Chang Gung medical journal
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There are many strategies available to treat palliation of airway obstruction due to benign or malignant conditions. The initial choice depends on the urgency of the situation, the extent of the disease process as assessed bronchoscopically, as well as the individual experience and preference of the physician. ⋯ Symptomatic relief and improved ventilatory function were achieved in this patient once patency of the trachea was restored successfully using bronchoscopic electrocautery. The technique is a straightforward, safe, and quick method to palliate airway obstruction.
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Neuropathic pain is caused by functional abnormalities of structural lesions in the peripheral or central nervous system, and occurs without peripheral nociceptor stimulation. Many common diseases, such as postherpetic neuralgia, trigeminal neuralgia, diabetic neuropathy, spinal cord injury, cancer, stroke, and degenerative neurological diseases may produce neuropathic pain. Recently, theories have been proposed that state there are specific cellular and molecular changes that affect membrane excitability and induce new gene expression after nerve injury, thereby allowing for enhanced responses to future stimulation. ⋯ Since it has been established that intense noxious stimulation produces a sensitization of central nervous neurons, it may be possible to direct treatments not only at the site of peripheral nerve injury, but also at the target of central changes. In order to provide better pain control, the mechanism-based approach in treating neuropathic pain should be familiar to physicians. In the future, it is hoped that a combination of new pharmacotherapeutic developments, careful clinical trials, and an increased understanding of the contribution and mechanisms of neuroplasticity will lead to an improvement in the results of clinical treatments and prevention of neuropathic pain.
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Randomized Controlled Trial Clinical Trial
The effects of continuous axillary brachial plexus block with ropivacaine infusion on skin temperature and survival of crushed fingers after microsurgical replantation.
Continuous axillary brachial plexus block with local anesthetic has been shown to improve tissue perfusion after replantation surgery of the extremity. The present study aimed to investigate whether continuous axillary brachial plexus block with ropivacaine infusion can improve the survival of the reconstructive fingers secondary to an increase in its skin temperature in patients receiving replantation surgery of the crushed fingers. ⋯ The result of this study demonstrated that axillary brachial plexus block with continuous infusion of 0.75% ropivacaine can increase the skin temperature, an index of tissue perfusion, of the reconstructive digits for 24 h after microvascular surgery of the crushed fingers. However, graft survival was good in both groups.
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Myotonic dystrophies or dystrophia myotonica (DM) is a clinical syndrome that includes myotonic dystrophy type 1 (DM1), myotonic dystrophy type 2 (DM2), myotonic dystrophy type 3 (DM3), and so forth. The terminology was recommended by the new nomenclature for myotonic dystrophies of an International Panel for Consensus. Previous studies have shown that DM1 is caused by the expansion of a cytosine-thymine-guanine (CTG) repeat in the DM protein kinase gene on chromosome 19, and DM2 is caused by an expansion of a cytosine-cytosine-thymine-guanine (CCTG) repeat in the zinc finger protein 9 (ZNF9) gene on chromosome 3. ⋯ The inverse correlation between age at onset and CTG repeat length is significant only in patients with small expansions of about 100-250 triplet repeats. Transmission contraction of the repeat size is likely to occur in alleles with large repeats and is associated with paternal transmission. In congenital DM1, individual variability of muscle differentiation does occur, in spite of the same number of CTG repeats in the leukocytes.
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Tension pneumothorax is not a rare complication of mechanical ventilation, but its occurrence immediately after intubation with a double-lumen endotracheal tube (DLT) is very rare. Subsequent impairment of the respiratory and cardiovascular function can be life threatening if it is not detected early enough and managed properly. ⋯ Herein we report a case of tension pneumothorax and pneumoperitoneum which occurred immediately after DLT intubation. It appeared before one-lung ventilation was applied because of an inappropriately small-sized and malpositioned DLT.