There are few studies that look at the influence of diabetes mellitus on early outcome following ... more There are few studies that look at the influence of diabetes mellitus on early outcome following carotid endarterectomy (CEA). Those available have reported conflicting results, with some showing poor outcome and others similar outcome to those without diabetes mellitus. To assess the influence of diabetes mellitus on early outcome following CEA. Clinical data on patients who had CEA over a 5-year period were acquired from a prospectively maintained computerised database. They were divided into two groups, namely diabetics and non-diabetics. Two hundred and sixty-four charts were analysed. There were no significant differences in patient demographics and risk factors for atherosclerosis between the two groups. The majority (71%) of patients had CEA for symptomatic carotid disease. Carotid shunting was performed selectively, and significantly more diabetic patients had CEA under the protection of a carotid shunt (p=0.0469). Postoperative strokes, transient ischaemic attacks and deaths were not significantly different between the two groups. Diabetes mellitus had no influence on the early surgical outcome following carotid endarterectomy.
There is little information on the surgical management of Takayasu's arteritis in children an... more There is little information on the surgical management of Takayasu's arteritis in children and adolescents. Information on 30 patients aged between eight and 17 years was culled from a prospectively maintained database on the Vascular Service of the University of KwaZulu-Natal, Durban, South Africa. Twenty-one patients had involvement of the descending aorta; in 19, this was confined to the aorta (type 2 disease). One had associated arch disease (type 3) and one had associated cardiac disease (type 4). One patient had isolated axillary artery occlusion (type 5). Eight patients had disease confined to the aortic arch (type 1), 22 had occlusive disease and eight were aneurysmal. All patients had operative repairs undertaken. There were no peri-operative deaths in the group who had cerebrovascular reconstruction, and one death (4.5%) in those who had descending aortic replacement. Patients were followed up for between one month and 11 years. Hypertension was improved or cured in 10...
One hundred and eight patients were admitted to King Edward VIII Hospital, Durban, with a penetra... more One hundred and eight patients were admitted to King Edward VIII Hospital, Durban, with a penetrating wound of the neck and were managed by a conservative policy. Intervention was undertaken if, and only if, there was an indication of damage to deep structures. Data were collected prospectively. Significant sequelae were seen in only 50 patients (46 per cent) and 26 underwent surgery. Three patients died from their neck injuries (2.8 per cent). 2 after operative intervention and 1 after conservative management. Morbidity was higher after surgery, though local sepsis in wound haematomas was more common in those treated conservatively. A selective policy for surgical intervention is safe and justifiable. A minimum mortality and morbidity can be obtained by adequate preoperative evaluation which includes the use of contrast radiography and angiography.
Fifty-eight patients have been treated for recurrent lower limb ischemia following bypass surgery... more Fifty-eight patients have been treated for recurrent lower limb ischemia following bypass surgery for aortoiliac occlusive disease over a three-year period. Based on clinical case notes, angiograms, operative notes and histologic examination of endarterectomy specimens, 32 patients (55.2%) were found to have progressive atherosclerotic occlusion involving the inflow (seven patients) or outflow (25 patients) tracts. Seven patients (12.0%) had problems related to graft angulation or mural thrombus fragmentation and, in four patients, anastomotic fibroplasia was demonstrated. Fifteen patients (25.9%) had not had their disease bypassed by the primary operation and required reoperation within one year. It is suggested that the use of juxtarenal end-to-end proximal anastomosis, extending to the groins distally in most cases, and good graft to host size match may be important considerations. Management entailed major aortic reconstructions in 28 patients, and local groin procedures or crossover grafts in 30 patients. There was one postoperative death (1.7%). Two patients had amputations (3.4%) although all grafts were functioning at the time the patients were discharged from the hospital. Major complications were more frequent following aortic reconstruction, and operations of this magnitude may, possibly, be confined to patients with aortic inflow obstruction, infection involving the graft body or redundancy of the graft body causing sufficient angulation to cause obstruction.
