Israel journal of medical sciences
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Synergistic necrotizing fasciitis of the penis and scrotum was first described by Fournier, and remains a rare, but life-threatening disease. The reported mortality rates in different series range between 22 and 60%. ⋯ A high index of suspicion, combined with early radical surgical intervention, is the key to effective treatment. Delayed diagnosis and treatment were the primary factors responsible for death.
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Randomized Controlled Trial Clinical Trial
A prospective study evaluating the usefulness of continuous supplemental oxygen in various endoscopic procedures.
The influence of oxygen supplementation on the prevalence of hypoxemia during endoscopic procedures was studied in 289 patients in a prospective clinical trial. The frequency of oxygen desaturation was found to decrease significantly in patients receiving oxygen via nasal prongs, compared to patients not receiving oxygen supplementation. ⋯ Similar effects were found in patients undergoing gastroscopy, colonoscopy, and endoscopic retrograde cholangiopancreatography. In view of the risks related to hypoxemia and its high prevalence in endoscopic procedures (28-50%) we recommend that a routine oxygen supplementation policy be considered in every patient undergoing endoscopy, especially when additional procedures are to be performed.
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Scapulothoracic dissociation has been described as a "closed traumatic forequarter amputation" and is characterized by massive soft tissue swelling of the shoulder, lateral displacement of the scapula, neurovascular injuries (brachial plexus, subclavian artery), an osseous-ligamentous injuries. In addition to the lateral displacement of the scapula, an acromioclavicular separation, a displaced fracture of the clavicle or sternoclavicular separation can be identified on plain X-rays. This injury pattern has been infrequently reported. We present a patient who had a previously unreported combination of roentgenographic findings, and in whom the diagnosis was revealed by computed tomographic evaluation.
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Since the limited accessibility of general intensive care units creates a situation in which medical patients in critical condition continue to be cared for in the regular wards, we conducted a retrospective cohort study to assess the treatment outcomes in such patients referred to the medical intermediate care unit (MICU). At the Soroka Medical Center, a facility with 810 beds, of which 170 beds are in medical wards, including an 8-bed intensive cardiac care unit and a 5-bed general intensive care unit, 119 patients were referred to the MICU, directly from the emergency room or from medical wards, during the first half of 1994. Eighty percent of the patients were admitted to the MICU directly from the emergency room. ⋯ The ratio of nursing staff to patient in the MICU was approximately 1:3, compared to 2:3 in the general intensive care unit and 1:12 in the wards. The mean cost of one day of hospitalization in the MICU was one-third that in the general intensive care unit and double the cost in a ward. Medical patients in critical condition can be treated in an MICU, with a savings in expenses and without impairing the patient's chances for survival.