Harefuah
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Abdominopelvic actinomycosis associated with the use of an intrauterine contraceptive device (IUD) is described. The diagnosis is usually made after exploratory laparotomy for severe abdominal pain and signs of an acute abdomen, or for prolonged lower abdominal pain and findings consistent with pelvic malignancy. 3 women aged 33, 44 and 52 years, respectively, are presented.
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907 patients were operated on for fracture of the proximal femur in 1986-1987 and were then followed for an average of 7 months. There was a relatively high rate of complications in those over the age of 71, in whom mortality reached 15.5%, while the overall mortality was 6.8%. There was also a high rate of complications in those operated 3 or more days after the fracture had occurred. ⋯ The mortality of males was higher (9.2%) than that of females (5.5%). In trochanteric fractures treated by various methods of rigid fixation there were no problems of union or delayed union. Early mobilization and early discharge from hospital reduced mortality and complications.
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Immediate management of severe head injuries still poses a serious challenge. 50 patients with severe head injuries (Glasgow Coma Scale, 8 or less) were treated from February 1, 1989 to April 30, 1990. The effects of age, Glasgow Coma Score at admission, CT findings, pupillary reactivity to light and intracranial pressure on outcome, were evaluated. ⋯ We attribute the high incidence of good outcome to the direct referral of the severe head injury patients, thus excluding delays at peripheral hospitals. In addition, aggressive management in the intensive care units and a broader range of indications for operation were also correlated with favorable outcome.
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The commonest form of cutaneous tuberculosis is lupus vulgaris, whose incidence has steadily decreased during recent decades. We describe an 82-year-old man who presented with a large plaque of lupus vulgaris on his chin and upper neck which had been present for 71 years. This case clearly emphasizes the need for increased awareness of this disease, since its frequency may be greater than generally thought.