Medical science monitor : international medical journal of experimental and clinical research
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Definitive chemoradiation (without surgery) is an accepted treatment for esophageal cancer. Persistent or recurrent local disease is not infrequent after chemoradiation, and this is its greatest drawback. Selected patients with isolated local failures of definitive chemoradiation can be salvaged by esophagectomy. ⋯ We propose modifications of surgical practice that may reduce complications. These include strict guidelines for patient selection, conservative mediastinal dissection, prevention of intraoperative lung injury (barotrauma and oxygen related toxicity), near total esophagectomy with cervical esophagogastric anastomosis, anterior mediastinal reconstruction, judicious use of staged reconstruction, perioperative enteral nutritional support, and aggressive detection and treatment of postoperative complications. By conceptually breaking the operation into component parts, such as resection and reconstruction, and then modifying each component to minimize complications, we believe that the operative mortality of salvage esophagectomy can
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Combined epidural-propofol anesthesia with use of noninvasive positive pressure ventilation (NPPV) via the nose has been used routinely in our operating theaters. The purpose of this report was to present a survey of this anesthesia. ⋯ The principle of our anesthesia consists of epidural anesthesia, sole propofol infusion and noninvasive airway management, so as to provide an anesthetic technique with minimal invasiveness. Although airway maintenance by NPPV is not always suitable, our anesthesia is practicable for certain kinds of operations.
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Diaphragm palsy is common in the advanced stages of motor neuron disease and is a primary cause of fatal outcome However, respiratory failure is a presenting symptom of motor neuron disease in only a small number of patients. ⋯ Failure of respiratory muscle function can be the first symptom of motor neuron disease, and may precede clinical manifestation in voluntary motor units in ALS. Therefore, in cases of unexplained acute respiratory failure or when respiratory support must be continued for no clear reason, a motor neuron disease such as amyotrophic lateral sclerosis, which leads to respiratory muscle weakness and diaphragm paralysis, should be taken into consideration.
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Comparative Study
Laypersons' expectation of the sequelae of whiplash injury: a cross-cultural comparative study between Canada and Greece.
The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Greece [a country where the chronic whiplash syndrome is rare or unknown] with that in Canada. ⋯ In Greece, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Greece may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.
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Biochemical and hormonal disturbances in calcium-phosphate storage accompanying chronic renal failure (CRF) lead to the loss of bone mass and the destruction of bone microarchitecture. The aim of this study was to evaluate the serum levels of PICP (procollagen I carboxyterminal propeptide) and ICTP (carboxyterminal telopeptide of type I collagen) as markers of bone growth in CRF children treated conservatively. ⋯ The results of our study of PICP and ICTP as markers of bone metabolism in children with CRF in the predialysis period indicate that their levels should be routinely monitored as specific biochemical parameters of bone structure.