Thoracic outlet syndrome (TOS) is one of the most poorly understood syndromes. Neurogenic TOS is ... more Thoracic outlet syndrome (TOS) is one of the most poorly understood syndromes. Neurogenic TOS is found in 95% of cases. The described anatomical spaces transform and evolve into 'entrapment spaces'. The aetiology is unclear. This study was based on the observation by a single surgeon that there appeared to be a high incidence of anatomical abnormalities in patients with neurogenic TOS. To attempt to clearly define anatomical anomalies causing TOS. The records from a prospectively maintained computer database of 219 patients submitted for surgery over a 10-year period (1999-2009) were reviewed. A substudy was done on the patients operated on over the last 4 years (n=63) in whom details of the intraoperative anatomical findings were meticulously recorded. Over the last 4 years, the surgical findings in the last 63 patients (67 operations) revealed a significant number of anatomical abnormalities believed to be responsible for the nerve compression. Brachial plexus anomalies were found in 99% of the patients--the majority comprised the postfixed configuration. In addition, 58% had a soft-tissue anomaly, 27% had a bony anomaly and 3% had other abnormalities. The majority had combinations of these abnormal findings. These findings strongly suggest that there is usually an identifiable anatomical cause, typically the brachial plexus, for the symptoms of TOS. We strongly recommend that the supraclavicular approach be used in order to define anatomical aberrations. Brachial plexus configuration anomalies causing TOS have not been emphasised previously. Further detailed recordings of these findings may help us better understand the aetiology of this poorly defined syndrome.
On average there are approximately 50 confirmed shark attacks worldwide annually. Despite their r... more On average there are approximately 50 confirmed shark attacks worldwide annually. Despite their rarity, such incidents often generate much public and media attention. The injuries of 86 consecutive victims of shark attack were reviewed from 1980 to 1999. Clinical data retrieved from the South African Shark Attack Files, maintained by the Natal Sharks Board, were retrospectively analyzed to determine the nature, treatment, and outcome of injuries. The majority of victims (n = 68 [81%]) had relatively minor injuries that required simple primary suture. Those patients (n = 16 [19%]) with more extensive limb lacerations longer than 20 cm or with soft-tissue loss of more than one myofascial compartment were associated with higher morbidity and limb loss. In 8 of the 10 fatalities, death occurred as a result of exsanguinating hemorrhage from a limb vascular injury. Victims of shark attack usually sustain only minor injuries. In more serious cases, particularly if associated with a major v...
Journal of neuroimaging : official journal of the American Society of Neuroimaging, 2000
The authors define the frequency, nature, and extent of cerebrovascular sequelae of Takayasu arte... more The authors define the frequency, nature, and extent of cerebrovascular sequelae of Takayasu arteritis using functional imaging. Retrospective analysis of the cases derived from the Durban Stroke Data Bank (n = 1100) and Durban Metropolitan Vascular Surgery Database (n = 5300) consisted of evaluation by contemporary neuroimaging modalities including single positron emission computed tomography (SPECT), magnetic resonance imaging (MRI) diffusion scanning, and transcranial Doppler (TCD). Of all the patients identified with Takayasu disease (n = 142), 29 (20%) patients were identified with a primarily cerebrovascular presentation. The recent advent of modern functional imaging techniques allowed only the 10 most recent patients with a cerebrovascular presentation to be evaluated. Of these 10, 8 (80%) had normal neurologic deficit scores (Canadian neurologic score) and 9 (90%) were not disabled as determined by handicap scores (Rankin). The anatomic brain scans (9 MRI, 1 CT) were normal...
