Journal of the Chinese Medical Association : JCMA
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Randomized Controlled Trial Comparative Study Clinical Trial
Percutaneous dilatational tracheostomy versus open tracheostomy--a prospective, randomized, controlled trial.
Percutaneous dilatational tracheostomy has gained popularity, but its superiority to open tracheostomy is unclear. The object of this study was to compare procedure time, complication, safety and cost-effect between the percutaneous dilatational tracheostomy (PDT) and the conventional open tracheotomy (OT). ⋯ The PDT appears to be a simple, safe and time-saving bedside procedure. It can be recommended when an elective tracheostomy is needed in a critical patient.
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Endovascular embolization of wide neck aneurysm often results in incomplete occlusion or aneurysm recurrence. The purpose of this study is to assess the efficacy and safety of stent-assisted embolization of wide neck aneurysms of the internal carotid artery (ICA). ⋯ Stent-assisted embolization is a treatment of choice for wide neck aneurysms or for patient with herniation of coil loops to parent artery after coil detached. It was proven both safe and effective over a relatively long follow-up.
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Case Reports
Metformin-associated lactic acidosis and acute renal failure in a type 2 diabetic patient.
Metformin belongs to a class of drugs known as the biguanides that are widely used in the treatment of type 2 diabetes mellitus. Its association with lactic acidosis is well established, although rare. Metformin-associated lactic acidosis is recognized as a potentially lethal condition that can occur in patients with contraindications to the drug, such as renal dysfunction, liver diseases, alcoholism, and cardiopulmonary diseases. ⋯ We describe a 75-year-old diabetic woman with acute renal failure and life-threatening lactic acidosis due to metformin intoxication. Clinical manifestations included vomiting, diarrhea, hypothermia, hypotension and transitory blindness. Her initial renal function was recovered after hemodialysis and she was discharged 3 months after admission.
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Cyanide poisoning may result from different exposures: residential fires, industrial accidents, drug and plant intoxication. Clinical features include coma, respiratory arrest and cardiovascular collapse. The biological hallmark is lactic acidosis. ⋯ In conclusion, antidotes are beneficial in cyanide poisoning. In suspected cyanide-poisoned patients, we recommend the use of hydroxocobalamin as first-line antidote, owing to its safety. In massive cyanide poisoning, due to the limited potency of hydroxocobalamin, continuous infusion of sodium thiosulfate should be associated.
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In 1680 Sydenham wrote, "Among the remedies which has pleased almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium." This appraisal is still true today. Morphine, the principal analgesic agent of the opium alkaloids, has provided the structural model from which modern synthetic opiates have been designed and synthesized. Morphine, as well as the synthetic opioids, has become a permanent part of the armamentarium of an anesthesiologist. ⋯ With the improved anesthetic management, surgeries have been pushed to new heights, which would have never been possible without creative and optimal anesthetic management. Unfortunately, surgery and anesthesia are continued to be pressured by medical economics to cut costs, while there is increased risk of managing the critically ill patients. This trend will continue; therefore, anesthesiologists today must rise to the challenge.