S Afr J Surg
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Comparative Study
Use of intravesical temperature as a monitor of core temperature during and following general anaesthesia.
The value of thermistor-bearing urinary catheters has not been extensively investigated in the postoperative period. This study compared thermistor-bearing urinary catheters with pulmonary artery catheters as a means of measuring core temperature during and following general anaesthesia in patients undergoing aortic aneurysmectomy. ⋯ The study indicates that in patients undergoing aortic aneurysmectomy, the thermistor-bearing urinary catheter is a clinically acceptable measure of core temperature during and following general anaesthesia.
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Patients with penetrating cardiac injuries present in a stable or only mildly shocked condition--especially if the laceration has sealed off and the patient has been adequately resuscitated. A large proportion of patients presenting to our unit are in a reasonably stable condition after resuscitation, and rapid diagnosis may be difficult. We present our experience over a 5-year period (191 patients), with particular reference to the stable patient. ⋯ Cardiac ultrasound is very useful (in the absence of haemothorax), and was performed in 103 of 191 patients, with 8 false-negatives and 3 false-positives. When an unstable patient presents with an obvious diagnosis use of cardiac ultrasound should be restricted. A subxiphoid window has diagnostic value where the cardiac ultrasound is inconclusive.
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Traumatic rupture of the thyroid gland is a rare event. This report describes such an injury, in this case caused by a kick from a horse. Blunt injury to the anterior structures of the neck involving the major blood vessels and larynx has been described, but major blunt injury to the thyroid gland is rare.
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With a view to the prevention of immediate and later complications of splenectomy, especially the risk of overwhelming post-splenectomy sepsis syndrome (OPSS), conservative treatments have been proposed when the haemodynamic condition of the patient permits this. In this study, we present our experience in a preserving non-operatively orientated care team in a tropical hospital. ⋯ The present study confirms the ability to preserve an increasing number of traumatised spleens by non-operative therapy. This has become possible as a consequence of increasing experience and confidence in pursuing a non-operative approach based on accurate diagnostic methods. Furthermore, non-operative management does not increase the length of stay in hospital and it reduces the total volume of blood transfusions required. While we agree with others that the choice between operative and non-operative management of splenic trauma should be based mainly on clinical grounds, ultrasonography and peritoneal lavage were important tools in the diagnostic pathway and in decision-making. It is worth noting that a 'safe' grade of spleen injury does not exist, since even minor lesions can lead to massive haemoperitoneum and shock requiring emergency splenectomy. In view of the now well known early and late complications after splenectomy, spleen preservation should be the treatment of choice for splenic trauma, especially in tropical countries.