External fixation for intra-articular fractures of the distal radius.

In a prospective study of 132 patients with an average age of 35 years, unstable intra-articular fractures of the distal radius were treated by external fixator. Only 15 cases required limited open reduction. Follow-up was for a mean of 42 months.

Surgical strategies in the treatment of pancreatic necrosis and infection.

Controversy still surrounds the management of necrotic and septic complications of acute pancreatitis. A review of the literature of the past decade dealing with the surgical treatment of pancreatic necrosis, pancreatic abscess and infected pancreatic necrosis has been undertaken. Three main patterns of management could be identified: (1) 'conventional treatment', consisting of pancreatic resection or necrosectomy with drainage; (2) 'local lavage', consisting of necrosectomy followed by regional lavage; and (3) 'open management', with resection or necrosectomy followed by planned multiple re-explorations.

Isolated traumatic posterior dislocation of the radial head.

Only 4 cases of isolated posterior dislocation of the radial head in adults have been reported in the English-language literature. We describe 2 cases with a clear mechanism of injury and present a concise review of the literature.

Barrett's oesophagus--radiological features in 100 cases.

The columnar-lined or Barrett's oesophagus is an acquired condition resulting from long-continued gastro-oesophageal reflux. In the last 20 years 149 patients with Barrett's oesophagus have been studied in the clinics of the Johannesburg Teaching Hospitals. Important radiological predictors of Barrett's oesophagus, as defined from a series of 100 cases, are the presence of a stricture well above the gastro-oesophageal junction (41 cases), a long stricture (13 cases) and ulceration in the body of the oesophagus (16 cases).

Serum keratan sulphate levels during prolonged rest.

Serum levels of keratan sulphate (KS) were measured by an enzyme-linked immunosorbent-inhibition assay on admission to hospital in 26 previously healthy young patients who had sustained fractures of the pelvis without involvement of the hips. The serum KS level was found to decrease during the period in hospital (5-6 weeks), but rose after return to ambulatory life (6-12 months). The results suggest that serum KS levels are related to rest.

Subxiphoid pericardial windows--helpful in selected cases.

There is a small group of patients who sustain multiple penetrating injuries who present with haemodynamic changes, making it difficult to clinically exclude or prove the presence of penetrating cardiac injury. It is in this select group of patients that we found subxiphoid pericardial windows to be extremely useful to prove or disprove the existence of a cardiac injury and thereby prevent a delay in diagnosing these injuries.

Collar material erosion after vertical-banded gastroplasty--an underestimated problem? A case report.

A case of collar material erosion after vertical-banded gastroplasty for morbid obesity is presented. Aetiological and therapeutic aspects of this possibly underestimated complication are discussed.

Methaemoglobinaemia due to accidental sodium nitrite poisoning. Report of 10 cases.

Nitrates and nitrites are widely used in the food and chemical industry. Poisoning with these agents may be potentially life-threatening as a result of the production of methaemoglobin. A group of 10 patients suffering from moderate to severe methaemoglobinaemia after accidental intoxication with a sodium nitrite salt is described.

Groin hernias--beware!

Groin hernias usually present no specific problems to the surgeon, and are a common complaint. There are, however, a select group of patients in whom a sudden change in the status of the hernia should alert the clinician to the possibility of the existence of underlying disease. These patients should be recognised and thoroughly evaluated before the hernia is repaired.

Klebsiella pneumoniae bacteraemia at an urban general hospital.

Of 47 patients with Klebsiella pneumoniae bacteraemia admitted to the Hillbrow Hospital, Johannesburg during a period of 18 months, 31 were males and 16 were females. Features predisposing to illness were found in 89.4% patients, chronic alcoholism, neoplastic disease and diabetes mellitus being the most common.

Cryptogenic fibrosing alveolitis. A study of an indigenous African population.

Cryptogenic fibrosing alveolitis (CFA) has not been described previously in any large group of indigenous African patients. This was a retrospective study of 46 such patients diagnosed as having CFA during a 73-month period. The clinical spectrum of illness was similar to that of other groups studied worldwide.

Initial hormonal and metabolic profile in critically ill patients with community-acquired lobar pneumonia.

A prospective study of 18 critically ill patients with community-acquired lobar pneumonia was undertaken at Hillbrow Hospital, Johannesburg, in order to document the initial plasma hormonal and substrate profile as part of the stress response to the infection. The results of these studies, carried out before therapy, were compared with the results in a group of healthy fasting adults. Highly significant (P less than or equal to 0.

