From the Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. R... more From the Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Received: November 4, 2014 Accepted: May 21, 2015 Address reprint request and correspondence to: I-Ting Tsai, Department of Emergency Medicine, E-Da Hospital, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan. Tel: +886-7-6150011 ext. 3166, Fax: +886-7-6150915, E-mail: edahospitaled@gmail.com Case Report
We describe a 49-year-old diabetic man with intermittent left arm pain and frequent episodes of c... more We describe a 49-year-old diabetic man with intermittent left arm pain and frequent episodes of chest tightness, together with elevated serum C-reactive protein and glucose levels. Three days later, he manifested fever and painful swelling of his left elbow joint from which synovial fluid was aspirated. Both synovial fluid and blood culture subsequently revealed growth of Burkholderia Pseudomallei. Ceftazidime 1 gram every 6 hours intravenously was given for 25 days. The patient was discharged uneventfully. Melioidotic septic arthritis is uncommon but potentially fatal, especially in southern Taiwan where melioidosis is endemic. Prompt diagnosis through synovial fluid bacterial study and antibiotic coverage are crucial.
Although peripheral blood reticulocyte enumeration reflects bone marrow functional integrity, whi... more Although peripheral blood reticulocyte enumeration reflects bone marrow functional integrity, which is important for differential diagnosis of hematological diseases, the factors affecting its accuracy have not been adequately addressed. Using 100 consecutive venous blood samples being processed with four supravital staining techniques [i.e., brilliant cresyl blue (BCB), new methylene blue (NMB), and BCB/NMB with Liu’s stain] for reticulocyte enumeration, two technologists (senior vs. junior) conducted microscopic counting. The results were compared with those obtained with an automated system (Sysmex XE-5000) that served as the standard. The aims of this study were to identify (1) the technique that gave the most reliable outcome, and (2) possible human factors (i.e., seniority, repeated counting) that may affect the counting results. Analysis showed least bias (i.e., deviation from automated counting) associated with BCB staining, followed by NMB. In addition, the senior observer ...
Background p-Cresylsulfate (PCS) is a protein-bound uremic toxin that accumulates in patients wit... more Background p-Cresylsulfate (PCS) is a protein-bound uremic toxin that accumulates in patients with chronic kidney disease. Previous studies have indicated that serum total PCS levels are significantly increased in the presence of abnormal corrected QT (QTc) intervals, and that they are associated with QTc prolongation. However, the QTc prolongation effect of PCS remains unclear. The current study aimed to investigate the arrhythmogenic effect of PCS using in vitro experiments and computer simulation. Methods The arrhythmogenic effect of PCS was evaluated by incubating H9c2 rat ventricular cardiomyocytes in vitro with increasing concentrations of PCS. Electrophysiological studies and mathematical computer simulations were performed. Results in vitro, the delayed rectifier potassium current (IK ) was significantly decreased in a dose-dependent manner after treatment with PCS. The modulation of PCS on IK was through regulation of the phosphorylation of the major potassium ion channel p...
Swallowing a toothbrush is a rare event. We report a 35-year-old schizophrenic man who swallowed ... more Swallowing a toothbrush is a rare event. We report a 35-year-old schizophrenic man who swallowed a toothbrush at least 3 months before the development of severe abdominal pain. He was transferred from a psychiatric institution to our emergency department where peritonitis was noted, Plain radiographs showed pneumoperitoneum and an intra-abdominal foreign body. During emergency laparotomy perforation in the duodenal third portion caused by a toothbrush was revealed, He had an uneventful postoperative recovery, and was transferred to the psychiatric ward eight days after surgery.
