Harefuah
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Infective endocarditis is a life-threatening disease which may be complicated by ring-valve abscess. Since this complication increases morbidity and mortality early diagnosis is important. Pericardial effusion complicating infective endocarditis is uncommon and should raise suspicion of the presence of an abscess. ⋯ Controlled trials are providing increasing evidence for the superiority of transesophageal echocardiography in detecting valvular vegetations. Moreover, it is the most accurate means of detecting ring-valve abscess in cases of infective endocarditis. In view of these advantages, we propose the use of transesophageal echocardiography in every case of infective endocarditis.
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100 patients were followed for 6-9 years after Roux-en-Y gastric bypass for morbid obesity. They were randomly selected from 600 patients operated on between 1980-85. ⋯ Longer follow-up of 6-9 years showed weight gain, with 24% having become morbidly obese again, 74% having lost more than 50% of their excess weight and only 7% having lost all their excess weight. We conclude that Roux-en-Y gastric bypass induces long term weight loss and largely prevents return of morbid obesity, as long as 6-9 years after surgery.
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Although pelvic inflammatory disease (PID) is a common complaint in young, fertile women, it is quite rare during pregnancy. Clinically it is characterized by abdominal pain, sometimes presenting as an acute abdomen with fever. ⋯ Since surgery during pregnancy in the presence of an infection leads to abortion in most cases, accurate diagnosis and appropriate treatment is of the greatest importance. A case of PID during pregnancy is presented.
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In 11 of 82 patients undergoing laparoscopic cholecystectomy, preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed. Indications were biliary pancreatitis in 5 and suspected common bile duct (CBD) stones in the other 6 (based on US or liver function tests, or both). The biliary tree was normal in 9 and laparoscopic cholecystectomy was performed. ⋯ Of the remaining 3 patients, 1 underwent sphincterotomy via ERCP and 3 weeks later, laparoscopic cholecystectomy. In the others, we intended to explore the CBD by laparoscopy, but had to resort to open cholecystectomy due to technical difficulties resulting from unsuspected acute cholecystitis. Based on our short experience, ERCP combined with laparoscopic cholecystectomy seems to be both safe and effective.
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The effect of immersion in a jacuzzi in relieving labor pains, and on cervical dilatation was examined in 40 parturients. They were immersed in the jacuzzi during labor for an average of 25.5 minutes. ⋯ The cervical opening increased during immersion by an average of 1.5 cm in the test group, compared with 0.3 cm in the controls (p < 0.01). Immersion in a jacuzzi during labor is apparently associated with analgesia and accelerated cervical dilatation.