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Biomedical subjects

M L Mohlala

Publications and source records attributed to M L Mohlala.

15 recordsLinked to original sources
PubMed1996

The Cardiothoracic Outreach Programme--a pilot project.

OBJECTIVE: To test the practicality, safety and benefits of major cardiothoracic surgery in two rural hospitals. DESIGN: Analysis of morbidity and mortality outcomes of a random collection of 35 patients, who underwent diverse surgical procedures. At each visit, the cardiothoracic team of Ga-Rankuwa Hospital-one surgeon, three registrars, two medical officers, six nurses, and four perfusionists-moved all equipment for major surgery, including bypass machines, to two small rural hospitals. Ga-Rankuwa Hospital, as a tertiary hospital attached to a medical school (Medical University of Southern Africa), mounted an outreach programme on a trial basis. The exercise was designed to render assistance, offer decentralised services, and test the skills of the cardiothoracic team in an environment where high-technology procedures have never been undertaken by the local health professionals. SETTING: Two rural hospitals, viz. Tintswalo and Mankweng, in the referral area of MEDUNSA, with no conventional ICU facilities. The support services for operative, pre-operative and postoperative care were very basic. The local personnel consisted only of general nurses and medical officers. None had experience of high-technology or complex theatre work. PARTICIPANTS: Thirty-five randomly selected patients of both sexes with ages ranging from 11 years to 64 years. Pre-operative diagnoses of diverse cardiac and lung conditions were made. The operations performed comprised 35 major procedures, including open heart operations and major lung procedures. The personnel comprised the MEDUNSA cardiothoracic team, who were assisted by local nurses. INTERVENTION AND OUTCOME: Thirty-five patients underwent 35 major procedures, all under general anaesthesia. Twenty cardiopulmonary bypasses were performed. There was 1 intra-operative death, due to low-output state. Intra-operative morbidity occurred in 2 of the 35 operations. These consisted of a cerebrovascular accident (CVA) (air embolism), and a temporary heart block. Late outcomes (after 1 week) were also analysed; the incidence was 1/35 operations. This was a CVA due to a left atrial appendage clot. Staff morale at the local hospital improved remarkably. The process of teaching the local professional nurses was surprisingly easy. Benefits included a decreased referral rate (100%), lower costs (transport, medicines, operations), excellent patient and community confidence in the work of the hospitals (increased hospital outpatient numbers), and political support (new tools, upgraded facilities and new equipment). RESULTS: The exercise was a resounding success in both measurable and general terms. All operations were successfully performed, with very low adverse outcomes (morbidity, mortality) and good quality of life for all the subjects. The safety and cost-effectiveness of cardiothoracic surgery under primitive conditions were demonstrated. The standard of patient care improved, and local staff acquired good basic skills in patient care. The referral patterns changed for the better and the confidence of the community in the services was enhanced. The risk/benefit ratio of the exercise was commendable. The feasibility of an extended service was encouraging.

Academic Medical Centers↗
PubMed1994

A technical approach to tracheal and oesophageal injuries.

Twenty patients with acute trauma to the trachea and oesophagus were managed in the last 6 years with a new technique. There were 2 female and 18 male patients with an average age of 26 years. The approach is direct, easy and reproducible. The approach is direct, easy and reproducible. The oesophageal rents are approached through the anterior and posterior tracheal lacerations without tracheal mobilisation. Muscle interposition was electively not used and cervical wounds not drained. Wound dehiscence was not experienced.

Adult↗
PubMed1989

Early operative management of chylothorax by thoracic duct ligation.

Chylothorax following mediastinal mobilisation for carcinoma of the oesophagus can be devastating, especially in malnourished, debilitated patients. Early surgical management in significant chylothorax (+ 500 ml/d) is suggested before nutritional degeneration occurs. Conservative management should be reserved for those patients who drain less than 500 ml/d.

Chylothorax↗
PubMed1989

Systolic and diastolic left ventricular dysfunction due to mild hypothermia.

Postoperative cardiac patients frequently are mildly hypothermic, yet the influence of hypothermia on left ventricular (LV) contractility has received little attention. To study the possible effects of mild hypothermia on LV function, six pigs were placed on partial right ventricular bypass, the hearts were electrically paced to control heart rate, and myocardial temperature was varied between 34 degrees and 38 degrees C. Using two pairs of orthogonally oriented sonomicrometer crystals in the left anterior descending (LAD) and left circumflex (LCX) distributions, we estimated regional work (the area within LV pressure-area loops) over a range of LV preloads. Diastolic function was assessed by measurement of the time constant of LV pressure decay during isovolumic relaxation. Regional work data were expressed as percentages of baseline (38 degrees C and end-diastolic pressure of 10 mm Hg). To control for preload variations, regional work and time constants were calculated from beats with end-diastolic areas within 0.1% of baseline. Regional work (mean +/- SEM) declined from 85.1 +/- 6.7% at 38 degrees C to 31.9 +/- 4.4% at 34 degrees C. Time constants were prolonged from 44.8 +/- 2.5 msec at 38 degrees C to 61.6 +/- 2.7 msec at 34 degrees C. These data demonstrate a marked depression of LV contractility, even at mild levels of hypothermia that may be encountered clinically after cardiac operations.

Animals↗
PubMed1989

Internal mammary artery haematoma.

Traumatic disruption of the internal mammary artery, which produces a well-circumscribed haematoma in the extrapleural plane and not a haemothorax, has not been described previously in English-language reports. Both blunt and penetrating trauma may be the cause. Ten such cases have been identified and verified by angiography.

Adult↗