Thesis (M.S.)--University of Hong Kong, 1993. / Also available in print.

Proefschrift--Utrecht. / Summary in Dutch. Bibliography: p. 105-110.

Thesis (M.D.)--Boston University

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Otorhinolaryngology.” Johannesburg, 2019 / INTRODUCTION: Laryngotracheal stenosis is rare but has become a well-recognized pathological otorhinolaryngological condition. It develops when scar tissue forms in the trachea and larynx. Laryngotracheal stenosis can cause significant morbidity and the management of it is often complex. Tracheal resection with end-to-end anastomosis is a well-recognized surgical procedure performed for treatment of larygotracheal stenosis and has been shown to have great success. AIM: To review the short-term outcomes of tracheal resection for larygotracheal stenosis at the Chris Hani Baragwanath Academic Hospital Otorhinolaryngology Department. METHOD: This was a retrospective study, reviewing 24 patients with larygotracheal stenosis who underwent segmental tracheal resection with end-to-end anastomosis at the Chris Hani Baragwanath Academic Hospital, performed between 2005 and 2015. RESULTS: The study included 24 patients with ages ranging from 18 to 64 years. There were 15 (62.5%) males and 9 (37.5%) females. The causes of larygotracheal stenosis were prolonged intubation in 22 (91.7%) and inhalation burns in 2 (8.3%) patients. Eleven patients (45.8%) had postoperative complications, of which 4 (36.4%) were minor complications and 7 (63.6%) were major complications. The outcomes of surgery were excellent in 13 (54.2%), satisfactory in 8 (33.3%) and unsatisfactory in 3 (12.5%). CONCLUSIONS: Prolonged intubation was found to be the most common cause of larygotracheal stenosis. Tracheal resection for larygotracheal stenosis has been shown to have satisfactory to excellent short-term outcomes in terms of successful decannulation, voice quality, and low morbidity. In our study, the surgery was successful in 21 (87%) patients, which is comparable to success rates shown in the literature. Preoperative tracheostomy and higher degree of stenosis Meyer Cotton (III and IV) were associated with high postoperative complications. Irrespective of the cause, tracheal resection is a good surgical option, for the treatment of patients with severe stenosis and those who have failed treatment from other alternative surgeries. / E.K. 2019

In contrast to other mammalians spontaneous endothelialization does not occur in humans. Since this lack of a functioning endothelium is thought to be a main reason for the unsatisfying performance of synthetic arterial grafts, we attempted to create an endothelium on the prosthetic surface by lining the graft with cultured endothelial cells. To provide sufficient cell-numbers for lining, a rapid and reliable harvest technique had to be developed first. In an initial series of 120 primary cultures, short segments of human saphenous veins were excised and cannulated before 0.1 % collagenase (CLS II) was instillated for 15 minutes to detach EC's. During the following growth under tissue culture conditions, we could demonstrate that a short transport time between vein excision and collagenase application is essential for a successful EC proliferation. In a subsequent study, evaluating risk factors, cell harvest and reproductive capacity of EC' s were markedly worse in smokers than in non-smokers. In order to further shorten the time span between vessel excision and collagenase application, an in situ canulation technique with immediate application of collagenase was developed. This harvest technique resulted in a 100% growth rate in 124 baboon primary cultures. Moreover, low plating densities not only achieved 43% shorter cell cycles than the usual plating densities, but also enabled mass-cultures after one single passage, thus reducing the cell damaging effect of trypsin. When the growth characteristics from 5 anatomically different sites were compared, the external jugular vein - which could be easily accessible and dispensable in each patient - proved to be an excellent source for EC cultures. The second goal of in-vitro endothelialization was the creation of shear stress resistant EC monolayers on the graft surface. A prerequisite for this is the use of a suitable underlying protein matrix, because EC do not adhere to uncoated surfaces of synthetic grafts. For that reason, primary adherence and cell attachment area of seeded human endothelial cells were determined on differently coated polytetrafluoroethylene (PTFE) grafts. Cell adherence and spreading was distinctly superior on two surface covering substrates: on fibronectin-treated type I/III collagen and on fibrinolytically inhibited fibrin glue (FG). Since FG is less thrombogenic than collagen, the shear stress resistance of cultured human endothelium was investigated on 6mm PTFE grafts, precoated with PG. EC seeding was performed in a microprocessor controlled seeding device, allowing a low inoculum of 12x10^4 EC/cm^2. A mock circulation simulated the flow patterns and the shear stress of the femoral artery. After 24 hours of perfusion, the grafts were still covered by a confluent endothelium. The in vivo persistence of cultured endothelium was then determined in the nonhuman primate model, using baboons. Since autologous in vitro lining requires a cell laboratory and is therefore confined to big centers, alogenic endothelialization with cryopreserved, pooled, blood-group identical endothelial cells was performed first. Bilateral femoral interpositions (10- 12cm) of experimental and control grafts were subsequently implanted into 18 baboons with the same blood group as that of the pooled cells. After 16 days of implantation the patency rate of grafts of the endothelialized group was similar to that of the control group (55.5 vrs 61.1 %; p> 0.1). Scanning electron microscopy revealed that 44.4% of experimental grafts were completely free of endothelium, while the remaining grafts showed a moderate cell coverage of 34.4+17.1 %. These remaining endothelial cells were found mainly as small cell islands, densely covered by leukocytes. For that reason, a similar series of baboon experiments was performed, using autologous EC from the external jugular vein. After 9 days of implantation, the patency rate of EC-lined and control grafts was 100% and 66.6%. Moreover, after both periods of observations, the endothelial coverage was shown to be intact in scanning electron microscopy and the underlying fibrin glue was well preserved in histological cross sections. An initially observed dense leukocyte adherence at the surface of the endothelium had disappeared after 4 weeks. In summary, we developed a method which results in endothelialized prosthetic vascular grafts with a significantly better patency rate than control grafts in the primate model. This method consists of the combination of in situ harvest of EC from external jugular veins, micro-grid follow-up, low density plating and microprocessor controlled seeding of endothelial cells onto fibrin glue coated PTFE grafts. We believe that these data provide a sufficient rational for initial clinical trials with autologous in vitro lining of prosthetic vascular bypass grafts.

