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Yeh F.-C.,National Defense Medical Center | Chiang W.-F.,National Defense Medical Center | Wang C.-C.,Armed Forces Kaohsiung General Hospital | Lin S.-H.,National Defense Medical Center
Canadian Journal of Emergency Medicine | Year: 2014

Hypokalemic periodic paralysis is the most common form of periodic paralysis and is characterized by attacks of muscle paralysis associated with a low serum potassium (K+) level due to an acute intracellular shifting. Thyrotoxic periodic paralysis (TPP), characterized by the triad of muscle paralysis, acute hypokalemia, and hyperthyroidism, is one cause of hypokalemic periodic paralysis. The triggering of an attack of undiagnosed TPP by β2-adrenergic bronchodilators has, to our knowledge, not been reported previously. We describe two young men who presented to the emergency department with the sudden onset of muscle paralysis after administration of inhaled β2-adrenergic bronchodilators for asthma. In both cases, the physical examination revealed an enlarged thyroid gland and symmetrical flaccid paralysis with areflexia of lower extremities. Hypokalemia with low urine K+ excretion and normal blood acid-base status was found on laboratory testing, suggestive of an intracellular shift of K+, and the patients' muscle strength recovered at serum K+ concentrations of 3.0 and 3.3 mmol/L. One patient developed hyperkalemia after a total potassium chloride supplementation of 110mmol. Thyroid function testing was diagnostic of primary hyperthyroidism due to Graves disease in both cases. These cases illustrate that β2-adrenergic bronchodilators should be considered a potential precipitant of TPP. © Canadian Association of Emergency Physicians. Source

Chen N.-F.,Armed Forces Kaohsiung General Hospital | Chen N.-F.,University of California at Los Angeles | Smith Z.A.,University of California at Los Angeles | Stiner E.,University of California at Los Angeles | And 4 more authors.
Journal of Neurosurgery: Spine | Year: 2010

Object. Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been approved for use in the lumbar spine in conjunction with the lumbar tapered cage. However, off-label use of this osteoinductive agent is observed with anterior fusion applications as well as with both posterior lumbar interbody fusion and transforaminal lumbar interbody fusion (TLIF). Complications using rhBMP-2 in the cervical spine have been reported. Although radiographic evidence of ectopic bone in the lumbar spine has been described following rhBMP-2 use, this finding was not previously believed to be of clinical relevance. Methods. This study was a retrospective review of 4 patients who underwent minimally invasive spinal TLIF (MIS-TLIF) in which bone fusion was augmented with rhBMP-2 applied to an absorbable collagen sponge. Case presentations, operative findings, imaging data, and follow-up findings were reviewed. Results. Four cases with delayed symptomatic neural compression following the off-label use of rhBMP-2 with MIS-TLIF were identified. Conclusions. Although previously believed to be only a radiographic finding, the development of ectopic bone following rhBMP-2 use in lumbar fusion can be clinically significant. This paper describes 4 cases of delayed neural compression following MIS-TLIF. The reader should be aware of this potential complication following the off-label use of rhBMP-2 in the lumbar spine. Source

Wen J.-J.,Kun Shan University | Chou H.-M.,Kun Shan University | Lee C.-K.,Armed Forces Kaohsiung General Hospital | Lee H.-C.,Armed Forces Kaohsiung General Hospital
Innovation, Communication and Engineering - Proceedings of the 2nd International Conference on Innovation, Communication and Engineering, ICICE 2013 | Year: 2014

The cosmology of physics described the use of different energy scale to investigate the interaction between dimension and action force and Lorentz invariance of electro-magnetism. The traditional chinese medicine mentioned the interaction between human and nature; explained the concept of counteraction and interrelation in Yin-Yang and Five Elements and established the theory of Organs meridian system. Meanwhile the western medicine emphasized the biological homeostasis and the setting of human body temperature associated with the uptake of food in order to maintain the dynamic stability of physiological function in eleven systems of the nervous, the cardiovascular and so on. This study is aimed to investigate De Qi of acupuncture in terms of physics and the interaction of spacetime effect between De Qi of acupuncture and cerebral cortex via the transmittion of peripheral spatial signals. In addition, we used the therapeutic principles of symmetric relationship between lesion site and acupuncture points as to upper-lower, left-right, interior-exterior and anterior-posterior positions. From the study of Lee CK et al, they used a combined treatment of acupuncture, steroids and hyper-baric oxygen to treat 35 cases of sudden deafness. The acupuncture was carried out at the traditional acupuncture points over head and hand. After the combined treatment, 30 out of 35 cases (85.7%) showed an improvement in hearing loss from 75.9 ± 24.9 dB (before) to 53.9 ± 32.2 dB (after), P < 0.01. From the results of this study, it seemed reasonable to explain the interaction of spacetime effect between De Qi of acupuncture and cerebral cortex, and the theory of neuroplasticity and cortical reorganization. © 2014 Taylor & Francis Group. Source

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