Treatment of obstetric hemorrhage with recombinant activated factor VII (rFVIIa).

Recombinant activated factor VII (rFVIIa, NovoSeven) was used in three patients with massive obstetric hemorrhage due to placenta previa accreta, rupture of the uterus and pre-eclampsia with HELLP. Administration of the drug markedly decreased the bleeding and enabled control of the hemorrhage. rFVIIa seems to be an adjunctive hemostatic measure for the treatment of severe obstetric hemorrhage.

Preliminary evaluation of Vipera palaestinae snake bite treatment in accordance to the severity of the clinical syndrome.

The intravenous administration of a 60 ml dose of Vipera palaestinae antivenin was the suggested standard treatment of every bitten patient. In this study 85 Vipera palaestinae bitten patients where selectively treated with antivenin depending on the severity of the clinical picture. Patients who developed systemic or severe local signs received 20 ml of antivenin over 30 min. If symptoms were still present, an additional 10 ml of antivenin was given until systemic signs subsided. Repeated doses of 10 ml of antivenin was administered in each case of systemic symptom relapse. 49% of patients did not exhibit any systemic symptoms and did not receive antivenin treatment. In 63% of antivenin treated cases symptoms were aborted by a single dose of 20 ml of antivenin. 23% of the antivenin treated patients needed 30-40 ml, 19 needed 50-60 ml and only 1 patient (2%) received 80 ml of drug. Serum sickness complications were found in 44% of antivenin treated patients. The results of this study show that antivenin treatment based on systemic symptoms is effective, required less antivenin than the treatment with fixed dose for each patient and reduces the incidence of serum sickness.

[Cardiac failure following sting of yellow scorpion in an adult].

3 men, aged 18, 29, and 47 had severe cardiovascular disturbances following the sting of the yellow scorpion (Leiurus quinquestriatus hebraeus), which is considered the most dangerous scorpion in Israel. Cardiovascular complications are common in children after scorpion sting, but are rare in adults. Pulmonary edema developed in 1 of those being reported and hypertension and arrhythmias in the other 2. Severe deterioration in left ventricle function was confirmed by echocardiographic measurement of diminished ejection fraction. All patients recovered completely. This is the first report of severe cardiac involvement in adults following scorpion sting. We therefore recommend that even adults who develop cardiac symptoms after scorpion sting, particularly those with chronic cardiac disease, be monitored and treated in an intensive care unit.

Rhabdomyolysis in paraphenylenediamine intoxication.

Edema of the upper airways and rhabdomyolysis developed in a young patient as a consequence of paraphenylenediamine poisoning. Treatment with adrenaline, steroids and enforced diuresis prevented tracheostomy and renal failure.

[Intraluminal stents for peripheral atherosclerosis].

Atherosclerotic disease remains the most common cause of death in industrialized countries. Balloon-expandable intraluminal stents were placed in 5 patients in whom conventional percutaneous transluminal angioplasty failed and in whom there was reobstruction of lower limb arteries. At the latest follow-up examinations (average 18 months) all patients showed clinical benefit, and in all cases the stents have kept the arteries patent.

[Superior vena cava syndrome due to hemothorax].

A 40-year-old man suffering from chronic uremia was admitted for hemodialysis. During cannulation of the subclavian vein, 1 of the arteries of the chest was punctured and bled into the right hemithorax. A large compressing hematoma occurred near the superior vena cava and acute superior vena cava syndrome developed very rapidly despite repeated intercostal drainage. Bedside, 1-shot-venography enabled accurate diagnosis and localization of the obstruction and permitted aimed surgical intervention.

[Perforation of the small bowel, bleeding and ARDS as complications of typhoid].

Ileal complications, including perforation and bleeding, are uncommon in the western world today. We report a 26-year-old man with typhoid fever who developed hypoxemia, pleural effusion, ileal perforation and ileal bleeding. He was treated with intravenous chloramphenicol and underwent 2 operations. The ileal complications developed during the third week of illness. To our knowledge this is the first such report in the Hebrew literature.