Medicine
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Surgery for abdominal aortic aneurysm (AAA) and concomitant severe coronary artery disease (CAD) is usually managed in a staged procedure. The anesthesia for concurrent surgery is rare and complex. In this report, we present an unusual case of undergoing simultaneous open abdominal aortic aneurysm (AAA) repair and coronary artery bypass grafting (CABG). ⋯ The anesthetic management of simultaneous open abdominal aortic aneurysm repair and coronary artery bypass grafting is rare and complicated. Reasonable operation and anesthesia protocols, close monitoring and management of hemodynamic changes, and appropriate cell salvage and hemostasis measures are of great significance to increase perioperative safety and reduce the risk of postoperative complications.
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Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive occlusion of the internal carotid artery and the secondary formation of collateral vessels. Bypass surgery is an effective treatment for MMD. Comprehensive evaluation of cerebral blood flow (CBF) and cerebrovascular response (CVR) is the common hemodynamic indication to surgery, the changes of which are usually identical. ⋯ CVR is a primary surgical indication of MMD, especially when the impairment of CVR and CBF are not consistent in the ipsilateral hemisphere. Meanwhile, HVT is the vital vasoactive challenges test for measuring CVR in MMD.
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Unicompartmental knee arthroplasty (UKA) is an ideal surgical approach in treatment of end-stage knee osteoarthritis (KOA), however, indications of UKA have been controversial, and the radiographic and symptomatic patellofemoral osteoarthritis (PFOA) are often considered as a contraindication of medial UKA. 337 fixed bearing UKAs were retrospectively recruited in our joint center between January 1, 2011 and June 30, 2020. There were 105 patients accompanied by PFOA and 232 patients have normal PF joint. International Cartilage Repair Society (ICRS) system was introduced to quantify the degeneration degree of PF joint. ⋯ After more than 5 years follow-up, UKA patients with or without PFOA could all achieve a satisfactory improvement of OKS, VAS and FJS score. ROM of the replaced knee increased from preoperative 110° to 130°. 74.3% (78/105) and 75.0% (174/232) patients have no change of K-L grade in PFOA and Non-PFOA group, OKS, FJS, VAS score and ROM were also comparable in all patients and no significant outcomes difference were found between two group. The presence of patellofemoral joint osteoarthritis and anterior knee pain should not be considered to be contraindications to medial fixed-bearing UKA.
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Epithelial Ovarian cancer (EOC) is the most lethal gynecologic cancer worldwide. Carboplatin (CP) is the main chemotherapeutic agent in the treatment of ovarian cancer. However, the development of a hypersensitivity reaction (HSR) in 10% to 15% of patients with EOC is an important limiting factor for the clinical use of CP. ⋯ None of the patients included in this study developed severe (grade 3-4) HSR during CP administration (no adrenaline was used, no need for intensive care). No deaths due to CP-D were noted. CP-D is a beneficial and safe method in treating platinum-sensitive recurrent EOC patients with CP-induced HSR.
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This study aimed to evaluate the efficacy of early antiviral treatment in preventing clinical deterioration in asymptomatic or mildly symptomatic severe acute respiratory syndrome coronavirus 2 infected (COVID-19) patients in home isolation and to share our experiences with the ambulatory management of nonsevere COVID-19 patients. This retrospective study included mild COVID-19 adult patients confirmed by real-time reverse transcription-polymerase chain reaction. They received care via an ambulatory management strategy between July 2021 and November 2021. ⋯ Early favipiravir outpatient treatment (≤ 5 days from onset of symptoms) in nonsevere COVID-19 patients was significantly associated with a lower rate of symptom deterioration than late favipiravir treatment (50 [4.6%] vs 65 [7.5%] patients, respectively; P = .008; odds ratio 1.669; 95% confidence interval, 1.141-2.441). The unfavorable prognostic factors for symptom deterioration were advanced age, body weight ≥ 90 kg, unvaccinated status, higher reverse transcription-polymerase chain reaction cycle threshold, and late favipiravir treatment. The early delivery of essential treatment, including antiviral and supervisory dexamethasone, to ambulatory nonsevere COVID-19 patients yielded favorable outcomes during the COVID-19 pandemic in Thailand.