Israel journal of medical sciences
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A series of eight women in whom a diagnosis of placenta previa with focal accretion was established, is presented. They were selected from a group of 153 women with placenta previa who delivered during the period 1968-77. The women with placenta previa accreta did not differ from those with placenta previa per se with respect to age, parity, obstetrical history, and antenatal, intrapartum or perinatal outcome. ⋯ Postpartum hemorrhage occurred in four of the women, three of whom were delivered vaginally. Of seven women who were managed conservatively, one required a hysterectomy to control bleeding. It is suggested that cases of placenta previa with focal accretion be managed conservatively.
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Case Reports
Adult respiratory distress syndrome treated with high-frequency positive pressure ventilation.
Adult respiratory distress syndrome (ARDS) is a severe disease that carries a poor prognosis (50 to 60% mortality). Although modern ventilatory techniques, especially positive end-expiratory pressure ventilation, have reduced the mortality rate somewhat, they are still far from serving as the ideal solution to this grave condition. ⋯ A dramatic improvement was achieved within 60 min of increasing the ventilatory rate from 12 to 80/min, with a concomitant decrease of tidal volume from 12 to between 2 and 23 ml/kg. HFPPV may be a useful alternative method in the treatment of patients with ARDS.
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Epidural morphine was evaluated for the control of postoperative pain after cesarean section (CS). Sixty-five patients undergoing elective CS with epidural bupivacaine were studied. Of these, 40 were given a single dose of 4 mg of morphine through an epidural catheter on termination of surgery. ⋯ The epidural morphine was associated with a prolonged period of postoperative analgesia and a greatly reduced total papaveretum requirement for the 48 h (30.9 mg for the study group in contrast to 67.6 mg for the controls). The difference between the two groups was significant (P less than 0.001). We concluded that epidural morphine is an efficient method for the control of postoperative pain following CS, a single dose of 4 mg providing relief from pain for 8 to 12 h and sometimes longer.
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Health services in Israel are provided by various organizations. In most areas, curative, preventive and welfare services are under the administration of separate agencies. Even in small towns, health and social services are provided by many agencies. ⋯ A model is suggested for the organization of comprehensive primary health care at the local level, with integrated curative, preventive and social services. Development of neighborhood health centers with comprehensive services may provide more effective and efficient care for the individual and family and may serve as a suitable framework for the development of community health care programs. The importance of surveillance of the health status of the community and the need for a relevant record system is stressed.