Biomedical subjects
Publications and source records attributed to C A Perrott.
Although duodenal diverticula are often seen on radiography and regarded as being 'incidental', perforations frequently lead to significant mortality and morbidity. The pre-operative diagnosis is often missed or delayed and intra-operative diagnosis requires a high index of suspicion. A case of missed diagnosis is presented, and intra-operative indicators of perforation and treatment suggested.
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In 97 patients undergoing elective biliary (44) or colorectal (53) surgery, cases were randomly allocated to receive peri-operative prophylaxis with either cefoxitin (Mefoxin; MSD) or metronidazole, penicillin and tobramycin (MPT). Sepsis occurred in 3 of the biliary cases (6,8%) and in 16 of the colorectal cases (30,2%). In the colorectal group sepsis occurred equally in patients receiving cefoxitin (22,2%) or MPT (38,5%) (P = 0,20). Patients who developed sepsis did not have a prolonged hospital stay; strict criteria were used to define sepsis in this study and this explains the apparently high sepsis rate. A positive wound culture at the end of the operation was more common after colorectal surgery (30,2%) than after biliary surgery (4,6%) and was associated with a higher subsequent infection rate (P = 0,02).
State-controlled hospital services in South Africa are racially determined, with separate facilities for the different racial groups. The recent violence seen in and around Pietermaritzburg has resulted in an increasing number of blacks attending hospitals other than their own racially defined institution. The majority of these patients make their own way to hospital, usually from nearby localities, suggesting a demand to utilize "local" facilities. Some 50% of all dogbites, 25% of shootings, and 20% of stabbings were brought in by the police. One third of shootings ended fatally. Possible reasons why some blacks attend hospitals other than their own racially defined, are explored.
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