Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Randomized Controlled Trial
Periarticular infiltration of 0.25% bupivacaine on top of femoral nerve block and intrathecal morphine improves quality of pain control after total knee arthroplasty: a randomized double-blind placebo controlled clinical trial.
Find out if the addition of periarticular local anesthetic infiltration enhances the quality of postoperative pain control in patients with knee arthroplasty (TKA) in spinal anesthesia and intrathecal morphine plus single shot femoral nerve block (FNB). MATERIAL AND METHOD. Ninety-nine patients scheduled for TKA under spinal anesthesia were enrolled after written informed consent, and randomized into two groups with either periarticular injection of 20 ml 0.25% bupivacaine (B-gr n = 50) or isotonic saline solution (S-gr n = 49). All patients had intrathecal morphine 0.2 mg and single shot FNB with 20 ml bupivacaine 0.25% and were adjusted postoperative analgesic requirement via patient controlled analgesia with morphine. Effect of postoperative pain control and requirement of additional analgesics were recorded. ⋯ Adding periarticular infiltration to femoral block and intrathecal morphine significantly enhances the quality of postoperative pain therapy in TKA patients. However combining three methods for analgesic therapy may be too much effort. Modifying infiltration techniques including continuous application needs further research.
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A 28-year-old G2P1 Thai woman presented with severe nausea and vomiting at 12 weeks' gestation. The initial diagnosis was hyperemesis gravidarum. She was clinically euthyroid. ⋯ The diagnosis of recurrent gestational thyrotoxicosis was established. There was no need of antithyroid drug treatment in this case. No adverse pregnancy outcomes were reported.
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Review Case Reports
Streptococcus gallolyticus subspecies pasteurianus meningitis in an infant: a case report and literature review.
A case of 6-week-old male infant with meningitis and concurrent bacteremia caused by Streptococcus gallolyticus subspecies pasteurianus (Streptococcus bovis biotype 11.2) is presented. The isolates were susceptible to all beta-lactam antibiotics. Nevertheless, delayed defervescence and lack of satisfactory clinical improvement after treatment with multiple beta-lactam antibiotics prompted the combination therapy of vancomycin and penicillin G. The patient completed a 2-week course of antibiotics and recovered uneventfully.