Harefuah
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Cryptococcal meningitis (CM) is common in the immunocompromised (especially due to AIDS), but also occurs in immunocompetent subjects. CM can complicate cryptococcal pneumonia (CP) not only in the immunocompromised but also in the immunocompetent. We describe a healthy 26-year-old man who developed a prolonged lung infection. ⋯ He recovered spontaneously, so no antifungal treatment was given. 4 months later he was admitted with cryptococcal meningitis and was treated successfully with amphotericin B. An extensive immunologic study revealed no abnormalities. Since CM can complicate cryptococcal pneumonia, it is recommended that patients with CP be followed, even if recovery is apparently complete.
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45% of all hospitalized burn casualties in Israel are children younger than 16 years old. In various hospitals they make up 30-60% of all burn casualties, depending on the proportion of children in the area of hospital intake, social and economic factors and the type of hospital. ⋯ In Israel, burned children are treated in 25 different hospitals and in departments of pediatric surgery, plastic surgery, general surgery, pediatrics or burn departments. There is no pediatric burn unit in Israel.
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Paralysis of the diaphragm may cause life-threatening respiratory distress in infants and young children because of paradoxical motion of the affected diaphragm and contralateral shift of the mediastinum during expiration. Phrenic nerve injury (PNI) may follow chest operations. 10 children with diaphragmatic paralysis and severe respiratory distress underwent plication of the diaphragm. Ages ranged from 14 days to 5 years. 9 had PNI after operations for congenital heart disease and 1 after resection of an intraspinal cervical lipoma. ⋯ Early diaphragmatic plication is simple and avoids more serious surgery. While effective in ventilator-dependent infants and young children, it should not be used in those with multi-organ failure. Early plication may prevent the complications of prolonged mechanical ventilation.
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We report acute polyarthritis in an 86-year-old man which was initially considered to be an exacerbation of osteoarthritis. After a delay of a few days a diagnosis of septic polyarthritis as an initial symptom of infective endocarditis was made. Although rheumatic manifestations in infective endocarditis are common, septic polyarthritis is rarely seen. In our patient the course of the disease was rapidly fatal.
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There is an international epidemic of violence in the emergency department (ED) which threatens medical staff daily. The problem is underestimated in Israel and there are as yet no regulations of the Ministry of Health and the Bureau of Security and Safety that deal with the problem. At the beginning of 1997 we conducted a retrospective survey to estimate the extent of this problem and to define its causes and the various options for management. ⋯ Most victims of violence didn't press charges because of fear resulting from threats of the patient and/or family. The violent patient was usually characterized by responders as a middle-aged man, sober, of low socioeconomic level, impatient, with a bad previous hospital experience, dissatisfied with treatment and who insisted on being admitted to hospital. Suggestions for violence management by questionnaire-responders included 24-hour police protection and a training program in violence management for hospital security and medical staff.