Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2007. / Härtill 4 uppsatser.

No description available.

Accompanying CD-ROM contains image files and software. Bibliography: leaves 259-286. Explores the factors affecting the movement of tumour cells from a primary malignancy across the peritoneal cavity to the port-site following laparoscopic intervention. Filter methods and radio-labelled tumour cells provided the most useful way of following cell movement. Concludes spread of tumour cells to the port-site is more likely in the presence of disseminated disease, as well as with inappropriate surgical technique. Metastasis may be reduced by the use of intraperitoneal lavage and appropriate surgical technique.

M.Tech. (Homoeopathy) / The climacteric describes the ongoing changes and symptoms, of the phase or transition period that may last 15-20 years in a woman's lifecycle, when ovarian function and hormonal production declines. Menopause is the permanent cessation of the menses, identified retrospectively after one year without menses and occurs within this period of climacteric (Bernstein et al. 1996). The most common symptoms of climacteric include hot flushes, night sweats, sleep disturbances, nervousness, depressive moods, feelings of vertigo, inability to concentration, joint pain, headache and heart palpitations. The most commonly used allopathic medication to palliate these symptoms is hormone replacement therapy (HRT). There are adverse side effects and risks associated with this treatment and not all women feel better on HR.T (Stoppard, 2001). The aim of this research study was to determine the efficacy of the Homoeopathic complexes Dr Reckeweg RI0® and R20® (Homoeopathic complexes) in relieving the symptoms of the climacteric. The methodology and Ethics were accepted by Higher Degrees Committee and Academic Ethics Committee on the 25 August 2008 (Ethical clearance no: 40/08). Participants were recruited by advertisements (Appendix A) at the University of Johannesburg, in health food shops and in pharmacies. This was a double blind, placebo controlled study involving thirty-two participants who were divided into two matched groups based on the severity of the menopausal symptoms. Volunteers were selected . using the exclusion and inclusion criteria. Volunteers meeting the inclusion criteria completed the information and consent form (Appendix B), and a patient profile and case history (Appendix C) were taken. The participants were randomly allocated to an experimental or control group, and given sets of medication (Remedy A and B, 50ml bottles) to take for a period of eight weeks (Appendix D). The participants took 10 drops of Remedy A (R10® or placebo) in the morning and Remedy B (R20® or placebo) at night. The participants were requested to complete the abbreviated Kupperman Menopause Index (KMI) weekly. The abbreviated KMI (Appendix E) scores were added...

M.Tech. / Menopause refers to the natural cessation of the menstrual cycle at the end of the reproductive years, and is usually defined retrospectively after twelve consecutive months of amenorrhoea. Climacteric is the term used to describe the life period surrounding menopause. It begins with physiological changes that mark the transition between the reproductive and post-reproductive years (Lewis and Bernstein, 1996). The mean age of menopause is 51 years, with a normal range from 45 to 56 years (Chamberlain and Malvern, 1996). There are many symptoms associated with menopause, including hot flushes and night sweats, headaches, sleep difficulties, vaginal dryness and loss of libido, urinary problems, joint and muscle pains, depression, irritability, and poor memory and concentration. Long-term risks and effects include osteoporosis and coronary heart disease (MacGregor, 2000). The aim of this study was to determine the efficacy of the homoeopathic similimum in the treatment of climacteric symptoms. The research study was advertised in local newspapers, pharmacies, and on the Doornfontein campus of the University of Johannesburg in order to recruit volunteers for the study. All volunteers were required to complete a Suitability Criteria Questionnaire. Following this, ten participants were selected who met the inclusion criteria. The study involved four homoeopathic consultations for each participant over a period of three months. During the first consultation a consent form was completed, the procedures of the research were explained to the participant, a full case history was taken, and a physical examination was performed. According to each participant’s individualized physical, mental and emotional symptoms ascertained from the case history, the researcher determined a suitable similimum remedy. A similimum remedy can be defined as the single remedy that fits the symptom picture (Digby, 1997). The abbreviated Kupperman Menopause Index was completed by each participant at the beginning of the treatment, and then at four-weekly intervals for the duration of the twelve week trial. The results were then transferred to the participants’ main Kupperman Menopause Index and compared, thus determining the effect of the homoeopathic similimum in treating climacteric symptoms.

