J Formos Med Assoc
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Although they have been documented, opioid treatments in obstetrics are mostly limited to methadone maintenance treatment in pregnant addicts or analgesia/anesthesia for labor. A literature search revealed no previous studies describing analgesic techniques for relief of severe cancer pain in pregnant patients. As response to morphine is dose-dependent, its conventional use can be problematic in pregnant women suffering from severe cancer pain because it is important to prevent opioid intoxication of the fetus. ⋯ We report our experience in treating a 35-year-old pregnant female, in her 32nd gestational week, suffering from neuropathic pain due to advanced ovarian cancer. Using a microcatheter technique, we administered small doses of morphine intrathecally and successfully controlled the pain before delivery without complications in the mother and fetus. Treatment options of systemic vs spinal and epidural vs intrathecal opioids under such unique circumstances are discussed.
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Viral hepatitis has a high prevalence in East Asia and is an important problem. Identification of the individual hepatitis viruses. A-E, has enabled researches to investigate the epidemiology and pathogenesis of viral hepatitis and its sequelae, and possible means of prevention. ⋯ Hepatitis C virus also contributes to the development of cirrhosis and HCC. No effect immunization is currently available, and hepatitis C can only be controlled by preventative measures. The epidemiology and pathogenesis of viral hepatitis is discussed in this review, including new viral hepatitis agents possibly responsible for non-A-E hepatitis.
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Over the past decade, pneumatic reduction has been increasingly accepted as the treatment of choice for pediatric intussusception. However the effectiveness of air compared with the more traditional barium reduction of intussusception continues to be a source of concern and debate. From August 1993 to November 1994, pneumatic reduction was used to treat 75 episodes in 73 patients with proven intussusception at Chang Gung Memorial Hospital, Taoyuan. ⋯ In two of the 10 patients in whom reduction failed, one was subsequently found to have a Meckel's diverticulum and the other a duplication cyst as a leading point. This prospective study indicates that air enema is a safe and effective form of treatment for intussusception in infants and children. Pneumatic reduction should be the treatment of choice in the initial management of intussusception.
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A patient with symptomatic atrioventricular blockage who had been treated by permanent pacemaker implantation, developed twiddler's syndrome 16 days after implantation. The electrode lead to the pacemaker pocket had been completely displaced, with the electrode tip having moved to the outside of the subclavian vein. ⋯ The patient is regularly followed up at an outpatient clinic and continues to be well. Although twiddler's syndrome is a rare complication of pacemaker implantation, preventive measures should be undertaken especially for those judged to be at high risk.
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Dental enamel pitting was studied as a diagnostic sign of pediatric tuberous sclerosis (TSC). Thirteen patients aged 2.5 to 18 years with varying degrees of TSC were evaluated. They were checked for the presence of enamel pitting by the use of two to three drops of dental plaque disclosing stain which was applied to the labial surfaces of dry teeth. ⋯ The total number of enamel pits in each patient varied from 1 to 26 and increased with age; 90% of the teeth with enamel pitting displayed one to two pits per tooth. The youngest patient with enamel pitting was 5 years old. The simplicity of this test and the high probability of pitting in TSC make the examination useful in the assessment of patients in whom the diagnosis of this serious genetic disease is being considered.