The legal consequences of gender reassignment procedures--a juristic vacuum.
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
J Moodley
Publications and source records attributed to J Moodley.
Abdominal wound sepsis associated with gynaecological surgery at King Edward VIII Hospital, Durban.
OBJECTIVE: To establish the prevalence of postoperative wound infection in major gynaecological surgery. SETTING: King Edward VIII Hospital (KEH), a large urban referral hospital for the province of KwaZulu-Natal, serving an underprivileged population. METHOD: A prospective study of postoperative wound sepsis in 270 patients who had had emergency and elective laparotomies. Data for each patient were obtained pre-operatively and during the postoperative period. RESULTS: The prevalence of surgical wound sepsis was 11.9%. The wound sepsis rate in emergency, elective and semi-elective cases was 14.6%, 6.5% and 4% respectively. Twenty-three per cent of the patients were HIV-infected, and this group had a wound sepsis rate of 28.6% compared with 6.8% in HIV-negative cases (P = 0.03). CONCLUSION: Surgical wound sepsis in major gynaecological surgery is common at KEH. HIV infection is associated with a high rate of wound sepsis.
Adolescent↗
Isolated pancreatic tuberculosis and obstructive jaundice.
Explore the source record for details and available documents.
Adult↗
Limited thoracoscopic ganglionectomy for primary hyperhidrosis.
Sympathetic ganglionectomy is universally accepted as an effective and enduring treatment for primary hyperhidrosis. However, the variable extent of the ganglionectomy to treat this condition has been reported to be associated with a troublesome compensatory hyperhidrosis in between 22% and 81% of patients. In this prospective evaluation of a limited second thoracic ganglionectomy this approach, in addition to always being effective for pallmar hyperhidrosis, proved useful in up to 90% of patients with associated axillary and plantar hyperhidrosis. A compensatory hyperhidrosis rate of 13% was noted, confirming that a limited ganglionectomy should be standard practice in the management of primary hyperhidrosis.
Adolescent↗
Diagnostic challenge of abdominal pain in late pregnancy--a case of adnexal torsion.
Clinical evaluation of pregnant patients with abdominal pain can be confusing, because the examination is usually hampered by the anatomical displacement of abdominal organs by the gravid uterus, and difficulty in localisation of pain. Delayed surgical intervention could result in increased maternal morbidity and poor fetal outcome. We report on a case of recurring acute abdominal pain in pregnancy, which led to diagnostic difficulties and resulted in a diagnostic laparotomy and caesarean delivery.
Abdomen, Acute↗
Right aortic arch with isolated left brachiocephalic artery.
Right aortic arch with complete isolation of the left brachiocephalic artery is an extremely uncommon anomaly of the aortic arch. This case reports the hitherto unreported association of the right aortic arch with isolated left brachiocephalic artery presenting with a subclavian steal syndrome detected in a 36-year-old female patient being investigated for increasing attacks of episodic dizziness, vertigo, and left upper limb claudication spanning 1 year. A review of the literature relevant to this condition is presented. It is likely that with advances in imaging techniques and a wider clinical usage of these investigative modalities there will be further recognition of these uncommon conditions.
Adult↗
Oxidative stress in pre-eclampsia.
