Publications (21)85.5 Total impact
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Article: Spontaneous bacterial empyema.
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ABSTRACT: Spontaneous bacterial empyema (SBEM) is defined as spontaneous infection of a preexisting hepatic hydrothorax. SBEM is diagnosed after exclusion of pneumonia, and, in patients with liver cirrhosis, it is still associated with significant morbidity and mortality. To date, studies focusing on SBEM are rare. This review will highlight the recent data focusing on the clinical characteristics, bacteriology, management, and outcome predictors of cirrhotic patients with SBEM. The Enterobacteriaceae (Escherichia coli and Klebsiella pneumoniae) are the major causative pathogens isolated from SBEM patients. Therefore, the cornerstone of therapy is antibiotic therapy with immediate empirical use of third-generation cephalosporins as first-line treatment. Chest-tube placement is not necessary. Regression analysis identified three independent factors related to poor outcome: high score of the model for end-stage liver disease-sodium (MELD-Na), initial ICU admission, and initial antibiotic treatment failure. High MELD-Na score may be a useful predictor of SBEM mortality in cirrhotic patients. Although SBEM is a rare complication of cirrhosis, the high mortality rate should increase physicians' index of suspicion in cirrhotic patients with hydrothorax and prompt immediate diagnostic thoracentesis. The MELD-Na score rather than Child-Pugh score may be a strong predictor of in-hospital mortality of SBEM patients.Current opinion in pulmonary medicine 03/2012; 18(4):355-8. · 3.08 Impact Factor -
Article: Cavitary pulmonary opacity in a diabetic patient.
Internal Medicine 01/2012; 51(15):2061-2. · 0.94 Impact Factor -
Article: Role of gallium-67 scintigraphy in the evaluation of occult sepsis in the medical ICU.
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ABSTRACT: Patients in intensive care units (ICUs) frequently have multiple infections or persistent fever despite management. The aim of this study was to evaluate the diagnostic contribution of gallium-67 scintigraphy in ICU patients with suspected occult sepsis. One hundred and seventeen patients (>18 years) who had undergone gallium-67 scintigraphy in the ICU of our medical center over a 3-year period were retrospectively reviewed and analyzed. Patients were categorized into Group 1 (n = 84), those with a known infectious source, but who still had persistent fever or sepsis despite antibiotic treatment or abscess drainage; or Group 2 (n = 33), those without an evident infectious source after clinical, physical, and imaging studies. Among the 117 patients, 19 (16.2%) had a new diagnosis. In Group 1, 12 patients (14%) had a new infection, including pneumonia (4 patients), bed sore infection (2 patients), pulmonary tuberculosis (2 patients), leg cellulitis (1 patient), psoas muscle abscess (1 patient), osteomyelitis (1 patient), and infective endocarditis (1 patient). In Group 2, seven patients (21.2%) had a new infectious source, including septic arthritis (3 patients), osteomyelitis (2 patients), neck abscess (1 patient), and cholecystitis (1 patient). Significant differences were not observed between patients with positive and negative findings on gallium-67 scintigraphy in characteristics, underlying diseases, laboratory data, and outcomes. Gallium-67 scintigraphy helped to detect new or additional infectious sites, particularly bone, joint, and soft tissues. However, differences in hospital stay and mortality were not observed between patients with positive and negative findings.Internal and Emergency Medicine 12/2011; 7(1):53-8. · 2.06 Impact Factor -
Article: Intestinal obstruction caused by small bowel volvulus.
The American journal of medicine 07/2011; 124(11):e3-4. · 4.47 Impact Factor -
Article: Outcome predictors of cirrhotic patients with spontaneous bacterial empyema.
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ABSTRACT: Spontaneous bacterial empyema (SBE) is a complication of cirrhotic patients in which a pre-existing pleural effusion becomes infected. This retrospective study was designed to investigate the bacteriology and outcome predictors of SBE in cirrhotic patients. Medical records of cirrhotic patients treated in a tertiary care university hospital from December 2004 to December 2008 were retrospectively reviewed. Of 3390 cirrhotic patients seen during the study period, 81 cases of SBE were diagnosed. The incidence of SBE was 2.4% (81/3390) in cirrhotic patients and 16% (81/508) in patients with cirrhosis with hydrothorax. There were 46 monomicrobial infections found in 46 SBE patients. Aerobic Gram-negative organisms were the predominant pathogens (n=29, 63%), and Escherichia coli (n=9, 20%) was the most frequently isolated sole pathogen. The mortality rate of SBE was 38% (31/81). Univariate analysis showed that Child-Pugh score, model for end-stage liver disease (MELD)-Na score, concomitant bacteraemia, concomitant spontaneous bacterial peritonitis, initial intensive care unit (ICU) admission and initial antibiotic treatment failure were predictors of poor outcomes. Multivariate regression analysis demonstrated that the independent factors related to a poor outcome were initial ICU admission [odds ratio (OR): 4.318; 95% confidence interval 1CI) 1.09-17.03; P=0.037], MELD-Na score (OR: 1.267; 95% CI 1.08-1.49; P=0.004) and initial antibiotic treatment failure (OR: 13.10; 95% CI 2.60-66.03). Spontaneous bacterial empyema in cirrhotic patients is a high mortality complication. The independent factors related to poor outcome are high MELD-Na score, initial ICU admission and initial antibiotic treatment failure. High MELD-Na score may be a useful mortality predictor of SBE in cirrhotic patients.Liver international: official journal of the International Association for the Study of the Liver 03/2011; 31(3):417-24. · 3.82 Impact Factor -
Article: Subcutaneous seroma after diagnostic thoracentesis.
