J Formos Med Assoc
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Case Reports
Neuroleptic malignant syndrome after the use of venlafaxine in a patient with generalized anxiety disorder.
Neuroleptic malignant syndrome (NMS) is a potentially lethal adverse reaction to neuroleptics, which is characterized by hyperthermia, extrapyramidal symptoms, altered consciousness and autonomic dysfunction. Although NMS is most commonly induced by the high-potency neuroleptics, its development has also been associated with the use of non-neuroleptic agents that block central dopamine pathways. ⋯ NMS was considered to have been caused by the recent addition and subsequent dose increase in his treatment regimen of venlafaxine, a serotonin norepinephrine reuptake inhibitor. He was successfully treated with bromocriptine, lorazepam, and fluid hydration in the ED and intensive care unit.
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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.
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Case Reports
Near-fatal methemoglobinemia after recreational inhalation of amyl nitrite aerosolized with a compressed gas blower.
Adverse effects associated with recreational inhalation of nitrites are usually mild and rarely life-threatening. We report a rare case of near-fatal methemoglobinemia after inhalation of amyl nitrite after aerosolizing the liquid using a compressed gas blower designed to clean photographic equipment that employed hydrofluoroalkane-134a as a propellant. A 31-year-old previously healthy male became dyspneic and fainted soon after the recreational inhalation of amyl nitrite aerosolized using a compressed gas blower. ⋯ After 100 mg of methylene blue (2 mg/kg body weight) was administered intravenously, he recovered consciousness, and dyspnea and cyanosis subsided gradually. This case illustrates the extraordinary hazard of the use of a compressed gas blower in the recreational inhalation of nitrites. Prompt recognition and rapid antidotal treatment may adequately correct near-fatal overdose associated with recreational use of amyl nitrite.
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Hospital-based general health screening plays an important role in the early detection of mental disorders. The present study examined the validity of the 5-item Brief Symptom Rating Scale (BSRS-5) in subjects admitted for a 2-day general health screening program. ⋯ The BSRS-5 is an effective screening instrument for the identification of psychiatric morbidity in hospital-based health screening settings.