South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Randomized Controlled Trial Comparative Study Clinical Trial
Synthetic laminaria tent for cervical ripening.
The efficacy and safety of a synthetic laminaria tent (Lamicel; Cabot) in ripening the cervix before induction of labour was compared with prostaglandin E2 (PGE2) oral tablets used intravaginally. Eighty patients were randomly assigned to use of the laminaria tent (N = 40) or PGE2 (N = 40). ⋯ However, the duration of labour was shorter in the PGE2 group than in the tent group (10, 14 h v. 11,61 h). These findings indicate that the synthetic laminaria tent is the preferred agent for cervical ripening in high-risk pregnancies and in developing countries.
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The adult respiratory distress syndrome developing within 24 hours in a patient who underwent suction lipectomy for body contouring under general anaesthesia is reported. During surgery, in which a total of 1.3 l of suction matter was removed, the patient became haemodynamically unstable and mildly hyperthermic. Subsequently, clinical signs and symptoms of the fat embolism syndrome developed. ⋯ Malignant hyperthermia was excluded as cause for the clinical presentation on muscle biopsy and in vitro caffeine contracture studies. Although usually complication-free, suction lipectomy may be associated with life-threatening incidents. Even suction volumes as low as 1.3 l have potential hazards, therefore the procedure merits regular postoperative observation and re-assessment.
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The prime object in the obstetric management of mothers who have previously delivered an infant with neonatal alloimmune thrombocytopenia is to prevent the occurrence of intracranial haemorrhage, which may occur in subsequent pregnancies in 15-20% of infants with this disease. Elective caesarean section at 38 weeks' gestation may obviate the problem, since it prevents trauma during vaginal delivery but it will not eliminate neurological sequelae in those infants who have already suffered antenatal intracranial bleeding, an entity now well described in these fetuses. A review is presented in which all possible antenatal and post-natal modalities of treatment in the management of these cases are highlighted.
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Preservative-free morphine sulphate (0.5 mg in 0.5 ml normal saline) was injected intrathecally as the sole analgesic in 10 primiparous patients in the first stage of labour. Elective forceps were applied under pudendal block anaesthesia to assist the second stage of labour to prevent cephalad spread during bearing down, and so reduce the side-effects of morphine sulphate. ⋯ No side-effects of morphine sulphate were observed in any of the infants delivered. It is concluded that intrathecal morphine sulphate combined with elective forceps delivery provides a satisfactory alternative to epidural anaesthesia in those patients whose cardiovascular status demands preservation of a normal or elevated systemic vascular resistance.
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The provincial ambulance services have developed into highly trained professional emergency medical services over the last few years. This rapid development seems to have caught the medical profession by surprise, so much so that in recent months some medical practitioners were of the opinion that ambulance personnel were being trained to do more than they should. ⋯ It would be in the interest of the patient if a sound working relationship between pre-hospital, hospital and private medical practitioners could be established and that each group becomes familiar with the capabilities of the other. It is equally important that ambulance personnel be welcomed into the health profession of which they are now an integral part.