Alfentanil and propofol infusions for surgery in the burned patient.

We have studied combinations of alfentanil and propofol for total i.v. anaesthesia in 24 severely burned patients.

Precursor T-cell lymphoma associated with human immunodeficiency virus type 1 (HIV-1) infection. First reported case.

The majority of lymphomas that develop in human immunodeficiency virus type 1 (HIV-1) positive patients have a B-cell phenotype, with few reported cases of T-cell lymphoma. Within the latter group, those that have been comprehensively phenotyped had a mature helper T-cell phenotype (CD4+). We report, for the first time, an HIV-1 positive patient with a precursor T-cell lymphoma (CD7+,CD1-,CD3-,CD4-, and CD8-).

The diagnostic yield of prebronchoscopy sputa and bronchial washings in patients with biopsy-proven pulmonary tuberculosis.

We report on a series of 35 patients with pulmonary tuberculosis diagnosed by flexible fibre-optic bronchoscopy and transbronchial lung biopsy after 3 sputum specimens had been microscopy-negative. This study re-evaluates this invasive procedure. Additional prebronchoscopy specimens of expectorated sputum yielded the diagnosis in 7 of 16 cases (43.

Use of magnesium sulphate in the anaesthetic management of phaeochromocytoma: a review of 17 anaesthetics.

Seventeen anaesthetics are described in 16 patients with phaeochromocytoma in whom magnesium sulphate (MgSO4) was the principal anti-adrenergic agent used. In 15 of the 17 anaesthetics, MgSO4 produced satisfactory control of cardiovascular changes at induction and tracheal intubation, but in four of these additional sodium nitroprusside was required to control the arterial pressure during handling of the tumour. In one pregnant patient undergoing Caesarean section, MgSO4 was ineffective in controlling cardiovascular disturbances because of inadequate serum magnesium concentrations.

Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation.

The effects of pre-treatment with 60 mg/kg body weight magnesium sulfate intravenous on cardiovascular responses and catecholamine release associated with tracheal intubation were measured in 15 normal patients and in 15 saline solution pre-treated controls. Magnesium pre-treatment increased heart rate by 13 +/- 3.9 beats/minute.

Vesicoileal fistula via Meckel diverticulum.

The presentation, diagnosis, and management of a patient with an ileovesical fistula is discussed, this being the second reported case in the literature.

A reevaluation of sputum microscopy and culture in the diagnosis of pulmonary tuberculosis.

This prospective study was undertaken to determine the interpretation of "scanty-positive" acid-fast bacilli on microscopy and to reevaluate simultaneous microscopy and culture of sputum for the accurate diagnosis of pulmonary tuberculosis (PTB). A total of 2,560 specimens were processed from 727 patients. There were 435 positive specimens (17.

Endobronchial appearance of tracheobronchial amyloidosis. A case report and suggested classification.

Tracheobronchial amyloidosis with the co-existence of submucosal plaques and tumour-like masses is reported. The subdivision of tracheobronchial amyloidosis into submucosal plaques and tumour-like masses is questioned since there appears to be no difference in their clinical presentation and pathological appearance. It is suggested that lower respiratory tract amyloidosis should be classified into tracheobronchial, nodular parenchymal and diffuse alveolar septal amyloidosis.

Heart block following propofol: a case report.

We report two cases of ventricular arrest with persisting atrial activity in association with propofol anaesthesia. In both cases, anticholinergic agents corrected the arrhythmia. It is recommended that anticholinergic drugs be given routinely when propofol is used in association with vagal stimulants.

Community-acquired pneumonia of diverse aetiology: prognostic features in patients admitted to an intensive care unit and a "severity of illness" core.

In a retrospective study of 73 patients with community-acquired lobar pneumonia of diverse aetiology admitted to an intensive care unit, an attempt was made to identify those factors among the demographic and clinical features and results of initial laboratory investigations that were predictive of the ultimate outcome. A lower mean white cell count (p = 0.03), platelet count (p = 0.

Sequential hormonal therapy and sequential hormonal and chemotherapy for advanced prostatic cancer.

Ninety-two patients with D2 prostatic cancer were studied. Initial treatment was with either diethylstilboestrol (DES) or orchidectomy. Response to DES (5/63, 81%) was significantly higher than for orchidectomy (18/29, 62%; p less than 0.