Chang Gung medical journal
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To identify clinical features that distinguish children with appendicitis who visited the emergency department twice or more from those diagnosed on the first visit to the emergency department. ⋯ Misdiagnosed appendicitis is a problem in the emergency department. A shorter stay in the emergency department, fewer laboratory tests, less diagnostic imaging, and fewer physical findings may be responsible for misdiagnosed appendicitis late at night in the emergency department.
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Conscious sedation for patients undergoing flexible bronchoscopy (FB) is suggested to alleviate discomfort and improve satisfaction despite controversy regarding its benefits. In Taiwan, the general FB practice involves local anesthesia only. This study aimed to assess the benefits and risks of conscious sedation in diagnostic FB. ⋯ Conscious sedation with clinically judged midazolam and alfentanil reduces discomforts, improves satisfaction, and carries slight, but manageable, hypoxemia risks in patients undergoing FB.
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Ventilator-associated pneumonia (VAP) contributes to high mortality, prolonged intensive care unit (ICU) stay and increased costs of health care. Reports of early predictors of death in patients with VAP are rare. Our study was designed to determine early predictors of poor outcome in patients with VAP. ⋯ A high APACHE II score (>27) at VAP onset was an independent and early predictor of mortality due to VAP.
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Comparative Study
The impact of regular biopsy in the first cystoscopic follow-up and other predictors on the recurrence of superficial bladder tumors.
To evaluate whether cystoscopic evaluations with bladder biopsy can serve as a significant predictor of superficial bladder tumor recurrence. ⋯ Our data support tumor number and intravesical therapy as important predictive factors for tumor recurrence. Cystoscopy combined with transurethral bladder biopsy mitigates tumor recurrence in the early years, but not in later years. Therefore, regular cystoscopic evaluation alone is sufficient for longterm patient surveillance.
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Case Reports
Intramuscular lorazepam in catatonia in patients with acute renal failure: a report of two cases.
Cases of catatonia in patients with renal failure have been rarely reported. In this report, we describe two renal-insufficient patients with catatonia who had a good response to intramuscular lorazepam whereby the catatonic symptoms were relieved. Case 1 involved a patient with end-stage renal disease and severe pneumonia related respiratory failure. ⋯ This report demonstrates that intramuscular lorazepam is safe, effective and rapid in relieving catatonia associated with renal function impairment. Neither of the patients had a recurrence of catatonia during a period of 6- months follow-up. In conclusion, intramuscular lorazepam may play an important role in the treatment of catatonia associated with renal insufficiency.