Crepitus happened into the soft tissue is indicated subcutaneous emphysema. Subcutaneous emphysem... more Crepitus happened into the soft tissue is indicated subcutaneous emphysema. Subcutaneous emphysema of leg without trauma was likely to diagnose gas gangrene or gas-forming myonecrosis (GFM) at emergency department (ED). On the other hand, abdominal fatal condition with gas from the gut may spread to the leg should be considered a different diagnosis. We report a case of critically ill patient who presented to the ED with initial features suggestive of necrotizing fasciitis with gas gangrene of left leg. Assessment and further intervention revealed subcutaneous emphysema of leg secondary to a perforation of rectum associated with previous anastomosis site for rectal cancer surgery. Subcutaneous emphysema of the leg rarely happened secondary to perforation of the gastrointestinal tract and has often created serious diagnostic problems which may lead to mortality. Consequently, prompt diagnosis and aggressive treatment is imperative. Physicians and surgeons should be aware of this cond...
Pneumoperitoneum, a common manifestation in patients with acute abdomen, is usually considered an... more Pneumoperitoneum, a common manifestation in patients with acute abdomen, is usually considered an indication for surgical intervention when combined with peritoneal signs such as in hollow viscera perforation. To date, only a few cases of spontaneous pneumoperitoneum secondary to a ruptured liver abscess have been reported. We describe a rare case in an 84-year-old woman complaining of progressive abdominal pain and vomiting for 2 days. Computed tomography of the abdomen revealed a gas-containing liver abscess complicated by pneumoperitoneum. She refused surgery and pig-tail drainage and her condition rapidly deteriorated despite antibiotic treatment. She died soon after admission to the hospital.
Camphorated oil is usually applied externally as a topical analgesic, anti-infective, rubefacient... more Camphorated oil is usually applied externally as a topical analgesic, anti-infective, rubefacient, and antipruritic agent. Although it is considered a natural product with negligible toxicity, camphor poisoning has been documented, especially in children. Common symptoms include headache, vomiting, agitation, hallucinations, and convulsions. We report an 84-year-old woman who ingested a large amount of camphor oil in a suicide attempt and presented to our emergency department with hypothermia, miosis, junctional bradycardia, acute pulmonary edema, and acute renal failure. She died of dysrhythmia and profound shock on the second day of hospitalization.
This study aimed at investigating the impact of hemolysis on different coagulation parameters. A ... more This study aimed at investigating the impact of hemolysis on different coagulation parameters. A total of 216 venous blood samples without visible hemolysis were collected from adult patients at a tertiary referral center over six months. The plasma obtained was quantified for six coagulation parameters including prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, antithrombin III, and protein C. The rest of the plasma from each blood sample was aliquoted into three tubes, each containing 1 mL of plasma with three different volumes of cell-free hemoglobin (i.e., 2, 4, 8 μL) from lysed RBCs to create simulated hemolyzed blood samples with hemoglobin concentration of approximately 0.1, 0.2, and 0.4 g/dL to mimic mild (1+), moderate (2+), and severe (3+) hemolysis, respectively, before repeating the coagulation tests to determine possible correlation between the simulated degree of hemolysis and the changes in test results of the coagulation parameters. Spearm...
Investigation of physician-related causes of unscheduled revisits to the emergency department (ED... more Investigation of physician-related causes of unscheduled revisits to the emergency department (ED) within 72 h with subsequent admission to the intensive care unit (ICU) is an important parameter of emergency care quality. Between 2012 and 2017, medical records of all adult patients who visited the ED and returned within 72 h with subsequent ICU admission were retrospectively reviewed by three experienced emergency physicians. Study parameters were categorized into “input” (Patient characteristics), “throughput” (Time spent on first ED visit and seniority of emergency physicians, and “output” (Charlson Comorbidity Index). Of the 147 patients reviewed for the causes of ICU admission, 35 were physician-related (23.8%). Eight belonged to more urgent categories, whereas the majority (n = 27) were less urgent. Patients who spent less time on their first ED visits before discharge (< 2 h) were significantly associated with physician-related causes of ICU admission, whereas there was no...
