Kaohsiung J Med Sci
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Kaohsiung J Med Sci · Apr 2010
Review Case ReportsAcute necrotizing pancreatitis complicated with ST elevation acute myocardial infarction: a case report and literature review.
Acute pancreatitis complicated with acute myocardial infarction has rarely been reported and the precise mechanisms of myocardial injury remain unclear. We report a 49-year-old man presenting with epigastralgia who had been hospitalized for acute necrotizing pancreatitis, and who subsequently developed ST elevation myocardial infarction. ⋯ Although a standard management protocol for these patients has not yet been developed, administration of thrombolytic agents may cause severe complications based on the limited case reports already published. We suggest that coronary angiography and further interventions such as angioplasty and possibly stenting should be performed in these cases.
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Kaohsiung J Med Sci · Apr 2010
Randomized Controlled Trial Comparative StudyComparison of spinal, low-dose spinal and epidural anesthesia with ropivacaine plus fentanyl for transurethral surgical procedures.
The aim of This study was to compare spinal, low-dose spinal, and epidural anesthesia using ropivacaine and fentanyl combinations for transurethral surgical procedures. Sixty patients with American Society of Anesthesiologists scores of I-III were allocated into three groups. After pre- loading with 5 mL/kg normal saline, patients in the spinal anesthesia group (Group S) received 15 mg of hyperbaric ropivacaine plus 25 microg of fentanyl intrathecally; patients in the epidural anesthesia group (Group E) received 112.5 mg of ropivacaine plus 25 microg of fentanyl epidurally via an epidural catheter; and patients in the low-dose spinal anesthesia group (Group L) received 10 mg of hyperbaric ropivacaine plus 25 microg of fentanyl intrathecally. ⋯ No complications or adverse effects were observed in any patient. We conclude that all three anesthetic techniques may be used safely and are appropriate for transurethral surgical procedures. However, low-dose spinal anesthesia with ropivacaine plus fentanyl may be preferable in transurethral surgery because we reach an adequate sensorial level with less motor blockade.
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Kaohsiung J Med Sci · Feb 2010
Case ReportsSuccessful conservative treatment of pneumatosis intestinalis and portomesenteric venous gas in a patient with septic shock.
Pneumatosis intestinalis (PI) and portomesenteric venous gas (PMVG) are alarming radiological findings that signify bowel ischemia. The management of PI and PMVG remain a challenging task because clinicians must balance the potential morbidity associated with unnecessary surgery with inevitable mortality if the necrotic bowel is not resected. The combination of PI, portal venous gas, and acidosis typically indicates bowel ischemia and, inevitably, necrosis. We report a patient with PI and PMVG caused by septic shock who completely recovered after conservative treatment.
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Kaohsiung J Med Sci · Dec 2009
Circulating chemokine levels in febrile infants with serious bacterial infections.
Early diagnosis of serious bacterial infections (SBI) in febrile young infants based on clinical symptoms and signs is difficult. This study aimed to evaluate the diagnostic values of circulating chemokines and C-reactive protein (CRP) levels in febrile young infants < 3 months of age with suspected SBI. We enrolled 43 febrile young infants < 3 months of age with clinically suspected SBI who were admitted to the neonatal intensive care unit or complete nursing unit of the pediatric department of Kaohsiung Medical University Hospital between December 2006 and July 2007. ⋯ Diagnostic accuracy was further improved by combining CRP and IL-8, when the area under the ROC curve increased to 0.91. CRP levels were superior to IL-8 and G-CSF levels for predicting SBI in febrile infants at initial survey. IL-8 levels could be used as an additional diagnostic tool in the initial evaluation of febrile young infants, allowing clinicians to treat these patients more appropriately.
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Kaohsiung J Med Sci · Sep 2009
Historical ArticleHistorical context for the growth of medical professionalism and curriculum reform in Taiwan.
Medical school curricular reform to address humanism is now a prominent issue in Taiwan. Taiwan's community of medical professionals have for the last 100 years played a leading role in the nation's modernization and democratization. ⋯ Collaboration with the international community, particularly with Taiwanese-American medical educators and researchers who bring their experience back to Taiwan, has been a potent force for the advancement of the humanities and professionalism in medical education. This paper presents the definition of professionalism and the history of the medical profession from the perspective of medical education in Taiwan, and discusses recent transitions.