Universiteit van die Oranje-Vrystaat - SAMJ Archive Browser

26 VOL 80.7 DEC 1991
SAMJ
Protein content of amniotic fluid - pitfalls in research planning
To the Editor: A simple urine 'dipstick"can be used to
distinguish amniotic fluid from urine,' and we therefore
decided to determine whether 'dipsticks' could be used to
c o b rupture of membranes.
To validate the method, we first carried out estimations
of protein content and comparative dipstick values on 48
specimens of liquor arnnii obtained f+om third-trimester
amniocentesis.
To our encouragement, we found that dipsticks always
tested positive for protein in liquor and that there was some
correlation with the amount of protein present, in that the
mean values were + = 261 mp/dl (N = 8), ++ = 386 mg/d
(N = 34) and +++ = 775 mg/d (N = 6).
Armed with this 'valuable' information we then proceeded
to test vaginal 'fluids' before and after rupturing
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Aan die Redaktem Ek verwys na die brief van dr. Burger'
waarin gestel word dat: 'dit herhaaldelik bewys is dat akah01
die vernaamste oorsaaklike faktor in motorongelukke en'
aanrandings is'.
. ,,
. -
& -
Daar bestaan geen navorsing wat aantoon dat alkohol
die vemaamste oorsmklike fakm by motorongelukke is nie.
Die enigste navorsing wat die afgelope paar jaar in Suid-
Afiika dew die Nasionale Instirnut vir Verkeer en Pad-
, ; navorsing gedoen is, het aangetoon dat alkohol verantwoordelik
is vir slegs 3,2% van alle ongelukke. Ek is seker
daarvan dat dr. Burger geen inligting het om sy stelling te
L
.
-
1 -
t
,-*
,-
tt
? I t
5, staaf nie en ek sou graag van hom vemeem indien die teen-
1
deel waar is.
, Dit is we1 so dat produkte wat alkohol bevat, ongelukkig
* misbruik word deur minderhede, meestal met ernstige
' gevolge vir almal betrokke. So ook kan haseutiese mid-
dels wat vryelik beskikbaar is en geadverteer word, misbruik
~mer~en& treatment of Jehovah's Witnesses
? .
To the Editor: The 'Opinion' by Burrows et al.' calls for a
Berent perspective. Thankfully numerous doctors in both
, I . ~ the private and the public sectors treat Jehovah's Wimesses
. in accordance with their wishes. They are usually not in
sympathy with, or do not even comprehend, the reasons for
the patient's re- of blood; nevertheless their ethics dic-
, i tate that the doctor is there for the patient and not vice
, . versa. Their respect for the fundamental ethic of informed
consent or refusal of consent is to be applauded. It is within
the legal right of a doctor to refuse to take on 2 case. Yet it
I speaks volumes about his basic humanity when he accom-
1. . modates a patient in dire need and, despite the frustration
h .
6
he may feel at the limitation imposed on therapeutic
options, tries all else in accord with the best standards
, he knows. It also speaks of his basic humility and open-
mindedness when he is prepared to use forms of therapy,
hitherto untried by himself, that others with more experi-
.> 3 i ence in dealing with the acutely anaemic Jehovah's Wimess
V L, ,
, b, .-fq -1 - find helpful. To claim that informed refusal of consent for a
particular aspect of proffered treatment with suggestions of
alternatives is a 'call for mismanagement' with which the
< a - '-*-I & J doctor refuses to taint his ethics may well be- a thin veil for
.. . a .. ,.. . ,
intellectual arrogance and bigotry.
, P.
L- . The contention that the cases of survival with extremely
,
membranes. To our editication and dismay we found d
all 28 vaginal tests were positive before (+ = 8, ++ =
+++ = 8) and after rupture of membranes (+ = 0, ++ =
+++ = 17).
Urine 'dipsticks' are therefore of no value in c 0 6
rupture of membranes, and we would have saved om:l
a great deal of time and laboratory work had we perfonr
the second part of the study initially.
J. DOMMISSE
Depamnent of Obstemn and Gynaecology
University of Cape Town
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1. Walsberg R, McCulloch J. it &e or amniotic fluid? S Aj. I
J 1985; 68: 918.
word deur minderhede. Dit is wensdenkery om te betc
dat die staak van advertensies van produkte wat alkol
bevat tot gevolg sal h2 dat die 'wonderlike dag' aantrt
wanner daar nie meer misbruik is nie. Die reg tot vrye t,
gang van en matige gebruik deur die bree bevolking beho
nie ingeperk te word omdat minderhede 'n produk rr
bruik nie. 'n Baie meer produktiewe en realistiese opm
sou wees om te konsentreer op die opvoeding var. I
minderhede wat hierdie produkte misbruik sodat hien
wangedrag gestaak word. ;
1. Burger MS. Alkoholadvertensies (Brief). S Afr Med J 199 1;
108.
low haemoglobin levels with which 'medical publicauc
are dotted' can be discarded 'precisely because they 2
unusual' seems failacious. They are 'unusual' for at le,
four reasons that do not allow their findings to be inv&
ted. Firstly, very few, if any, non-Jehovah's Wimess patlel
will be allowed to remain untransfused at extremel: I(
haemoglobin values. (Besides, we all know of numero
transfused patients who have not survived either.) 3
leaves the Jehovah's Wimess in dire straits; not only n
there relatively few of them around, but acutely axen
ones are even rarer. The third factor is that many of h
acutely anaemic Witnesses are either clandestinely L%
fused by overzealous 'good Samaritans' or abandond
truly suboptimal marmgement, making death inevi-ab
Fourthly, not even a moderate percentage of cases o2 sl
vival are published. In many centres which kquentlj trl
Jehovah's Wimesses in accord with their wishes, these sl
vivals have become routine and thus no longer newswcd
Others simply do not have the time or interest TO
through the rigours of publishing.
In effect, Burrows et al. are putting the desp-rz
Jehovah's Wimess into a no-win situation. He eithe:
lates his deeply held religious convictions or he gets ro,
merely token, treatment, since the alternative methods 2