Medicine
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Raynaud phenomenon is a vasospastic disorder affecting the hands and feet, and the efficacies of traditional treatments, such as pharmacological therapies and sympathectomy, are not uniform. Patients with paraneoplastic Raynaud phenomenon do not benefit from the traditional treatments. The use of botulinum toxin type A (BTX-A) for Raynaud phenomenon has been reported for several years; however, there are few reports regarding botulinum toxin type A in the treatment of paraneoplastic Raynaud phenomenon. We describe a case report of the beneficial effects of botulinum toxin type A on Raynaud phenomenon in a patient with lung cancer. ⋯ This study used botulinum toxin type A for a patient with paraneoplastic Raynaud phenomenon. Botulinum toxin type A significantly improved the patient's clinical symptoms without significant complications. These findings suggest that BTX-A may represent a good option for the treatment of paraneoplastic RP.
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Observational Study
Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit.
The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality. At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. ⋯ The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.
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The aim of the study was to report the detailed surgical techniques of living donor liver transplantation (LDLT) in patients with Budd-Chiari syndrome (BCS). ⋯ Favorable outcomes are achievable with LDLT treatment of patients with BCS, which carries important implications for countries with inadequate cadaveric donor pools.
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The aim of this study was to compare the biomechanical characteristics between bilateral and unilateral lumbo-iliac fixation in unilateral comminuted sacral fractures (USF) by finite element analysis. ⋯ From the finite element view, the stability of ULF is insufficient to reconstruct the posterior pelvic ring. Furthermore, the unilateral fixation may lead to imbalance of lumbar vertebra and pelvis. On the contrary, the BLF can provide satisfied stability and lumbar balance.
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Observational Study
Predictive factors of true bacteremia and the clinical utility of blood cultures as a prognostic tool in patients with community-onset pneumonia.
Although blood cultures (BCs) are an important component of diagnostic practice for antibiotic management in patients with pneumonia, several studies have questioned whether they should be performed. The objective of this study was to evaluate the predictive factors of bacteremia and the role of BCs in patients with community-onset pneumonia (community-acquired pneumonia and healthcare-associated pneumonia). This study was retrospectively conducted in patients with community-onset pneumonia who were hospitalized at Jeju National University Hospital between January 2012 and December 2014. ⋯ In patients with PSI class V and a CURB-65 score of 4 to 5 points, the TB group tended to show a higher inhospital mortality rate than the CNB group (50.0% vs 29.4%; P = 0.060, 60.0% vs 42.5%; P = 0.480). The areas under the curve for PSI score and CURB-65 score for predicting TB revealed an increased tendency compared with that of C-reactive protein (0.72, 95% CI 0.630-0.809; and 0.72, 95% CI 0.622-0.819 vs 0.629, 95% CI 0.522-0.735, respectively). It seemed reasonable to selectively conduct BC in patients hospitalized with severe community-onset pneumonia based upon its low overall positive rate, its effects on antimicrobial modification, and the associations of TB with the severity indices of pneumonia.