To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of... more To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of pulmonary embolism (PE) with mortality and risk factors for PE as well as the therapeutic benefit of anticoagulant prophylaxis. Embase, PubMed, Cochrane controlled trials register, and Web of Science databases were searched from inception to October 10, 2020. We included all published trials on PE in patients diagnosed with COVID-19 with eligibility of the trials assessed following the PRISMA guidelines. Sixteen clinical trials with 5826 patients were eligible. There were significant associations of PE with the male gender [odd ratio (OR) = 1.59, 95% CI 1.28–1.97], mechanical ventilation (OR = 3.71, 95% CI 2.57–5.36), intensive care unit admission (OR = 2.99, 95% CI 2.11–4.23), circulating D-dimer [mean difference (MD) = 5.04 µg/mL, 95% CI 3.67–6.42) and CRP (MD = 1.97 mg/dL, 95% CI 0.58– 3.35) concentrations without significant correlation between PE and mortality (OR = 1.31, 95% CI 0....
The proliferation and migration of vascular smooth muscle cells (VSMCs) are essential in the path... more The proliferation and migration of vascular smooth muscle cells (VSMCs) are essential in the pathogenesis of various vascular diseases, such as atherosclerosis and restenosis. Among the mediators of VSMC during atherosclerosis development, platelet-derived growth factor (PDGF)-BB is a potent mitogen for VSMCs and greatly contributes to the intimal accumulation of VSMCs. Glossogyne tenuifolia (GT, Xiang-Ru) is a traditional antipyretic and hepatoprotective herb from Penghu Island, Taiwan. This study evaluated the inhibitory effect of GT ethanol extract (GTE) and GT water extract (GTW) on proliferative and migratory activities in PDGF-BB-induced VSMCs. The experimental results demonstrated that GTE significantly inhibited the PDGF-BB-stimulated VSMC proliferation and migration, as shown by MTT, wound healing, and Boyden chamber assays. GTE was found to have a much more potent inhibitory activity than GTW. Based on the Western blot analysis, GTE significantly blocked the PDGF-BB-induce...
From the Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. R... more From the Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Received: November 4, 2014 Accepted: May 21, 2015 Address reprint request and correspondence to: I-Ting Tsai, Department of Emergency Medicine, E-Da Hospital, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan. Tel: +886-7-6150011 ext. 3166, Fax: +886-7-6150915, E-mail: edahospitaled@gmail.com Case Report
We describe a 49-year-old diabetic man with intermittent left arm pain and frequent episodes of c... more We describe a 49-year-old diabetic man with intermittent left arm pain and frequent episodes of chest tightness, together with elevated serum C-reactive protein and glucose levels. Three days later, he manifested fever and painful swelling of his left elbow joint from which synovial fluid was aspirated. Both synovial fluid and blood culture subsequently revealed growth of Burkholderia Pseudomallei. Ceftazidime 1 gram every 6 hours intravenously was given for 25 days. The patient was discharged uneventfully. Melioidotic septic arthritis is uncommon but potentially fatal, especially in southern Taiwan where melioidosis is endemic. Prompt diagnosis through synovial fluid bacterial study and antibiotic coverage are crucial.
Although peripheral blood reticulocyte enumeration reflects bone marrow functional integrity, whi... more Although peripheral blood reticulocyte enumeration reflects bone marrow functional integrity, which is important for differential diagnosis of hematological diseases, the factors affecting its accuracy have not been adequately addressed. Using 100 consecutive venous blood samples being processed with four supravital staining techniques [i.e., brilliant cresyl blue (BCB), new methylene blue (NMB), and BCB/NMB with Liu’s stain] for reticulocyte enumeration, two technologists (senior vs. junior) conducted microscopic counting. The results were compared with those obtained with an automated system (Sysmex XE-5000) that served as the standard. The aims of this study were to identify (1) the technique that gave the most reliable outcome, and (2) possible human factors (i.e., seniority, repeated counting) that may affect the counting results. Analysis showed least bias (i.e., deviation from automated counting) associated with BCB staining, followed by NMB. In addition, the senior observer ...
