Biomedical subjects
Publications and source records attributed to J Dommisse.
A detailed analysis of 854 perinatal deaths according to both fetal and obstetric cause is presented. The ratio of stillbirths to neonatal deaths was 2.3:1. Almost 25% occurred in unbooked mothers. The major problems identified were preterm labour, unexplained stillbirth, abruptio placentae, infection, and protein-uric hypertension.
A long list of psychiatrically inclined illnesses or symptoms, especially some cases of mood disorder, dementia, paranoid psychoses, violent behavior and fatigue, have been documented to be caused by vitamin-B12 deficiency, among other causes. The author uses reputably published literature--and extrapolations from it--to show that these conditions are possibly more commonly caused by B12 deficiency than is currently generally accepted, mostly because of a lack of appreciation of the lowest serum-B12 level that is necessary to protect against the cerebral manifestations of this deficiency. After surveying the whole area of psychiatry and nutritional deficiencies in general, the author deals with the role of vitamin-B12 in mood disorders, paranoid psychoses and dementia in more detail. In doing so, he cites some useful conclusions from the literature, including the debunking of several myths about the diagnosis and treatment of brain-B12-deficiency, especially the efficacy of high dose oral treatment and the relative inefficacy of the Schilling's test.
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1. It is the opinion of 85% of the 289 gynecologists who replied to the questionnaire that the present Abortion Act should be reviewed. 2. At least 75% of respondents supported termination under the following circumstances: In a girl under age 14--85% In a girl under age 16--76% After failed female sterilisation--78% 3. TOP 'on request' before 12 weeks was not supported by the majority (60%) and 93% were opposed to termination 'on request' after 12 weeks gestation. 4. The results of this survey were discussed by the Council of SASOG who agreed to the publication of the data but considered that only changes acceptable to at least 75% of the members could be supported by Council and that the minority viewpoint should also be respected.
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Twenty-two patients with eclampsia were randomly allocated to receive either intravenous phenytoin sodium or intravenous magnesium sulphate. The groups were comparable. No side-effects occurred and therapeutic levels were obtained in both groups. While none of the 11 patients managed with magnesium sulphate had further convulsions, four of the 11 treated with phenytoin sodium did and were subsequently effectively treated with magnesium sulphate. These results suggest that phenytoin sodium is not as effective an anticonvulsant in eclampsia as is magnesium sulphate.
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Ten patients with gestational proteinuric hypertension were studied with a Swan-Ganz thermodilution haemodynamic catheter before, during and after plasma volume expansion. Five patients were treated with dihydralazine before volume expansion and five after volume expansion. Before treatment all patients had a low pulmonary capillary wedge pressure (PCWP), low cardiac index (CI) and high systemic vascular resistance (SVR). Following volume expansion the PCWP and CI increased, the SVR decreased but the blood pressure (BP) was unchanged. Administration of dihydralazine following volume expansion led to a decrease in PCWP, an increase in CI and a decrease in SVR and BP. Dihydralazine alone caused an increase in heart rate, PCWP, and CI, and a decrease in SVR and BP. Volume expansion, by increasing CI and decreasing SVR, may be of therapeutic benefit in the severely hypertensive pregnant patient with a low cardiac index.
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A black patient with the HELLP syndrome is presented. This syndrome is apparently rare in black patients in South African hospitals. In patients with gestational proteinuric hypertension, the importance of recognising epigastric pain is emphasised. The management of maternal thrombocytopenia and the possible consequences for the fetus are described.
Three pregnant patients with infective endocarditis presented with haematuria. The importance of this symptom is stressed and a brief review of immune-complex glomerulonephritis is given. The role of antibiotic therapy in preventing infective endocarditis is discussed.
This paper accepts the idea that patterns and distribution of health care and resources are determined by "realpolitik," and that South Africa is at present in the throes of a political revolution, the outcome of which is bound to reflect a considerable degree of "self-determination" of the majority black (African, Asian, and mixed-race) people. It is postulated that the health services-and other pre-determinants of the health of the black people-will be shaped by a mixed socialist-capitalist economy and a socialized or nationalized form of health care service. This is because all the leading players in the revolutionary stakes, especially the exiled African National Congress of South Africa (ANC) and the above-ground United Democratic Front (UDF) and its affiliate, the National Alternative Medical and Dental Association (NAMDA), who are the front-runners, advocate these kind of changes for the future of South Africa, as exemplified in the ANC's Freedom Charter of 1955.Powerful political forces, both inside South Africa and in the Western World, are resisting this outcome, despite it clearly being the democratic will of the people, as shown by all the polls. These reactionary strategies would leave the health of most blacks in South Africa and Namibia little improved over its present status.
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Prostaglandin E2 in a new gel form (Prepidil; Upjohn) was found to be as efficient in inducing labour as artificial rupture of membranes combined with intravenous oxytocin administration. There were no side-effects in the 25 patients in the study group. Prepidil gel has the advantage of simplicity and patient acceptance.
The very idea/philosophy behind the South African government's policy of Apartheid (separation), is insulting and humiliating to the black people and tends to incite arrogance and a sense of superiority, even omnipotence, in the whites. Personality development is skewed along racial lines. The mental effects of malnutrition and certain physical diseases, both of which are widespread in South African blacks, especially among their children, are well known. The torture to which security-police detainees have been subjected has resulted in thousands of cases of mental ill-health, as well as physical ill-health, and about 100 deaths, in the past 30 years. Authoritative reports about the in-patient psychiatric facilities for blacks have shocked the world medical, psychiatric and lay communities, and out-patient services for blacks are only sparsely existent, especially in the rural areas (the so-called 'independent homelands' and 'self-governing national states'). The socio-political climate makes interracial therapy, necessary because of the paucity of trained black professionals, particularly difficult. This fact, and the psychological implications of Apartheid, have, until very recently, hardly ever been addressed by psychiatrists and psychologists practising in South Africa. The United Nations and its agency, the World Health Organization, have taken unequivocally oppositional stands for decades but the (West-oriented) World Medical Association and the (mostly-Western) World Psychiatric Association have yet to speak out on this issue, like they have on those involving the Soviet Union and other Eastern Bloc countries.