J Formos Med Assoc
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Clinical Trial Controlled Clinical Trial
Respiratory response to carbon dioxide stimulation during low flow supplemental oxygen therapy in chronic obstructive pulmonary disease.
Oxygen supplementation is the treatment most commonly used to relieve dyspnea in chronic obstructive pulmonary disease (COPD). There is a lack of data, however, on the response of the respiratory drive to low flow oxygen in severe stable COPD. The purpose of this investigation was to evaluate the magnitude of chemoresponsiveness to low flow supplemental oxygen in patients with COPD of variable severity in terms of mouth occlusion pressure at 100 msec (P0.1), P0.1 and minute ventilation (MV) response to CO2 stimulation, and blood gas tension. ⋯ We conclude that short-term oxygen therapy may blunt respiratory response to CO2 in COPD with chronic hypercapnia. Cautious observation of respiratory response is needed during oxygen therapy in COPD patients with a higher magnitude of air-trapping and hypercapnia.
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Factors predicting reintubation after unplanned extubation (UE) are not well established. We prospectively studied the incidence and clinical features of UE and predictive factors for reintubation in medical intensive care unit (ICU) patients. We also validated the scoring system of Listello and Sessler to predict the outcome after UE. ⋯ Pneumonia as the cause of respiratory failure was the most important predicting factor for reintubation after UE. Reintubation after UE may not be necessary, especially in patients with heart disease as the cause of respiratory failure. The scoring system of Listello and Sessler did not accurately predict reintubation after UE in this study.
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Leptospirosis, a zoonotic disease with worldwide distribution, is often overlooked in Taiwan. Clinicians at our medical center in southern Taiwan became alert to the potential for leptospirosis after the first documented case of severe leptospirosis--Weil's syndrome was diagnosed at our emergency department in early September 2000. ⋯ Two of these patients who rapidly received doxycycline therapy survived, while the remaining three patients who received delayed penicillin therapy died. These cases suggest that the incidence of leptospirosis may have been underestimated in Taiwan, and underscore the urgent need for increased clinician awareness of this infectious disease.
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Comparative Study
Comparison of predictive accuracy among six prognosis prediction systems for patient mortality in intensive care units.
This study compared the goodness-of-fit of six prognostic prediction systems. ⋯ In this study, MPM II or APACHE II had the best predictive model of the tested systems for critically ill patients.
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Failure of embryologic development of a lobe of the thyroid gland is a rare anomaly. We report a 47-year-old female with right thyroid hemiagenesis, papillary thyroid cancer, and an ectopic prelaryngeal thyroid rest. ⋯ During the operation, an isthmus and an enlarged left lobe with a cancer mass 2 cm in diameter were found, and a solitary piece of thyroid tissue about 0.7 cm in length was present just below the hyoid bone. We conclude that recognition of this rare anomaly by means of both scintigraphy and ultrasonography is valuable for a complete thyroidectomy, and for avoiding unnecessary contralateral dissection and damage.