Background p-Cresylsulfate (PCS) is a protein-bound uremic toxin that accumulates in patients wit... more Background p-Cresylsulfate (PCS) is a protein-bound uremic toxin that accumulates in patients with chronic kidney disease. Previous studies have indicated that serum total PCS levels are significantly increased in the presence of abnormal corrected QT (QTc) intervals, and that they are associated with QTc prolongation. However, the QTc prolongation effect of PCS remains unclear. The current study aimed to investigate the arrhythmogenic effect of PCS using in vitro experiments and computer simulation. Methods The arrhythmogenic effect of PCS was evaluated by incubating H9c2 rat ventricular cardiomyocytes in vitro with increasing concentrations of PCS. Electrophysiological studies and mathematical computer simulations were performed. Results in vitro, the delayed rectifier potassium current (IK ) was significantly decreased in a dose-dependent manner after treatment with PCS. The modulation of PCS on IK was through regulation of the phosphorylation of the major potassium ion channel p...
Swallowing a toothbrush is a rare event. We report a 35-year-old schizophrenic man who swallowed ... more Swallowing a toothbrush is a rare event. We report a 35-year-old schizophrenic man who swallowed a toothbrush at least 3 months before the development of severe abdominal pain. He was transferred from a psychiatric institution to our emergency department where peritonitis was noted, Plain radiographs showed pneumoperitoneum and an intra-abdominal foreign body. During emergency laparotomy perforation in the duodenal third portion caused by a toothbrush was revealed, He had an uneventful postoperative recovery, and was transferred to the psychiatric ward eight days after surgery.
Crepitus happened into the soft tissue is indicated subcutaneous emphysema. Subcutaneous emphysem... more Crepitus happened into the soft tissue is indicated subcutaneous emphysema. Subcutaneous emphysema of leg without trauma was likely to diagnose gas gangrene or gas-forming myonecrosis (GFM) at emergency department (ED). On the other hand, abdominal fatal condition with gas from the gut may spread to the leg should be considered a different diagnosis. We report a case of critically ill patient who presented to the ED with initial features suggestive of necrotizing fasciitis with gas gangrene of left leg. Assessment and further intervention revealed subcutaneous emphysema of leg secondary to a perforation of rectum associated with previous anastomosis site for rectal cancer surgery. Subcutaneous emphysema of the leg rarely happened secondary to perforation of the gastrointestinal tract and has often created serious diagnostic problems which may lead to mortality. Consequently, prompt diagnosis and aggressive treatment is imperative. Physicians and surgeons should be aware of this cond...
Pneumoperitoneum, a common manifestation in patients with acute abdomen, is usually considered an... more Pneumoperitoneum, a common manifestation in patients with acute abdomen, is usually considered an indication for surgical intervention when combined with peritoneal signs such as in hollow viscera perforation. To date, only a few cases of spontaneous pneumoperitoneum secondary to a ruptured liver abscess have been reported. We describe a rare case in an 84-year-old woman complaining of progressive abdominal pain and vomiting for 2 days. Computed tomography of the abdomen revealed a gas-containing liver abscess complicated by pneumoperitoneum. She refused surgery and pig-tail drainage and her condition rapidly deteriorated despite antibiotic treatment. She died soon after admission to the hospital.
Camphorated oil is usually applied externally as a topical analgesic, anti-infective, rubefacient... more Camphorated oil is usually applied externally as a topical analgesic, anti-infective, rubefacient, and antipruritic agent. Although it is considered a natural product with negligible toxicity, camphor poisoning has been documented, especially in children. Common symptoms include headache, vomiting, agitation, hallucinations, and convulsions. We report an 84-year-old woman who ingested a large amount of camphor oil in a suicide attempt and presented to our emergency department with hypothermia, miosis, junctional bradycardia, acute pulmonary edema, and acute renal failure. She died of dysrhythmia and profound shock on the second day of hospitalization.
