J Formos Med Assoc
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Multicenter Study
Pain control in Taiwanese patients with cancer: a multicenter, patient-oriented survey.
Under-treatment of cancer pain remains a common problem in Taiwan. Prior studies were mainly in hospitalized patients and limited to one or a few centers. This prospective, multicenter, patient-focused survey assessed the prevalence, severity and management of cancer pain in oncology clinic outpatients. Analgesic use and patient satisfaction with analgesic therapy were also evaluated. ⋯ The results of this survey of Taiwanese outpatients with cancer confirm that cancer pain is under-treated in oncology clinics in Taiwan. A major goal of cancer management is to achieve high rates of patient satisfaction and compliance with treatment which maintains or improves quality of life.
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Case Reports
Massive subcutaneous emphysema following bronchoscopy-guided percutaneous dilatational tracheostomy.
Although percutaneous dilatational tracheostomy (PDT) has become a safe procedure for airway management in critically ill patients, this operation can be associated with serious life-threatening complications. Massive subcutaneous emphysema is an unusual and sometimes lethal complication which may extend the length of stay in the intensive care unit (ICU). We report 2 cases, including 1 fatality, of massive subcutaneous emphysema without tracheal wall laceration that occurred in the ICU after elective bronchoscopy-guided Ciaglia Blue Rhino (Cook Critical Care, Bloomington, IL, USA) PDT. ⋯ In case 1, we reduced the ventilator pressure and prescribed bronchodilator to decrease the airway pressure and keep the airway patent. In case 2, the suggested approach was to check if the fenestration of tracheostomy tube was extraluminal or change to non-fenestrating cannulas. For diminishing the impact of PDT on respiratory mechanics, especially in patients with underlying lung diseases, we recommend introducing the bronchoscope only when needed, instead of keeping the bronchoscope in the airway throughout the PDT procedure and using forceps to create a larger stoma if the dilation procedure is not smooth.