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 2003
Non-recognition of a critical aortic arch branch variation at surgery, with fatal consequences, p... more Non-recognition of a critical aortic arch branch variation at surgery, with fatal consequences, prompted a retrospective analysis of the prevalence of aortic arch branch variations in the South African population. Three hundred and twenty aortic arch angiograms were analysed from existing records (January 1988--March 1998) of the vascular unit, Department of Surgery, University of Natal. Aortic arch branch variations were observed in 17 cases (5.3%). These variations were as follows: (i) 11 cases with two primary branches (3.4%); (ii) 1 case with three primary branches (0.3%); and (iii) 5 cases with four primary branches (1.6%). The clinical presentations which these variations give rise to are well known and may present during the first days of life or later in adulthood, or remain clinically silent. Non-recognition of the latter situation in the presence of vascular trauma may have fatal consequences.
There is little information on reconstructive arterial surgery for Takayasu Arteritis, and the ap... more There is little information on reconstructive arterial surgery for Takayasu Arteritis, and the approach is generally negative in this regard. Common causes of death are stroke, aneurysm rupture and the complications of renovascular hypertension and renal failure. The present study aims to examine the results of arterial reconstruction in the medium and long term in patients with histologically proven Takayasu's disease. In the last 11 years 134 patients have been referred to the vascular service of whom 81 (60%) were suitable for operation. Forty-nine were women; age range 3-45 years (average 29.5 years). In 28 the disease was confined to the aortic arch (Type 1); 41 had descending aortic involvement (Type II); six had a combination of arch and aortic disease (Type 111) and two associated cardiac lesions (Type IV). Four had isolated peripheral lesions (Type V). Seventy percent of these lesions were aneurysmal. Of the 28 type I patients, two had aortic arch reconstruction, seven segmental replacement. Of the 49 with type II, III and IV disease 26 had thoraco-abdominal aortic replacement using a bypass technique. The remainder had infrarenal aortic replacement and bypass procedures. Type V (four patients) had interposition grafts. Overall operative mortality in the Type I patients was 3.6% (stroke) and in the type II-IV 4%. All of the latter followed operation for aneurysm rupture and there were no elective deaths. Three months to 11 years after operation four patients (5%) developed fatal progression of the disease and seven (8.9) non-fatal disease progression of whom three required surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)
There are few studies that look at the influence of diabetes mellitus on early outcome following ... more There are few studies that look at the influence of diabetes mellitus on early outcome following carotid endarterectomy (CEA). Those available have reported conflicting results, with some showing poor outcome and others similar outcome to those without diabetes mellitus. To assess the influence of diabetes mellitus on early outcome following CEA. Clinical data on patients who had CEA over a 5-year period were acquired from a prospectively maintained computerised database. They were divided into two groups, namely diabetics and non-diabetics. Two hundred and sixty-four charts were analysed. There were no significant differences in patient demographics and risk factors for atherosclerosis between the two groups. The majority (71%) of patients had CEA for symptomatic carotid disease. Carotid shunting was performed selectively, and significantly more diabetic patients had CEA under the protection of a carotid shunt (p=0.0469). Postoperative strokes, transient ischaemic attacks and deaths were not significantly different between the two groups. Diabetes mellitus had no influence on the early surgical outcome following carotid endarterectomy.
There is little information on the surgical management of Takayasu's arteritis in children an... more There is little information on the surgical management of Takayasu's arteritis in children and adolescents. Information on 30 patients aged between eight and 17 years was culled from a prospectively maintained database on the Vascular Service of the University of KwaZulu-Natal, Durban, South Africa. Twenty-one patients had involvement of the descending aorta; in 19, this was confined to the aorta (type 2 disease). One had associated arch disease (type 3) and one had associated cardiac disease (type 4). One patient had isolated axillary artery occlusion (type 5). Eight patients had disease confined to the aortic arch (type 1), 22 had occlusive disease and eight were aneurysmal. All patients had operative repairs undertaken. There were no peri-operative deaths in the group who had cerebrovascular reconstruction, and one death (4.5%) in those who had descending aortic replacement. Patients were followed up for between one month and 11 years. Hypertension was improved or cured in 10...