M.Tech. / Menopause is defined as the physiological cessation of menses due to decreased ovarian function and is established when the menses have not occurred for a year, usually occurring at a median age of 50.8 years. The period around the menopause is a time of transition that can contribute to both emotional and physical symptoms. The purpose of the study was to determine the efficacy of the homoeopathically prepared remedy Lachesis in the treatment of the symptoms of the menopause in women whose symptoms match the symptom picture of Lachesis. Thirty female volunteers between the ages of sixty and sixty years were recruited from the Johannesburg and Potchefstroom areas. This was a single-blind study and the participants did not know if they were in the control or experimental group. The participants were required to complete an Abbreviated Kupperman Index on a weekly basis throughout the four week trial period. The Experimental group experienced a 58.27% overall decrease in average Kupperman score, compared to 28.65% of the Control group. The P-value of the total response of the trial is 0.2110, therefore there is not a significant statistical difference between the two groups over the total trial period. Although there was not a statistically significant difference for the total response between the two groups there was statistically significant differences between the two groups for the following individual symptoms: profuse sweating, depressive moods and the inability to concentrate.

Studies of anaemia occurring during pregnancy have been of two main types. The first type, from which information of great value has been collected, is the mass survey of large series of cases. Studies of such a nature have the disadvantage that the less common varieties of pregnancy anaemia are pooled amongst the more common, a feature which is largely responsible for the perpetuation of traditional rather than factual ideas on the subject of these less common forms. The second type of study, of which the present is an example, consists of a more intensive and detailed investigation of individual cases with the main purpose of interpreting pathogenesis in terms of deviation from that which is physiological. Anaemia and pregnancy are common associations. It is important to distinguish between anaemia which is apparently due to pregnancy and anaemia which is associated coincidentally with pregnancy. In the present enquiry, the phrase "anaemia during pregnancy" generically denotes that a case is pregnant and anaemic at the same time. " Anaemia of pregnancy" and "pregnancy anaemia" are used synonymously to indicate that the anaemia is conditioned directly by pregnancy; it is perhaps too strong to refer to such anaemia as being due to pregnancy. ". Anaemia complicated by pregnancy" indicates that pregnancy occurs coincidentally with some disorder of the blood which ordinarily occurs quite apart from and is quite unrelated to pregnancy. The present investigation has sought to establish normal standards for the less commonly noted physical features of red cell fragility and red cell size during normal pregnancy, and to investigate these features in mild and severe grades of anaemia during pregnancy, followed through to the puerperium. At the same time, full haematological investigations were carried out and the results of various types of treatment followed. The type of response to treatment was used as an important aid to the diagnosis of the type of anaemia. That the investigation of the red cell fragility in pregnancy might afford information of value was suggested by Dr. J.M. Vaughan on the evidence of a single case under 2 her own observation some time previously in which the fragility was increased. The observations of Cassells (1938) also suggested that with an accurate technique for fragility estimation the red cells during pregnancy could be shown to behave differently from other forms of anaemia as regards their fragility. As no controlled work had been published on the subject, it was necessary to establish standards of red cell fragility for pregnancy uncomplicated by anaemia, and to compare these standards with the findings in pregnancy complicated by anaemia. On the assumption that red cell fragility is at least in part related to red cell thickness (Haden, 1934, Dacie and Vaughan, 1938), estimations of mean cell volume and mean cell diameter were an essential part of the investigation. Red cell counts, haemoglobin estimations, reticulocyte counts, white cell counts, and estimation of plasma bilirubin were part of the routine investigation.

