Harefuah
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[The benefit of combining spinal morphine and intravenous buprenorphine for perioperative pain].
Concurrent administration of opioids with different affinity produces synergistic antinociceptive effect in rats. We tested the perioperative antinociceptive effects of the simultaneous double blind administration of morphine, a pure agonist and buprenorphine, a partial agonist, in 30 patients undergoing hysterectomy under general anesthesia. Pre- and post-operatively regimens consisted of random patient assignment to intrathecal 0.3 mg morphine plus intravenous saline (group 1), intravenous 0.09 mg buprenorphine plus intrathecal saline (group 2) or intrathecal morphine 0.3 mg plus intravenous buprenorphine 0.09 mg (group 3). ⋯ Buprenorphine-induced analgesia in group 3 lasted significantly (P < 0.05) longer than in group 2. Side effects in groups 2 and 3 were by 44% and 42% fewer than in group 1, respectively, with no withdrawal symptoms. Thus, concomitant administration of intrathecal morphine and low dose intravenous buprenorphine produces better and longer pain relief than intravenous buprenorphine alone in women after hysterectomy.
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Case Reports
[Many faces of West Nile fever--the first case of West Nile fever in the western Galilee, Israel].
West Nile Fever (WNF) is caused by a B arbovirus, which was first isolated in 1937 in Uganda. In Israel the disease bears an epidemic character, and during 1950-1957 several widespread outbreaks of WNF were described in detail. It emerged from obscurity in 1999 when the first incursion of the virus in North America caused 62 cases of encephalitis and 7 deaths in New York. ⋯ While neurological disease has been prominent in some epidemics, the West Nile virus infection is usually asymptomatic in areas of the world where the virus is endemic. This is a case study of the first patient diagnosed and treated for West Nile Fever in the Western Galilee, Israel. The epidemiology, pathogenesis, clinical manifestations, diagnosis and treatment of the disease are presented in detail.
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Traumatic Brain Injury (TBI) has been established as a category in reporting systems. Uniform data systems case definition has been suggested for hospital discharge data surveillance systems cases based on ICD-9-CM diagnostic codes. These include fractures and specific mention of intracranial injuries such as contusion, laceration, hemorrhage, and concussion. Inspection of data from the Israel National Trauma Registry suggested that two diagnostic groups of very different severity and outcome were being unjustifiably combined. ⋯ The groups were significantly different in severity, hospital resource use, immediate outcome, demographic and injury circumstances.