Chang Gung medical journal
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Incorrect placement of pedicle screws may lead to neurovascular injury, so the position is important for the reduction of spinal fractures. CT-based image-guided surgery has been promoted as a means to theoretically improve the accuracy of pedicle screw placement. Patients who underwent CT-based navigation-assisted pedicle screw fixation for thoracic or lumbar fractures were reviewed to evaluate the accuracy of pedicle screw placement for spinal fracture cases. ⋯ The accuracy of pedicle screw placement is crucial for thoracolumbar spine fracture fixation. The placement of pedicle screws can be done accurately with the aid of a CT-based image-guided system. Furthermore, this opens the possibility for surgeons to reduce radiation exposure by eliminating the need for intraoperative fluoroscopy.
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This study aimed to present experience in treating patients with posterior fossa epidural hematoma (PFEDH) and to discuss the risk factors, clinical features, and outcome in PFEDH patients with acute clinical deterioration (ACD). ⋯ This study demonstrated that an occipital fracture across the transverse sinus on CT and vomiting on presentation are risk factors for ACD during hospitalization. In this study, PFEDH patients including those with ACD had good outcomes. Further studies are necessary to clarify the clinical course and risk factors for the clinical deterioration of PFEDH patients and to establish a treatment strategy.
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Acute painful scrotum is one of the most challenging urological emergencies. Irreversible parenchymal damage will develop if a testicle is twisted. The aim of the study was to determine the importance of different clinical clues to help differentiate the causes of this devastating condition. ⋯ Pain duration and left side manifestation are independent risk factors of testicular torsion. Prompt surgical exploration should be done if testicular torsion is highly suspected.
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Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as those with life-threatening respiratory failure or post-cardiotomy cardiogenic shock. Patients on ECMO with acute renal failure have high mortality rates. This study identifies specific predictors of hospital mortality for patients receiving ECMO and continuous arteriovenous hemofiltration (CAVH). ⋯ During ECMO plus CAVH support, both the OSF and APACHE II scores showed good discriminative power in predicting hospital mortality for these patients.
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Awareness of the anatomy and variations of the extensor tendons on the dorsum of the hand is necessary when assessing the traumatized or diseased hand and when considering tendons for repair or transfer. A complete quantitative documentation of the extensor tendons is lacking. ⋯ Variations of the extensor tendons were common in this study, especially for the middle and ring fingers which showed multiple tendons of the EDC.