M. Tech. / Although Chiropractors rely on palpation as a clinical tool, its reliability still remains to be proven (O‟Haire and Gibbons, 2000). Motion palpation is based on the assumption that Chiropractors‟ and other manual medicine practitioners‟ static palpation is performed correctly to identify bony anatomical landmarks (O‟Haire and Gibbons, 2000). The most common method taught to chiropractic students on the location of the seventh thoracic spinous process, is to place the patient‟s hand in the small of their back, forcing the inferior angle of the scapula to become more prominent. The horizontal line from the inferior angle of the scapula to the vertebral column is said to be on the seventh thoracic spinous process (T7). Therefore the scapula is a widely used anatomical landmark. One would therefore expect the literature to all be in agreement to the position of this line, but according to the literature consulted, it seems to vary. This study aimed to determine whether palpation of the inferior angle of the scapula was a reliable, accurate and/or a valid method of determining the location of the seventh thoracic spinous process. Sixty participants were marked by three examiners in the seated position, using the inferior angle of the scapula to locate the seventh thoracic spinous process. After being marked by all three examiners, measurements were then made on CT scan films as well as visual assessments by examiners to assess the location of the markers on the thoracic anatomy. The results demonstrated substantial inter-examiner reliability, and poor accuracy in locating the seventh thoracic spinous process. This is disappointing as the ability to palpate spinal levels is a basic skill and the cornerstone of Chiropractic assessment.

Penetrating injuries of the intrathoracic great vessels are well recognized although uncommon. In the First World War no survivors with thoracic vascular injury were recorded among soldiers treated with penetrating injuries to the chest as recorded by Makins. The first record of successful repair of a penetrating thoracic aortic injury was in 1922 by Dshanelidze in Russia. Similar to Makins' experience, De Bakey and Simeone in the Second World War recorded no surviving patients with involvem_ent of the thoracic aorta and its branches among American soldiers. Furthermore, no injuries to the thoracic aorta and its branches were recorded in Korean war soldiers undergoing vascular surgery by both Jahnke and Hughes. Rich reported 3 survivors of aortic injuries in the Vietnam war among 1000 patients with vascular injuries. By 1969 only 43 successfully treated cases had been reported but increasing numbers of patients sustaining injuries to the great arteries at the level of the thoracic inlet have been reported subsequently in civilian practice. Experience has grown over the years but patient numbers remain small and individual surgeons may only manage 2 or 3 of these patients in his life time. The largest single reported series consists of 93 patients in Memphis over a 13 year period. All victims were rapidly transported to hospital and were resuscitated en route. As a consequence, a large number critically ill patients reached hospital who may have died in earlier years. However some of these patients inevitably died in hospital contributing to the high mortality of 16, 7% reported. Our experience is different in that most of our victims who reach hospital will survive as poor community triage facilities prevent more than 95% of penetrating thoracic vascular trauma victims reaching hospital alive, hence we have a selection of less severely injured patients who eventually reach our hospital alive producing our mortality rate of 5%. Another important difference is that most of our patients suffered stab wounds as compared to gunshot wounds noted in the Memphis. Buchan and Robbs in Durban reported on 52 patients who had penetrating cervicomediastinal vascular injury with a remarkably similar experience to our own in Cape Town with the exception of a larger number of aortic injuries (21 out of 52 patients) recorded and a higher mortality rate of 17% as a result of these aortic injuries.

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002. xvi, 125 leaves / The purpose of this study was to determine the effect of spinal manipulation as compared to passive oscillatory mobilization, on thoracic spine range of motion, pain threshold and subjective pain experience, in patients with chronic mechanical thoracic spine dysfunction.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2002. / The purpose of this study was to determine the effect of spinal manipulation as compared to passive oscillatory mobilization, on thoracic spine range of motion, pain threshold and subjective pain experience, in patients with chronic mechanical thoracic spine dysfunction. / M

M.Tech.