J Formos Med Assoc
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To evaluate the ICU mortality rate of mechanically ventilated hematopoietic stem cell transplantation (HSCT) recipients and to identify the factors that were associated with ICU mortality. The impact of surgical lung biopsy (SLB) in patients with unexplained pulmonary infiltrates was also evaluated. ⋯ The ICU mortality rate of mechanically ventilated HSCT recipients was high. Factors associated with ICU mortality were older age, high APACHE II score, presence of shock, and higher respiratory or heart rate at the time of ICU admission. SLB might provide specific diagnosis in HSCT recipients with unexplained pulmonary infiltrates and aid modification of treatment.
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With the advent of microsurgery, composite defect in the mandible can be repaired with various forms of osteocutaneous free flaps. However, it is difficult to accurately reconstruct a large defect in the mandible when not enough mandibular reference blueprints remain. This case report describes a large ameloblastoma at the left lower molar region and ascending ramus of the mandible in a 53-year-old male patient. ⋯ The temporomandibular joint was restored with temporal is muscle as an interpositional disc replacement. The complex defect in the mandible was thus repaired with satisfactory functioning and esthetic result. We suggest that with the help of mirror imaging coupled with laser stereolithographic technique, a precontoured titanium plate can be made for the reconstruction of large mandibular defects.
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Randomized Controlled Trial
Domiciliary positive expiratory pressure improves pulmonary function and exercise capacity in patients with chronic obstructive pulmonary disease.
This study assessed how positive expiratory pressure (PEP) affected pulmonary function, functional capacity, and subjective cough difficulty in individuals with chronic obstructive pulmonary diseases (COPD). ⋯ Four-week PEP therapy as an adjunct to FET further enhanced DLCO and 6MWD, and reduced cough difficulty compared to FET only in COPD patients with mucus hypersecretion.
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Perioperative mortality in patients with Eisenmenger's syndrome is very high, particularly following cesarean section. This case report describes the successful use of low-dose bupivacaine-fentanyl spinal anesthesia for lower extremity surgery in a nonparturient with Eisenmenger's syndrome. A 21-year-old woman with Eisenmenger's syndrome was scheduled to have a fibular head tumor excision. ⋯ There were no hypotension, respiratory depression, hypoxemia, and other severe hemodynamic alterations. No drug was administered via the epidural catheter in the 2-hour operative period and the postoperative course was uneventful. Therefore, we propose that intrathecal opioids combined with local anesthetics may be an alternative anesthetic method in patients with Eisenmenger's syndrome.
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Primary tumor or tumor-like lesions of the spleen are rare. Among them, vascular lesions are the most common. Vascular tumor of the spleen is different from the usual hemangioma of soft tissue because the vascular structure of the spleen is unique. ⋯ In this study, we report a case of SANT occurring in a 43-year-old woman, in whom there were also multiple calcifying fibrous pseudotumors (CFPTs) in the abdominal cavity. Both SANT and CFPT are thought to be variants of inflammatory pseudotumor. Coexistence of these two rare entities in a patient has never been reported, and this fact suggests that there might be a common mechanism contributing to the formation of these two types of lesions.