BACKGROUND: The objective of this study was to test the hypothesis that maternal plasma, cord plasma and placental tissue lipid peroxidation products are increased and antioxidants are decreased in women with pre-eclampsia. METHODS: Placenta, maternal and cord plasma were collected at delivery from 29 normal, 21 pre-eclamptic and six eclamptic women. Plasma was collected from 21 non-pregnant matched controls. The analyses were measured by HPLC and colorimetric assay. RESULTS: Plasma maternal concentrations of uric acid, LPO, MDA, ascorbic acid, vitamin E and cholesterol were not significantly different in pre-eclampsia as compared with normal pregnancy. Plasma concentrations of ascorbic acid and vitamin E were not significantly different in normal pregnancy as compared with the non-pregnant controls. Cord plasma concentrations of MDA were significantly higher in eclampsia (1.16+/-0.26 micromol/l) as compared with normal pregnancy (0.79+/-0.05 micromol/l, p<0.02) and pre-eclampsia (0.83+/-0.05 micromol/l, p<0.05). Cord plasma concentrations of vitamin E were significantly higher in eclampsia (21.3+/-7.5 micromol/l) as compared with normal pregnancy (10.2+/-1.1 micromol/l, p<0.01) and pre-eclampsia (10.4+/-1.8 micromol/l, p<0.04). Placental concentrations of LPO, MDA and ascorbic acid were not significantly different in pre-eclampsia as compared with normal pregnancy. Plasma cord concentrations of LPO and placental concentrations of vitamin E were undetected for normal pregnant, pre-eclamptic and eclamptic women respectively. Uric acid concentrations were significantly increased in eclampsia as compared with the non-pregnant controls (p<0.0001), normal pregnant controls (p<0.0001) and pre-eclampsia (p<0.008). CONCLUSIONS: The findings in this study do not show any evidence of deficiency in the maternal protective antioxidant systems or increased production of lipid peroxidation products, LPO and MDA in African women with pre-eclampsia as compared with normal pregnancy. However, there was evidence of increased cord plasma concentrations of MDA and vitamin E in eclampsia as compared with normal pregnancy and pre-eclampsia. The placenta may be effective in removing MDA. The antioxidant uric acid serves as a protective role whilst the antioxidant and oxidant capacity in the different study groups remained unchanged.
Adolescent↗
A randomized study comparing rectally administered misoprostol versus Syntometrine combined with an oxytocin infusion for the cessation of primary post partum hemorrhage.
BACKGROUND: Post partum hemorrhage is a major cause of maternal death, particularly in developing countries, and most cases are due to an atonic uterus. Hemorrhage can occur despite active management of the third stage of labor. Presently, misoprostol (Cytotec, Searle Pharmaceuticals) is the only thermostable uterotonic agent potentially available which would be economically beneficial for developing countries where refrigeration of drugs poses a problem. The objective of the study was to compare intra-muscular Syntometrine (Sandoz Pharmaceuticals) (ampoule=5 iu oxytocin and 500 mcg ergometrine maleate) plus Syntocinon (Sandoz Pharmceuticals) (10 iu oxytocin diluted in 500 ml normal saline) intravenous infusion versus 800 mcg misoprostol per rectum for treatment of primary post partum hemorrhage in a developing country. METHODS: Randomized single blinded two-center study, set in both a township and teaching hospital in South Africa. Sixty-four women with primary post partum hemorrhage due to an atonic uterus were recruited. The primary outcome measure was whether the hemorrhage ceased within 20 minutes of administering the first line treatment, once hemorrhage was clinically recognized. RESULTS: There was a 28.1% difference between the misoprostol arm and the Syntometrine and Syntocinon arm (p=0.01). This result had a greater than 80% power. Misoprostol performed better. CONCLUSION: 800 mcg misoprostol per rectum is effective at treating primary post partum hemorrhage.
Administration, Rectal↗
Non-operative management of haemobilia.
BACKGROUND: The aim was to evaluate a non-operative approach to the management of haemobilia. METHODS: This was a retrospective analysis of patients presenting over 10 years with haemobilia. All patients had upper gastrointestinal endoscopy, abdominal ultrasonography and digital subtraction angiography. Superselective coil and/or Gelfoam embolization was done as close as possible to the bleeding site. Completion angiography was performed routinely to confirm adequate embolization. RESULTS: There were 23 patients with liver trauma and six with inflammatory conditions. All patients required resuscitation with fluids and blood transfusion, and had the haemobilia controlled successfully by angiographic embolization. There was one death from fulminant hepatic sepsis. CONCLUSION: This series attests to the efficacy of a non-operative approach to haemobilia using radiological diagnosis and intervention.
Adolescent↗
The ileal flange: an anatomical landmark.
Explore the source record for details and available documents.
Abdomen↗
Thoracic splanchnic nerves: implications for splanchnic denervation.
