Post-tonsillectomy haemorrhage following traditional uvulectomy in an adult patient

A 28-year-old IsiPedi-speaking black South Africa male patient presented with recurrent attackes of dry throat, dry cough, sore throat and globus pharyngeus. When asked what he thought was responsible for his symptoms, he said that he suspected an infection of the uvula (lelingwana) and according to \'Pedi\' culture would require surgical removal. After the physical examination, a clinical assessment of chronic tonsillitis and laryngopharyngeal reflux disease was made. The attending surgeon informed him that there was no indication for the removal of the uvula but he would benefit from tonsillectomy and anti-reflux medication. The patient reluctantly agreed to the suggested procedure and a day-case tonsillectomy under general anaesthesia using dry mono-polar diathermy dissection technique was performed. The procedure ws successful with dry tonsillar fossae. When the patient recovered from anaesthesia, he immediately enquired if his uvula was removed but was informed that the tonsils were the only tissues removed as indicated and and consented to. He was discharged and placed on amoxycillin and Myprodol (an analgesic). Later in hte day (19h00), he was rushed back to the casualty department with marked oropharyngeal bleeding and in severe hypovoleamic shock. He was immediately resuscitated and prepared for examination under anaesthesia in the theatre. The main finding was bleeding from a freshly cut uvula but the tonsillar fossae showed no active bleeding.SA Fam Pract 2005;47(1): 4

Composition of Non Volatile Oils and Antimicrobial Activities of Extracts from Monanthotaxis Discolor, and an Undescribed Uvariondedron Species

The chemical compositions of non volatile oil extracts from two Annoneceous plant species Monanthotaxis discolor and an undescribed Uvariodendron species which are endemic to Eastern Arc Mountains, Tanzania were determined by GC-MS. The biological activities of extracts and fractionated samples were also determined. Both methanol and dichloromethane extracts of the root bark of M. discolor showed mild antimicrobial activity and had positive brine shrimp test (BST). The BST test for dichloromethane extract of M. discolor root bark were LC50 41.794 μg/ml and that of methanol extract showed LC50 13.560 μg/ml. The petroleum ether and dichloromethane extracts of root bark of Uvariodendron species showed cytotoxicity of LC50 33.06 μg/ml and LC50 35.35 μg/ml, respectively. Twelve major constituents were identified from the dichloromethane extract of M. discolor root bark of which the following compounds were in high composition; α- cadinol (42.85%), (-)-alloaromadendrene (11.7%) aristolone (10.57 %), γ-cadinene (8.72%), δ- cadinene (3.44%) and cubenene (2.28%). The Second fraction of the third repeated column chromatography from the VLC fraction of dichloromethane extract and the first fraction of the VLC of methanol extract root bark revealed, among others 23 components of which the most abundant were; (-)-alloaromadendrene (15.1%), T-cadinol (8.08%), chamigren (5.3%) and γ- Cadinene (5.1%). Other components were also identified from other methanol fractions; (+)- aromadendrene, (18.2%), (-)-alloaromadendrene (12.8%), 4,9-muurodiene (5.3%), T-cadinol (83%), ς-himachelene (0.63%) and ledol (0.3%). The ethanol:dichloromethane (1:1) extract of the leaves of M. discolor showed four different components from those identified from root bark extracts among which heptacosane and tributylamine had percentage composition of (3.42%) and (0.34%),.respectively. The petroleum ether extract of the root bark of the undescribed Uvariodendron species revealed seven components of which the most abundant were methyl eugenol (38.7%) and elemicin (18.2%). For the ethanol extract of stem bark oil mixtures the most abundant components were δ-cadinol (0.25%), methyl eugenol (0.12%), isoelemecene (0.04%), and diisooctyphthalate (0.02%).Keywords: Annoneceous, Monanthotaxis discolor, undescribed Uvariodendron species, Antimicrobial, cytotoxicity, α-cadinol, (-)-alloaromadendrene, T-cadinol, methyl eugenol, elemicin, aromadendrene

Public health and economic costs of investigating a suspected outbreak of Legionnaires' disease.

