Aggressive fibromatosis--impact of prognostic variables on management.

Objective: To determine the impact of prognostic variables on local control in patients with aggressive fibromatosis treated with or without radiation.

Materials And Methods: Forty-two patients presenting to the combined sarcoma clinic at Johannesburg Hospital with aggressive fibromatosis from 1990 to 2003 were analysed retrospectively. There were 14 males and 28 females.

Hyaluronidase augments pneumolysin-mediated injury to human ciliated epithelium.

Objectives: The main objective of this study was to investigate the effects of pneumococcal hyaluronidase (0.1-10microg/ml), alone and in combination with pneumolysin (50 and 100ng/ml), on human ciliated epithelium.

Methods: Ciliary beat frequency (CBF) and structural integrity of human ciliated respiratory epithelium in vitro were studied using a phototransistor technique and a visual scoring index, respectively.

Biventricular pacing for heart failure alters electro-mechanical coupling of both ventricles.

Aim: The exact mechanisms whereby biventricular pacing enables cardiac resynchronisation are not completely understood. This study looked at the effect of biventricular pacing on interventricular asynchrony in patients submitted to biventricular pacing.

Methods: A prospective series of 13 consecutive patients were selected from those referred for biventricular pacing.

The therapeutic challenge of Gram-negative sepsis: prolonging the lifespan of a scarce resource.

Mortality from severe bacterial sepsis remains high. The pathogenesis involves production of pro and anti-inflammatory cytokines which mediate: neutrophil adhesion to the endothelium, diffuse capillary leak, disseminated intravascular coagulation, vasodilatation and mitochondrial dysfunction, all of which culminate in microcirculatory failure. Therapy is multifaceted.

The need for tighter rheumatoid arthritis control in a South African public health care center.

Objective: Medical facilities are restricted in public health care centers in South Africa and patients that enroll in these centers are socioeconomically deprived. We investigated the impact of rheumatoid arthritis (RA) on disability in both a public health care and a private care center.

Methods: The disability index of the Health Assessment Questionnaire (HAQ-DI) and an extensive range of disease and non-disease-related patient characteristics were recorded in 359 RA subjects, 196 public care and 163 private care patients.

Preparing and responding to mass casualties in the developing world.

Disasters, albeit on a small scale, are an everyday event in Africa. They contribute to depriving millions of Africans of access to basic services, often considered rights in more affluent societies. The massive amounts of aid donated during disasters, could be limited by strengthening systems of disaster preparedness beforehand.

Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials.

Background: Uncontrolled bleeding is a leading cause of death in trauma. Two randomized, placebo-controlled, double-blind trials (one in blunt trauma and one in penetrating trauma) were conducted simultaneously to evaluate the efficacy and safety of recombinant factor VIIa (rFVIIa) as adjunctive therapy for control of bleeding in patients with severe blunt or penetrating trauma.

Methods: Severely bleeding trauma patients were randomized to rFVIIa (200, 100, and 100 microg/kg) or placebo in addition to standard treatment.

Spinal epidural haematoma mimicking spontaneous subarachnoid haemorrhage.

Spinal epidural haematoma is increasingly picked up using magnetic resonance imaging, especially following trauma. The presentation can be varied especially if there is a trivial history of trauma. Spontaneous subarachnoid haemorrhage can occur in spinal haematoma as a rare and unusual presentation and can be easily misdiagnosed.

Biomarkers of endothelial dysfunction, cardiovascular risk factors and atherosclerosis in rheumatoid arthritis.

Cardiovascular event rates are markedly increased in rheumatoid arthritis (RA), and RA atherogenesis remains poorly understood. The relative contributions of traditional and nontraditional risk factors to cardiovascular disease in RA await elucidation. The present study comprises three components.

Procalcitonin and C-reactive protein levels in HIV-positive subjects with tuberculosis and pneumonia.

Pulmonary tuberculosis (PTB) and pneumococcal community-acquired pneumonia (PCAP) are common causes of lower respiratory tract infections in HIV-seropositive patients and may have similar clinical and radiological features. This study aimed to assess the value of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in HIV-seropositive patients with pneumonia, and to investigate their potential role in differentiating pneumococcal from mycobacterial infections. HIV-seropositive patients admitted with pneumonia were evaluated prospectively, 34 with PTB and 33 with PCAP.

Traditional and nontraditional cardiovascular risk factors are associated with atherosclerosis in rheumatoid arthritis.

Objective: To determine the association between cardiovascular (CV) risk factors and atherosclerosis in patients with rheumatoid arthritis (RA).

Methods: The common carotid artery intima-media thickness (IMT) and plaque were evaluated by high resolution B-mode ultrasound in 74 consecutive patients with RA. Patients with an IMT > or = 0.

Pneumonia associated with HIV infection.

Purpose Of Review: Pneumonia occurs commonly in HIV-infected patients and this review highlights some of the recent findings in the epidemiology, pathogenesis, clinical features, treatment and prevention of this condition.

