J Formos Med Assoc
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Legionella pneumophila is a common cause of sporadic community-acquired pneumonia, but culture-proven legionellosis is rarely diagnosed. There is no laboratory test for Legionnaires' disease that can detect all patients with the disease. Culture is the standard diagnostic method and should be initiated as soon as possible in suspected cases. ⋯ Culture of the sputum yielded L. pneumophila serogroup 6, although there was no elevation of the serum antibody titer. Pneumonia resolved gradually and he was extubated after treatment with levofloxacin followed by erythromycin. L. pneumophila other than serogroup 1 should be included in the differential diagnosis of patients with suspected atypical community-acquired pneumonia.
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Case Reports
Angiosarcoma with pulmonary metastasis presenting with spontaneous bilateral pneumothorax in an elderly man.
Cutaneous angiosarcoma is a rare and invasive endothelial-derived sarcoma that occurs most frequently in the scalp and facial skin of elderly men. It is frequently accompanied by thin-walled cavitary pulmonary metastasis, and is often obscure on chest radiograph. We report a case of angiosarcoma of the scalp with cystic metastasis to the lung in a 63-year-old man, presenting as recurrent bilateral spontaneous pneumothorax. ⋯ Pulmonary metastasis was confirmed by video-assisted thoracoscopic surgery, and pleurodesis was performed. After the operation, the patient received chemotherapy; no recurrence of pneumothorax was found during 6 months of follow-up. Pneumothorax in the elderly should be differentiated from malignant metastatic lung tumors.
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Randomized Controlled Trial
Comparison of the Gow-Gates mandibular block and inferior alveolar nerve block using a standardized protocol.
Although several previous studies have compared the efficacy of Gow-Gates mandibular block (GGMB) and inferior alveolar nerve block (IANB), the results remain controversial. This study used an objective, standardized and precise protocol to evaluate and compare the effectiveness and success rate of GGMB and IANB. ⋯ This study demonstrated that the efficacy of pulpal and gingival tissue anesthesia are not significantly different between the GGMB and IANB methods.
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There are limited data on the effectiveness of mannequin-based simulations in pediatrics. This study developed a training program using a high-fidelity child mannequin to simulate critical cases in an emergency department, and examined the learning gains derived from this simulation. Eighteen pediatric residents, as pairs, participated in a high-fidelity simulation pretest, training session and a posttest. ⋯ The pre- and posttest performances were scored for task-specific technical skills and behaviors. The learning gains between the pre- and posttests were significant (p < 0.001) for task-specific technical skills (from 64 +/- 15% to 93 +/- 4%) and behaviors (from 65 +/- 18% to 85 +/- 12%). This study suggests that high-fidelity simulation can enhance learning about how to manage critical cases in the pediatric emergency department.
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The best medicine for febrile convulsions (FCs) is not prescription medications but effective communication of related information to parents. Therefore, a quick assessment tool for obtaining information about parental responses to FCs is essential for educating parents, clinical practice and research. This paper describes the development and psychometric testing of a questionnaire on parental knowledge, attitudes, concerns and practices (KACP) toward FC. ⋯ For research purposes, the KACP questionnaire measures parental responses with a moderate level of reliability and validity. Cross-cultural investigation of the questionnaire is needed to facilitate its use in other countries.