Splanchnic neurectomy is of value in the management of chronic abdominal pain. It is postulated that the inconsistent results of splanchnicectomies may be due to anatomical variations in the pattern of splanchnic nerves. The advent of minimally invasive and video-assisted surgery has rekindled interest in the frequency of variations of the splanchnic nerves. The aims of this study were to investigate the incidence, origin and pattern of the splanchnic nerves in order to establish a predictable pattern of splanchnic neural anatomy that may be of surgical relevance. Six adult and 14 fetal cadavers were dissected (n = 38). The origin of the splanchnic nerve was bilaterally asymmetrical in all cases. The greater splanchnic nerve (GSN) was always present, whereas the lesser splanchnic nerve (LSN) and least splanchnic nerve (ISN) were inconsistent (LSN, 35 of 38 sides (92%); LSN, 21 of 38 sides (55%). The splanchnic nerves were observed most frequently over the following ranges: GSN, T6-9: 28 of 38 sides (73%); LSN, when present, T10-11: (10 of 35 sides (29%); and ISN, T11-12: 3 of 21 sides (14%). The number of ganglionic roots of the GSN varied between 3 and 10 (widest T4-11; narrowest, T5-7). Intermediate splanchnic ganglia, when present, were observed only on the GSN main trunk with an incidence of 6 of 10 sides (60%) in the adult and 11 of 28 sides (39%) in the fetus. The higher incidence of the origin of GSN above T5 has clinical implications, given the widely discussed technique of undertaking splanchnicectomy from the T5 ganglion distally. This approach overlooks important nerve contributions and thereby may compromise clinical outcome. In the light of these variations, a reappraisal of current surgical techniques used in thoracoscopic splanchnicectomy is warranted.
Abdominal Pain↗
Untoward effects of rapid-acting antihypertensive agents.
Cerebral haemorrhage remains a major cause of hypertensive cerebral mortality. Lowering of raised blood pressure is therefore crucial in the clinical management of hypertensive disorders of pregnancy. This article reviews rapid-acting agents employed in life-threatening situations.
Antihypertensive Agents↗
Management of the critically ill cardiac patient.
The decline in rheumatic fever has made heart disease in pregnancy an uncommon problem in the developed world but it remains an important cause of maternal morbidity and mortality in developing countries. Pregnancy is particularly dangerous in the presence of cyanotic congenital heart disease, Eisenmenger's syndrome, primary pulmonary hypertension, Marfan's syndrome, dilated cardiomyopathy and significant mitral stenosis. Severe stenosis is often complicated by pulmonary hypertension and atrial fibrillation. Maternal disease status should be determined using echocardiography to define cardiac anatomy, assess ventricular function and estimate intracardiac pressure gradients. Patients in the New York Heart Association functional classes 1 and 2 generally have a favourable outcome. Closed mitral commissurotomy is safe and effective in relieving stenosis across the mitral valve in selected patients. More recently the technique of percutaneous balloon mitral valvotomy has successfully been used in the treatment of mitral stenosis. Termination of pregnancy is advised in patients with severe pulmonary hypertension, including Eisenmenger's syndrome.
Critical Illness↗
Current cerebrovascular neuroimaging modalities and their application to eclampsia.
Explore the source record for details and available documents.
Journal Article↗
Immunolocalisation and endothelin-1 values In pre-eclampsia: an immunocytochemical study.
Maternal plasma ET-1 levels and the immunolocalisation of ET1 in the fetal membranes of pre-eclamptic primigravidae at >/=28 weeks, gestation were studied. The levels of maternal plasma ET1 and immunoreactive ET-1 were increased in pre-eclampsia. Immunoreactive ET-1 was localised in the amnion, chorion and decidua of normal pregnant women as well as those with preeclampsia-eclampsia. Intense labelling was observed in moderate pre-eclampsia (BP 140/90 - 170/110 mmHg) with very intense labelling in severe pre-eclampsia (BP >170/110 mmHg), especially in the amniotic epithelium, chorionic villi, maternal blood vessels, cytotrophoblasts and giant cells of the decidua. The increased ET-1 levels demonstrated in fetal membranes of pre-eclamptic women are probably produced in a paracrine and/or autocrine manner, contributing to the hypertension, vasospasm and fetal growth restriction characteristic of the syndrome. A larger study would be required to show significant change in endothelin production in pre-eclampsia.
Journal Article↗
Leptin levels in the obese African parturient.
