J Formos Med Assoc
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Intermittent positive pressure ventilation via tracheostomy has been the most common method of providing ventilatory support for patients with respiratory failure since the late 1950s. It is the standard procedure for individuals who suffer from acute respiratory failure, impaired consciousness, and severe restrictive lung disease. However, numerous adverse complications from these invasive techniques have been reported in those who are long-term ventilator users. ⋯ In this way, it can prevent patients from requiring either tracheostomy or endotracheal tube, but is not effective enough to ventilate patients with markedly decreased lung compliance because the high airway resistance provides air leakage from the non-invasive interface. Non-invasive respiratory aids should be the first choice to maintain ventilation for patients with respiratory failure secondary to neuromuscular disorder, because of their benefits of easy application, satisfactory results, fewer complications and early active rehabilitation. Increased understanding of non-invasive respiratory aids should assist in the management of patients with chronic respiratory failure.
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This study evaluates the prognostic factors and causes associated with mortality in Chinese diabetic patients after lower extremity amputations. Medical records of all diabetic patients admitted to the National Taiwan University Hospital for leg amputations from 1982 to 1991 were reviewed. Demographic data, medical history, amputation levels and admission routines, including fasting plasma glucose, cholesterol, triglycerides, blood urea nitrogen, creatinine, urine protein and electrocardiograms, and bacterial culture done during the admission period were recorded. ⋯ A history of hypertension and coronary heart disease were found to be the best indicators for predicting a fatal outcome with rate ratios of over two-fold. This study shows that post-amputational mortality is high in diabetic patients and that the major cause of death is cerebral infarction. The major cause of death in this study differs from that reported for Caucasians, for whom cardiovascular disease is the most important cause of death.
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Determination of the level of amputation of an ischemic lower limb presents a difficult problem. This prospective study evaluated parameter capable of predicting wound healing in patients with peripheral vascular disease. Forty-four amputations performed on 38 patients for advanced ischemia of a lower extremity were analyzed. ⋯ However, ankle segmental pressure was not associated with the outcome of wound healing in the amputations distal to the ankle joint. The absolute skin temperature and the difference between the skin and ambient temperature were found to be poor predictors for wound healing. No significant differences were detected among the successes and failures with regard to the patient's sex, age, blood chemistry and duration of diabetes mellitus.
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Case Reports
Fracture of the posterior process of the talus associated with subtalar dislocation: report of a case.
Although subtalar dislocation is not common in foot trauma, fracture of the entire posterior process of the talus is even rarer. The concomitant injury of a subtalar dislocation associated with a fracture of the posterior process of the talus has not yet been reported in the medical literature. A 52-year-old woman involved in a traffic accident had her right foot twisted into an inversion deformity. ⋯ The subtalar dislocation was treated with a closed reduction. The fracture of the posterior process was treated with an open reduction and internal fixation. After the anatomic reduction of both injuries, the patient recovered and returned to her previous activities.
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The surgical treatment of acute type A aortic dissection remains a great challenge to all cardiac surgeons. From January 1991 to June 1993, 21 consecutive patients (13 men and eight women, aged 34 to 74 years) underwent emergency operations to repair acute type A aortic dissection, with the aid of hypothermic circulatory arrest. The intima tear was located in the ascending aorta in 13 patients, in the aortic arch in five patients, and in the descending aorta in three patients. ⋯ Post-treatment follow-ups (mean, 18.2 months) were completed in all patients except one, who died 12 months after the operation as a result of a traffic accident. All of the surviving patients are doing well without any further aortic operations. Our experience suggests that surgical repair of the acute type A aortic dissection can be a simple and safe procedure if sutureless intraluminal grafts are used and hypothermic circulatory arrest and retrograde cerebral perfusion are utilized.