heart disease in children in south Africa; particularly within the public sector; are grossly inadequate


Subject(s)
Management Audit , Pediatrics
4.
SA Heart Journal ; 7(1): 10-16, 2010.
Article in English | AIM (Africa) | ID: biblio-1271316

ABSTRACT

Most children with congenital heart disease have a good outcome if treated appropriately; however the majority of children with heart disease in south Africa do not receive appropriate care. this is related to serious deficiencies in as a major shortage of skilled personnel to care for these children at all levels .Most public sector hospitals are unable to cope with the number of patients requiring surgery; mainly due to inadequate theatre time allocation and intensive care facilities. Key interventions to address these deficiencies include: 1. strategies to improve both the training and the retention of all professionals involved in the care of congenital heart disease. 2. Programmes to increase awareness of both congenital and acquired heart disease in children among health care personnel. 3. Ensuring appropriate infrastructure and equipment designed for children with congenital heart disease are available. 4. Development of congenital heart surgery as an independent subspecialty with dedicated resources and personnel. 5. Dedicated intensive care facilities for paediatric heart surgery. In addition; development of appropriate patterns of referral; timulation of research and positive private-public partnerships are all necessary to ensure that appropriate care is delivered


Subject(s)
Delivery of Health Care , Health Personnel , Management Audit , Pediatrics , Workforce
5.
Cochrane Database Syst Rev ; (2): CD003176, 2003.
Article in English | MEDLINE | ID: mdl-12804454

ABSTRACT

BACKGROUND: Rheumatic heart disease remains the most important cause of acquired heart disease in developing countries. Although the prevention of rheumatic fever and the management of recurrences is well established the optimal management of active rheumatic carditis is still unclear. OBJECTIVES: To assess the effects of anti-inflammatory agents such as aspirin, corticosteroids and immunoglobulin for preventing or reducing further heart valve damage in patients with acute rheumatic fever. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Issue 4, 2000), MEDLINE (1966 to April 2002), EMBASE (1998 to November 2002), LILACS (1998 to November 2002), Index Medicus (1950 to December 2000) and references lists of identified studies. SELECTION CRITERIA: Randomised controlled trials comparing anti-inflammatory agents (e.g. aspirin, steroids, immunoglobulins) with placebo or controls, or comparing any of the anti-inflammatory agents with one another, in patients with acute rheumatic fever diagnosed according to the Jones, or modified Jones criteria. The presence of cardiac disease one year after treatment was the major outcome criteria selected. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Eight randomised controlled trials involving 996 people were included. Several steroidal agents viz. ACTH, cortisone, hydrocortisone, dexamethasone and prednisone, and intravenous immunoglobulin were compared to aspirin, placebo or no treatment in the various studies. Six of the trials were conducted between 1950 and 1965, whilst the remaining two were done in the last 10 years. Overall there was no significant difference in the risk of cardiac disease at one year between the corticosteroid-treated and aspirin-treated groups (relative risk 0.87, 95% confidence interval 0.66 to 1.15). Similarly use of prednisone (relative risk 1.78, 95% confidence interval 0.98 to 3.34) or intravenous immunoglobulins (relative risk 0.87, 95%confidence interval 0.55 to 1.39) when compared to placebo did not reduce the risk of developing heart valve lesions at one year. REVIEWER'S CONCLUSIONS: There is no benefit in using corticosteroids or intravenous immunoglobulins to reduce the risk of heart valve lesions in patients with acute rheumatic fever. The antiquity of most of the trials restricted adequate statistical analysis of the data and acceptable assessment of clinical outcomes by current standards. New randomised controlled trials in patients with acute rheumatic fever to assess the effects of corticosteroids such as oral prednisone and intravenous methylprednisone, and other new anti-inflammatory agents are warranted. Advances in echocardiography will allow for more objective and precise assessment of cardiac outcomes.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Myocarditis/drug therapy , Rheumatic Heart Disease/drug therapy , Aspirin/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Randomized Controlled Trials as Topic , Steroids
7.
Heart ; 88(4): 335-6, 2002 Oct.
Article in English | MEDLINE | ID: mdl-12231585

