Medicine
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Catheter-related thrombosis is a serious complication of lung transplantation under venovenous extracorporeal membrane oxygenation (ECMO). Although ECMO-related thrombosis is not uncommon, there are few reports of giant hollow catheter thrombosis in lung transplantation under venovenous ECMO (ECMO). Blood loss and transfusion of coagulation factors may promote ECMO-related thrombosis. Hollow catheter thrombus was not detected on ultrasonography performed after initiation of ECMO. Therefore, it is essential to identify, manage, and reduce or avoid such thrombosis. ⋯ It is uncommon for massive hollow thrombus to occur during venovenous-ECMO-assisted lung transplantation. Fibrinogen and prothrombin complexes promote the formation of thrombus, and the measurement of the wall thickness of ECMO catheter may help to detect such thrombus.
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Query of Prescription Drug Monitoring Programs (PDMPs) is recommended before prescribing opioids by the US Centers for Disease Control and Prevention, to inform clinical practice and aid diversion prevention. Many states mandate prescriber PDMP use; however, little is known about PDMP perception of utility and use among Obstetricians-Gynecologists (OB/GYN), who are the primary provider for most women during pregnancy. This study examined OB/GYN perceptions and utilization of their state PDMP. ⋯ In qualitative responses, reported frustration with PDMPs was evident. OB/GYNs are diverse in their perceptions regarding the utility and purpose of PDMPs. Tailored education is needed regarding clinical utility of PDMPs for OB/GYN practice.
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Observational Study
A preliminary study of cortical morphology changes in acute brainstem ischemic stroke patients.
The study aimed to explore the cortical thickness and gyrification abnormalities in acute brainstem ischemic patients in both the ipsilateral and contralateral hemisphere compared with healthy controls. Structural magnetic resonance imaging data were prospectively acquired in 48 acute brainstem ischemic patients, 21 patients with left lesion and 27 with right lesion, respectively. Thirty healthy controls were recruited. ⋯ Significant decreases of cortical thickness loss were found in bilateral cerebral hemispheres of the brainstem ischemic patients compared to the healthy controls (P < .05, family-wise error (FWE)-corrected). We also found significant gyrification decreases in the insula, transverse temporal, supramarginal of the ipsilateral on hemisphere in the right brainstem ischemic patients compared to the healthy controls (P < .05, FWE-corrected). Brainstem ischemic patients have widely morphological changes in the early phase and may be helpful in designing individualized rehabilitative strategies for these patients.
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Hyperparathyroid crisis is a rare and potentially life-threatening complication of severe calcium intoxication. Parathyroidectomy is the only curative method for hyperparathyroid crisis. Several case reports and case series have been published on the medical and surgical treatments for hyperparathyroid crisis, however, few reports have focused on the associated perioperative anesthetic management. ⋯ Patients with hyperparathyroid crisis should undergo a thorough preoperative evaluation. Difficult airway, fluid depletion, multiple organ dysfunction, hypercoagulability, and concomitant diseases are the primary challenges in anesthetic management. After tumor removal, the serum calcium level should be monitored closely and calcium should be supplemented in a timely manner to prevent serious complications.
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This study examined the different demands for overseas liver transplantation between genders and roles from the perspective of overseas liver transplant recipients and primary caregivers. An exploratory qualitative method was employed using a purposive sample of individuals who had received overseas liver transplantation. We recruited 28 recipients and 29 family members from a leading hospital in Taiwan. ⋯ Most female primary caregivers would engage in the health care task but needed more medical personnel, assistance, and high emotional support from relatives. This study revealed the common and urgent demands of overseas liver transplant recipients and primary caregivers. The unique demands of recipients and primary caregivers based on their gender and roles were rooted in the potential influences of traditional cultures and modern medicine in an ethnic-Chinese society.