South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Randomized Controlled Trial Comparative Study Clinical Trial
Precautions against intra-ocular pressure changes during endotracheal intubation--a comparison of pretreatment with intravenous lignocaine and diazepam.
Endotracheal intubation after administration of succinylcholine is associated with a rise in intraocular pressure (IOP). That this is likely to have harmful effects in patients with penetrating eye injuries is self-evident. The efficacy of various means of abolishing these effects is debatable. ⋯ IOP, pulse rate and systolic blood pressure were recorded after induction, after intubation and after return of spontaneous respiration. Statistical analysis of the data showed that diazepam diminished the rise in IOP, while lignocaine had little effect (P less than 0,05). It is concluded that pretreatment with diazepam 0,05 mg/kg is beneficial in reducing the ocular risks of endotracheal intubation.
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A woman with paranoid psychosis and terminal breast cancer refused palliative radiation, demanding pain-killers and permission to leave hospital to go into the mountains and die on her own. Was it ethical to allow her to do so, or should a court order have been sought to impose hospital treatment on her? Should she have been persuaded to accept hospital care? When do those in charge deem a terminally ill patient unable to understand the issues, and dictate treatment? Our aim in this article is to highlight a number of ethical matters regarding patient care, as well as to try and determine the role a hospice should play with regard to the terminally ill patient with associated psychiatric disorder.
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Case Reports
Quadriplegia following venous air embolism during posterior fossa exploration. A case report.
A frequent complication of posterior fossa exploration with the patient in the sitting position is venous air embolism. Spinal cord deficits following such a mishap have rarely been reported. We report a case in which a patient who suffered venous air embolism developed quadriplegia from the C6 level. The mechanisms of passage of air into the arterial system are discussed.
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In a time-and-motion study in family practice it was found that 35,8% of all patient contact was per telephone. The study further revealed that 12,3% of total practice time was spent on the telephone, stressing its importance as a useful tool in family practice. The study supports others which suggest that 'telephone medicine' is worthy of careful examination in terms of cost-effectiveness. The implications for the doctor-patient relationship are also considered.