South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Abnormal peri-operative haemorrhage in asymptomatic patients is not predicted by laboratory testing.
The pre-operative identification of individuals at high risk of bleeding during major elective surgery is obviously important. Extensive haemostatic screening is, however, expensive and may be inappropriate in low-risk groups. Accordingly, we undertook two studies to determine whether it could be justified in patients without a history of abnormal bleeding. ⋯ A single patient had mild thrombocytopenia, and 8 had a prolonged partial thromboplastin time; none showed abnormal peri-operative haemorrhage. In the second study, over a 4-month period, 49 patients out of 1,872 required larger peri-operative blood transfusions than anticipated; on investigation, none of these patients was shown to have disturbances in haemostatic mechanism, the transfusion having been indicated for technical reasons. Patients undergoing elective surgery should be asked about medication and previous bleeding and if they have no history thereof and a physical examination is negative, pre-operative screening for coagulation defects would appear to be unnecessary.
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Sex-workers play an important role in the spread of sexually transmitted diseases (STDs) and this article tries to show that they can also play an important role in their prevention. Community participation by sex-workers in the prevention of STDs can also decrease the incidence thereof.
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Comment Letter
Gonococcal infection in acute haemorrhagic conjunctivitis.
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This study reports on the process of peer review of peri-operative mortality at Tygerberg Hospital. The peri-operative mortality rate for the past 3.5 years was 11.9/10,000. ⋯ In 2.3/10,000, the anaesthetic contributed to the death of the patient and in 10 cases (total case load = 94,945; i.e. 1.1/10,000) anaesthesia was responsible for the death of the patient. The majority of the peri-operative deaths (8.5/10,000) were caused by a combination of trauma and haemorrhagic shock.
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In October 1988 the orthotopic liver transplantation programme recommenced at Groote Schuur Hospital. The experience gained from our first 10 patients is described here. Anaesthesia for this type of surgery is demanding given the long duration of the operation and the severe haemodynamic and physiological alterations that can occur. ⋯ All patients were electively ventilated in the surgical intensive care unit postoperatively. One patient died 11 days postoperatively. The remainder are well at the time of writing.