Chang Gung medical journal
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Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to a medical response. One-lung ventilation is required during VATS. In this study, we evaluated the efficacy of intraoperative wire-guided endobronchial blockade (WEB) for achieving 1-lung ventilation during a thoracoscopic procedure for pediatric empyema. ⋯ VATS can safely and effectively be performed in children with a proper anesthetic technique. With the development and clinical use of this new device, the bronchial blocker tube proved to be effective and easy to use for establishing 1-lung ventilation in a pediatric population.
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A diagnostic triad characterizes Brugada syndrome. It consists of a right bundle branch block, ST-segment elevation in leads V1-V3 and sudden cardiac death (SCD). Approximately 50% of patients with Brugada syndrome noted to have familial occurrence, this suggests a genetic component of the disease. ⋯ With ICD therapy, the mortality rate at a 10 year follow-up was 0%. Supporting data for long-term pharmacological therapy with quinidine, or isoproterenol for prevention of SCD, in these patients, is uncomplete. Future advances in understanding the molecular mechanisms of Brugada syndrome may provide answers to many of the controversial issues in the management of this disease.
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Airway obstruction and feeding difficulty can occur in patients born with Pierre Robin sequence. In select patients with pronounced micrognathia, surgical intervention to relieve the airway obstruction is necessary. The surgical indications and appropriate surgical procedure continue to have a great deal of controversy. The purpose of this study was to evaluate our experience of tongue-lip adhesion in the management of upper airway obstruction associated with Pierre Robin sequence. ⋯ This retrospective review showed that with a thorough preoperative airway evaluation, TLA could be successfully used to treat select patients with Pierre Robin sequence suffering from severe upper airway obstruction. Thus, TLA should be first considered when surgical relief of airway obstruction is indicated and when obstruction is limited to the classic tongue base obstruction type.