Chang Gung medical journal
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Posterior decompression, instrumentation, and posterolateral fusion are surgical procedures for the treatment of degenerative lumbar diseases. Solid fusion usually causes adjacent problems. This study investigated the clinical outcome and radiographic fate of the L5-S1 segment in patients who underwent posterior instrumented surgery for degenerative lumbar diseases. ⋯ The L5-S1 disc degenerated more after posterolateral lumbar floating fusion. However, there was no symptomatic inferior adjacent instability or symptomatic L5-S1 disc degeneration requiring further L5-S1 fusion at a mean 5.1 years follow-up.
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Most of the sources of bleeding in patients with obscure gastrointestinal bleeding are located in the small bowel. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are innovative modalities to examine the small intestine. This study evaluated the combined use of CE and DBE in patients with obscure gastrointestinal bleeding. ⋯ CE can provide useful information on the indications for DBE and the selection of the route of DBE. DBE can verify the findings of CE and provide therapeutic intervention. Combined use of CE and DBE is effective in the diagnosis and management of patients with obscure gastrointestinal bleeding.
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Neuromuscular blocking agents (NMBAs) are widely used during the induction and maintenance of anesthesia. Postoperative residual curarization (PORC) following the use of NMBAs still occurs even though intermediate-acting NMBAs were used. Train-of-four (TOF) stimulation is used to quantify the degree of neuromuscular blockade. The TOF ratio of 0.7 in the adductor pollicis muscle was associated with normal respiratory function. Pharyngeal function returned to normal while the TOF ratio reached 0.9. The aim of this study was to survey the PORC in the post-anesthesia care unit (PACU). ⋯ PORC is still a clinical problem in the modern PACU. Objective neuromuscular monitoring needs to be performed to ensure patient safety.
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The timing of initiation of epidural analgesia and its causal relationship with mode of delivery is controversial. This retrospective investigation reviews and determines whether early initiation of epidural analgesia in nulliparous women influences the rate of cesarean sections as well as other obstetric outcome measures. ⋯ The administration of epidural analgesia with a regimen of ropivacaine and fentanyl should not be delayed until cervical dilatation reaches 3 cm in nulliparas who are in spontaneous labor or have spontaneous rupture of the membranes. The timing of epidural analgesia should be determined on an individualized basis.
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Review Case Reports
Long-term anterior thalamus stimulation for intractable epilepsy.
Deep brain stimulation (DBS) has re-emerged as an alternative therapy for intractable epilepsy. In this study, we investigated the feasibility, efficacy and safety of long-term anterior thalamic nucleus (ATN) stimulation for intractable epilepsy. ⋯ Based on our study results and literature review, it appears reasonable to conclude that long-term ATN stimulation is a safe and effective treatment for seizure reduction in patients with intractable epilepsy.