Cardiothoracic surgery training in South Africa: Where to from here?

Standing in the operating theatre and seeing a heart’s function improve after replacing a stenotic aortic valve, or repairing an incompentent mitral valve or revascularising obstructed coronary arteries is an amazing experience. Very few people have the oppurtunity to see a heart come to life when we removethe aortic cross clamp after cardiac surgery. Blood fl ushes the cardioplegia out of the coronaries, the myocardial cells fuel its sodium, potassium and calcium pumps from the life giving blood, and the heart starts beating: a miracle we get to witness every day

The pressure fl ow relationship of the internal mammary artery after offpump anastomosis to the left anterior descending coronary artery

Objective: To assess the pressure flow relationship of the internal mammary artery (IMA) in situ, after skeletonisation and after anastomosis to the left anterior descending (LAD) coronary artery, using either halothane, sevoflurane or propofol as an anaesthetic agent. Methods: 15 Pigs were used in total, five received halothane, five sevoflurane and five propofol as an anaesthetic agent. The flow in the internal mammary artery in each of the pigs, was measured at various arterial pressures. This was done with the IMA in situ, then after dissecting the artery off the chest wall using the skeletonisation technique and finally after offpump grafting to the left anterior descending coronary artery. Results: The pressure flow relationship of the internal mammary artery after skeletonisation was found to be linear (r=0.8650). The pressure flow correlation after grafting the skeletonised internal mammary artery to the left anterior descending coronary artery was found to be similarly linear (r=0.8766). In the sevoflurane subgroup, with the IMA still in situ, a degree of autoregulation was found to be present, but after skeletonisation this was subsequently lost (p=0.011). Conclusions: The pressure flow relationship in the internal mammary artery after skeletonising the vessel and after OPCAB anastomosis to the LAD was found to be linear. In the subgroup of pigs receiving sevoflurane, some degree of autoregulation was demonstrated in the in situ IMA. This remnant of autoregulation was lost after skeletonisation and after grafting of the vessel to the left anterior descending coronary artery. SAHeart 2009; 6:222-22

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

CITATION: Webster, I., Goussard, P., Gie, R., Janson, J. & Rossouw, G. 2017. The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV. Expert Review of Respiratory Medicine, 11(2):159-165, doi:10.1080/17476348.2017.1280397.The original publication is available at https://www.tandfonline.com/toc/ierx20/currentBackground: Bronchoscopy is an important investigation in the diagnosis and management of childhood respiratory diseases widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC). Aims and Objectives: Aim of this study was to describe the indications, findings and complications of paediatric bronchoscopy in a middle income country with a high prevalence of tuberculosis (TB) and HIV. Methodology: A retrospective analysis of a database which included all bronchoscopies on neonates and children over a 3.5 year period (January 2010 to June 2013) in a tertiary care children’s hospital in South Africa. Results and Discussion: A total of 509 bronchoscopies, of which 502 (98%) were fibre-optic bronchoscopies, were performed on neonates (2.3%) and children (median age = 18 months; range 1 day- 14.6 years)( (male=58%) of which 5.1% were HIV-infected. The main indications were: large airway compression 40% (n = 204) complicated pneumonia (25 %) and persistent stridor (15 %). Pathology was observed in 64% (n = 319) of bronchoscopes . The most common pathology seen was lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being removing foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications occurred during or following bronchoscopy. Conclusion The diagnostic yield of paediatric bronchoscopy did not significantly differ from those reported from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.post printMaster