Chang Gung medical journal
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Randomized Controlled Trial
Dexamethasone effectively reduces postoperative nausea and vomiting in a general surgical adult patient population.
Postoperative nausea and vomiting (PONV) is still a common and major complication for surgical patients, which may delay post-anesthetic care unit discharge, prolong hospital stay and thus increase the cost of hospitalization. It is understood that PONV is a multi-factorial outcome and occurs more often with general anesthesia than with other anesthetic methods. Prophylactic administration of antihistamines, antidopaminergics, anticholinergics, phenothiazines, serotonin antagonist, steroids and even acupuncture has been shown to be effective. However, expenses and side effects of these agents have also been a concern for clinical doctors. The aim for this prospective study was to find an agent that is cost effective and side effect free (or at least with a low incidence of side effects) for the prevention of PONV. ⋯ We conclude that the prophylactic intravenous administration of 10 mg dexamethasone immediately before the induction of anesthesia is effective in preventing PONV in the general surgical adult patient population.
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Case Reports
Extracorporeal life support in resuscitation for acute myocardial infarction with cardiogenic shock.
In this investigation we report our experience of using extracorporeal life support (ECLS) to resuscitate a 69-year-old woman with critical left main coronary artery disease complicated by acute myocardial infarction and cardiogenic shock. Intra-aortic balloon pump and ECLS were deployed within 45 minutes after the insult to restore the circulatory support while emergent revascularization surgery was performed within 3 hours of the insult. ⋯ ECLS is effective in resuscitation of patients with cardiogenic shock. ECLS restored the systemic perfusion rapidly and avoided further injury to the organs, thus, improving the results of the subsequent coronary bypass surgery.
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The 1918 influenza A virus pandemic caused a death toll of 40 to approximately 50 million. Currently, because of the widespread dissemination of the avian influenza virus (H5N1), there is a high risk of another pandemic. Avian species are the natural hosts for numerous subtypes of influenza A viruses; however, the highly pathogenic avian influenza virus (HPAI) is not only extremely lethal to domestic avian species but also can infect humans and cause death. This review discusses why the avian influenza virus is considered the most likely candidate for the first flu pandemic of the 21st century.
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The efficacy of epidural steroid injection for sciatica due to herniated disc is controversial. This study evaluates the therapeutic effect of an alternative technique that uses a modified approach of epidural steroid injection for the above mentioned disease. The aim was to determine whether this procedure can reduce the need of surgery among discectomy candidates. ⋯ Transforaminal epidural steroid injection is a relatively simple, effective and low-risk alternative to surgical decompression for the treatment of lumbar disc herniation in selected cases. The procedure significantly alleviates the severity of sciatica due to a herniated disc and improves the patient's daily activity; this reduces the need for surgical decompression.
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This is a prospective study of peri-procedure and post-procedure complications and successful weaning of long-term mechanically-ventilated patients following video bronchoscopy-guided percutaneous dilatational tracheostomy (PDT). ⋯ PDT is a bedside procedure with relatively low complication and mortality rates when performed for patients on long-term mechanical ventilation in a medical ICU. The previous duration of trans-laryngeal intubation was an important determinant for successful weaning after PDT.