This paper provides one of the first assessments of the burden of both the public health investigation and the economic costs associated with an apparent outbreak of Legionnaires' disease (LD) in South East London. In addition to epidemiological, microbiological and environmental investigations, we collected data on the staff time and resources committed by the 11 main organizations responsible for managing the outbreak. Of the overall estimated costs of 455,856 pounds, only 14% (64,264 pounds) was spent on investigation and control of the outbreak compared with 86% (391,592 pounds) spent on the hospital treatment of the patients. The time and money spent on public health services in this investigation appear to represent good value for money considering the potential costs of a major outbreak, including the high case-fatality rate in LD generally and the high health-care costs. Further research is needed to determine optimum strategies for the cost-effective use of health system resources in investigations of LD. Whether the threshold for investigation of cases should be based on observed incidence rates or the cost-effectiveness of investigations, or both, should be debated further

MIDDLESEX (Reino Unido). Inglaterra. Condado. Mapas generales. 1734? (1726-1734?). 1:92600

Comprende la división territorial de los tres condados y la división interna de cada uno de ellosFecha probable tomada de: "Tooley's Dictionary of Mapmakers ". Tring, Hertfordshire, England : Map Collector Publications Limited, 1979, p. 588Escala hallada a partir de un minuto de latitud [= 2 cm]. Coordenadas referidas al meridiano de Londres (O 2°36°--E 1°23'/N52°6'--N 51°40'). Recuaddro geográfico de 5' en 5'. Orientado con lis en rosa de treinta y dos vientos prolongadosOrografía de perfilIndica la calidad del fondo en la desembocadura del TámesisPresenta una red de cuadrícula para la localización de los distintos puntos representados, acompañada de un índice alfabético para cada condadoOrlado por los escudos de armas de cada una de las ciudades que conforman los tres condados, continuándose por falta de espacio en una hoja más de menor tamañoTítulo y mención de responsabilidad en cartela decorada con figuras mitológicas y angelote

Sir David Wilkie's sketches, Spanish & oriental

Láminas suelta

Lima (Perú). Planos de población. 1700-1730

Copia Digital. Real Academia de la Historia : 2010Forma de ingreso: Legado. Fuente de ingreso: Gonzalo Menéndez-Pidal y Goyri (Madrid). Fecha de ingreso: 29 de febrero de 2003Relieve por montes de perfil y sombreado. Arbolado y cultivos. Hidrografía sombreada con un fino rayado e iluminada a la aguad

A simple reproducible method of preventing lobar torsion

Torsion of remaining lobes after pulmonary resection is a potentially serious complication with high reported morbidity and mortality. A range of additional procedures has been described, we have used a simple, effective, quick and easy to reproduce minor procedure to prevents torsion

War and peace in phylogenetics: a rejoinder on total evidence and consensus

Abstract.-For more than 10 years, systematists have been debating the superiority of character or taxonomic congruence in phylogenetic analysis. In this paper, we demonstrate that the competing approaches can converge to the same solution when a consensus method that accounts for branch lengths is selected. Thus, we propose to use both methods in combination, as a way to corroborate the results of combined and separate analyses. We could engage in this debate by opting for character congruence, taxonomic congruence, or the conditional combination approach. Rather, we prefer to suggest using combined and separate analyses jointly, as proposed by de Queiroz (1993; see also Larson, 1994). Interestingly, a distance-based procedure relying on the average consensus has been applied successfully by Lapointe et al. (1999) to combine either trees or data matrices in a coherent fashion. This hybrid procedure is defined as a global congruence approach (see Lapointe, 1998b) because it assesses neither the congruence among characters nor that among individual phylogenies; rather, it evaluates the congruence between total evidence and consensus trees. This approach can thus be used to cross-corroborate the trees obtained by combined and separate analyses. In the present paper, we apply the socalled global congruence approach to a wide variety of published datasets sampled from the systematic literature, using a uniform 88