CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 15, ISSUE 4, JULY 2004
Title: Recommendations for
hypertension in sub-Saharan Africa : editorial
Authors: Seedat, Y.K.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.157-158
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Title: Differences in cardiovascular
function of rural and urban African males : the
THUSA study : cardiovascular topics
Authors: Schutte, Rudolph; Huisman, Hugo W.;
Malan, Leone; Van Rooyen, Johannes M.; Schutte,
Aletta E.; Malan, Nicolaas T.; De Ridder,
Johannes H.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.161-165
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Abstract: Introduction: South Africa's black
population has been in a process of transition
from rural monocultural environments to
industrialised urban environments since the
early 1990s. This transition has led to an
increased susceptibility to cardiovascular
diseases such as hypertension, which in this
group commonly leads to stroke. Besides the
already observed increases in blood pressure,
there is still uncertainty as to how the factors
associated with urbanisation influence the
cardiovascular system as a whole.
Aim: To obtain a more complete cardiovascular
profile and its association with the lipid
profile and subcutaneous fat distribution of the
African in transition.
Methods: A cross-sectional epidemiological study
was performed which included 433 men from the
North- West Province. The Finapres apparatus and
Modelflow software program were used to obtain a
more elaborate cardiovascular profile. The lipid
profile and subcutaneous fat were also
determined.
Results: An increase in systolic blood pressure
(SBP) and diastolic blood pressure (DBP) was
observed in the urban group. The heart rate (HR)
did not differ while the stroke volume (SV) and
cardiac output (CO) was lower in the urban
group. Arterial compliance (CW) also showed a
decrease in the urban group along with an
increased total peripheral resistance (TPR),
compared with the rural group. The lipid profile
and BMI did not differ between the two groups.
Conclusions: The factors associated with
urbanisation elevate blood pressure via a
peripheral mechanism. This peripheral mechanism
may be due to endothelial damage associated with
low-density lipoprotein cholesterol (LDL-C) and
a truncal subcutaneous fat distribution.
Title: The William Nelson ECG quiz
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.165, 181
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Title: Serum lipid parameters and
the prevalence of corneal arcus in a
dyslipidaemic patient population :
cardiovascular topics
Authors: Meyer, D.; Liebenberg, P.H.; Maritz,
F.J.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.166-169
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Abstract: Aim: To determine whether an
association exists between plasma lipoprotein
constituents and the prevalence of corneal arcus
in dyslipidaemic patients.
Methods: Adult patients (n = 115) were included
if their fasting total serum cholesterol
concentrations exceeded the 95th percentile or
their serum low-density lipoprotein (LDL) : high
density lipoprotein (HDL) ratios exceeded 5.
Slit-lamp assessment of the corneas was
performed.
Results: The study group divided into a subgroup
with arcus 37% (43) and a subgroup without arcus
63% (72). Total serum cholesterol and
triglyceride levels were not associated with
corneal arcus. A significant difference was
found (p < 0.05) between the mean levels of LDL
cholesterol (LDL-C) in the group without arcus
(5.61 + 1.74 mmol/l) and the group with arcus
(5.96 + 1.71 mmol/l). The mean serum
HDL-cholesterol (HDL-C) in the group with
corneal arcus was 1.04 + 0.30 mmol/l as opposed
to 1.31 + 0.38 mmol/l in the group without arcus
(p < 0.005 for difference). The mean LDL-C :
HDL-C ratio in the group without arcus was 4.28
(SD: 1.99), and 5.73 (SD: 2.09) in the group
with a corneal arcus (p < 0.05).
Conclusions: Low HDL-C levels, high LDL-C levels
and LDL-C : HDL-C ratios > 5 have been
implicated as risk factors of numerous
circulatory diseases. The observations in this
study suggest that the presence of corneal arcus
in the dyslipidaemic patient correlates strongly
with these same risk indicators.
