Harefuah
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External cardiac pacing has recently been reintroduced as an effective method in emergency cardiac stimulation. We report for the first time the results of external cardiac pacing in a mobile intensive cardiac care unit. In 9 of 10 patients treated during the first 3 months of 1990, effective pacing was achieved. We conclude that external cardiac pacing is a rapid, safe and effective means of temporary pacing during emergency treatment, before admission to hospital.
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The timing of cholecystectomy in acute cholecystitis is still controversial. A marked change toward early surgery has been noted in the past decade. In a retrospective study of 197 patients we evaluated the results of cholecystectomy in 117 who underwent elective cholecystectomy, and in 80 operated on during the acute phase of cholecystitis. ⋯ Therefore, early operation during the acute phase of cholecystectomy is advised. For patients older than 60 years who have cardiovascular disease, we recommend delaying surgery until the acute inflammation subsides. The waiting period before surgery should be as short as possible in order to reduce the risk of recurrent cholecystitis and its complications.
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Scurvy, a rare disease, is still found today in malnourished patients. We recently diagnosed a case of scurvy in a 64-year-old woman resulting from a self-imposed diet. She had severe anemia and the characteristic gingival and skin lesions, which responded dramatically to ascorbic acid therapy. We report this case to make physicians aware of the possibility of scurvy and of its clinical symptoms.
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Short-term psychiatric hospitalization, developed during the past 2 decades, needs thorough evaluation with regard to its advantages. It is important to be able to identify those patients who might be aided by such treatment. Therefore the psychiatric emergency room physician should have at hand a model which would enable quick and relatively accurate decisions in identifying such patients. ⋯ This data may aid the physician during the initial interview in the psychiatric emergency room in deciding on further treatment. We also found that psychiatric emergency room diagnoses are usually reliable; and that those whose only diagnosis was "for observation" had a fair chance of a successful result after short-term hospitalization (discharge directly from the emergency room unit). We therefore presume that a sharper characterization of patients referred to the psychiatric emergency room may aid in tailoring the most suitable treatment for any particular patient, thus reserving short-term hospitalization only for those who would benefit the most.(ABSTRACT TRUNCATED AT 250 WORDS)
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Pheochromocytoma is a rare tumor, the diagnosis of which is based on a history of hypertension, and symptoms, signs and laboratory data associated with increased release of catecholamines. The combination of pheochromocytoma and shock is uncommon, but when it does occur, is often associated with necrosis of the tumor. We report an unusual case of a patient whose clinical findings suggested fulminating septic shock. Only at postmortem was the diagnosis of pheochromocytoma made.