Journal of clinical medicine research
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Cystic fibrosis patients require daily airway clearance therapies. The primary objective of this study was to compare the short-term efficacy of high-frequency chest compression and positive expiratory pressure mask on expectorated sputum, pulmonary function, and oxygen saturation in patients with CF hospitalized for an acute pulmonary exacerbation. ⋯ Airway clearance therapies; High-frequency chest compression; Sputum; Cystic fibrosis.
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Peripheral nerve catheter placement is used to control surgical pain. Performing bilateral brachial plexus block with catheters is not frequently performed; and in our case sending patient home with bilateral brachial plexus catheters has not been reported up to our knowledge. Our patient is a 57 years old male patient presented with bilateral upper extremity digital gangrene on digits 2 through 4 on both sides with no thumb involvement. The plan was to do the surgery under sequential axillary blocks. On the day of surgery a right axillary brachial plexus block was performed under ultrasound guidance using 20 ml of 0.75% ropivacaine. Patient was taken to the OR and the right fingers amputation was carried out under mild sedation without problems. Left axillary brachial plexus block was then done as the surgeon was closing the right side, two hours after the first block was performed. The left axillary block was done also under ultrasound using 20 ml of 2% mepivacaine. The brachial plexus blocks were performed in a sequential manner. Surgery was unremarkable, and patient was transferred to post anesthetic care unit in stable condition. Over that first postoperative night, the patient complained of severe pain at the surgical sites with minimal pain relief with parentral opioids. We placed bilateral brachial plexus catheters (right axillary and left infra-clavicular brachial plexus catheters). Ropivacaine 0.2% infusion was started at 7 ml per hour basal rate only with no boluses on each side. The patient was discharged home with the catheters in place after receiving the appropriate education. On discharge both catheters were connected to a single ON-Q (I-flow Corporation, Lake Forest, CA) ball pump with a 750 ml reservoir using a Y connection and were set to deliver a fixed rate of 7 ml for each catheter. The brachial plexus catheters were removed by the patient on day 5 after surgery without any difficulty. Patient's postoperative course was otherwise unremarkable. We concluded that home going catheters are very effective in pain control postoperatively and they shorten the period of hospital stay. ⋯ Brachial plexus; Home going catheters; Post-operative pain.
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The objective of this study was to assess the utilization of local anesthetics by emergency physicians (EP) and pediatric physicians (PP) who performed a lumbar puncture (LP) in pediatric patients from birth to 24 months of age. ⋯ Local anesthetic; Lumbar puncture; Emergency physician; Pediatric physician.
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We report a female patient diagnosed as Vogt-Koyanagi-Harada (VKH) and polycystic ovary syndrome (PCOS). She has diagnosed as VKH with diminished vision, bilateral serous retinal detachment, the signs of fundus fluorescein angiography and the findings of optical coherence tomography. The patient was referred to the gynecology clinic for her complaints as weight gain, hirsutismus and amenorrhea. She has also been diagnosed with PCOS. With oral steroid treatment, visual acuity has improved and the detachments have resolved within a month. VKH disease may be associated with polycystic ovary syndrome. The two conditions may have a common autoimmune pathogenesis. ⋯ Autoimmune pathogenesis; Polycystic ovary syndrome; Vogt-Koyanagi-Harada.
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Case Reports
Traumatic optic neuropathy and central retinal artery occlusion following blunt ocular trauma.
We present a case as a rare sign of traumatic optic neuropathy and central retinal artery occlusion following blunt ocular trauma. A 10-year-old child suffered complete loss of the vision of one eye following a blunt ocular injury. He sustained an occlusion of the central retinal artery and traumatic optic neurupathy of the affected eye. Isolated cases of central retinal vessel occlusions and traumatic optic neurapathy following ocular blunt trauma are rare conditions. Clinicians to be aware of the potential for blunt ocular trauma to cause optic nerve damage and retinal vessel occlusions. ⋯ Blunt ocular trauma; Retinal artery occlusion; Traumatic optic neuropathy.