This study examined the effect of a single dose of methylprednisolone ((MP) 30 mg/kg) given before cardiopulmonary bypass (CPB) on the alveolar/arterial oxygen gradient (AaDO2) and arterial oxygen tension/inspired oxygen fraction quotient (PaO/FiO2) at I, 24 and 48 hours after CPB. The study was prospective and patients were randomly allocated to one of two groups. Of the 295 patients entered into the study, 165 received MP and 130 did not. The mortality rate in the MP group was 4.24% and in the control group the mortality rate was 3.85% (P = 0.894). No difference in the postoperative PaO/FiO2 and AaDO2 could be demonstrated when patients who had received MP were compared with those who had not received MP pre-operatively.
Despite advances in antimicrobial therapy, endocarditis continues to be a difficult therapeutic problem. In countries where streptococci remain the commonest cause of this disease, penicillin and gentamicin are still the best empirical choices. Studies have allowed some refining of therapy by identifying criteria, on the basis of which decisions can be made about the duration of therapy and the need for synergistic aminoglycosides. In prosthetic endocarditis the preponderance of staphylococci as causative agents dictates the empirical use of vancomycin until sensitivity data are available.
Electron microscopic and semi-quantitative morphologjcal methods were employed to determine the effect of torbafylline, a new methylxanthine derivative, on the response of capillaries to ischaemia and subsequent reperfusion Sixteen vervet monkeys under general anaesthesia were studied. A pneumatic tourniquet was applied to a hind limb for 3 hours. Eight animals received torbafylline (20 mglkg) by intravenous infusion prior to tourniquet application. Open muscle biopsies were taken from the tibialis anterior before tourniquet application, just before tourniquet release and after 6, 12 and 24 hours of reperfusion. All specimens were prepared for transmission electron microscopy. The capillaries in all pre-tourniquet specimens were normal. Endothelial cell oedema, abnormal cytoplasmic organelles and altered levels of pinocytosis occurred in various numbers of capillaries in each experimental specimen. A numeric Index was created to descriptionbe the seventy of capillary pathomorphology. Torbafylline was shown significantly to reduce the severity of capillary pathomorphology during reperfusion.
The management of Down syndrome patients. with heart disease is a well-published ethical dilemma. Controversy exists .about whether to operate or not, and what lesions should be operated on. Tbere is, to our knowledge, no published data on Down syndrome patients with congenital heart disease in southern Africa. This ethical dilemma is even worse in our country with its limited resources and is exacerbated by the complexity of heart disease in these children. The aim of this study was to analyse our data on patients with Down syndrome and heart disease and to establish whether surgery is feasible or not. Data on 67 Down syndrome patients were analysed. The pre-operative mortality rate was 23.8 %, while the postoperative mortality rate was 20%. No patient with uncomplicated tetralogy of Fallot who was operated on died. Although no statistical difference between the two groups could be demonstrated, the quality of life of those operated on improved dramatically. In conclusion, the same indications applicable to patients with heart disease without Down syndrome must be applied to Down syndrome patients with heart disease.
The annular subvalvular left ventricular aneurysm (ASLVA) is a rare entity that occurs mostly in young blacks, predominantly from poor socio-economic groups in sub-Saharan Africa (82% of reported cases) and south India, areas with a high incidence of tuberculosis. Eighteen reports in the literature descriptionbe 25 children. A further 9 children are reported here. Rheumatic fever, bacterial endocarditis and tuberculosis have all been considered as possible causes of ASLVA. The association of tuberculosis (according to International Union Against Tuberculosis and Lung Disease criteria for diagnosis of childhood tuberculosis) suggests a tuberculous origin of ASLVA. Rheumatic fever and infective endocarditis characteristics were confirmed less often.