Cold feet from adrenal leiomyosarcoma.
Explore the source record for details and available documents.
Adrenal Gland Neoplasms↗
Biomedical subjects
U O Von Oppell
Publications and source records attributed to U O Von Oppell.
Blunt cardiac rupture caused by zip gun backfire.
A 16-year-old boy who sustained right ventricular rupture after backfiring of a homemade zip gun is reported. The unusual nature of this case together with the mechanisms and management of blunt cardiac rupture are briefly discussed.
Adolescent↗
Role of thoracic surgery for childhood tuberculosis.
Lymphadenopathy is the hallmark of intrathoracic tuberculosis in children. The role of the thoracic surgeon in treating childhood tuberculosis is to relieve the more severe symptoms of lymphadenopathy, prevent the more long-term secondary damage that lymphadenopathy may cause to the lung, and treat the sequelae of thoracic tuberculosis. We reviewed the role of surgery in childhood tuberculosis at Red Cross Children Hospital from January 1981 to January 1996 in 161 children under 13 who were admitted for 168 therapeutic surgical interventions for proved intrathoracic tuberculosis and its related complications. We classified patients according to the pathophysiology of their disease to clarify the role of surgery in their management. Successful decompression of lymph nodes that were acutely compromising major airways was done in 25 children, and decompression for chronic airway compression was successful in 8 of 11 children. Therapeutic bronchoscopy successfully opened an airway obstructed by intraluminal tissue in 68% of 28 patients, with long-term pulmonary reexpansion in 50%. Pulmonary resections for postprimary tuberculous damage were done in 72 patients with a mortality of 2.7% and morbidity of 16.7%. Another 17 patients were operated on for pleural disease and 15 for other tuberculosis-related problems. The mortality for all patients undergoing surgery for complications of tuberculosis during childhood was 1.9% (3/161), suggesting that when indicated, an aggressive surgical approach is relatively safe.
Airway Obstruction↗
Pulmonary artery banding: adequacy and long-term outcome.
OBJECTIVE: Pulmonary artery banding remains a palliative option for patients with congenital heart disease and excessive pulmonary blood flow, if there is unfavourable anatomy or frail condition. In contrast to more developed countries, our patients at Red Cross Children's Hospital, Cape Town, often present to medical services late and in poor nutritional condition. We retrospectively reviewed patients undergoing pulmonary artery banding to determine major variables that influenced long-term outcome. METHODS: In a 10-year period ending June 1992, 135 consecutive patients underwent pulmonary artery banding; 89 with ventricular septal defect type non-mixing disorders, and 46 with mixing or complex disorders. The median age was 3.0 months and weight 3.5 kg with 74.8% of patients weighing less than the third percentile (NCHS adapted), and 39.3% had an additional serious medical illness. RESULTS: Pulmonary banding mortality was 8.1%, and was higher in neonates (22.2%), P = 0.04) but was not related to congenital disorder, associated medical illness, or associated coarctation or interrupted aortic arch. The pulmonary band was inadequate at follow-up in 28.9%, which occurred more commonly if banding was necessary before 3 months of age (41.5%, P = 0.003) but was not related to weight, congenital disorder or associated respiratory infection. Sixty patients (44.4%) have now proceeded to definitive repair with a mortality of 23.3%, which was increased if the pulmonary band was inadequate at the time of definitive repair (44.4%: P = 0.02), but was not related to the congenital disorder. CONCLUSIONS: An inadequate pulmonary artery band adversely affects outcome and demands further aggressive management prior to definitive repair.
Cause of Death↗
Syphilitic aortic aneurysm eroding through the sternum.
Syphilitic aortic aneurysms are uncommon today. A syphilitic aneurysm eroding through the anterior chest wall with successful surgical treatment is reported. The large size these aneurysms reach, in conjunction with the overlying pressure-induced skin necrosis necrosis can represent a technical challenge to the surgeon, both in the method of repairing the aneurysm as well as reconstructing the chest wall. Syphilitic aortic disease is also briefly reviewed.
Anastomosis, Surgical↗
Acute traumatic rupture of the thoracic aorta. A comparison of techniques.
Twenty-eight patients were treated for acute blunt thoracic aortic rupture at Groote Schuur Hospital between January 1984 and March 1994. Aortic arch ruptures occurred in 2 patients and were successfully repaired by means of hypothermic circulatory arrest. Descending aortic ruptures were repaired more safely by insertion of an interposition graft as opposed to direct suture reapproximation, and with the aid of partial heparinless bypass as opposed to simple aortic cross-clamping.
Accidents, Traffic↗
Aortic valve replacement in elderly women with small aortic roots: comparing sorin pericardial and St. Jude Medical mechanical valves.
After implanting 19mm and 21mm Sorin pericardial aortic valves (AVR) in 35 women over the age of 60 years, it was our clinical impression that these patients had an unduly high incidence of residual valve stenosis. A retrospective comparison of our experience with this valve and the 19mm St. Jude mechanical AVR in a similar group of 26 patients, operated during the same period (October 1987 to July 1994), was carried out. In comparison to the 19mm St. Jude valve, the 19 mm Sorin Pericardial valve was associated with significant residual stenosis in elderly women despite similar body surface areas. This prosthesis/patient mismatch was not eliminated by the use of a 21 mm Sorin pericardial valve. Although the Sorin pericardial valves was associated with a reduced incidence of thromboembolism and anticoagulation related hemorrhage, it had a significantly increased risk of permanent valve related morbidity and mortality. As a result if this experience we have discontinued our use of the Sorin pericardial valve.
