Israel journal of medical sciences
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In South Africa, early lessons in primary health care were lost to sight and have been rediscovered only recently. Priorities need to be reassessed in order to better allocate resources to community needs. Developing and developed communities require different primary care services. ⋯ In developing communities, where there is a shortage of doctors, trained nurses operate local clinics with the help of community workers. Community participation and the cooperation of the traditional healers are necessary. Appropriate training of personnel for an effective role in public health care is essential.
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The accurate diagnosis of acute lower abdominal pain continues to be a problem. In Israel, a diagnostic sign often sought as indicating pelvic peritonitis is a rectal temperature of greater than 1.0 C higher than the simultaneous oral temperature. We established that in each of the 20 emergency rooms surveyed both oral and rectal temperatures are measured as part of the admission procedure for patients with acute lower abdominal pain. ⋯ Oral temperatures alone were elevated in 4.5% of patients with acute appendicitis or PID and also in 13% of patients with undiagnosed abdominal pain. These differences were not significant. We conclude that the common Israeli practice of measuring both rectal and oral temperatures in patients with acute lower abdominal pain gives no more information than the measurement of either one.
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A near fatal complication of central venous catheterization in a newborn infant is reported. Five days after insertion, the catheter tip eroded through the wall of the vein, causing hydromediastinum and hydrothorax with acute circulatory and respiratory distress. The diagnosis was confirmed by noting that the tip of the catheter had become curved downwards, by aspirating slightly bloodstained fluid from the pleural space and by injecting radio-opaque dye through the catheter. ⋯ The factors causing this complication are discussed. Recommendations are made about the type of catheter, its appropriate placement and maintenance. The diagnosis and management are surveyed.
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Continuous retroperitoneal bleeding may be an immediate life-threatening complication of pelvic fractures. While surgical control of the bleeding vessels has been advocated in these cases, today angiographic embolization of the branches of the internal iliac arteries is proving to be the treatment of choice. ⋯ It avoids the disadvantages of surgery, general anesthesia, loss of the tamponade effect of the retroperitoneum when opened, and the not uncommon difficulty of identifying and ligating the bleeding vessels. Two cases in which massive retroperitoneal bleeding associated with pelvic fractures was controlled by angiographic embolization are described, illustrating the importance of early angiography.