Canadian Medical Association Journal 11/2010; 183(3):345. · 8.22 Impact Factor -
Article: Ultrasound-guided pigtail catheters for drainage of various pleural diseases.
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ABSTRACT: Little is known about the efficacy and safety of ultrasound-guided pigtail catheters for the management of various pleural diseases in the emergency department, ward, and intensive care unit. We conducted a retrospective study in a university hospital during a 1-year interval. A total of 276 patients (178 men and 98 women) underwent 332 pigtail catheters (the drain size ranged from 10F to 16F) under ultrasound guidance. The mean ± SEM patient age was 59 ± 18 years, and mean duration of drainage was 6.1 ± 2 days. A total of 64 drains (19.2%) were inserted for pneumothoraces; 98 drains (29.5%), for malignant effusions; 119 drains (35.8%), for parapneumonic effusions/empyemas; and 38 drains (11.4%), for massive transudate pleural effusions. The overall success rate was 72.9%. The success rate was highest when the drain was used to treat massive transudate effusions (81.6%) and malignant pleural effusions (75.5%), followed by parapneumonic effusions/empyemas (72.2%), hemothoraces (66.6%), and pneumothoraces (64.0%). Only 10 (3.0%) drains had complications due to the procedure, including infection (n = 4, 1.2%), dislodgment (n = 4, 1.2%), wound bleeding at the pigtail catheter puncture area complicated with hemothoraces (n = 1, 0.3%), and lung puncture (n = 1, 0.3%). There was no significant difference in success rate when different catheter sizes were used to treat pleural diseases. Ultrasound-guided pigtail catheters provide a safe and effective method of draining various pleural diseases. We strongly suggest that ultrasound-guided pigtail catheters be considered as the initial draining method for a variety of pleural diseases.The American journal of emergency medicine 10/2010; 28(8):915-21. · 1.54 Impact Factor -
Article: Secondary spontaneous pneumothorax: which associated conditions benefit from pigtail catheter treatment?
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ABSTRACT: The study aimed to assess the clinical efficacy of pigtail catheter drainage for patients with a first episode of secondary spontaneous pneumothorax (SSP) and different associated conditions. We retrospectively reviewed the records of patients with SSP who received pigtail catheter drainage as their initial management between July 2002 and October 2009. A total of 168 patients were included in the analysis; 144 (86%) males and 24 (14%) females with a mean age of 60.3 ± 18.3 years (range, 17-91 years). Data regarding demographic characteristics, pneumothorax size, complications, treatments, length of hospital stay, and associated conditions were analyzed. In total, 118 (70%) patients were successfully treated with pigtail catheter drainage, and 50 (30%) patients required further management. Chronic obstructive lung disease was the most common underlying disease (57% of cases). Secondary spontaneous pneumothorax associated with infectious diseases had a higher rate of treatment failure than SSP associated with obstructive lung conditions (19/38 [50%] successful vs 78/104 [75%] successful, P = .004) and malignancy (19/38 [50%] successful vs 13/16 [81%] successful, P = .021). Moreover, patients with SSP associated with infectious diseases had a longer length of hospital stay than those with obstructive lung conditions (23.8 vs 14.5 days, P = .003) and malignancy (23.8 vs 12.1 days, P = .017). No complications were associated with pigtail catheter drainage. A higher rate of treatment failure was noted in SSP patients with infectious diseases; thus, pigtail catheter drainage is appropriate as an initial management for patients with SSPs associated with obstructive lung conditions and malignancy.The American journal of emergency medicine 10/2010; 30(1):45-50. · 1.54 Impact Factor -
Article: Black pleural effusion in melanoma.
Canadian Medical Association Journal 04/2010; 182(8):E314. · 8.22 Impact Factor -
Article: Transthoracic ultrasonography in predicting the outcome of small-bore catheter drainage in empyemas or complicated parapneumonic effusions.
