Chang Gung medical journal
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Comparative Study
Comparison of patient-controlled epidural analgesia and continuous epidural infusion for labor analgesia.
In recent years, patient-controlled epidural analgesia (PCEA) has been developed as an attractive alternative to continuous epidural infusion (CEI) for labor pain control. PCEA is still not popular for labor pain control in Taiwan and disparities may exist between different ethnic and cultural groups toward the attitude of labor pain control. The aim of this study was to investigate whether there were any differences between PCEA and CEI in the maintenance of epidural analgesia for Taiwanese parturients undergoing spontaneous delivery. ⋯ The results of this study provided further evidence that PCEA is a highly effective method of the control of labor pain, which was highly accepted by women in labor. In a busy obstetric unit, this could potentially improve parturient satisfaction and reduce the workloads of clinicians and nurses.
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There has been a decline in the incidence of acute rheumatic fever in recent decades in developed countries and in Taiwan. Sydenham's chorea, a major manifestation of rheumatic fever, was the most common cause of chorea in children in the past. ⋯ Hemichorea is rare. We report on a 10-year-old boy who presented with progressive right side involuntary movements, an apical systolic murmur, prolonged PR interval, and elevated antistreptolysin O titer, who was diagnosed with acute rheumatic fever.
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Case Reports
Extensive sensory block caused by accidental subdural catheterization during epidural labor analgesia.
A 32-year-old parturient requested epidural analgesia for labor. A lumbar epidural block was performed at the L1-2 interspace. Thirty minutes after the loading dose of the local anesthetic mixture, she suffered numbness in both arms and high sensory block up to the C6 dermatome without significant motor blockade. ⋯ Accidental subdural catheterization is a rare complication of epidural block. Due to the smaller potential space, a subdural injection usually produces a high level block disproportional to the volume injected. Thus, patients receiving epidural block should be closely monitored following injection of local anesthetics regardless of the concentration or volume administered.
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Fourier-transform infrared (FT-IR) microspectroscopic mapping can be used to distinguish between different tissue structures, and to increase the image contrast between normal and cancerous regions of a given tissue sample. This study demonstrates the biochemical changes associated with a consistent link between cancerous tissue and various molecular changes in the IR spectra of human pancreatic cancer tissue using FT-IR mapping. Tissue samples were obtained immediately after resection in a patient who underwent a distal pancreatectomy including the pancreatic body and tail. ⋯ The cancerous tissue contained significant protein content, and the distributions of DNA and lipid were very low, indicating low amounts of nucleic acids and lipids in human pancreatic cancer tissue. The analytical results indicate that these FT-IR microspectroscopic biochemical images reflect the distribution of cell components, which could be correlated with stained tissue in adenocarcinoma in pancreatic tissues. This study with samples of noncancerous and cancerous pancreatic tissues has clearly demonstrated that FT-IR microspectroscopy using the mapping method can be used for diagnosis.
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Subacromial impingement syndrome, with pain and limited motion, is a common disease encountered daily in clinics. This study determined the efficacy of subacromial injections of corticosteroids and local anesthesia for treatment of painful subacromial impingement syndrome. ⋯ Subacromial injection of corticosteroids and local anesthesia is an effective therapy for the treatment of symptomatic subacromial pathology, such as impingement pain, tendonitis and bursitis. The injection can substantially reduce pain and increase range of motion of the shoulder. If there is no improvement following injections, a rotator cuff tear should be suspected.