TABLE OF CONTENT: Cardiovascular Journal of Africa, Vol 15, Issue 4, Jul / Aug 2004

1. Title: Recommendations for hypertension in sub-Saharan Africa : editorial
   Authors: Seedat, Y.K.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 4, Jul / Aug
   Published: 2004
   Pages: p.157-158
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2. Title: Differences in cardiovascular function of rural and urban African males : the THUSA study : cardiovascular topics
   Authors: Schutte, Rudolph; Huisman, Hugo W.; Malan, Leone; Van Rooyen, Johannes M.; Schutte, Aletta E.; Malan, Nicolaas T.; De Ridder, Johannes H.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 4, Jul / Aug
   Published: 2004
   Pages: p.161-165
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   Abstract: Introduction: South Africa's black population has been in a process of transition from rural monocultural environments to industrialised urban environments since the early 1990s. This transition has led to an increased susceptibility to cardiovascular diseases such as hypertension, which in this group commonly leads to stroke. Besides the already observed increases in blood pressure, there is still uncertainty as to how the factors associated with urbanisation influence the cardiovascular system as a whole.
   Aim: To obtain a more complete cardiovascular profile and its association with the lipid profile and subcutaneous fat distribution of the African in transition.
   Methods: A cross-sectional epidemiological study was performed which included 433 men from the North- West Province. The Finapres apparatus and Modelflow software program were used to obtain a more elaborate cardiovascular profile. The lipid profile and subcutaneous fat were also determined.
   Results: An increase in systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed in the urban group. The heart rate (HR) did not differ while the stroke volume (SV) and cardiac output (CO) was lower in the urban group. Arterial compliance (CW) also showed a decrease in the urban group along with an increased total peripheral resistance (TPR), compared with the rural group. The lipid profile and BMI did not differ between the two groups.
   Conclusions: The factors associated with urbanisation elevate blood pressure via a peripheral mechanism. This peripheral mechanism may be due to endothelial damage associated with low-density lipoprotein cholesterol (LDL-C) and a truncal subcutaneous fat distribution.
    
3. Title: The William Nelson ECG quiz
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 4, Jul / Aug
   Published: 2004
   Pages: p.165, 181
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4. Title: Serum lipid parameters and the prevalence of corneal arcus in a dyslipidaemic patient population : cardiovascular topics
   Authors: Meyer, D.; Liebenberg, P.H.; Maritz, F.J.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 4, Jul / Aug
   Published: 2004
   Pages: p.166-169
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   Abstract: Aim: To determine whether an association exists between plasma lipoprotein constituents and the prevalence of corneal arcus in dyslipidaemic patients.
   Methods: Adult patients (n = 115) were included if their fasting total serum cholesterol concentrations exceeded the 95th percentile or their serum low-density lipoprotein (LDL) : high density lipoprotein (HDL) ratios exceeded 5. Slit-lamp assessment of the corneas was performed.
   Results: The study group divided into a subgroup with arcus 37% (43) and a subgroup without arcus 63% (72). Total serum cholesterol and triglyceride levels were not associated with corneal arcus. A significant difference was found (p < 0.05) between the mean levels of LDL cholesterol (LDL-C) in the group without arcus (5.61 + 1.74 mmol/l) and the group with arcus (5.96 + 1.71 mmol/l). The mean serum HDL-cholesterol (HDL-C) in the group with corneal arcus was 1.04 + 0.30 mmol/l as opposed to 1.31 + 0.38 mmol/l in the group without arcus (p < 0.005 for difference). The mean LDL-C : HDL-C ratio in the group without arcus was 4.28 (SD: 1.99), and 5.73 (SD: 2.09) in the group with a corneal arcus (p < 0.05).
   Conclusions: Low HDL-C levels, high LDL-C levels and LDL-C : HDL-C ratios > 5 have been implicated as risk factors of numerous circulatory diseases. The observations in this study suggest that the presence of corneal arcus in the dyslipidaemic patient correlates strongly with these same risk indicators.
    
5. Title: EVAR : critical applied aortic morphology relevant to type-II endoleaks following device enhancement in patients with abdominal aortic aneurysms : cardiovascular topics
   Authors: Du Toit, D.F.; Saaiman, J.A.; Labuschagne, B.C.J.; Vorster, W.; Van Beek, F.J.; Boden, B.H.; Geldenhuys, K.M.
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 4, Jul / Aug
   Published: 2004
   Pages: p.170-177
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   Abstract: Endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) is an established alternative option to conventional surgery for AAA, provided optimal anatomical morphology of the aneurysm sac, neck and outflow exists. In most documented series of EVAR, type-II endoleak occurrence is a universal procedural drawback. This is referred to as the Achilles heel of EVAR. This morphological study, addressing predominantly non-aneurysmal aortic anatomy, reveals the dyssynchronous origins of the renal ostia, ectopia of the superior mesenteric artery and median sacral artery, variations in the length of the infrarenal abdominal aorta, multiple mainstem renal arteries, and the presence of accessory renal arteries (in 13% of cadavers). Such potential vascular anomalies need careful consideration pre-operatively prior to EVAR.
   In a prospective, clinical study of EVAR in 163 patients over 60 months, using four different aortic stent devices, we demonstrated an intraprocedural type-II endoleak rate, before exclusion, of 3% (5/163). Most were related to patent lumbar arteries. An active policy of intraprocedural aneurysm pressure sac measurement and angiography was used to demonstrate type-I and type-II endoleaks, focusing on the applied anatomy of aortic side branches and variations. Selective intraprocedural coil embolisation and thrombin injection into the sac was utilised to thrombose persisting and large lumbar arteries that predisposed to retroleaks. We recorded a low incidence of persisting type-II endoleaks using this proactive treatment strategy by addressing variant aortic morphology and patent lumbar arteries during EVAR. One aneurysm-related death (0.6%) was observed due to late rupture after EVAR, and a single intraprocedural death was related to unpredictable aneurysm rupture.
   In conclusion, comprehensive anatomical knowledge of the abdominal aorta and its main collateral side branches, including variations, is a fundamental prerequisite if satisfactory and predictable results are to be achieved after EVAR, especially regarding prevention, diagnosis and treatment of type-II endoleaks. Intraprocedural aneurysm sac pressure monitoring, coil embolisation and the use of injection of thrombin into the aneurysm sac of selected patients is useful in reducing the incidence of post-EVAR type-II persisting endoleaks.
    
6. Title: Pre-operative intercostal nerve blockade for minimally invasive coronary bypass surgery : a standardised anaesthetic regimen for rapid emergence and early extubation : cardiovascular topics
   Authors: Exadaktylos, Aristomenis K.; Trampitsch, Ernst; Mares, Peter; Czerny, Martin; Grimm, Michael; Muhm, Manfred
   From: Cardiovascular Journal of South Africa, Vol 15, Issue 4, Jul / Aug
   Published: 2004
   Pages: p.178-181
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