Prolactin, HCG and oestrogen are reported to have a role in regulating serum leptin levels and therefore adiposity in pregnancy. The aim of this study was to determine serum leptin levels during pregnancy in African women, and was conducted in the Antenatal Clinic, King Edward VIII Hospital, Durban, South Africa. Eighty-two obese and non-obese women were studied. Demographic details and anthropometric measurements were recorded, and serum leptin levels determined by radio-immunoassay in all women. Age, parity and gestational age showed a weak correlation with leptin levels. Weight (4=0.6); body mass index (r=0.5), and the circumference of midarm (r=0.4), waist (4-0.6, hip (5=0.5) and thigh correlated positively with leptin values. Serum leptin values in African pregnant women are not dissimilar to that of studies in other racial groups.
Journal Article↗
Soluble transferrin receptors in anaemia of pregnancy.
Anaemia is one of the most common disorders in pregnancy. The most common cause is iron deficiency. Iron deficiency anaemia is relatively easy to diagnose using a serum ferritin of <15 ng/ml. However, because ferritin is an acute phase reactant, the diagnosis of iron deficiency anaemia in hospitalised or ill patients may be difficult, since serum ferritin may be normal or raised, even in the face of iron deficiency. Soluble transferrin receptor assay (STfR) may be useful in these situations because it reflects the degree of iron requirement in relation to supply, and it is not an acute phase reactant. This study was undertaken to detect subclinical anaemia in pregnant women and to correlate STfR assay with the current diagnostic tests for iron deficiency anaemia. One hundred and fifty-three consenting pregnant women seen at the antenatal clinic at King Edward VIII Hospital (KEH) were recruited. Women on haemantinics, who had renal failure, haemoglinopathy and blood transfusion in the past 3 months, were excluded. An ELISA technique was used for the assay of STfR while standard methodology was used for the other biochemical and haematological assays (FBC, urea, creatinine, c reactive protein and iron studies). One hundred and fifty subjects were included in the final analysis. Seventy-two (48%) had varying degrees of iron deficiency anaemia. In 70% (105) of the samples analysed, serum ferritin and STfR agreed on the presence/absence of iron deficiency anaemia. STfR and S:F were 75% and 86% sensitive; 63% and 82% specific, respectively. The calculated positive and negative predictive values are: STfR 64% and 75%; S:F 84% and 87%; Hb 58% and 57%; mean corpuscular volume 91% and 55%, respectively. Ferritin remains the gold standard for the diagnosis of iron deficiency anaemia. However, because ferritin is an acute phase reactant, soluble transferrin receptor assay may be a better test in ill and hospitalised patients where ferritin may be normal or elevated, despite iron deficiency.
Journal Article↗
Vasectomy in developing countries.
Vasectomy is an acceptable technique of sterilisation in affluent societies; however, cultural barriers exist in most parts of Africa. The object of this study was to establish the prevalence of vasectomies at King George V Hospital (KGH), Durban, over a 3-year period, to determine attitudes towards vasectomy, and to identify ways of improving its acceptability. This was a retrospective study. Clinical details of case files were analysed and interviews of clients who had vasectomy were conducted telephonically or through home visits. A total of 308 (88.3%) clients were contacted. The mean age at vasectomy was 35 years (range 15-51 years). The majority, 50.3%, were Indians; 21% whites, 15.6% coloured and 12.3% were Africans; 290 of the men were married with a mean duration of marriage of 10.3 years (3-25 years). Ninety-four per cent were in a monogamous relationship and all remained married to date. Sixty-four per cent had above-matriculation educational status. Most of the patients became aware of vasectomy through family planning clinics or health personnel; only 4.9% received information through the media. Fifty-three per cent (n=164) of couples had problems with previously used contraception prior to decision for vasectomy. The complication rate was 6.5% while 1% regretted having had the procedure. Only two men (0.7%) desired reversal. On direct questioning, sexual activity remained unchanged in 95.1%, and actually improved in 3.2% of the men following vasectomy. Most believed that there is not enough information on vasectomy available, especially through the media, and that with appropriate counselling vasectomy is a safe permanent contraception that should be actively promoted.
Journal Article↗