One hundred and eight patients were admitted to King Edward VIII Hospital, Durban, with a penetra... more One hundred and eight patients were admitted to King Edward VIII Hospital, Durban, with a penetrating wound of the neck and were managed by a conservative policy. Intervention was undertaken if, and only if, there was an indication of damage to deep structures. Data were collected prospectively. Significant sequelae were seen in only 50 patients (46 per cent) and 26 underwent surgery. Three patients died from their neck injuries (2.8 per cent). 2 after operative intervention and 1 after conservative management. Morbidity was higher after surgery, though local sepsis in wound haematomas was more common in those treated conservatively. A selective policy for surgical intervention is safe and justifiable. A minimum mortality and morbidity can be obtained by adequate preoperative evaluation which includes the use of contrast radiography and angiography.
Fifty-eight patients have been treated for recurrent lower limb ischemia following bypass surgery... more Fifty-eight patients have been treated for recurrent lower limb ischemia following bypass surgery for aortoiliac occlusive disease over a three-year period. Based on clinical case notes, angiograms, operative notes and histologic examination of endarterectomy specimens, 32 patients (55.2%) were found to have progressive atherosclerotic occlusion involving the inflow (seven patients) or outflow (25 patients) tracts. Seven patients (12.0%) had problems related to graft angulation or mural thrombus fragmentation and, in four patients, anastomotic fibroplasia was demonstrated. Fifteen patients (25.9%) had not had their disease bypassed by the primary operation and required reoperation within one year. It is suggested that the use of juxtarenal end-to-end proximal anastomosis, extending to the groins distally in most cases, and good graft to host size match may be important considerations. Management entailed major aortic reconstructions in 28 patients, and local groin procedures or crossover grafts in 30 patients. There was one postoperative death (1.7%). Two patients had amputations (3.4%) although all grafts were functioning at the time the patients were discharged from the hospital. Major complications were more frequent following aortic reconstruction, and operations of this magnitude may, possibly, be confined to patients with aortic inflow obstruction, infection involving the graft body or redundancy of the graft body causing sufficient angulation to cause obstruction.
Thoracic outlet syndrome (TOS) is one of the most poorly understood syndromes. Neurogenic TOS is ... more Thoracic outlet syndrome (TOS) is one of the most poorly understood syndromes. Neurogenic TOS is found in 95% of cases. The described anatomical spaces transform and evolve into 'entrapment spaces'. The aetiology is unclear. This study was based on the observation by a single surgeon that there appeared to be a high incidence of anatomical abnormalities in patients with neurogenic TOS. To attempt to clearly define anatomical anomalies causing TOS. The records from a prospectively maintained computer database of 219 patients submitted for surgery over a 10-year period (1999-2009) were reviewed. A substudy was done on the patients operated on over the last 4 years (n=63) in whom details of the intraoperative anatomical findings were meticulously recorded. Over the last 4 years, the surgical findings in the last 63 patients (67 operations) revealed a significant number of anatomical abnormalities believed to be responsible for the nerve compression. Brachial plexus anomalies were found in 99% of the patients--the majority comprised the postfixed configuration. In addition, 58% had a soft-tissue anomaly, 27% had a bony anomaly and 3% had other abnormalities. The majority had combinations of these abnormal findings. These findings strongly suggest that there is usually an identifiable anatomical cause, typically the brachial plexus, for the symptoms of TOS. We strongly recommend that the supraclavicular approach be used in order to define anatomical aberrations. Brachial plexus configuration anomalies causing TOS have not been emphasised previously. Further detailed recordings of these findings may help us better understand the aetiology of this poorly defined syndrome.
