CME : Your SA Journal of CPD - Volume 27, Issue 7, 2009
Volume 27, Issue 7, 2009
Source: CME : Your SA Journal of CPD 27 (2009)More Less
The First Blast of the Trumpet Against the Monstrous Regiment of Women was written by the Scottish reformer, John Knox, in 1558. The 'regiment' that he was referring to was government and the book was aimed specifically at Mary I of Scotland and Mary I of England. His argument was of course that biblical law states that women are subservient to men and so should not rule over them - under any circumstances.
Author J. Van MarleSource: CME : Your SA Journal of CPD 27, pp 295 –300 (2009)More Less
An aneurysm is defined as a localised dilatation of an artery with an increase in diameter of ≥ 50% than that of the 'normal' undilated adjacent vessel. Aneurysms may occur in all arteries but are most commonly found in the infra-renal abdominal aorta (Fig.1). Abdominal aortic aneurysms (AAAs) are often associated with iliac, femoral and popliteal artery aneurysms, the last accounting for the majority of peripheral arterial aneurysms.
Source: CME : Your SA Journal of CPD 27, pp 301 –305 (2009)More Less
Peripheral arterial disease (PAD) is a chronic atherothrombotic occlusive disorder of the peripheral circulation that predominantly affects the large, medium-sized and small arteries of the lower limbs. The prevalence of PAD ranges from 3% to 10% overall, increasing to 15 - 20% in patients over 70 years. Classic risk factors for PAD include age over 55 years, smoking, diabetes mellitus, hypercholesterolaemia, hypertension, obesity and sedentary lifestyle. Patients with PAD may be asymptomatic or can present with intermittent claudication (IC) and/or critical limb ischaemia (CLI). Patients with CLI have ankle pressures below 50 mmHg and/or toe pressures below 30 mmHg, ischaemic rest pain and/or tissue necrosis (skin ulcer or gangrene). PAD may be classified into 3 segmental types depending on the distribution of the occlusive disease (Table I). Patients with CLI have multi-segment disease as a rule. PAD is not a benign disease; the risk of mortality in patients with established PAD secondary to cardiovascular and cerebrovascular events far outweighs the 4% risk of a major amputation over 10 years. Asymptomatic patients with PAD have an approximately 10-year shorter life expectancy than patients without PAD. Patients with IC have a 10-year mortality rate approaching 50%. Patients with CLI have 1- and 5-year mortality rates approaching 25% and 50% respectively. The modern evidence-based approach to treatment of PAD therefore emphasises lifestyle modification, control of risk factors, antiplatelet therapy, lipid-lowering agents and foot care. Patients with CLI will, in addition, need some form of surgical therapy: amputation, percutaneous transluminal angioplasty (PTA), peripheral stent or bypass procedure.
Source: CME : Your SA Journal of CPD 27, pp 306 –311 (2009)More Less
Deep-vein thrombosis (DVT) and pulmonary embolism (PE) are major causes of significant morbidity and mortality which are frequently, but not exclusively, associated with surgery, injury and other reasons for hospitalisation. In the acute setting, PE may be fatal while in the long term pulmonary hypertension can develop, particularly from recurrent PE. Post-thrombotic chronic venous insufficiency, better described as post-phlebitic chronic lower-limb venous hypertension (CVH), occurs as a result of the DVT causing deep venous reflux and/or venous outflow obstruction and can cause swelling, skin changes (dermatoliposclerosis) and venous ulceration. With appropriate therapy the risk of both the primary condition as well as the consequences thereof can be reduced. As DVT and PE are inextricably linked the syndrome is usually referred to as venous thromboembolism (VTE).
Author Lynne TudhopeSource: CME : Your SA Journal of CPD 27, pp 312 –315 (2009)More Less
Diabetes mellitus is increasing globally at an alarming rate. The disabling complications of the disease are draining the health care resources of both developed and developing nations. Admissions for diabetic foot-related complications to hospitals and clinics worldwide are the most common reason for hospital bed occupancy in this patient population and, in fact, 15% of the annual health care budget is used on treating the diabetic foot.
Source: CME : Your SA Journal of CPD 27, pp 316 –319 (2009)More Less
In order to fully understand the clinical presentation and concepts of management of occlusive extracranial cerebrovascular disease, a working knowledge of the relevant anatomy is helpful.
There are four major vessels supplying the brain - two internal carotids and two vertebrals. This constitutes the anterior and posterior circulation. The first branch of the internal carotid is the ophthalmic which supplies the eye via its retinal branch. The internal carotid then continues on to the temporoparietal region of the brain as the middle cerebral artery. The temporoparietal lobe provides motor and sensory function to the opposite side of the body. The dominant hemisphere, which is usually the left in right-handed people, and vice versa, contains the speech centre, known as Broca's area.
Author T.V. MulaudziSource: CME : Your SA Journal of CPD 27, pp 320 –322 (2009)More Less
Human immunodeficiency virus (HIV) disease was first described in 1981 in the USA in young homosexual men presenting with opportunistic infections associated with severe immune deficiency. The virus itself was identified 2 years later and the link between HIV and acquired immune deficiency syndrome (AIDS) was established.
Author Martin V. ForleeSource: CME : Your SA Journal of CPD 27, pp 323 –327 (2009)More Less
The fundamentals of varicose vein surgery have not changed for many decades and conventional open surgery remains the gold standard against which other treatment modalities are measured. Conventional open surgery is, however, not without problems. The recurrence rate is 10 - 15% at 2 years and as high as 60 - 70% after 20 years. Approximately 25% of patients require further surgery and recurrent disease accounts for 20% of all varicose vein surgery. Despite being a relatively minor procedure for a nonlife-threatening condition, varicose vein surgery is a common reason for litigation, accounting for 17% of settled claims in general/vascular surgery. Complications include cutaneous nerve injury (5 - 7%), haematoma (10%), deep vein thrombosis (DVT) (<2%), pulmonary embolism (0.2 - 0.5%), wound infection and pain.
Author Chris BatemanSource: CME : Your SA Journal of CPD 27, pp 332 –333 (2009)More Less
Stomach stapling 'great for women'
Man with broken neck told to take painkillers
Rioting prisoners rape 20 women
National health insurance (NHI) - the storm clouds gather
HIV 'cure' on our website not a problem - ANC
I'm sick of the media's witch-hunt - Manto
Shop bust over 'milk scam'
Nurses caring less?