South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Randomized Controlled Trial Comparative Study Clinical Trial
Anti-endotoxin in the treatment of severe surgical septic shock. Results of a randomized double-blind trial.
A randomized double-blind trial of human antilipopolysaccharide (anti-LPS)-specific globulin (LG-1) versus placebo (albumin) in the treatment of severe septic shock of surgical origin was carried out over a 6-month period from June to December 1983. Hospital mortality was 10 patients (59%) out of 17 in the control group and 9 out of 17 (53%) in the treated group. ⋯ Measurement of serum endotoxin and anti-LPS levels at the time of admission to the study and 24 hours later revealed no significant difference between controls and treated patients. Significantly higher mortality rates were observed in patients who were endotoxemic after 24 hours of treatment compared with those who were not (chi 2 = 4,80; P less than 0,025).
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A case of profound cardiovascular collapse after the administration of Althesin (alphaxalone-alphadolone) and suxamethonium is described. During subsequent anaesthesia in the same patient, cardiovascular collapse followed the administration of thiopentone and suxamethonium. It is concluded that suxamethonium, rather than Althesin, was the provocative agent.
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A 25-year-old paraplegic man who had sustained a T3/T4 vertebral compression fracture 3 years previously presented with severe, painful spasm of the left hamstring muscle group of 2 hours' duration. This spasm produced extreme knee flexion of a degree which held the left foot posterior to the right buttock. An intravenous injection of 2 g magnesium sulphate produced immediate relief. Possible mechanisms of action of magnesium are discussed.
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Beriberi heart disease should be considered in all patients with cardiac failure and a history of alcohol abuse or dietary deficiency. We studied the haemodynamic changes which took place immediately after intravenous administration of thiamine to a patient with high-output beriberi. Cardiac output and stroke volume fell rapidly, but not below normal levels, and systemic vascular resistance rose.
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Many vital indices and scores have been proposed and used, particularly in relation to trauma. Most were primarily designed for and, within limits, are successful in hospital application. Attempts to use all or part of these in the prehospital context are misguided. ⋯ The value of the MVI lies in its adaptability to emergency medical care systems at all stages of development. The necessity for the MVI is outlined, as is the detailed working of the system. The hope is expressed that through adaptation of the MVI in different areas a consolidated prehospital scoring system may be achieved.