Biomedical subjects
K D Gunston
Publications and source records attributed to K D Gunston.
Pregnancy after tubal occlusion -- a 7-year study.
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Iron dextran in the treatment of iron-deficiency anaemia of pregnancy. Haematological response and incidence of side-effects.
Sixty pregnant patients with a haemoglobin (Hb) less than 8 g/dl and proven iron-deficiency anaemia were randomly allocated to two treatment groups. Group A received the usual recommended dose of iron dextran (Imferon; Fisons) and group B received two-thirds of the recommended dose. A further 30 patients received oral iron (group C). There was no difference in Hb value between the three groups 4 weeks after treatment or 3 months after delivery. At 6 months after delivery, a higher mean Hb value was found in the patients in group A than those in groups B and C. Significantly higher serum ferritin levels were found in group A and this difference was still present 6 months postnatally. There was no significant difference in the incidence of delayed reactions between the two groups who received iron dextran.
Anti-K (kell) antibodies in pregnancy.
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Rhesus disease. A case report.
A case of rhesus disease in a neonate after sensitisation of a Rh-positive mother with an incomplete D-antigen is presented. Despite severe haemolysis, the outcome was successful. The probable mechanism of sensitisation and the role of Rho(D) immune globulin (RhoGAM) and blood transfusion is discussed.
Premenstrual syndrome in Cape Town. Part II. A double-blind placebo-controlled study of the efficacy of mefenamic acid.
Thirty patients suffering from the premenstrual syndrome were studied for five consecutive menstrual cycles. An untreated baseline cycle without medication was followed by four treatment cycles. Mefenamic acid or placebo was taken on days 11-26 of the cycle in a prospectively randomized double-blind cross-over manner, with each patient acting as her own control. On subjective assessment, there was a significant overall improvement on mefenamic acid compared with placebo. With the exception of gastro-intestinal symptoms, mefenamic acid was not significantly better than placebo for any of the individual symptoms assessed on the patients daily symptom checklists.
Premenstrual syndrome in Cape Town. Part I. An analysis of 100 consecutive patients.
One hundred consecutive patients who attended the premenstrual syndrome clinics at Groote Schuur and Somerset Hospitals were analysed. The incidence did not correlate with age, marital status or parity. Seventy per cent of patients were employed or were full-time students, and 72% had a regular menstrual pattern. The commonest symptoms were irritability, depression and abdominal bloating.
Age of menarche, standard of education and early adolescent pregnancy.
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Dilation and curettage - is it essential.
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Coital injuries of the vagina in non-virginal patients.
A series of 19 non-virginal patients who sustained vaginal injuries during normal coitus is presented. Twelve were between 16 and 25 years of age and 5 were older than 45 years. All presented with profuse or prolonged vaginal bleeding. The initial diagnosis was frequently wrong because a history of injury was not forthcoming and visualization of the lesion was obscured by the bleeding. The possibility of such trauma should be kept in mind; digital examination confirms the diagnosis. Prompt surgical suturing under general anaesthesia is required to control the haemorrhage.
Morbidity after total abdominal hysterectomy.
Total abdominal hysterectomy (TAH), the commonest major gynaecological operation performed at the Groote Schuur and Somerset Hospitals, is associated with considerable financial and social problems for the family. A retrospective series of 300 consecutive patients who had undergone TAH is presented. This series was analyzed for factors influencing the prevalence of wound haematoma, sepsis and dehiscence, pain and decreased mobility, the main parameters of postoperative morbidity. The four factors found to be important in minimizing postoperative complications of TAH were: (i) the experience of the surgeon; (ii) the use of the Pfannenstiel rather than the subumbilical midline incision; (iii) closure of the skin with Dermalon rather than with black silk; and (iv) drainage of the wound.
Pregnancy after tubal occlusion. A 5-year study.
During the 5-year period 1976--1980 9 430 patients underwent tubal occlusion at Groote Schuur Hospital, Cape Town. Of these patients 24, or 2.5/1 000, became pregnant after the procedure. An analysis of the pregnancy rate for each method of tubal occlusion is reported. Bilateral tubal occlusion by laparotomy or falope rings has flow failure rate; cauterization has not.
Macroscopic and microscopic changes in the fallopian tube after bipolar cauterization.
A total of 43 patients who had undergone laparoscopic tubal occlusion by means of bipolar cauterization underwent bilateral salpingectomy 6-30 months later. The macroscopic and microscopic changes in the fallopian tubes are described. Although 35 patients appeared to have occluded tubes on macroscopic examination, only 22 showed occlusion on microscopic examination.
The role of continuous-flow blood fraction separators in clinical practice.
Continuous-flow blood fraction separators facilitate the efficient exchange of large volumes of plasma or red cells and therefore have clinical application in the rapid correction of abnormalities located predominantly in either of these compartments. Plasmapheresis has been successfully used in managing 2 patients with previously refractory myasthenia gravis, in reducing the antibody titre in a rhesus-sensitized woman, and in diminishing anti-A titre in a patient requiring bone marrow transplantation from an ABO-incompatible but HLA- and MLC-identical sibling. Continuous-flow red cell exchange effectively reduced the haemoglobin S concentration in an individual with sickle cell disease prior to general anaesthesia and abdominal surgery. Complications were not encountered although the procedures were carried out repetitively over prolonged periods of time. All 5 patients tolerated their exchanges without discomfort. As with any new and expensive technique, caution should attend the introduction of continuous-flow plasma or red cell exchange into clinical medicine. Careful evaluation of the safety and the benefits is needed to establish perspective and to distinguish between established and developmental indications.
A comparison of the bubble test performed on amniotic fluid and gastric aspirate in mother-baby pairs.
In 25 mother-infant pairs the bubble test performed on amniotic fluid obtained shortly before delivery was compared with that performed on gastric aspirate collected at birth. In the majority of infants the gastric aspirate bubble score exceeded that of the amniotic fluid. It is suggested that the former may more accurately reflect the degree of pulmonary maturity at delivery.
Rhesus and other blood group incompatibilities in pregnancy.
All pregnant patients should be screened for atypical antibodies. Anti-D immunoglobulin should be administered to Rh-negative patients after an abortion, ectopic pregnancy, and delivery of an Rh-negative infant to prevent the occurrence of immunization. The management of immunized patients is discussed.
Laparoscopic sterilization on a day-case basis.
A prospective series of 307 patients who underwent laparoscopic sterilization on a day-case basis is presented. Of these, 196 patients attended for the 6-month and 117 for the 1-year follow-up visit. There were 5 Blacks, 197 Coloureds and 105 Whites. Sterilization was done by means of tubal cauterization (137), Hulka-Clemens clips (34) and Falope rings (136). Although 18% of patients were under 30 years old, 16% were 40 years of age or older. A marked tendency to low parity was evident, 43% of Coloureds and 90% of Whites being para 3 or less. The main operative problem was uterine perforation. Of the patients 17% were not discharged on the day of operation. By the 5th postoperative day 86% had returned to normal working activities. Significantly more postoperative abdominal pain was reported in the clip and ring groups. Seven pregnancies occurred in the series, 6 after tubal cauterization and 1 after the application of Falope rings. On patient was probably pregnant at the time of the operation. Most patients reported no change in libido at the 1-year follow-up visit, and in 20% libido was increased Mild pelvic infection was the only significant finding at the 6-month and 1-year follow-up visits. Apart from the disturbingly high pregnancy rate and the relatively large number of patients who were not discharged on the day of operaton, the sterilization programme has been most acceptable.
Kernicterus.
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