Chang Gung medical journal
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Comparative Study
Breast reconstruction with a muscle-sparing free transverse rectus abdominis myocutaneous flap: comparison between immediate and delayed groups.
Breast reconstruction offers not only physical but also psychological rehabilitation. Autologous tissue transfer is a good option for breast reconstruction. The purpose of this study was to investigate the success rate, complications, and cosmetic outcomes following use of a muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap for breast reconstruction. ⋯ A muscle-sparing free TRAM flap is a good option for breast reconstruction. Both the success rate and patient satisfaction are high. The subsequent adjuvant therapy need not be delayed following immediate reconstruction.
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We report the negative emotional state as pessimistic mood of a case with narcissistic personality disorder during the period of narcissistic decompensation. In addition, we identified the clinical differences between pessimistic mood and depressive disorder. An 28-year-old unmarried woman experienced herself, her life and the external object as futile and disappointing after repeated failure to satisfy her grandiose fantasies about the search for ideal love. ⋯ Clinically, decompensated narcissistic patients do not exhibit the typical attitude of worthlessness or guilty feelings, and are devoid of certain specific depressive emotions (e.g., sadness, sorrow, etc.). In contrast, decompensated narcissistic patients with pessimistic mood exhibit a dominant sense of futility and other negative emotions presented as outrage and disappointment. The purpose of this case report was to emphasize the importance to recognize clinical features of pessimistic mood for the differential diagnosis and management of the decompensated narcissistic patient.
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Caudal epidural block (CEB) has become increasingly important for pediatric analgesia in recent years. However, data regarding CEB in adult ambulatory surgery are scarce. The aim of this study was to verify whether CEB could be applied as a simple, safe and economic method of anesthesia for adult patients undergoing minor gynecologic procedures (MGP). ⋯ Single-dose CEB with 1.5% lidocaine 20-mL was an easy and simple technique. It provided satisfactory anesthesia for MGP and did not prolong patients' discharge time. CEB may be another choice of anesthetic technique in such cases of clinical practice.
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Case Reports
Reproducible hepatic dysfunction following separate anesthesia with sevoflurane and desflurane.
Both desflurane and sevoflurane have individually been reported to induce hepatic dysfunction; however hepatic dysfunction after administration of both of them separately in a single patient has not previously been reported. As their metabolites differ in nature, we considered that it would be unlikely that their combined use would cause sensitization and induce hepatic dysfunction. We report on the first patient with reproducible liver dysfunction after sevoflurane and desflurane. ⋯ The symptoms improved, and the serum transaminase level returned to normal after conservative therapy. The similar time interval between the operation date and the onset of hepatic dysfunction, after excluding other possibilities, made us highly suspicious that the hepatic dysfunction was induced by sevoflurane on 1 occasion and desflurane on the other. We suggest that inhaled anesthetics should be totally replaced by intravenous anesthetics for future operations in patients with such a diagnosis.
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Case Reports
Awake fiberoptic intubation for cesarean section in a parturient with odontoid fracture and atlantoaxial subluxation.
We report on the anesthetic experience of a 38-week pregnant patient in labor with an upper cervical spinal cord injury after an unusual trauma. She was transferred from a district hospital to our medical center with acute quadriplegia and sensory loss. Plain cervical spine x-ray and computed tomographic scan showed a C2 odontoid (dens of axis) process type II fracture and atlantoaxial (C1-C2) subluxation. ⋯ The instability of her cervical spine precluded the use of regional anesthesia; so awake nasal fiberoptic endotracheal intubation followed by general anesthesia was performed. The anesthetic course was uneventful, and the outcome of the parturient and newborn was good. We discuss our anesthetic considerations, intubation techniques and a review of the literature.