Medicine
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Case Reports Observational Study
Validity of the use of a subfascial vessel as the recipient vessel in a second free flap transfer: A retrospective clinical review.
Performing a greater number of free flap procedures inevitably results in an increase in the number of cases that experience free flap failure. In cases that require a second free flap after the failure of the first, recipient vessel selection becomes difficult. Furthermore, recipient vessel selection can be complicated if the vessel is deep in the recipient site, or if there is an increased risk of vessel damage during the dissection. ⋯ The mean time for the dissection of the recipient perforator was 45 minutes. All the flaps exhibited full survival, although a partial loss of the skin graft at the flap donor site was observed in 1 patient; this defect healed with conservative management. We recommend using a subfascial vessel as the recipient vessel for both first and second free flaps, especially if access to the major vessel is risky or challenging.
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Case Reports
Can endotracheal intubation be the first step in management of nonconvulsive status epilepticus?: A case report.
Nonconvulsive status epilepticus (NCSE) is prolonged seizure activity without motor manifestations. Clinically, there are certain examination findings, in addition to elements of history, that help differentiate it from other encephalopathies. When diagnosing NCSE, the physician faces significant difficulties due to inconsistent clinical presentation and somewhat nonspecific electroencephalogram (EEG) criteria. ⋯ Accordingly, we recommend consideration of NCSE in any unconscious patient whose presentation cannot be explained by other disorders. Furthermore, we suggest moving directly to utilizing anesthetic agents and endotracheal intubation, together with anti-epileptic drugs, in the treatment regimen in order to optimize patient outcomes.
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Case Reports
Sirolimus alternative to blood transfusion as a life saver in blue rubber bleb nevus syndrome: A case report.
Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by multiple venous malformations. The gastrointestinal bleeding and secondary iron deficiency anemia are the most common complications. There are currently no effective treatments for BRBNS. Here, we report a case of successful treatment with a small dose of sirolimus of a BRBN patient with a de novo gene mutation. ⋯ we report a case of a mutation in exon 15 of the TEK gene leading to BRBN. It was successfully treated with a small dose of sirolimus as an alternative to blood transfusion in order to save the of BRBN patient's life.
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Observational Study
Association between paced QRS duration and atrial fibrillation after permanent pacemaker implantation: A retrospective observational cohort study.
Right ventricular pacing often results in prolonged QRS duration (QRSd) as the result of right ventricular stimulation, and atrial fibrillation (AF) may result. The association of pacing-induced prolonged QRSd and AF in patients with permanent pacemakers is unknown. We selected 180 consecutive patients who underwent pacemaker implantation for complete/advanced atrioventricular block. ⋯ Receiver operating characteristic curve suggested that QRSd variation in lead V6 could predict AF occurrence, especially for patients with long preimplantation QRSd (≥120 ms, area under the curve was 0.826, 95% CI 0.685-0.967). QRSd variation in lead V6 might be positively correlated with postimplantation AF occurrence. In patients with pacemaker implantation, QRSd could be a complementary criterion for optimizing the right ventricular septal pacing site, and smallest QRSd might be worth pursuing.
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Repeated occurring stroke in short intervals with hypercoagulability is unusual so in such cases the conventional vascular risk factors might not be the causes of stroke. ⋯ This case of recurrent stroke with coagulation disorders without evidence of cancer in imaging and blood test is rare. So in a stroke patient, we should consider malignancy or metastasis as a differential diagnosis as it may be the first manifestation of active cancer elsewhere.