Browsing by Author "Immelman, E J"

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    The incidence and prevention of Postoperative Venous Thrombosis
    (1973) Joffe, Stephen Neal; Terblanche, J T; Immelman, E J
    In the last few years a very high incidence of deep vein thrombosis has been reported in the literature. Venous thrombosis and its sequel, pulmonary embolus account for 12. 5% of all postoperative deaths and is the single greatest threat to recovery after surgical operations. This study was undertaken to investigate the incidence of postoperative deep vein thrombosis occurring at Groote Schuur Hospital using the newer methods of diagnosis. No previous similar study has been conducted in South Africa. The high-risk factors predisposing to venous thrombosis have been assessed and the techniques of diagnosis using Radio-active fibrinogen, Doppler ultrasound and Venography have been studied. The local findings reported in this study confirmed the high reported incidence. Methods of prevention of venous thrombosis using low doses heparin and sodium pentosan polysulphate have been assessed.
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    Non-specific aortic arteritis (Takayasu's disease) : the Cape Town experience
    (1989) Currer, Trevor H; Immelman, E J
    Non-specific aortic arteritis remains a disease of unknown aetiology, in which the treatment is empiric, the indications for surgery controversial and the prognosis unpredictable. Most series emanate from the Far East, with few contributions from Africa. The pattern of disease as seen in-Cape Town has not been documented since the study of Schrire and Asherson in 1964, containing 18 cases. In this study at Groote Schuur and Red Cross Children's Hospital from 1952 to 1987, only patients who had been extensively investigated and subjected to angiography were included. strict· inclusion criteria excluded patients with specific forms of aortic arteritis. 220 patients were studied of which 77% were female. Mean age 25(1-66). 68% were "Coloured" or Asian, 24% Black and 8% White. Involvement of the entire aorta was seen in 62%. The· aortic arch was involved in 70% but isolated arch disease occurred in only 9%. Aortic bifurcation disease occurred in 30%, an unusually high incidence. 93% had occlusive disease. 50% had aneurysms, which usually occurred together with occlusive disease. 7 patients presented with ruptured aneurysm. Hypertension due to renal artery stenosis or to coarctation was the commonest presentation (76%). 103 (47%) patients had cardiac disease (hypertensive cardiac failure or aortic incompetence.) Upper or lower limb claudication was present in 77 patients with gangrene in only 11. 43 patients had clinical evidence of cerebrovascular disease. 54 patients are known to have died, with cardiac failure responsible for almost 50%. Follow-up of 5-20 years was possible in 40% of patients. Two-thirds showed no further progression in this period. Vascular reconstruction was performed in 43 patients (21%). Other treatment modalities included corticosteroids (11%) and antituberculous therapy (28%). Proven tuberculosis was present in only 20% of cases. The pattern of disease in Cape Town tends to be diffuse, usually with extensive branch vessel involvement, and thus seldom amenable to reconstructive vascular surgery. Hypertension and cardiac failure are the commonest presenting symptoms and the most frequent cause of death. The aetiology of this condition remains obscure and the pathogenetic link with Tuberculosis is controversial. A significant number of patients have "burnt out" disease, and prolonged survival has been observed.
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    A system for the acquisition and digital analysis of lower limb flow waveforms
    (1994) Smith, Leonard; Capper, Wayne L; Bunn, Anthony E; Immelman, E J
    A PC based waveform acquisition and analysis system has been developed for use in aorta-iliac arterial assessment. A Motorola DSP56001 based system containing dual Analog to Digital converters is used to sample phase quadrature demodulated signals from a commercially available continuous wave Doppler unit. The Power Spectral Density is calculated using an autoregressive model from which the mean velocity waveform is calculated. This waveform is used to calculate the damping factor, vessel compliance and runoff resistance of a simple electrical model of the lower limb arterial circulation using a non-linear regression technique of curve fitting in the time domain. A pilot study using the system shows a significant separation (p < 0.001 Mann Whitney U-test) between the damping factors of a normal control group (quartile range = 0. 15 - 0.25 ; median = 0. 19) and a patient group with angiographically determined aorta-iliac arterial disease (quartile range = 0.45 - 0.89 ; median= 0.49).