Aged↗
Aortic dissection repair with GRF glue complicated by heart block.
Gelatin-resorcin-formaldehyde-glutaraldehyde (GRF) biologic glue is an available adjunct to repair acute ascending aortic dissections. Permanent complete heart block complicated the operative repair of 2 of 6 patients. The pathophysiology of heart block resulting from either the acute dissecting process or the technique of applying GRF glue is discussed.
Acute Disease↗
Surgical cure of the Wolff-Parkinson-White syndrome--a comparison of two techniques.
Curative arrhythmia surgery for patients with symptomatic Wolff-Parkinson-White syndrome (WPW) was first performed in South Africa in November 1987. Pre-operatively all patients were symptomatic despite medical therapy, and 32% were assessed as being at risk for sudden death. The first 9 patients (November 1987 to December 1989) underwent either epicardial or localised endocardial surgical dissections, and a cure was obtained in 66%. Aberrant atrioventricular conduction recurred in 2 patients, 3 degrees atrioventricular heart block occurred in 2 patients, and there was 1 postoperative death in a patient who had undergone simultaneous coronary artery bypass grafting. In contrast, a standardised endocardial technique was used in the subsequent 10 patients. Surgical cure was obtained in all 10 patients (P < 0.01). However, 1 patient required reoperation 24 hours after the first procedure because of early postoperative recurrence due to initial incorrect pathway localisation. This was successful. There were no deaths, and no patient developed atrioventricular heart block. In view of the excellent surgical results, arrhythmia surgery should be considered in select WPW patients who either have refractory symptoms or are at risk for sudden death. Furthermore, this reliable surgical technique provides an essential back-up should alternative interventional procedures such as percutaneous radiofrequency ablation fail.
Adolescent↗
Heart transplantation at Groote Schuur Hospital, Cape Town. Twenty years' experience.
Human allogeneic heart transplantation was started at Groote Schuur Hospital in Cape Town in 1967. Since then 110 hearts (61 heterotopic and 49 orthotopic) and 12 heart-lung transplantations have been performed in the unit. Ten procedures were retransplantations including 2 third interventions. The patients fall into three groups according to their immunosuppressive therapy: group A (N = 55) from 1967 to 1982 received the so-called 'conventional treatment' (azathioprine, methylprednisolone and antithymocyte globulin (ATG)); group B (N = 15) from 1983 to 1984 received cyclosporin A in high dosage, together with methylprednisolone; and group C (N = 30) received quadruple drug therapy of low-dose cyclosporin A, together with azathioprine, methylprednisolone in lower dosages and antithymocyte globulin (for the first 4-6 days and rescue-ATG for severe rejection). The results have improved significantly over the years. The actuarial survival rate after heart transplantation within the last 12 months is 94%. Several important steps have been inaugurated: in 1973 heterotopic heart transplantation was initiated and in 1984 hormonal therapy of brain-dead organ donors was started. Radionuclide scanning, in combination with endomyocardial biopsies, has proved to be a very sensitive means of monitoring rejection.
Cyclosporins↗
Biocor No- React stentless aortic valve--short-term results.
OBJECTIVES: Short-term results of the bioprosthetic Biocor No-React composite porcine stentless aortic valve (Biocor Industria e Pesquisas LTDA, Belo Horizonte, Brazil) implanted in patients in whom anticoagulation was thought to be contraindicated or expected to be non-compliant. METHODS: Retrospective review of 52 consecutive prospective patients in whom this valve was implanted, between September 1994 and May 1998. RESULTS: Average age was 44 +/- 17 years; 75% of patients were operated on for rheumatic heart disease and combined procedures were done in 40% of cases. Early mortality was 5.8%, and related to pre-operative ejection fraction ( P < 0.03), New York Heart Association (NYHA) class (P < 0.01), and bacterial endocarditis (P < 0.04). On discharge, 84% of survivors were in NYHA class I and 16% in class II. The average postoperative prosthetic valve peak gradient on echocardiography was 19.9 +/- 11 mmHg and was related to pre-operative ejection fraction and smaller valve sizes. Postoperative residual trivial or mild aortic regurgitation was seen in 19 patients (36.6%), resolved on follow-up in 10 cases, and did not correlate with structural deterioration, re-operation, mortality, or widening of the non-coronary sinus. The non-coronary aortic sinus was widened on closure, because of perceived crowding of the adjacent stentless valve commisures, in 52% of cases. This was thought to be related to the use of an oblique as opposed to transverse aortotomy. Patient survival, inclusive of operative deaths, was 88.5%, and event-free survival was 80.0% at 4 years. CONCLUSION: The short-term results of this stentless aortic valve in a young predominantly third-world population group are acceptable, and appear to be superior to the results for mechanical valves in a similar patient group. We would recommend a transverse aortotomy above the sinotubular ridge to be the more appropriate aortotomy incision when using stentless aortic valves.
Adolescent↗