An imaginary legal conundrum: A reply to the response by Mahomed, Nöthling-Slabbert and Pepper.

In their original article on the subject of research using human biological material, Mahomed, Nöthling-Slabbert and Pepper advanced the notion that the law regarding ownership of human biological material is uncertain, and proposed that our country's healthcare policy of altruism be changed to mandatory profit-sharing by research participants. In my critique article, I took issue with the notion that the relevant law is uncertain, and suggested that Mahomed et al. failed to present a convincing argument in support of the proposed policy change from altruism to profit-sharing. In their response to my critique article, Mahomed et al. persist with the notion that the relevant law is uncertain; I suggest that this notion is erroneous, as our common law in this regard is well established, and as the authors base their argument exclusively on foreign case law. The authors further fail to make use of the opportunity to augment their argument in support of their proposed policy change from altruism to profit-sharing - in fact, they contradict themselves by disavowing their proposed policy change.

Posterior intravaginal slingplasty for vaginal prolapse.

OBJECTIVE: To evaluate the results of the posterior intravaginal slingplasty (IVS). PATIENTS AND METHODS: From a urogynecology database, 42 patients who had undergone posterior IVS procedures were analyzed. All the selected patients had also had a posterior colporrhaphy (88% with mesh inserted into the rectovaginal space). RESULTS: Intraoperatively, there was one complication, a rectum perforation. All patients were followed-up, with a median of 13 months. Recurrent prolapse, grade 3 or 4, developed in 12 patients (29%) which included ten cystoenteroceles (24%), four rectoenteroceles (10%), and three cases of utero/vault prolapse (7%). Repeat surgery was performed in six patients (14%). For utero/vault prolapse, eight patients presented preoperatively with grades 3 and 4 prolapse. On follow-up, three patients had utero/vault prolapse, one of whom did not have utero/vault prolapse on presentation. Therefore, of the eight patients presenting with utero/vault prolapse, only two had repeat prolapse on follow-up, which reflected an improvement of 75%. CONCLUSION: The posterior IVS delivered satisfactory results for vault and posterior compartment prolapse, with a 75% improvement in vault prolapse. It was not possible, however, to separate the effect of posterior IVS and posterior colporrhaphy on the prevention of recurrent prolapse nor on the improvement of difficulty in defecation. Due to the utilization of the now-abandoned vaginal anterior colposuspension procedure for the treatment of anterior compartment prolapse, no conclusions regarding the impact of the posterior IVS on the anterior compartment can be made.

A safe area and angle for harvesting autogenous tendons for anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) reconstruction with autogenous semitendinosus and gracilis tendons has become a common surgical procedure. Lower leg paresthesia following injury to the infrapatellar nerve during harvesting of the tendons has been well documented. Few authors have described the position of the infrapatellar nerve on a flexed knee, which is the position used during ACL reconstruction. The purpose of this study was to determine a safe area and angle where an incision could be made for harvesting of the semitendinosus and gracilis tendons, with the knee in flexion. Twenty right cadaver knees and 20 left knees were dissected. Landmarks on the knee were identified, from where the distances to the nerves (infrapatellar and saphenous) were measured with a vernier caliper. A safe area on the right knee was determined to be on the tibial tuberosity plane between 3.7 and 5.5 cm with a safe angle of incision of 51.6 degrees. A safe area on the left knee was determined to be on the tibial tuberosity plane between 3.6 and 4.9 cm with a safe angle of incision of 52.5 degrees. The results may assist orthopedic surgeons performing ACL reconstruction with semitendinosus and gracilis tendons to avoid cutaneous nerve damage and, therefore, patient discomfort.

Midazolam for the intravenous induction of anaesthesia in children.

Midazolam was compared with thiopentone as an intravenous anaesthetic induction agent in children between four and twelve years of age undergoing elective minor surgical procedures. Successful induction of anaesthesia was achieved in both groups of patients. With midazolam induction time was longer than with thiopentone, but the difference was not statistically significant. The incidence of apnoea was greater with thiopentone, but not significantly so. It is concluded that midazolam is effective and safe, and could prove a reasonable alternative to thiopentone as an intravenous induction agent in children undergoing elective minor operations.