Title: EVAR : critical applied
aortic morphology relevant to type-II endoleaks
following device enhancement in patients with
abdominal aortic aneurysms : cardiovascular
topics
Authors: Du Toit, D.F.; Saaiman, J.A.;
Labuschagne, B.C.J.; Vorster, W.; Van Beek,
F.J.; Boden, B.H.; Geldenhuys, K.M.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.170-177
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Abstract: Endovascular repair (EVAR) of
abdominal aortic aneurysms (AAA) is an
established alternative option to conventional
surgery for AAA, provided optimal anatomical
morphology of the aneurysm sac, neck and outflow
exists. In most documented series of EVAR,
type-II endoleak occurrence is a universal
procedural drawback. This is referred to as the
Achilles heel of EVAR. This morphological study,
addressing predominantly non-aneurysmal aortic
anatomy, reveals the dyssynchronous origins of
the renal ostia, ectopia of the superior
mesenteric artery and median sacral artery,
variations in the length of the infrarenal
abdominal aorta, multiple mainstem renal
arteries, and the presence of accessory renal
arteries (in 13% of cadavers). Such potential
vascular anomalies need careful consideration
pre-operatively prior to EVAR.
In a prospective, clinical study of EVAR in 163
patients over 60 months, using four different
aortic stent devices, we demonstrated an
intraprocedural type-II endoleak rate, before
exclusion, of 3% (5/163). Most were related to
patent lumbar arteries. An active policy of
intraprocedural aneurysm pressure sac
measurement and angiography was used to
demonstrate type-I and type-II endoleaks,
focusing on the applied anatomy of aortic side
branches and variations. Selective
intraprocedural coil embolisation and thrombin
injection into the sac was utilised to thrombose
persisting and large lumbar arteries that
predisposed to retroleaks. We recorded a low
incidence of persisting type-II endoleaks using
this proactive treatment strategy by addressing
variant aortic morphology and patent lumbar
arteries during EVAR. One aneurysm-related death
(0.6%) was observed due to late rupture after
EVAR, and a single intraprocedural death was
related to unpredictable aneurysm rupture.
In conclusion, comprehensive anatomical
knowledge of the abdominal aorta and its main
collateral side branches, including variations,
is a fundamental prerequisite if satisfactory
and predictable results are to be achieved after
EVAR, especially regarding prevention, diagnosis
and treatment of type-II endoleaks.
Intraprocedural aneurysm sac pressure
monitoring, coil embolisation and the use of
injection of thrombin into the aneurysm sac of
selected patients is useful in reducing the
incidence of post-EVAR type-II persisting
endoleaks.
Title: Pre-operative
intercostal nerve blockade for minimally
invasive coronary bypass surgery : a
standardised anaesthetic regimen for rapid
emergence and early extubation : cardiovascular
topics
Authors: Exadaktylos, Aristomenis K.;
Trampitsch, Ernst; Mares, Peter; Czerny, Martin;
Grimm, Michael; Muhm, Manfred
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.178-181
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Abstract: Background: Minimally invasive direct
coronary artery bypass grafting (MIDCAB) has
become a popular adjunct to cardiac bypass
surgery in selected patients. Although MIDCAB
without cardiopulmonary bypass is considered to
be a relatively noninvasive procedure, the
trauma to the muscle tissue caused by the
anterolateral thoracotomy often leads to more
pain than that of patients undergoing routine
sternotomy. The purpose of our study was to
evaluate the pre-operative application of an
intercostal nerve blockade, combined with
general anaesthesia for peri- and postoperative
pain control, and its efficacy for early
extubation.
Methods and Results: Nine consecutive patients
undergoing MIDCAB surgery were evaluated.
Pre-operative ipsilateral intercostal nerve
blockade was employed in all patients. After
induction, isofluran (0.4-0.8%) and nitrous
oxide in combination with the pre-operative
nerve blockade provided sufficient anaesthesia
throughout the procedure (mean operative time:
147 min). Only 2/9 patients required additional
small doses of narcotics. All patients could be
safely extubated within 15 minutes of skin
suture. Postoperative discomfort and pain were
minimal.
