S Afr J Surg
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A congenital posterolateral diaphragmatic (Bochdalek) hernia generally presents with symptoms within a day after birth. This article reports on 3 children whose hernias produced symptoms for the first time beyond a week of age. One 3-year-old child died acutely with symptoms resembling that of a tension pneumothorax. ⋯ The first requisite for the diagnosis of a congenital diaphragmatic hernia (CDH) is a high index of suspicion. Cystic lesions or masses in the lower lung fields should suggest the possibility of a CDH with herniated abdominal content at any age. Congenital diaphragmatic hernias should be included in the differential diagnosis of apparent lower lobe pneumonias in all children below a month of age.
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The authors reviewed 33 revision hip arthroplasties using the long-stemmed porous coated anatomic (PCA) prosthesis that required adjuvant patch-grafting for proximal defects of the femur. All hips were revised for aseptic loosening. The mean follow-up period was 3.7 years (2.0-5.8 years). ⋯ Proximal stress protection bone resorption was not seen, although cancellisation of the calcar was noted in 20/33 (60%) hips. Serial radiological review demonstrated some degree of subsidence of the femoral stem in 20/33 (60%) hips. The authors conclude that patch-grafting of the proximal femur at revision surgery incorporates and is not inhibited by the presence of a rigid long-stemmed implant.
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Randomized Controlled Trial Clinical Trial
Penetrating stab wounds of the chest--when should chest physiotherapy commence? A comparative study.
In an effort to optimise the physiotherapy management of patients with penetrating stab wounds to the chest, 26 male patients, aged between 18 and 30 years, were randomised to one of two groups on admission to Hillbrow Hospital. The patients in group I received chest physiotherapy immediately after insertion of the intercostal drain, while patients in group II received chest physiotherapy 9-12 hours after insertion of the drain as is currently the normal hospital procedure. Mean duration of intercostal drainage in group I was 40 hours and that in group II 65.92 hours. ⋯ There was a significant difference in the duration of hospitalisation between the two groups, this being shorter in group I than in group II. The prevalence of spiking temperatures was also significantly lower in group I than in group II, since only 2 patients in group I but 8 patients in group II developed a spiking temperature (P = 0.0207). This study suggests that an aggressive approach of immediate chest physiotherapy in these patients has definite beneficial results.
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Chylous ascites is an extremely rare complication of abdominal aortic surgery. A case with a successful outcome is presented, followed by a review of the 17 published cases. ⋯ Conservative management, beginning with a low-fat diet and medium-chain triglyceride (MCT) supplementation, is recommended, changing to total parenteral nutrition if unsuccessful. Failure of non-operative treatment may necessitate the need for laparotomy and ligation of leaking lymphatics or peritoneovenous shunting.
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In critically ill patients continuous venovenous haemodiafiltration (CVVHD) is a method of renal replacement therapy gaining popularity. The advantage of CVVHD over intermittent haemodialysis and peritoneal dialysis lies in the accurate control of ultrafiltration and of solute clearance. Two paediatric patients with acute renal failure treated successfully with CVVHD are described. The role of CVVHD in renal supportive therapy in South African paediatric intensive care units is discussed.