South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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'Be fruitful, and multiply' is a divine injunction. Religious problems of seminal collection and genital surgery occur in the investigation and treatment of orthodox Jewish men.
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A case of disseminated blastomycosis is reported. The patient presented with lung involvement, lupus vulgaris-like lesions, mainly of the face, and subcutaneous abscesses overlying areas of bone destruction. The diagnosis was confirmed by mycological microscopy and culture of skin material from involved areas. The importance of early diagnosis and the favourable response to treatment are emphasized.
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From 1981 to 1984, 1,720 patients requiring critical care were admitted to two multidisciplinary intensive care units (MDICUs) run by a department of critical care at the University of the Orange Free State, Bloemfontein. The majority (61%) were referred from outside the metropolitan area. The most important referring specialties were surgery (25%), medicine (19%), orthopaedics (14%), paediatrics (10%) and obstetrics and gynaecology (9%). ⋯ Care by the referring doctor was impractical and limited numbers of patients in each discipline make independent 'level-1' units (ICU doctor in unit at all times) undesirable. The cost of care of the 1,720 patients over 4 years was approximately R5 700,000. Demand for MDICU care increased by 40% from 1981 to 1984.
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The effect of suxamethonium on serum potassium levels was studied in 20 black patients undergoing emergency surgery. All patients were resuscitated pre-operatively to achieve a normal pH (range 7.35-7.45), normal electrolyte values (potassium range 3.5-4.5 mmol/l), and an adequate circulating blood volume using the criteria of systolic blood pressure in excess of 100 mmHg and a central venous pressure maintained at more than 2 cm H2O. Suxamethonium (approximately 0.8 mg/kg) was administered during a standard rapid intubation sequence for the induction of anaesthesia. In the adequately resuscitated emergency patient an induced respiratory alkalosis may prevent the rise in serum potassium previously reported with the use of suxamethonium.
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Analgesics containing dipyrone continue to be available throughout Africa, including South Africa and Zimbabwe. Although an effective analgesic and antipyretic, dipyrone may cause severe side-effects, including agranulocytosis. The mechanism of this hypersensitivity reaction has been well documented, and many reports of agranulocytosis associated with dipyrone use have been published. ⋯ Dipyrone is known by a variety of official names, which may contribute to confusion in deciding whether a particular preparation contains this drug. The prescribing information contained in the Monthly Index of Medical Specialities (MIMS) (South Africa) and the MIMS Desk Reference is inadequate for some of the products available, although the package inserts do provide more detailed information. The continued use of these products is difficult to justify when safer alternatives are available.