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.
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To assess the ability of the Acute Physiology and Chronic Health Evaluation (APACHE II) system and Trauma-Injury Severity Scoring (TRISS) system in predicting group mortality in intensive care unit (ICU) trauma patients. ⋯ Both APACHE II and TRISS scores were shown to accurately predict group mortality in ICU trauma patients. APACHE II and TRISS may be utilized for quality assurance in ICU trauma patients. However, neither APACHE II nor TRISS provides sufficient confidence for prediction of outcome of individual patients.
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Randomized Controlled Trial
Single injection fascia iliaca block for pain control after arthroscopic anterior cruciate ligament reconstruction: a randomized, controlled trial.
Arthroscopic anterior cruciate ligament reconstruction (AACLR) is one of the orthopedic surgeries associated with moderate to severe post-operative pain. The fascia iliaca block (FIB), a block of the femoral nerve and lateralfemoral cutaneous nerve of the thigh, is relatively simple, safe, and provides effective analgesia post-operatively ⋯ The fascia iliaca block is effective for providing pain control for at least 24 hours after anterior cruciate ligament reconstruction. This technique is quite easy, safe, and inexpensive to use.