ABSTRACT

The discrete form of subaortic stenosis is thought to be an acquired lesion, the aetiology of which may be a combination of factors which include an underlying genetic predisposition, turbulence in the left ventricular outflow tract, and various geometric and anatomical variations of the left ventricular outflow tract. A review of hypotheses relating to its aetiology is provided


Subject(s)
Discrete Subaortic Stenosis/etiology , Hemorheology , Humans , Ventricular Dysfunction, Left/etiology , Ventricular Outflow Obstruction/etiology
8.
Phytopathology ; 90(9): 1026-31, 2000 Sep.
Article in English | MEDLINE | ID: mdl-18944529

ABSTRACT

ABSTRACT Isolates of Sclerotium rolfsii, the causal organism of stem rot or southern blight of groundnut, can be placed in mycelial compatibility groups (MCGs) based on hyphal interactions between isolates. The aim of this study was to determine whether amplified fragment length polymorphism (AFLP) analysis was a suitable technique to assess genetic variability between isolates and MCGs of S. rolfsii. For preliminary genetic analysis, 10 isolates were selected from each of two MCGs and compared with each other using the restriction enzymes EcoRI and MseI and 4 primer pairs. The number of polymorphisms ranged from 10 to 36 per primer combination, with an average of 22.5. AFLP analysis clearly showed genotypic differences (22%) among MCGs B and C, with a maximum variation of 6.41% between any two isolates per group using four primer pairs. Certain isolates could not be distinguished from each other. A more in-depth study of 10 isolates from MCG B, using 8 additional primer pairs, showed small genetic differences (maximum of 4.2% and minimum of 0.2%) between isolates. These results suggested that DNA could be pooled for comparison of MCGs. Pooled DNA from isolates within groups using 20 primer pairs confirmed differences between 9 MCGs. This technique effectively differentiated MCGs of S. rolfsii from each other and also detected differences between isolates within a single MCG.

10.
Pediatr Cardiol ; 20(2): 150-1, 1999.
Article in English | MEDLINE | ID: mdl-9986895

ABSTRACT

Cardiac myxomas are rarely diagnosed in children, and biatrial tumors are an unusual presentation in any age group. An 8-year-old boy with massive biatrial cardiac myxomas, who presented in acute cardiogenic shock with no preceding cardiac symptomatology, is reported.


Subject(s)
Heart Atria , Heart Neoplasms/diagnosis , Myxoma/diagnosis , Neoplasms, Multiple Primary/diagnosis , Child , Diagnosis, Differential , Echocardiography , Heart Atria/surgery , Heart Failure/etiology , Heart Failure/surgery , Heart Neoplasms/surgery , Humans , Male , Myxoma/surgery , Neoplasms, Multiple Primary/surgery
11.
Cardiol Young ; 8(4): 440-2, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9855096

ABSTRACT

The finding of bland, sterile vegetations in children with severe tetralogy of Fallot is unexpected, and to our knowledge, has not been reported previously. Eight patients diagnosed with tetralogy between January 1993 and July 1997 had sterile vegetations proven by histological and microbiological evaluation, in their right ventricular outflow tracts. Four of these patients were experiencing severe hypercyanotic spells, and four had severely reduced effort tolerance at presentation. They all underwent cardiac catheterization and were submitted for surgical repair. At surgery, the vegetations were thought to be causing further narrowing of the already tight fibrotic infundibular stenosis. Two of these patients had evidence of damaged valves, without evidence of active endocarditis. Although initially sterile, these vegetations, may in some instances, become infected.


Subject(s)
Endocarditis/complications , Tetralogy of Fallot/complications , Adolescent , Child , Child, Preschool , Diagnosis, Differential , Echocardiography, Doppler , Endocarditis/diagnostic imaging , Endocarditis/microbiology , Female , Humans , Infant , Male , Tetralogy of Fallot/diagnostic imaging , Tetralogy of Fallot/microbiology , Tetralogy of Fallot/surgery
12.
Heart ; 78(4): 413-5, 1997 Oct.
Article in English | MEDLINE | ID: mdl-9404261

