Kaohsiung J Med Sci
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Kaohsiung J Med Sci · Nov 2010
Case ReportsRight thoracotomy for carinal resection with left thoracoscopic pneumonectomy as a new approach for left sleeve pneumonectomy: a case report.
A 43-year-old woman, with a history of asthma that had been treated for the previous 3 years, was diagnosed with an endobronchial tumor, based on chest computed tomography. A biopsy proved the tumor to be adenoid cystic carcinoma. For carinal involvement and submucosal extension in the left main bronchus, rigid bronchoscopy was done to maintain airway patency, and then a left sleeve pneumonectomy was done via a right thoracotomy and left video-assisted thoracoscopic surgery. ⋯ This case revealed that endobronchial lesions should be highly suspected after treatment for asthma fails. It also highlighted that, because the carina naturally deviates to the right, combined right thoracotomy and left video-assisted thoracoscopic surgery for left sleeve pneumonectomy provides an anatomical advantage for carinal tracheobronchoplasty. Furthermore, the combination reduces the postoperative physiological burden that could be caused by bilateral thoracotomy.
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Postobstructive pulmonary edema is life-threatening, and results from a sudden episode of upper airway obstruction. Croup is generally thought to be a benign condition, but occasionally it can develop into postobstructive pulmonary edema. We present a case of a 5-year-old boy with recurrent croup, who was diagnosed with postobstructive pulmonary edema. Our experience alerts pediatricians to this easily misdiagnosed disease.
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Kaohsiung J Med Sci · Sep 2010
Anesthesia induction with sevoflurane and propofol: evaluation of P-wave dispersion, QT and corrected QT intervals.
The present study compared the effects of anesthesia induction with sevoflurane and propofol on hemodynamics, P-wave dispersion (Pwd), QT interval and corrected QT (QTc) interval. A total of 72 adult patients were included in this prospective study. All patients had control electrocardiograms (ECGs) before anesthesia induction. ⋯ There was no significant difference in Pwd and QT and QTc intervals on control ECGs. In the sevoflurane group, except for control ECGs, Pwd and QTc interval on all ECGs were significantly longer than those in the propofol group (p < 0.05). We conclude that propofol should be used for anesthesia induction in patients with a predisposition to preoperative arrhythmias, and in those whose Pwd and QTc durations are prolonged on preoperative ECGs.
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Kaohsiung J Med Sci · Aug 2010
Characteristics of undiagnosed liver abscesses on initial presentation at an emergency department.
Liver abscesses often present with nonspecific symptoms and laboratory examination abnormalities, resulting in missed diagnoses at emergency departments (ED). The purpose of this study was to determine if there are differences in presentation and prognosis between patients in whom liver abscess is diagnosed at an ED or once the patient has been transferred to a ward. Patients with a liver abscess who were discharged from our hospital between 2005 and 2007 were retrospectively reviewed. ⋯ Undiagnosed liver abscess presented less abdominal pain and more symptoms or examination abnormalities related to infection of the respiratory and urinary tracts. Abdominal sonography should be performed more frequently at EDs to exclude liver abscess from differential diagnosis. However, further diagnosis and treatment while the patient with liver abscess is attending a ward does not affect prognosis.
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Kaohsiung J Med Sci · Aug 2010
Effect of low-flow anesthesia education on knowledge, attitude and behavior of the anesthesia team.
The aim of this study was to evaluate the effect of education on the knowledge, attitude and behavior of anesthesiology staff and residents towards low-flow anesthesia. The staff and residents in the Department of Anesthesia and Reanimation, Zonguldak Karaelmas University were given theoretical and practical training in delivering low-flow anesthesia. To evaluate their attitudes and behaviors toward low-flow anesthesia, we collected data during the 6 months before training, during the first 3 months after training, and at 4-6 months after training. ⋯ The mean fresh gas flow was significantly lower at the two post-training assessments than before training (p < 0.05). In conclusion, low-flow anesthesia may be used more frequently if educational seminars are provided to anesthetists. The use of low-flow anesthesia may increase further by allocating more time to this technique in anesthesia training programs provided at regular intervals.