Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Experience of percutaneous dilatational tracheostomy by using Grigg's technique in Siriraj Hospital.
Percutaneous dilatational tracheostomy (PDT) was increasingly performed after the commercial kit was available in 1985. Several studies showed that PDT was equivalent to surgical tracheostomy considering perioperative and long-term complications and PDT was more cost-effective and provide greater feasibility in terms of bedside capacity and nonsurgical operation. ⋯ PDT is a safe procedure and can be performed easily and rapidly at the bedside either in intensive care unit or general ward with closed monitoring. Proper patient selection and attention to technical detail are necessary in maintaining low complication rates.
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Septic shock is a serious condition leading to high mortality and morbidity. Many varieties of attempts aiming toward improving outcomes have been implemented. However the appropriate therapeutic endpoint of shock resuscitation is still under investigation. The authors report here the dynamics of commonly used parameters, namely central venous oxygen saturation (ScvO2) and lactate concentration during resuscitation. ⋯ Central venous oxygen saturation and its changes during treatment were heterogeneous which made this parameter less reliable than others to monitor management. The lactate clearance, although slow, is uniform and may be used alone or in combination with other parameters to monitor resuscitation.
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Review Case Reports
Pulmonary lipiodol embolism after transcatheter arterial chemoembolization for hepatocellular carcinoma: a case report and literature review.
Acute pulmonary lipiodol embolism is a rare but possibly fatal complication of transcatheter arterial chemoembolization (TACE). The authors report a 63-years-old woman with unresectable large (7.4 x 7.9 cm) hepatocellular carcinoma (HCC) who had been diagnosed pulmonary lipiodol embolism after the first TACE. Intraoperative angiography did not show the communication between pulmonary circulation and tumor feeding artery. ⋯ Two weeks after TACE, follow-up CT of liver revealed the absence of almost lipiodol granule in lungs. The patient did not receive TACE again because of pulmonary metastasis. In this article we reviewed the cases of pulmonary lipiodol embolism that had been reported in the literature including clinical risk factors, possible mechanisms and the pathophysiology of this complication.
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To assess the validity and test-retest reliability of a Thai translation of the Migraine Disability Assessment (MIDAS) Questionnaire in Thai patients with migraine. ⋯ The present study reveals that the Thai-MIDAS has satisfactory validity and reliability in comparison with the original English MIDAS version.
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Cardiac arrhythmia is an important complication of critically ill patients, especially in perioperative period and early after myocardial infarction. However, the information regarding this condition in medical critically ill without active coronary artery disease patients is limited. ⋯ Arrhythmia is a serious complication of medical critically ill patients and associated with high mortality rate. Appropriate shock management together with proper metabolic support may prevent this condition.