ABSTRACT

The presenting features and treatment responses of six children with junctional ectopic tachycardia are evaluated. Two of the patients were siblings and both presented in early childhood with cardiopulmonary failure. The elder sibling died, the surviving sibling was controlled on a combination of amiodarone, digoxin, and sotalol. The remaining four patients presented in later childhood with tachycardia induced cardiomyopathy. Two of the patients were diagnosed incidentally and have normalised their myocardial function on sotalol therapy. The other two presented in congestive cardiac failure. Radiofrequency His bundle ablation and insertion of a permanent pacemaker to control the arrhythmia was undertaken in the elder of the two patients. The remaining patient has had marginal recovery of myocardial function on a combination of amiodarone and sotalol treatment. Improvement in myocardial function may take several months and is dependent on control of the tachycardia in some patients. Sotalol, when used as single or combination treatment, was partially successful in four cases in reducing heart rate. None of the patients reverted to sinus rhythm.


Subject(s)
Electrocardiography , Tachycardia, Ectopic Junctional/diagnosis , Amiodarone/therapeutic use , Anti-Arrhythmia Agents/therapeutic use , Cardiac Pacing, Artificial , Catheter Ablation , Child , Child, Preschool , Digoxin/therapeutic use , Drug Therapy, Combination , Female , Heart Failure/etiology , Heart Failure/therapy , Humans , Infant , Male , Retrospective Studies , Sotalol/therapeutic use , Tachycardia, Ectopic Junctional/drug therapy , Tachycardia, Ectopic Junctional/surgery
13.
J Pediatr ; 127(5): 746-8, 1995 Nov.
Article in English | MEDLINE | ID: mdl-7472829

ABSTRACT

Clinically silent endocarditis was detected in 4 (11%) of 36 hospitalized children with staphylococcal bacteremia who underwent echocardiographic examination. Pericarditis was detected in two further children. Only one child had underlying cardiac disease (patent ductus arteriosus). Echocardiography should be considered in children with staphylococcemia even if an obvious extracardiac focus is apparent.


Subject(s)
Bacteremia/complications , Endocarditis, Bacterial/etiology , Pericarditis/etiology , Staphylococcal Infections/complications , Bacteremia/diagnosis , Bacteremia/drug therapy , Child , Child, Preschool , Cross Infection/diagnosis , Cross Infection/drug therapy , Cross Infection/etiology , Disease Progression , Echocardiography , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Female , Humans , Infant , Infant, Newborn , Male , Pericarditis/diagnosis , Pericarditis/drug therapy , Prospective Studies , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus/isolation & purification , Treatment Outcome
14.
Curationis ; 16(2): 17-23, 1993 Jun.
Article in Afrikaans | MEDLINE | ID: mdl-8375006

ABSTRACT

An exploratory contextual study was undertaken to expand the insight into and the meaning of the perceptions of the mother of a hyperactive child. The phenomenological method of interviewing was used to gather data. The interviews were recorded on tape and later transcribed verbatim. The random test population consisted of eight participants who were specially selected for the purpose of this study. Data was analysed by way of content analysis. The results firstly crystallised in the mother's experiences with her hyperactive child and secondly in the elements which influenced these experiences. The mother's experience is contained in her involvement with her child and in her interaction with him. She experiences vehement feelings of anger, empathy, insufficiency, guilt and depression. At the same time there is the perception that she is responsible for her child's hyperactivity and the accompanying behavioural problems. The mother finds herself in a stressful situation where she is a buffer between her child and the world. Her experience is influenced inter alia by her religious system, personal stress, the behaviour of the hyperactive child, and the availability of support systems. Based on the findings of this study, it seems that the mother of young hyperactive children are already mentally ill to a degree, or are at risk to develop mental illness. In the light of this, group therapy seems to be the most meaningful intervention to support mothers of young hyperactive children.


Subject(s)
Attention Deficit Disorder with Hyperactivity , Mothers/psychology , Stress, Psychological/etiology , Adult , Attention Deficit Disorder with Hyperactivity/therapy , Child Rearing , Child, Preschool , Data Collection/methods , Female , Humans , Infant , Maternal Behavior , Nursing Evaluation Research , Role , Social Support
16.
Eur J Clin Pharmacol ; 28 Suppl: 105-7, 1985.
Article in English | MEDLINE | ID: mdl-3902482

ABSTRACT

The effect of atenolol on visual reaction time was tested in 30 healthy subjects in a between-subject double-blind placebo-controlled trial. Visual reaction time was defined as the time between the display of a light signal and its extinction by the subject. Acute or chronic administration of atenolol had no effect on visual reaction time when compared with placebo.