This study aimed at investigating the impact of hemolysis on different coagulation parameters. A ... more This study aimed at investigating the impact of hemolysis on different coagulation parameters. A total of 216 venous blood samples without visible hemolysis were collected from adult patients at a tertiary referral center over six months. The plasma obtained was quantified for six coagulation parameters including prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, antithrombin III, and protein C. The rest of the plasma from each blood sample was aliquoted into three tubes, each containing 1 mL of plasma with three different volumes of cell-free hemoglobin (i.e., 2, 4, 8 μL) from lysed RBCs to create simulated hemolyzed blood samples with hemoglobin concentration of approximately 0.1, 0.2, and 0.4 g/dL to mimic mild (1+), moderate (2+), and severe (3+) hemolysis, respectively, before repeating the coagulation tests to determine possible correlation between the simulated degree of hemolysis and the changes in test results of the coagulation parameters. Spearm...
Investigation of physician-related causes of unscheduled revisits to the emergency department (ED... more Investigation of physician-related causes of unscheduled revisits to the emergency department (ED) within 72 h with subsequent admission to the intensive care unit (ICU) is an important parameter of emergency care quality. Between 2012 and 2017, medical records of all adult patients who visited the ED and returned within 72 h with subsequent ICU admission were retrospectively reviewed by three experienced emergency physicians. Study parameters were categorized into “input” (Patient characteristics), “throughput” (Time spent on first ED visit and seniority of emergency physicians, and “output” (Charlson Comorbidity Index). Of the 147 patients reviewed for the causes of ICU admission, 35 were physician-related (23.8%). Eight belonged to more urgent categories, whereas the majority (n = 27) were less urgent. Patients who spent less time on their first ED visits before discharge (< 2 h) were significantly associated with physician-related causes of ICU admission, whereas there was no...
To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of... more To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of pulmonary embolism (PE) with mortality and risk factors for PE as well as the therapeutic benefit of anticoagulant prophylaxis. Embase, PubMed, Cochrane controlled trials register, and Web of Science databases were searched from inception to October 10, 2020. We included all published trials on PE in patients diagnosed with COVID-19 with eligibility of the trials assessed following the PRISMA guidelines. Sixteen clinical trials with 5826 patients were eligible. There were significant associations of PE with the male gender [odd ratio (OR) = 1.59, 95% CI 1.28–1.97], mechanical ventilation (OR = 3.71, 95% CI 2.57–5.36), intensive care unit admission (OR = 2.99, 95% CI 2.11–4.23), circulating D-dimer [mean difference (MD) = 5.04 µg/mL, 95% CI 3.67–6.42) and CRP (MD = 1.97 mg/dL, 95% CI 0.58– 3.35) concentrations without significant correlation between PE and mortality (OR = 1.31, 95% CI 0....
The proliferation and migration of vascular smooth muscle cells (VSMCs) are essential in the path... more The proliferation and migration of vascular smooth muscle cells (VSMCs) are essential in the pathogenesis of various vascular diseases, such as atherosclerosis and restenosis. Among the mediators of VSMC during atherosclerosis development, platelet-derived growth factor (PDGF)-BB is a potent mitogen for VSMCs and greatly contributes to the intimal accumulation of VSMCs. Glossogyne tenuifolia (GT, Xiang-Ru) is a traditional antipyretic and hepatoprotective herb from Penghu Island, Taiwan. This study evaluated the inhibitory effect of GT ethanol extract (GTE) and GT water extract (GTW) on proliferative and migratory activities in PDGF-BB-induced VSMCs. The experimental results demonstrated that GTE significantly inhibited the PDGF-BB-stimulated VSMC proliferation and migration, as shown by MTT, wound healing, and Boyden chamber assays. GTE was found to have a much more potent inhibitory activity than GTW. Based on the Western blot analysis, GTE significantly blocked the PDGF-BB-induce...
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