South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
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Adult respiratory distress syndrome is being recognized more frequently as a complication of a number of conditions. The causes, pathophysiology, pathology, clinical manifestations and management are reviewed in this article. The use of positive end-expiratory pressure (PEEP) and super-PEEP is discussed. The value of measurements of mixed venous oxygen partial pressure (PVO2) in the treatment of respiratory failure, especially in the presence of high inspired oxygen tensions, is explained and emphasized.
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As part of a larger study aimed at enhancing the development of young children with Down syndrome, information was collected regarding the time at and circumstances in which 32 couples were told of their child's handicap. In addition, the level of their present acceptance or rejection of their child in the family was assessed. The findings indicated that early disclosure of the handicap was one of the most important factors associated with parental acceptance and nurture of a mentally handicapped child. Other factors of importance were the nature of the information given by the informant and the position in the family of the handicapped child.
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The importance of routine pre-oxygenation before induction of anaesthesia was demonstrated in animals. The onset of dangerous levels of hypoxia after the administered of suxamethonium can be delayed considerably by the administration of pure oxygen for 5 minutes before induction. ⋯ After pre-oxygenation the volume of oxygen in the functional residual capacity of the lungs shows a sixfold increase. This is the principal oxygen store during apnoea.
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Postoperative pulmonary complications, the most common of which are atelectasis and pneumonia, are due largely to the pathophysiological effects on the lungs of anaesthesia and surgery as well as pre-existing disease, in particular chronic obstructive airways disease (COAD). Pre-operative assessment, including pulmonary function tests, will allow the prediction of the risk of pulmonary complications. Active measures can then be introduced to reduce these complications.
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The general practitioner's important role as a counsellor on sexual matters is stressed. The psychosexual development of an individual is discussed. Some neglected conditions where family counselling may be required are presented, together with suggestions for the management of the sexual aspects of chronic illnesses and conditions.