Awolf in wolf's clothing the abdominal compartment syndrome

Four patients are described in whom massive abdominal distension after laparotomy led to increased airway and central venous pressure and severely reduced urine output. All cases were associated with massive fluid resuscitation and operative findings were a grossly oedematous bowel with free fluid under pressure in the abdomen. These findings are consistent with the diagnosis of intra-abdominal compartment syndrome. In 1 case trauma was remote from the abdomen indicating that abdominal surgery or trauma may not be a prerequisite for the development of the condition. Recognition of the features of the condition is essential as it can only be treated by decompression of the abdominal contents

Carotid endarterectomy in Durban - the first 10 years

This study was a prospective evaluation of the Durban experience with carotid endarterectomy over the past decade. Since 1981, 478 carotid endarterectomies have been performed in 411 patients. The majority of these patients were white men, with an average age of 60,6 years. The indication for surgery was a lateralising transient ischaemic attack or atnaurosis fugax in 65,50/0, lateralising stroke « 1 year before surgery) in 14,4%, non-lateralising global cerebral ischaemia in 9,4% and asymptomatic carotid stenosis in 10,7%. Carotid endarterectomy was performed under general anaesthesia and with invasive monitoring; 25% of patients underwent selective shunting. After open carotid bifurcation endarterectomy, all but 6 underwent primary closure (99,4%). The combined major stroke/mortality rate was 6%. This audit identified a group of patients who presented with a history of stroke within the year preceding surgery and who had a significantly higher postoperative stroke/mortality rate of 20,2%. Long-term follow-up, ranging from 1 month to 96 months, showed 80,7% to be strokefree after 8 years. This audit demonstrates a postoperative stroke/ mortality rate comparable to that of other series and additionally confirmed the durability of carotid endarterectomy in the long term

The potential benefit of pre-operative assessment of amputation wound healing potential in peripheral vascular disease

Choosing the most distal amputation level that will heal is difficult in patients with peripheral vascular disease. From 1984 to 1988,965 patients underwent 1 563 amputations for lower limb peripheral vascular disease at King Edward VIII Hospital, Durban. The primary amputation revision rate was 51% with a mortality rate of 23,1%. Random pre-operative assessment of amputation wound healing potential using a transcutaneous oxygen pressure index was investigated over the 4-year period, 1987 - 1990. This was responsible for a reduction in the amputation revision rate to 8,2% in patients tested

Observações preliminares sobre o "declínio" da seringueira.

A partir de 1983, uma enfermidade aparentemente nova vem sendo observada em seringais de cultivo no Estado do Amazonas, constituida pela reducao da taxa de crescimento e/ou definhamento das plantas. Estao sendo feitos ensaios para se identificar um possivel agente infeccioso, bem como selecao de clones tolerantes, ensaios de adubacao e avaliacao de comportamento das plantas afetadas.bitstream/item/76995/1/CPAA-PESQ.-AND.-44-86.pd

Development of a portfolio of learning for postgraduate family medicine training in South Africa: a Delphi study

<p>Abstract</p> <p>Background</p> <p>Within the 52 health districts in South Africa, the family physician is seen as the clinical leader within a multi-professional district health team. Family physicians must be competent to meet 90% of the health needs of the communities in their districts. The eight university departments of Family Medicine have identified five unit standards, broken down into 85 training outcomes, for postgraduate training. The family medicine registrar must prove at the end of training that all the required training outcomes have been attained. District health managers must be assured that the family physician is competent to deliver the expected service. The Colleges of Medicine of South Africa (CMSA) require a portfolio to be submitted as part of the uniform assessment of all registrars applying to write the national fellowship examinations. This study aimed to achieve a consensus on the contents and principles of the first national portfolio for use in family medicine training in South Africa.</p> <p>Methods</p> <p>A workshop held at the WONCA Africa Regional Conference in 2009 explored the purpose and broad contents of the portfolio. The 85 training outcomes, ideas from the WONCA workshop, the literature, and existing portfolios in the various universities were used to develop a questionnaire that was tested for content validity by a panel of 31 experts in family medicine in South Africa, via the Delphi technique in four rounds. Eighty five content items (national learning outcomes) and 27 principles were tested. Consensus was defined as 70% agreement. For those items that the panel thought should be included, they were also asked how to provide evidence for the specific item in the portfolio, and how to assess that evidence.</p> <p>Results</p> <p>Consensus was reached on 61 of the 85 national learning outcomes. The panel recommended that 50 be assessed by the portfolio and 11 should not be. No consensus could be reached on the remaining 24 outcomes and these were also omitted from the portfolio. The panel recommended that various types of evidence be included in the portfolio. The panel supported 26 of the 27 principles, but could not reach consensus on whether the portfolio should reflect on the relationship between the supervisor and registrar.</p> <p>Conclusion</p> <p>A portfolio was developed and distributed to the eight departments of Family Medicine in South Africa, and the CMSA, to be further tested in implementation.</p