Clonazepam withdrawal psychosis.
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Biomedical subjects
Publications and source records attributed to R Jaffe.
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Of 106 liveborn infants weighing 751 to 1,500 g born to 97 mothers, 97 (91.5%) were transferred to the Neonatal Intensive Care Unit for premature infants at the Beilinson Medical Center, Petah Tikva. Treatment with tocolytic agents (ritodrine) and corticosteroids (betamethasone) was introduced when indicated but no preventive antibiotics were used during the antenatal period. All infants received immediate care by a neonatologist and 77 infants (72.6%) survived. Although the cesarean section deliveries increased during the survey from 21.7% during the first period to 43.3% during the second, there was no statistically significant difference in the survival rate. Thus it seems that there is no advantage in performing cesarean sections for very-low-birth weight infants in either vertex or breech presentations.
The diagnosis of appendicitis in pregnancy is complex because of altered maternal physiology and anatomy, and definitive therapy is often delayed. Ultrasonic screening is important in either diagnosing or excluding many pathologic conditions that complicate pregnancy and present a clinical picture similar to that of appendicitis. Reported here is a case in which a periappendicular abscess due to a perforated appendix was diagnosed by sonographic screening.
Forty-two women with gynecologic abnormalities were studied with the use of magnetic resonance imaging. Magnetic resonance imaging correctly assessed the origin of the pelvic mass in all patients. In the evaluation of leiomyoma, magnetic resonance imaging accurately depicted the number, size, and location of the lesion. In the evaluation of endometrial carcinoma, magnetic resonance imaging depicted the location of the lesion, the presence of cervical extension, and the depth of myometrial penetration in the majority of the cases. In the analysis of adnexal cysts, magnetic resonance imaging was sensitive in localizing the lesion and was able to distinguish serous from hemorrhagic fluid. This preliminary report indicates that magnetic resonance imaging may become a valuable imaging modality in the diagnosis of gynecologic abnormalities.
A case of a stromal sarcoma in a cervical polyp is presented. The tumor was confined to the polyp as evidenced by the histological examination of the uterus and cervix after surgery. In spite of that the patient died of widespread abdominal metastasis 1 year after the initial diagnosis.
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Numerous causes can lead to hepatic dysfunction following orthotopic liver transplantation. The most common cause is rejection, which is usually nonpreventable. The clinical presentation, time of onset, and even treatment are variable. Other causes, such as perioperative ischemic injury, vascular thrombosis, and complications of bile duct reconstruction may be preventable with good surgical technique. Infections can also be minimized by careful adjustment of immunotherapy, avoidance overimmunosuppression, and the judicious use of antibiotics. Hepatic dysfunction following orthotopic liver transplantation requires rapid assessment and proper treatment in order to prevent serious and possibly fatal complications.
A case of diffuse chorioangiomatosis leading to fetal hydrops, disseminated intravascular coagulopathy with massive umbilical vein thrombosis and fetal death is described. Although rare, this benign mesenchymatous malformation of the placenta should be kept in mind as a possible cause of neonatal morbidity. Prenatal diagnosis could prevent fetal death.
The efficacy of a preoperative single-dose of co-trimoxazole in reducing postoperative urinary tract infection and febrile morbidity after abdominal hysterectomy was evaluated in a randomized placebo-controlled study of 90 patients undergoing surgery. Among the co-trimoxazole patients, 6.2% developed urinary tract infection compared to 31% in the placebo group (p less than 0.001) and 12.5% febrile morbidity compared to 38% in the placebo patients (p less than 0.025). No adverse side effects of co-trimoxazole were observed and this regimen seems both safe and effective.
Intrauterine fetal supraventricular tachycardia is a rare condition often associated with the syndrome of nonimmune hydrops fetalis. When the fetus is preterm it is vital to treat the arrhythmia with maternally administered drugs and different regimens have been reported in the literature. We report 1 case of this arrhythmia successfully treated in utero with maternally administered digoxin resulting in complete reversal of the hydrops fetalis and the birth of a healthy baby. A review of the relevant literature is brought forth.
To assess the effectiveness of bromocriptine in reducing the size of PRL-secreting macroadenomas with extrasellar extension, we conducted a prospective multicenter trial in patients without prior radiotherapy, applying a standard protocol of treatment and tumor size evaluation. Basal serum PRL levels [1441 +/- 417 (+/- SEM) ng/ml for women; 3451 +/- 1111 ng/ml for men] fell in all patients and to 11% or less of basal values in all patients but 1. Normal PRL levels were reached in 18 of the 27 patients. In 13 patients (46%), tumor size was reduced by greater than 50%, in 5 patients (18%) by about 50%, and in 9 patients (36%) by approximately 10-25%. The extent of tumor size reduction did not correlate with basal PRL, nadir PRL, percent fall in PRL, or whether PRL levels reached normal. However, a reduction in PRL levels always preceded any detectable change in tumor size. In 19 patients, reduction in tumor size was evident by 6 weeks, but in the other 8, such reduction was not noted until the 6 month evaluation. In the 4 patients in whom bromocriptine was discontinued at the end of 1 yr, tumor reexpansion occurred in 3. Visual fields improved in 9 of the 10 patients in whom they were abnormal. Because of the excellent results found in most of the patients in this series, we suggest that therapy with bromocriptine should be considered as initial management for patients with PRL-secreting macroadenomas.
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Using ultrasound examination of the ovary routinely has given us an opportunity to find a sign that is always present when ovulation is about to occur. It consists in the appearance of a double contour inside the wall of the follicle, the outline of the wall losing its sharpness (due to the separation of the cellular mass of the granulosa). In 55 cases studied by ultrasound and laparoscopy there were 34 proven ovulations. The sign was present in 29 of these cases (85%). In 21 cases when ovulation did not take place the sign was present in only 2 cases (9.5%). This important sign therefore can be used in every case where it is necessary to work out the exact moment of ovulation for artificial insemination or in vitro fertilisation.
A single 5-gm dose of mezlocillin or a placebo was administered intravenously 30 minutes before surgery to patients undergoing emergency cesarean section. The assignment of drug or placebo was randomized. Postoperative morbidity occurred in 62.5% of patients receiving placebo and in 18.4% of those receiving mezlocillin (P less than 0.001). The incidences of febrile morbidity, endometritis, and urinary tract infection were significantly lower in the group given mezlocillin. Other benefits of antibiotic prophylaxis included a shorter hospital stay and no serious infections in the group given mezlocillin.
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