La vaccination est un outil important et très efficace dans la prévention des maladies. Cependant, pour que la vaccination soit pleinement efficace, chaque individu doit recevoir toutes les doses de vaccins nécessaires à l’établissement et au maintien d’une immunité protectrice. Les personnes ayant eu une manifestation clinique indésirable après une vaccination (MCIV) précédente sont parfois enclines à arrêter ou retarder leur série vaccinale par crainte d’une récidive (potentiellement plus sévère) de la MCIV s’ils reçoivent les prochaines doses du vaccin. Lors de la prise en charge de ces patients, le médecin doit évaluer la MCIV et déterminer s’il est sécuritaire pour le patient de recevoir les prochaines doses de vaccin. Cette dernière étape est souvent difficile car la majorité des études de sécurité vaccinale décrivent la fréquence des MCIV dans la population générale mais rapportent rarement le risque de récidive et les facteurs influençant ces récidives. L’objectif de cette thèse était d’évaluer le risque de récidive des MCIV et d’identifier les facteurs qui influencent ce risque de récidive. Afin de répondre à cet objectif, quatre études ont été menées : 1) L’étude 1 est une revue systématique avec méta-analyse qui a permis de synthétiser la littérature disponible sur le risque de récidive des MCIV. 2) L’étude 2 est une analyse rétrospective qui avait pour but d’estimer le risque de récidive des MCIV à partir des données recueillies par le système de surveillance passive du Québec entre 1998 et 2016. 3) L’étude 3 est une analyse rétrospective de dossiers médicaux qui avait pour but d’estimer le risque de récidive des MCIV d’allure allergique et comparer la prise en charge des patients ayant eu une MCIV d’allure allergique aux recommandations de pratique du Joint Task Force on Practice Parameters (JTFPP), un groupe d’experts américains. 4) L’étude 4 était une analyse secondaire des données de réactogénicité recueillies lors de trois essais cliniques menés en Europe entre 2004 et 2010 auprès de 5026 enfants âgés de moins de 2 ans. Elle avait pour but d’estimer le risque de récidive des MCIV et l’interaction résultant de la coadministration du vaccin à 4 composantes contre le méningocoque de sérogroupe B (4CMenB, Bexsero™, GSK) et des vaccins de routine sur l’occurrence, la récidive et la sévérité des MCIV. Ce travail a montré qu’à ce jour, très peu d’études ont évalué le risque de récidive des MCIV. La revaccination est sécuritaire chez la majorité des patients avec une MCIV légère ou modérée. Pour les patients avec des MCIV graves les données semblent aussi aller dans la même direction mais sont moins robustes car ces patients étaient moins souvent revaccinés. La majorité des MCIV d’allure allergique ne sont pas suggestives d’anaphylaxie mais sont prises en charge comme si elles en étaient. La définition de l’anaphylaxie du JTFPP est non spécifique et nécessiterait probablement une révision. Limiter les précautions (tests cutanés et la revaccination en doses graduées) aux patients ayant eu une MCIV d’allure allergique débutant ≤ 1 heure suivant la vaccination (compatible avec une réaction IgE médiée) et à ceux rencontrant les critères spécifiques de l’anaphylaxie (quel que soit le délai de survenue) semble suffisamment sensible et prudent pour prévenir les anaphylaxies lors de la revaccination. Comparé à l’administration à des visites séparées, la coadministration du 4CMenB et des vaccins de routine réduit le risque de MCIV de 4% à 49% (interaction négative) selon la MCIV avec une réduction plus importante chez les enfants ayant eu des MCIV lors des vaccinations antérieures. Comparé aux enfants sans antécédents de MCIV, les enfants avec des antécédents sont plus à risque de présenter la même MCIV lors des vaccinations ultérieures mais les récidives ne sont généralement pas plus sévères que les MCIV antérieures. En conclusion, la majorité des personnes ayant eu une MCIV lors de vaccination(s) précédente(s) peuvent être revaccinées de manière sécuritaire. Pour fournir une base scientifique robuste aux cliniciens prenant en charge les patients ayant eu des MCIV, il serait utile que les futures études cliniques présentent non seulement le risque global de MCIV mais aussi leur risque de récidive. / Immunization is an important and very effective tool in the prevention of diseases. However, for immunization to be fully effective, each individual must receive all the vaccine doses needed to establish and maintain a protective immunity. People who have had a previous adverse event following immunization (AEFI) are sometimes inclined to stop or delay their vaccination series by fear of a potentially more severe