Osaka city medical journal
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Comparative Study
Management of postoperative intraabdominal abscess in laparoscopic versus open appendectomy.
Complicated appendicitis (gangrenous or perforated appendicitis) is a risk for postoperative intraabdominal abscess, but management of intraabdominal abscess may differ between laparoscopic and open appendectomy. ⋯ Our results suggest that insertion of abdominal drainage may be appropriate treatment for intraabdominal abscess after laparoscopic appendectomy. Light anesthesia may induce residual abscess in open appendectomy performed under spinal analgesia.
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Case Reports
Asystole developed during total gastrectomy under general anesthesia combined with thoracic epidural anesthesia.
We report a 73-year-old woman who developed sudden bradycardia and asystole due to vagal reflex during transabdominal total gastrectomy under general anesthesia with thoracic epidural analgesia. General anesthesia was induced with propofol, fentanyl and maintained with sevoflurane and epidural infusion of lidocaine. ⋯ Surgery was completed uneventfully and the patient was discharged without complications. For preventing life-threatening bradycardia and asystole by vagal reflex, we suggest the use of atropine prior to the operations in patients undergoing abdominal or ophthalmic surgery, where vagal reflex may occur.
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The six-minute walk test (6MWT) is widely used for integrated assessment of patients with chronic obstructive pulmonary disease (COPD). However, little is known concerning which resting pulmonary function test measurements relate to six-minute walk distance (6MWD). ⋯ The present results suggest that age, IC, and DLCONA were significantly associated with 6MWD in patients with COPD.
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Whether a laparoscopic approach is more effective for acute appendicitis than standard open appendectomy remains controversial. ⋯ Laparoscopic appendectomy has some disadvantages, such as long operative time and possible of serious complications, but generally accelerates postoperative early recovery to shorten hospitalization.
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Comparative Study Clinical Trial
Effects of tiotropium or combined therapy with salmeterol on hyperinflation in COPD.
Hyperinflation is widely accepted as an abnormal state affecting clinical symptoms, activities of daily living and exercise tolerance in chronic obstructive pulmonary disease (COPD). Reducing hyperinflation is an essential theme in COPD treatment. In this study, we let patients with COPD hyperventilate to evoke hyperinflation, and evaluated the effects of tiotropium alone or in combination with salmeterol on hyperventilation-evoked hyperinflation. ⋯ Tiotropium improved airflow obstruction and hyperventilation-evoked hyperinflation. In combination with salmeterol, the improvement in airflow obstruction was greater, but hyperventilation-evoked hyperinflation was not further improved.