Harefuah
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Ketoacidosis is a common condition in patients with new onset type 1 diabetes and remains a major reason for hospitalization of those with established disease. The major cause of mortality in ketoacidosis is cerebral edema. Although rarely diagnosed on a clinical basis, cerebral edema may have subtle manifestations and is probably under-diagnosed. Novel insights into the underlying pathophysiology of cerebral edema associated with ketoacidosis may help us treat this life threatening condition and prevent the low, yet significant, mortality associated with it.
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Over the past 20 years, a series of procedures have been designed to reconstruct the aortic root of patients with aortic insufficiency, in whom the pathology and hence, the surgery, spares the valve leaflets. The objective of this current study was to evaluate our midterm results comparing the reimplantation technique with the remodeling technique in patients with aortic regurgitation due to aortic dissection, aortic root and ascending aortic aneurysms. ⋯ In acute dissection reimplantation provides better haemostasis and there may be more stable repair, both in Marfan and non-Marfan patients. In Marfans it seems that the reimplantation technique provides better long-term results.
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Following the introduction of endoscopic techniques to other surgical fields such as general surgery, gynecology urology and thoracic surgery, cardiac surgeons sought their own methods of using minimally invasive techniques. ⋯ Thoracoscopic assisted mitral valve repair (via port access) has the potential to provide all the advantages of minimally invasive surgery: accelerates recovery, decreases pain, and maintains overall surgical efficacy, while avoiding the complications and pathology of midsternotomy. For appropriate patients, this is the method of choice in our department.
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Multicenter Study
[Percutaneous discectomy and intradiscal radiofrequency thermocoagulation for low back pain: evaluation according to the best available evidence].
Within the framework of evidence-based medicine, high quality randomized trials and systematic reviews are needed for new medical treatment. Clinicians should conscientiously, explicitly and judiciously use the best current evidence in making decisions about the care of individual patients. This paper summarizes the best available evidence from systematic reviews and randomized controlled trials concerning two minimally invasive procedures: percutaneous discectomy and percutaneous intradiscal radiofrequency thermocoagulation. ⋯ Results of systematic reviews were retrieved from four leading evidence-based databases: the National Institute for Clinical Excellence--NICE, which is an independent organization responsible for providing national guidance on treatments, the Cochrane Library, which is the largest library world-wide for systematic reviews and randomized controlled trials, the Center for Review and Dissemination (CRD) at the University of York, which undertakes reviews of research about the effects of interventions in health and social care and finally, a search via Medline. The results from those systematic reviews and randomized trials shows that, at present, unless or until better scientific evidence is available, automated percutaneous discectomy and laser discectomy should be regarded as research techniques. Radiofrequency denervation can relieve pain from neck joints, but may not relieve pain originating from lumbar discs, and its impact on low-back joint pain is uncertain.