On average there are approximately 50 confirmed shark attacks worldwide annually. Despite their r... more On average there are approximately 50 confirmed shark attacks worldwide annually. Despite their rarity, such incidents often generate much public and media attention. The injuries of 86 consecutive victims of shark attack were reviewed from 1980 to 1999. Clinical data retrieved from the South African Shark Attack Files, maintained by the Natal Sharks Board, were retrospectively analyzed to determine the nature, treatment, and outcome of injuries. The majority of victims (n = 68 [81%]) had relatively minor injuries that required simple primary suture. Those patients (n = 16 [19%]) with more extensive limb lacerations longer than 20 cm or with soft-tissue loss of more than one myofascial compartment were associated with higher morbidity and limb loss. In 8 of the 10 fatalities, death occurred as a result of exsanguinating hemorrhage from a limb vascular injury. Victims of shark attack usually sustain only minor injuries. In more serious cases, particularly if associated with a major v...
Journal of neuroimaging : official journal of the American Society of Neuroimaging, 2000
The authors define the frequency, nature, and extent of cerebrovascular sequelae of Takayasu arte... more The authors define the frequency, nature, and extent of cerebrovascular sequelae of Takayasu arteritis using functional imaging. Retrospective analysis of the cases derived from the Durban Stroke Data Bank (n = 1100) and Durban Metropolitan Vascular Surgery Database (n = 5300) consisted of evaluation by contemporary neuroimaging modalities including single positron emission computed tomography (SPECT), magnetic resonance imaging (MRI) diffusion scanning, and transcranial Doppler (TCD). Of all the patients identified with Takayasu disease (n = 142), 29 (20%) patients were identified with a primarily cerebrovascular presentation. The recent advent of modern functional imaging techniques allowed only the 10 most recent patients with a cerebrovascular presentation to be evaluated. Of these 10, 8 (80%) had normal neurologic deficit scores (Canadian neurologic score) and 9 (90%) were not disabled as determined by handicap scores (Rankin). The anatomic brain scans (9 MRI, 1 CT) were normal...
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie, 2003
Non-recognition of a critical aortic arch branch variation at surgery, with fatal consequences, p... more Non-recognition of a critical aortic arch branch variation at surgery, with fatal consequences, prompted a retrospective analysis of the prevalence of aortic arch branch variations in the South African population. Three hundred and twenty aortic arch angiograms were analysed from existing records (January 1988--March 1998) of the vascular unit, Department of Surgery, University of Natal. Aortic arch branch variations were observed in 17 cases (5.3%). These variations were as follows: (i) 11 cases with two primary branches (3.4%); (ii) 1 case with three primary branches (0.3%); and (iii) 5 cases with four primary branches (1.6%). The clinical presentations which these variations give rise to are well known and may present during the first days of life or later in adulthood, or remain clinically silent. Non-recognition of the latter situation in the presence of vascular trauma may have fatal consequences.
There is little information on reconstructive arterial surgery for Takayasu Arteritis, and the ap... more There is little information on reconstructive arterial surgery for Takayasu Arteritis, and the approach is generally negative in this regard. Common causes of death are stroke, aneurysm rupture and the complications of renovascular hypertension and renal failure. The present study aims to examine the results of arterial reconstruction in the medium and long term in patients with histologically proven Takayasu's disease. In the last 11 years 134 patients have been referred to the vascular service of whom 81 (60%) were suitable for operation. Forty-nine were women; age range 3-45 years (average 29.5 years). In 28 the disease was confined to the aortic arch (Type 1); 41 had descending aortic involvement (Type II); six had a combination of arch and aortic disease (Type 111) and two associated cardiac lesions (Type IV). Four had isolated peripheral lesions (Type V). Seventy percent of these lesions were aneurysmal. Of the 28 type I patients, two had aortic arch reconstruction, seven segmental replacement. Of the 49 with type II, III and IV disease 26 had thoraco-abdominal aortic replacement using a bypass technique. The remainder had infrarenal aortic replacement and bypass procedures. Type V (four patients) had interposition grafts. Overall operative mortality in the Type I patients was 3.6% (stroke) and in the type II-IV 4%. All of the latter followed operation for aneurysm rupture and there were no elective deaths. Three months to 11 years after operation four patients (5%) developed fatal progression of the disease and seven (8.9) non-fatal disease progression of whom three required surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)
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