S Afr J Surg
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Tramadol is a multimodal analgesic with proven dose-related efficacy over a variety of perioperative surgical fields and is efficacious in treating both neuropathic and cancer pain. It is of particular use in patients with impaired cardiorespiratory, hepatic or renal function, and is an important addition to the armamentarium of the surgeon.
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There is increasing awareness of the value of day case paediatric surgery in fulfilling the needs of the community. Is this cost effective, are there hidden complications and is there a need for routine follow-up? Seven hundred and thirty-one children attending the Red Cross War Memorial Children's Hospital day surgery unit over a 32-month period, and undergoing 912 procedures confined to the inguinoscrotal region, were enrolled in the study. Surgical procedures performed included inguinal herniotomy, orchidopexy and circumcision. ⋯ Our trial confirms that wound sepsis is an infrequent but significant complication of day case groin surgery. Routine follow-up by surgical day units of minor surgical cases is not warranted and will incur unnecessary cost. Only 1.5% of postoperative cases will require further medical attention and septic lesions in the lymphatic drainage area should be regarded as risk factors.
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A 61-year-old woman was admitted to hospital with features of subacute bowel obstruction. Contrast enema and computed tomography (CT) scanning showed evidence of a diaphragmatic hernia. The patient underwent thoraco-laparotomy which revealed a sliding hiatal hernia with transverse colon in the hernial sac. Repair of the defect and segmental resection of the colon were performed, with good postoperative recovery.
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This case highlights an unusual pleural cyst in a 3-year-old child that simulated a pneumothorax on chest radiograph. The child presented with mild respiratory distress and the 'pneumothorax' failed to respond to pleural intubation. At thoracotomy, a 10 cm air-filled cyst was found attached to the visceral pleura by a narrow pedicle. ⋯ Postoperatively, the lung expanded and the child recovered without any sequelae. Histological examination of the cyst showed it to be lined with mesothelial cells. It is suggested that this cyst arose from a mesothelial inclusion cyst or sub-mesothelial pleural tissue, which communicated with the peripheral lung tissue.