recurrence of the AEFI if they receive the next doses of vaccine. When managing these patients, physicians should evaluate the AEFI and determine if it is safe for the patient to receive the next doses of vaccine. This last step is often difficult because most vaccine safety studies describe AEFI frequency in the general population but rarely report their risk of recurrence and the factors influencing these recurrences. The objective of this thesis was to assess the risk of AEFI recurrence and to identify the factors influencing it. To meet this objective, four studies were conducted: 1) Study 1 is a systematic review with meta-analysis that synthesized the available literature on the risk of AEFI recurrence. 2) Study 2 is a retrospective analysis aimed at estimating the risk of AEFI recurrence using the data collected by the Quebec passive surveillance system between 1998 and 2016. 3) Study 3 is a retrospective analysis of medical records that aimed at estimating the risk of recurrence of allergic-like AEFIs and comparing the management of patients who had an allergic-like AEFI with the practice guidelines of the Joint Task Force on Practice Parameters (JTFPP), a group of American experts. 4) Study 4 was a secondary analysis of reactogenicity data collected in three European randomized controlled clinical trials conducted between 2004 and 2010 among 5026 children aged less than 2 years. The purpose of this study was to estimate the risk of AEFI recurrence and the interaction resulting from the co-administration of the 4-component meningococcal serogroup B vaccine (4CMenB, Bexsero ™, GSK) and routine vaccines on the occurrence, recurrence and severity of AEFIs. This work has shown that to date, very few studies have evaluated the risk of AEFI recurrence. Re-immunization is safe in most patients with mild or moderate AEFIs. For patients with serious AEFIs, the data appear to be in the same direction but are less robust as these patients were less often re-immunized. Most allergic-like AEFIs are not suggestive of anaphylaxis but are treated as if they were. The JTFPP definition of anaphylaxis is nonspecific and may require revision. Limiting precautions (skin tests and revaccination in graduated doses) to patients who have had an allergic-like AEFI starting ≤ 1 hour following vaccination (compatible with an IgE-mediated reaction) and those meeting the specific criteria of anaphylaxis (whatever their delay of onset) seems sufficiently sensitive and careful to prevent anaphylaxis during re-immunization. Compared to separate visits, co-administration of 4CMenB and routine vaccines reduces the risk of AEFI from 4% to 49% (negative interaction) depending on the AEFI with a greater reduction in children who have had an AEFI at previous immunizations. Compared to children without a history of AEFI, children who have had a previous AEFI are at higher risk of presenting the same AEFI at subsequent immunizations but recurrences are generally not more severe than previous events. In conclusion, the majority of people who have had an AEFI during previous immunization(s) can be safely re-immunized. To provide a robust scientific basis to clinicians caring for patients with AEFIs, it would be useful for future clinical studies to present not only the overall risk of AEFI but also their risk of recurrence.

Submitted in partial fulfilment of the requirements tor the degree of Master of Medicine (Anaesthesia) in the Department of Anaesthesla University of the Witwatersrand / This study investigated the postoperative management of hypothermia of intraoperative origin using a forced-air convective warming device. Hypothermia develops during the intraoperative period partly as a result of disordered thermoregulation induced by anaesthesia and partly because of the nature of the operational injury and the surgical environment. Both the hypothermic state and the consequences of physiological attempts to return the core temperature to normal, which take place during the postoperative period, are associated with non-beneficial effects. Attempts to prevent intraoperative decline in core temperature are a part of anaesthesia management. However, most of the traditional options available are inefficient or ineffective, particularly in adults. This study evaluated the performance of a new device, the forced-air convective warmer, in the management of the postoperative hypothermic state. Results showed that when compared to a hypothermic control group the device made a significant difference to the thermal state of a group of hypothermic postoperative patients but only if it was used for at least two hours postoperation. / Andrew Chakane 2018