Recent Findings: Pneumonia remains an important cause of morbidity and mortality in HIV-infected patients. A number of factors have been identified that increase the risk of pneumonia.

HIV seropositive in pregnant South African women who initially refuse routine antenatal HIV screening.

This study was instituted primarily to determine the HIV seroprevalence of pregnant South African women who refused routine HIV testing at the antenatal clinic of the Johannesburg Hospital, South Africa. Fifty such patients were identified, who, after being fully counselled and informed, agreed to participate in the study, provided total anonymity was adhered to: they did not want to know their results, irrespective of outcome. Blood specimens were given a laboratory reference number only, with no other reference to the patient and analysed utilising the ELISA immunoassay.

Atrioventricular septal defect associated with type A postaxial polydactyly.

We report two more patients with the association of postaxial polydactyly and atrioventricular septal defects. Additional cardiac findings, not previously described, were tetralogy of Fallot in the first case, and double orifice right atrioventricular valve in the second child.

Psychotic manifestations in brain tumour patients: 2 case reports from South Africa.

Two cases are presented of adult males diagnosed with psychosis who were found to have intraventricular tumours (central neurocytomas). In both cases the psychotic manifestations disappeared following surgical removal of the tumours. The relationship between structural brain lesions and psychotic manifestations is discussed.

Damage control in the abdomen and beyond.

Background: Damage control is not a modern concept, but the application of this approach represents a new paradigm in surgery, borne out of a need to care for patients sustaining multiple high-energy injuries.

Methods: A Medline search was performed to locate English language articles relating to damage control procedures in trauma patients. The retrieved articles were manually cross-referenced, and additional academic and historical articles were identified.

Imiglucerase low-dose therapy for paediatric Gaucher disease--a long-term cohort study.

Background: Gaucher disease is the most common lysosomal storage disorder caused by the insufficiency of the lysosomal enzyme, glucocerebrosidase. This deficiency results in absent or inefficient conversion of glucocerebroside (a membrane lipid) to ceramide and glucose. Accumulation of glucocerebroside occurs primarily in macrophage lysosomes (i.

HIV/AIDS: impact on maternal mortality at the Johannesburg Hospital, South Africa, 1995-2001.

This study investigated maternal mortality at the Johannesburg Hospital, a 1100-bed academic hospital in South Africa. Patient records were assessed retrospectively over two time periods: 1995/1996 and 2000/2001. Causes of death were noted and compared with national data.

Subclinical hypothyroidism is associated with insulin resistance in rheumatoid arthritis.

We investigated the prevalence of subclinical hypothyroidism and its association with insulin resistance and other cardiovascular (CV) risk factors in rheumatoid arthritis (RA). We recorded thyroid function tests, insulin resistance markers comprising the Homeostasis Model Assessment for insulin resistance (HOMA-IR), the Quantitative Insulin Sensitivity Check Index (QUICKI) and triglycerides/high-density lipoprotein (HDL) cholesterol ratios, and other CV risk factors in 126 patients with RA. Fifteen (12%) were taking thyroxine for hypothyroidism and 14 (11%) had subclinical hypothyroidism (thyrotropin > 4 mU/L and normal free thyroxine levels).

CD4 T-lymphocyte subset counts in HIV-seropositive patients during the course of community-acquired pneumonia caused by Streptococcus pneumoniae.

Total lymphocyte counts, CD4 T-lymphocyte counts and CD4/CD8 ratios were measured in 30 anti-retroviral-naive HIV-seropositive patients upon hospital admission for acute community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae, and again 1 month after resolution of infection. There was a significant depression of the total lymphocyte count (p < 0.005) and CD4 T-lymphocyte count (p < 0.

Substance abuse and major trauma in Johannesburg.

Introduction: The abuse of alcohol and drugs is a major public health problem and intoxication is one of the most important risk factors for violence and other causes of injury. The aim of the current study was to evaluate the prevalence of drug and alcohol use associated with injury in adult trauma patients in an inner city trauma unit in Johannesburg.

Methods: A cohort of 105 adult trauma patients admitted to our university trauma unit and its allied medicolegal laboratory were studied in order to provide prospective data and enable us to correlate the prevalence and type of substance abuse with the demographics and injury patterns after major trauma.

High sensitivity C-reactive protein as a disease activity marker in rheumatoid arthritis.

Objective: To elucidate the potential contribution of high sensitivity C-reactive protein (hs-CRP) testing in the assessment of disease activity in rheumatoid arthritis (RA).

Methods: We recorded clinical and psychological variables, the hs-CRP, and erythrocyte sedimentation rate (ESR) in 146 consecutive patients with RA. We analyzed the associations between the ESR and hs-CRP versus the other recorded variables.

Low-dose oral vitamin K is safe and effective for outpatient management of patients with an INR>10.

Background: Low-dose oral vitamin K effectively returns an international normalized ratio (INR) between 4.5 and 10.0 to an INR of 2.