J Formos Med Assoc
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Critical flicker frequency (CFF) decreases due to optic nerve and retinal damage in patients with optic neuritis or glaucoma. Because retinal degeneration is also found in high myopia, we investigated whether the modulation transfer function (MTF) and CFF are altered in patients with high myopia. ⋯ The findings of this study support that the CFF decreases and MTF increases in patients with high myopia, and that the alternation of MTF is related to the degree of myopia. CFF and MTF may, therefore, have potential as indexes to evaluate the severity of retinal degeneration in patients with high myopia.
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Randomized Controlled Trial Clinical Trial
Correlation of arterial and end-tidal carbon dioxide in spontaneously breathing patients during ambulatory gynecologic laparoscopy.
Laparoscopy can be performed while patients are under total intravenous anesthesia (TIVA), or sedated and breathing spontaneously through the normal airway. Respiratory monitoring is difficult when patients are sedated or anesthetized, however. The purposes of this study were to evaluate the reliability of end-tidal carbon dioxide (ETCO2) measurement for monitoring arterial carbon dioxide pressure (PaCO2), and to assess the PaCO2/ETCO2 gradient among patients receiving TIVA while breathing spontaneously through the normal airway. ⋯ The results showed that ETCO2 was highly correlated with PaCO2 in group 1 (correlation coefficient r = 0.85), but not in group 2 (r = 0.55). In group 2, the PaCO2/ETCO2 gradient increased as time elapsed, with significant differences (p < 0.05) between the values at induction and those at 30 minutes after the change to the Trendelenburg position and thereafter. These results indicate that the ETCO2 and PaCO2 values correlate well during the first 20 minutes after the change to the Trendelenburg position in laparoscopy patients receiving TIVA with spontaneous breathing, but that PaCO2 monitoring is still necessary.
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In this retrospective study, we examined the usefulness of computed tomographic angiography (CTA) for the detection and assessment of circle of Willis aneurysms in patients with acute nontraumatic subarachnoid hemorrhage (SAH), using selective digital substraction angiography (DSA) as the gold standard. Thirty-five patients who presented with acute, nontraumatic SAH, diagnosed on the basis of unenhanced computed tomography or lumbar puncture findings or both, underwent both CTA and DSA. The CTA images were interpreted for the presence, location, size, and shape of the aneurysm, presence of a neck, and relationship of the aneurysm to adjacent arterial branches. ⋯ Our results confirm the accuracy of CTA in comparison with DSA. Because of its reliability, minimal invasiveness, and rapidity, CTA may become the technique of choice for neuroradiologic work-up of SAH patients. DSA then would be used to diagnose intracranial aneurysms only in selected, questionable cases.
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We present a case of glyphosate-induced cardiogenic shock in a young man. The patient a 26-year-old man, presented with nausea and vomiting 4 hours after attempting suicide by drinking 150 mL of glyphosate surfactant. Cardiogenic shock with accelerated idio-ventricular rhythm on electrocardiography developed after admission. ⋯ Over the next 16 hours, the QRS complex gradually narrowed, sinus rhythm returned, and the hemodynamic status improved. Echocardiograms revealed diffuse left ventricular hypokinesis with markedly reduced ejection fraction while the patient was in shock; normal left ventricular function resumed the next day. In this case, the glyphosate surfactant poisoning-induced shock may have been due to transient suppression of the cardiac conduction system and contractility, rather than intravascular hypovolemia.
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Randomized Controlled Trial Clinical Trial
Postoperative short-term sedation with propofol in cardiac surgery.
We conducted a randomized double-blind study to assess the safety and effectiveness of short-term sedation with propofol in adult patients immediately after cardiac surgery. Sixty hemodynamically stable adult patients who underwent cardiac surgery were randomly assigned to receive propofol postoperatively or no postoperative sedation. The propofol group (n = 30) received propofol infusion (1 mg.kg-1.hr-1) immediately after they awoke postoperatively. ⋯ Subjective evaluations (scored on an analog scale: 0 = nil, 10 = extreme) revealed that patients receiving propofol felt less pain than those in the control group (2.3 +/- 2.7 vs 4.7 +/- 3.1, p < 0.05), had better sleep quality (7.8 +/- 2.9 vs 5.1 +/- 2.9, p < 0.05), and were more satisfied with the care they received (8.3 +/- 2.2 vs 5.8 +/- 3.9, p < 0.05). These findings suggest that propofol infusion is effective for short-term sedation of cardiac surgery patients postoperatively and that an infusion rate adequate to maintain a Ramsay score of 3 may be ideal. Postoperative sedation should be considered for all cardiac surgery patients, not only those with outward signs of anxiety or agitation.