Subject(s)
Atenolol/pharmacology , Reaction Time/drug effects , Adult , Clinical Trials as Topic , Double-Blind Method , Female , Humans , Male , Sex Factors , Visual Acuity/drug effects
17.
Aviat Space Environ Med ; 53(6): 591-4, 1982 Jun.
Article in English | MEDLINE | ID: mdl-7115246

ABSTRACT

A study on 721 healthy male aircrew assessed whether the blood pressure response to exercise could be used to predict the development of hypertension. A positive blood pressure response to exercise, recorded 30 s after the completion of exercise, was defined as a systolic blood pressure of 200 torr or more (systolic test) or a raised diastolic blood pressure (diastolic test). While 236 (32.7%) became hypertensive with a blood pressure greater than 149/90 torr, 17% of these had shown a positive systolic response and 17% a positive diastolic response. The other 485 individuals (67.3%) remained normotensive throughout the mean follow-up period of 68 months (range 12-170 months). Of this group, 88% never manifested a positive systolic or diastolic response to exercise. Although 5% of the normotensive subjects manifested a positive systolic response to exercise, and 12% manifested a positive diastolic response to exercise, a longer period of follow-up may reduce this figure. It is concluded that exercise related blood pressure is a useful test in predicting the development of essential hypertension.


Subject(s)
Blood Pressure , Hypertension/diagnosis , Physical Exertion , Adult , Follow-Up Studies , Humans , Male , Middle Aged , Statistics as Topic
18.
S Afr Med J ; 61(17): 611-2, 1982 Apr 24.
Article in English | MEDLINE | ID: mdl-7079850

ABSTRACT

One hundred and twenty-five patients who had suffered transmural inferior myocardial infarctions were followed up for a mean period of 55 months. On electrocardiography the area under the pathological Q waves in the inferior leads was measured serially. Eighty-one patients (65%) showed a highly significant time-related diminution in Q-wave area. The ECGs of 17 subjects (14%) became normal and there was no electrocardiographic evidence of the previous myocardial infarction. The Q waves of the remaining 44 subjects (35%) remained constant or increased. A discussion of the possible mechanisms of changes in Q-wave size follows.


Subject(s)
Electrocardiography , Myocardial Infarction/physiopathology , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged
19.
S Afr Med J ; 61(15): 542-3, 1982 Apr 10.
Article in English | MEDLINE | ID: mdl-7064038

ABSTRACT

One hundred and seventy-one patients who had had a myocardial infarction were evaluated at the Institute for Aviation Medicine, Pretoria. Patients were graded according to the New York City Heart Association classification of cardiac functional capacity and then subjected to exercise electrocardiography. Only 20% of the 74 patients whose exercise electrocardiograms revealed ischaemic heart disease felt that their cardiovascular function was limiting their daily activity. This lack of correlation between the two forms of assessment was highly significant (P less than 0,0001). It is therefore concluded that clinical evaluation of an individual with known ischaemic heart disease may be misleading.


Subject(s)
Electrocardiography , Exercise Test , Myocardial Infarction/classification , Adult , Aged , Female , Humans , Male , Middle Aged
20.
S Afr Med J ; 61(15): 539-42, 1982 Apr 10.
Article in English | MEDLINE | ID: mdl-7064037

ABSTRACT

Same-day exercise electrocardiography and ambulatory electrocardiographic (Holter) monitoring were performed on 167 patients, all of whom had suffered myocardial infarctions over the past 12 years. A significant correlation (P less than 0,0001) was found when comparing exercise testing for ischaemic ST-segment changes and the number of complexity of ventricular arrhythmias found on Holter monitoring. Two different methods of arrhythmia classification were used and the results were similar. The value of simultaneous Holter monitoring and exercise electrocardiography to detect 'late' exercise-related ventricular arrhythmias was not found to be sufficient to warrant their widespread simultaneous use.


Subject(s)
Arrhythmias, Cardiac/complications , Electrocardiography , Exercise Test , Myocardial Infarction/complications , Adult , Aged , Female , Humans , Male , Middle Aged , Myocardial Infarction/physiopathology
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