South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Total hip replacement was carried out on 22 patients under general anaesthesia. Of these, 10 were pretreated with methylprednisolone (30 mg/kg); 1 of these developed the adult respiratory distress syndrome (ARDS) and had high levels of thromboxane B2 (TXB2) 5 minutes after fixation of the femoral prosthesis and at the end of the operation. The other 12 patients served as controls; 5 of them developed ARDS and had statistically significant higher TXB2 levels than the other 7 control patients who remained well. ⋯ There was no statistical difference in 6-keto-PGF1 alpha levels between the patients who developed ARDS and those in the control group who remained well. Steroids reduce arachidonic acid metabolism by inhibiting the release of substrate for cyclo-oxygenase and lipoxygenase activity. Patients prone to ARDS thus benefit from methylprednisolone administration.
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A 27-year-old White woman with syringomyelia underwent a caesarean section. The pre-operative preparation and anaesthetic management are presented, and the specific problems discussed.
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Fifty-eight well Black infants between the ages of 10 and 15 weeks were examined for the presence of craniotabes and investigated for the presence of vitamin D deficiency and rickets. Thirty-five infants were found to have craniotabes and 5 of these had radiological evidence of rickets. ⋯ The majority of infants with craniotabes had normal biochemical values. Craniotabes is a common finding in 3-month-old infants and is of no help in diagnosing rickets in this age group.
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Total external ophthalmoplegia was observed in a patient following oral administration of phenytoin, although the state of consciousness was relatively unimpaired and the plasma phenytoin level was within the recommended therapeutic range. This report demonstrates the potency of phenytoin to act selectively on the vestibulo-ocular system. Recognition of such association may be important as regards further investigations aimed at excluding structural brainstem lesions.
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Case Reports
Adult respiratory distress syndrome associated with miliary tuberculosis. A case report.
In this report we describe a patient with miliary tuberculosis who presented with the adult respiratory distress syndrome. The diagnostic problems are discussed and the value of transbronchial lung biopsy is emphasized. Our experience with this patient stresses the need for maintaining a high index of suspicion for treatable causes of adult respiratory distress syndrome.