Harefuah
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Health consumers' satisfaction has become a factor of increasing importance for health care systems. It is dictated by modern management methods and also by the competition between health care providers. ⋯ This subject is reviewed according to existing publications and we mention our own experience on the matter. Satisfaction surveys are not an inherent objective but an important lever for quality of care improvement and assurance.
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To present our experience with spinal anesthesia in premature and former premature infants, and to focus on technical aspects and pitfalls enlightened with increasing experience. ⋯ Successful spinal anesthesia in premature and former premature infants depends on close attention to preoperative assessment, patient positioning during and immediately after anesthetic induction, drug dosing and perioperative monitoring. A relatively high dose of local anesthetic should be administered.
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Ascites is the most common complication in cirrhotic patients. The presence of ascites predisposes the cirrhotic patients to complications that significantly increase their morbidity and mortality. These include spontaneous bacterial peritonitis and the hepato-renal syndrome. ⋯ This theory proposes that elevated blood levels of vasodilators cause a systemic vasodilatation, that leads to the development of a hyperdynamic circulation. This vasodilatation causes activation of compensatory vasoconstrictive mechanisms. The vasoconstrictors cause functional kidney damage, which leads to the retention of sodium and water, and thus to the development of ascites.
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In the last decade the treatment of renal cell carcinoma (RCC) have changed dramatically. Currently, laparoscopic radical nephrectomy, partial nephrectomy in the presence of normal contralateral kidney as well as ablative surgery for small renal masses, are vivid options for the treatment of localized RCC. For metastatic RCC, cytoreductive nephrectomy is the standard of care prior to immunotherapy or combined treatment with tumor vaccines. ⋯ More experimental therapies involving targeting RCC cells using specific markers such as G250 are under investigation. In addition, changes in the 1997 TNM classification of RCC are anticipated. Retiring--routine adrenalectomy during radical nephrectomy and immunotherapy using tumor infiltrating lymphocytes (TIL).
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Pubic rami fractures are common in the elderly, resulting from low energy traumatic falls. The recovery of some of these patients may be disproportionately slow. ⋯ There is a considerable high rate of association of combined pubic and sacral fractures. Greater awareness of this clinical condition is required.