Southern medical journal
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Southern medical journal · Nov 2009
Review Case ReportsAcute respiratory distress syndrome, sepsis, and cognitive decline: a review and case study.
The objective of this investigation is to review existing research pertaining to cognitive impairment and decline following critical illness and describe a case involving a 49-year-old female with sepsis and acute respiratory distress syndrome (ARDS) with no prior neurologic history who, compared to baseline neuropsychological test data, experienced dramatic cognitive decline and brain atrophy following treatment in the medical intensive care unit (ICU) at Vanderbilt University Medical Center. The patient participated in detailed clinical interviews and underwent comprehensive neuropsychological testing and neurological magnetic resonance imaging (MRI) at approximately 8 months and 3.5 years after ICU discharge. Compared to pre-ICU baseline test data, her intellectual function declined approximately 2 standard deviations from 139 to 106 (from the 99 to the 61 percentile) on a standardized intelligence test 8 months post-discharge, with little subsequent improvement. ⋯ A brain MRI nearly 4 years after ICU discharge demonstrated interval development of profound and generalized atrophy with sulcal widening and ventricular enlargement. The magnitude of cognitive decline experienced by ICU survivors is difficult to quantify due to the unavailability of pre-morbid neuropsychological data. The current case, conducted on a patient with baseline neuropsychological data, illustrates the trajectory of decline occurring after critical illness and ICU-associated brain injury with marked atrophy and concomitant cognitive impairments.
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Southern medical journal · Nov 2009
Case ReportsCollateral meridian acupressure therapy effectively relieves postregional anesthesia/analgesia backache.
Epidural and spinal aesthesia may cause backache. In fact, the overall incidence of postneuraxial block backache is 9% to 50% and the incidence of back pain on the third postoperative day ranges from 5.91% to 22% after spinal anesthesia. ⋯ Despite administering conventional treatment modalities including bed rest, cold/warm packing, physical therapy, and medications with nonsteroidal anti-inflammatory drugs (NSAIDs), strong analgesics, and opioids, the backache persisted and disturbed the patients' daily life. Surprisingly, utilization of a new acupressure technique, collateral meridian acupressure therapy (CMAT), relieved the backache dramatically.
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Southern medical journal · Nov 2009
Remifentanil to facilitate high-resolution computed tomography imaging of the chest or magnetic resonance imaging in infants.
High-resolution computed tomography (CT) imaging or magnetic resonance (MR) imaging may require brief periods of apnea for image acquisition. In adults, this may be done by voluntary breath holding. In infants and children, such studies are generally performed under general anesthesia using a laryngeal mask airway with maintenance of spontaneous ventilation. ⋯ This technique facilitated anesthetic care by allowing the use of a laryngeal mask airway (LMA) for both the radiologic imaging as well as bronchoscopy which was performed after the radiologic imaging. The use of a bolus dose of remifentanil provided a brief period of apnea for the acquisition of the radiologic images.
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Southern medical journal · Nov 2009
Editorial CommentHelicobacter pylori and gastric cancer: a marital risk?