South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Comparative Study
The interscalene approach to block of the brachial plexus.
One hundred consecutive cases of interscalene brachial plexus block are presented. The technique is reliable, safe and easy to perform. ⋯ Multiple injections are not necessary. The technique is also highly acceptable to the patient.
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Secondary drowning is a respiratory distress syndrome which develops after a latent period following apparently successful resuscitation from near-drowning. Eighteen cases of near-drowning have been reviewed and one case history is presented in detail to illustrate the importance of anticipating the development of this syndrome. Successful management of these patients involves ventilatory support and careful monitoring of the neurological and cardiovascular status. Because many doctors are unaware of the syndrome and because it has a good prognosis if recognized and treated early, a review of the clinical features and treatment is warranted.
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A patient with a bizarre fungating tumour of the anterior abdominal wall is described. The lesion had the histological features of Bowen's disease and also had the appearance of a basal cell carcinoma with sebaceous differentiation. ⋯ As far as we know, Bowen's disease has once previously been reported in a Black patient in South Africa. We have not encountered any other description in the literature of Bowen's disease presenting as a fungating tumour.
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Case Reports
Congo-Crimean haemorrhagic fever in South Africa. Report of a fatal case in the Transvaal.
A 13-year-old boy, after having spent a week at a camp in a nature reserve in the western Transvaal, developed an acute illness of sudden onset characterized by chills, severe headache, muscle pains and high fever. On the 3rd day he developed a haemorrhagic state with profuse bleeding from the gastro-intestinal tract and other mucous membranes and petechial haemorrhages into the skin, from which he died on the 6th day after onset of the illness. ⋯ The provisional clinical diagnosis of Congo virus fever was confirmed in the laboratory by the isolation of the virus in newborn mice inoculated with the patient's blood. This is the first incrimination of Congo virus as the cause of a fatal case of haemorrhagic fever in South Africa, although it is known to occur in several countries in the tropical region of Africa and in south-eastern Europe and Asia.
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Tuberculosis is a major health problem in South Africa. More than 40 000 new cases are notified annually and there is good evidence that this represents only a proportion of all patients with active disease. ⋯ In the 1970s our death rate from this disease probably approximated that which pertained in the UK in the 1940s just before antituberculosis drugs came into general use. Current concepts in tuberculosis and its control are reviewed and the suggestion made that a specialized task force be set up to improve control measures in South Africa.