Conclusion: From our initial experience with
preoperative intercostal nerve blockade for the
MIDCAB procedure, we concluded that it provides
profound somatic analgesia as an effective
adjunct to general anaesthesia with reduced
doses of narcotics and sedatives. MIDCAB
impresses with its ease of technical
performance, its reliability and safety. The
minimised chest-wall pain improves patients'
chances of early tracheal extubation. In
accordance with the minimally invasive surgical
approach, it provides a contribution towards
'minimally invasive anaesthesia'. The surgeons'
and the patients' acceptance is excellent.
Because the results of this study are based on
observation and verbalisation of the
investigators' impressions, and no objective
measurements were made which would have allowed
a comparison between the MIDCAB technique and
the golden standard of general anaesthesia with
opioid analgesia, a further study should be
conducted to prove our theory.
Title: Diaphragmatic hernia
mimicking an atrial mass : a two-dimensional
echocardiographic pitfall and a cause of
postprandial syncope : case report
Authors: Ker, J.; Van Beljon, J.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.182-183
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Abstract: A large hiatal hernia constitutes a
form of posterior mediastinal mass that can
encroach on the posterior aspects of the heart.
During two-dimensional echocardiography this
phenomenon may be confused with an intra-atrial
mass or various other posterior mediastinal
masses. Furthermore, such a large hiatal hernia
encroaching on the heart may cause syncope. We
present such a case and the various possible
mechanisms of syncope, as well as review the
two-dimensional echocardiographic pitfalls in
these patients.
Title: Old dogmas and new hearts : a
role for adult stem cells in cardiac repair? :
review article
Authors: Niesler, Carola U.
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.184-189
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Abstract: The vast developmental repertoire of
embryonic stem cells is well recognised. These
primitive stem cells can differentiate in vivo
and in vitro into cells of all three embryonic
germ layers (endoderm, mesoderm, ectoderm),
making them attractive potential agents to
target for enhanced tissue repair and
regeneration. Adult stem cells on the other hand
are considered more restricted in their lineage
differentiation capabilities. Recent research
has challenged this dogma with the finding that
bone marrow-derived stem cells can differentiate
into a wide variety of cell types including
muscle (skeletal and cardiac). Furthermore,
although the myocardium has for decades been
regarded as a post-mitotic organ, a series of
studies has indicated that a population of stem
cells exists which is capable of at least
partial reconstitution of the myocardium
following an ischaemic insult. It is therefore
now accepted that adult stem cells could be used
to enhance myocardial repair. This review
discusses the current status of adult stem cell
research in the light of its potential for
improving myocardial repair.
Title: LDL cholesterol goals rapidly
achieved at various starting doses of Pfizer's
atorvastatin : drug trends in cardiology
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.190
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Title: VALUE study highlights the
need for aggressive BP lowering in high-risk
patients : drug trends in cardiology
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.191-192
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Title: Comments by a South African
cardiologist at the meeting
Authors: Moodley, Rajen
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.194-195
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Title: INVEST study adds important
data for clinical practice in new-onset diabetes
: drug trends in cardiology
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.195
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Title: Aggressive
cholesterol-lowering treatment in type 2
diabetes mellitus : an update : drug trends in
cardiology
Authors: Delport, Rhena
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.195-196
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Title: Added benefits of nifedipine
(Adalat(R) GITS) beyond lowering blood pressure
: drug trends in cardiology
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.198-199
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Title: Cardio news
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.200
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.
Title: ISHR Satellite Abstracts :
Cellular Injury in Ischaemia : supplement
From: Cardiovascular Journal of South Africa,
Vol 15, Issue 4, Jul / Aug
Published: 2004
Pages: p.ii-iv, 1-15
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Notes: Continues as Cardiovascular Journal of
Africa from Volume 18, Issue 3, May/Jun 2007,
ISSN 10159657.