No abstract

In a letter to the editor [1] Hesslewood recently drew attention to the fact that a patient suffered serious neurological complications following the intrathecal administration of technetium-99m diethylene triamine pentaacetic acid (99mTc-DTPA). No information on the patient, type of DTPA kit or the preparation used was given. This report, however, raises the question of whether the continued use of 99mTc-DTPA for cisternography can be supported.In our previous report referenced in the letter, two of the first 15 patients we studied developed adverse reac-tions [2]. Since this publication is not readily available, a short summary of this study and of our subsequent experience using 99mTc-DTPA for intrathecal use seems to be appropriate.The adverse reactions we reported were apparently provoked by the sequestration of calcium and magnesium ions in the cerebrospinal fluid at the site of the injection. This problem was traced to the DTPA kits of a manufacturer which contained DTPA as the sodium salt and not CaNa3DTPA. Trisodium DTPA is able to strongly complex many kinds of metallic ions such as Ca, Mg and Tc, whereas calcium trisodium DTPA can bind Tc but not Ca or Mg.In isolated ischiatic nerves of rats, nerve conduction could be irreversibly blocked using HzNa3DTPA solutions, even at relatively low concentrations (5 mEq/1), while CaNa3DTPA caused no effect, even at much higher concentrations (20 mEq/1). We also found that stan- Table 1. DTPA kits containing free acid or sodium DTPAnot suitable for intrathecal use

Complicaţiile postoperatorii (44,4% faţă de 17,2%, P = 0,03) şi durata mai lungă a internării în spital (7,28 zile faţă de 5,95 zile, P = 0,004) au fost de asemenea mai frecvent observate la pacienţii cu HIV +. Nu au existat diferenţe în ceea ce priveşte ratele de ruptură ale apendicelui, rezultatele histopatologice şi mortalitatea. Concluzii: Pacienţii HIV+ s-au prezentat mai târziu la spital, iar intervenţia chirurgicală a fost asociată cu o rată mai ridicată a morbidităţii postoperatorii şi o perioadă mai lungă a internării.

This study involved a descriptive analysis of surgical resources and included the total number of hospitals, number of hospital beds, number of surgical beds, number of general surgeons (specialist and non-specialist), and the number of functional operating theatres in public and private hospitals in South Africa. The public hospitals included all district, regional and tertiary hospitals in all nine provinces.