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ABSTRACT: Thoracic sonography has been advocated as being complementary to small-bore catheter drainage in pleural effusions. However, it is not known whether the initial sonographic appearances of empyemas or complicated parapneumonic effusions (CPPEs) can predict the outcomes of small-bore catheter drainage for these pleural insults. This retrospective study investigated the outcomes of patients who had been diagnosed with empyema and CPPE and had received ultrasound-guided small-bore catheter (size from 12F to 16F) drainage in a tertiary university hospital from September 2005 to August 2007. Patients were excluded when empyemas or CPPEs were traumatic, they were less than 18 years old or their charts were incomplete. We evaluated 141 small-bore catheters in 70 patients with empyemas and 71 patients with CPPEs over a two-year period. The mean age was 58+/-15 y and the male gender was more frequent (112 men, 79%). The overall successful rate of small-bore catheter drainage in empyemas or CPPEs was 63% (89/141). The sonographic appearances of these empyemas or CPPEs exhibited a complex septated pattern in 57% (81/141) of patients and a complex nonseptated pattern in 43% (60/141) of patients. The success rate in a complex nonseptated sonographic pattern was significantly higher than in a complex septated sonographic pattern (48/60, 80% vs. 41/81, 51%, respectively; p=0.001). Moreover, patients with complex septated sonographic patterns also had higher intensive care unit admission rates compared with nonseptated sonographic patterns (22/81, 27%, vs. 8/60, 13%, respectively; p=0.0047), as well as infection-related mortality rates (17/81, 21% vs. 4/60, 7%, respectively; p=0.018). The appearance of sonographic septation is a useful sign to help predict the outcome of small-bore catheter drainage in cases of empyemas or CPPEs. Patients with a complex septated sonographic pattern have a poorer prognosis for a successful outcome, higher ICU admission rate and a higher mortality rate.Ultrasound in medicine & biology 08/2009; 35(9):1468-74. · 2.02 Impact Factor -
Article: Systemic and bronchoalveolar cytokines as predictors of in-hospital mortality in severe community-acquired pneumonia.
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ABSTRACT: The aim of this study was to determine whether cytokine expression (interleukin [IL]-1beta, IL-6, IL-8, IL-10, and tumor necrosis factor [TNF]-alpha), C-reactive protein, and endotoxins on the first day of intensive care unit (ICU) admission are associated with hospital mortality in severe community-acquired pneumonia (CAP). This was a prospective study with bronchoalveolar lavage (BAL) and blood sampling. This study was carried out in a 44-bed medical ICU of a 1700-bed university hospital. Participants included 112 mechanically ventilated patients with severe CAP. Serum and BAL fluid IL-1beta, IL-6, IL-8, IL-10, TNF-alpha, C-reactive protein, and endotoxins on the first day of ICU admission were obtained. The concentrations of TNF-alpha in BALF and IL-6, IL-8, IL-10, and TNF-alpha in serum were higher in nonsurvivors than in survivor patients with CAP. Of these 112 patients with severe CAP (39%), 44 developed acute respiratory distress syndrome (ARDS); these patients seemed to have higher serum IL-6, IL-8, and IL-10 levels than did the non-ARDS group. Furthermore, in the ARDS population, we found that the endotoxin levels in the BAL fluid were higher in the survival than in the nonsurvival group and BAL fluid concentrations of IL-6, IL-8, and IL-1beta and sera levels of IL-6 and IL-10 were lower in the survival than in the nonsurvival group, and they were associated with a high negative predictive value. Serum and BAL fluid levels of the studied cytokines on admission may provide valuable prognostic information for patients with severe CAP.Journal of critical care 08/2009; 25(1):176.e7-13. · 2.13 Impact Factor -
Article: Ultrasound in peripheral pulmonary air-fluid lesions. Color Doppler imaging as an aid in differentiating empyema and abscess.
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ABSTRACT: The aim of this study was to reevaluate the clinical significance of sonographic appearances, in particular the application of color Doppler ultrasound imaging, in discriminating peripheral air-fluid lung abscess from empyema. We retrospectively studied patients who had had peripheral air-fluid lesions due to empyema or lung abscess and who had undergone color Doppler ultrasound and grayscale ultrasound examinations between January 2003 and October 2007. A total of 34 patients with confirmed lung abscess and 30 patients with empyema were identified. The four sonographic characteristics observed and analyzed were the wall characteristics of the lesions (wall width, luminal margin, outer margin, and chest wall angle), split pleura sign, internal echogenicity (suspended microbubble sign, complex-septated effusions, and passive atelectasis), and identification of color Doppler ultrasound vessel signals in pericavitary lesions (consolidation or atelectasis). Among the sonographic characteristics, complex-septated effusions and passive atelectasis were specific for empyema, but the sensitivity was only 40% (n = 12 of 30) and 47% (n = 14 of 30), respectively. The identification of color Doppler ultrasound vessel signals in pericavitary consolidation was the most useful and specific for identifying lung abscesses. In our series, if we define the identification of color Doppler ultrasound vessel signals in a pericavitary consolidation as a predictor for peripheral lung abscess, we can achieve sensitivity, specificity, positive predictive value, and negative predictive value of 94%, 100%, 100%, and 94%, respectively. Color Doppler ultrasound is a powerful tool for differentiating the peripheral air-fluid abscess from empyema, with high specificity and without any risk.Chest 04/2009; 135(6):1426-32. · 5.25 Impact Factor -
Article: Endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis of a mediastinum mass with severe central airway obstruction after stenting.
Southern medical journal 03/2009; 102(3):337-8. · 0.92 Impact Factor -
Article: Outcome predictors of chronic renal disease patients with parapneumonic empyemas.
Southern medical journal 12/2008; 101(11):1187. · 0.92 Impact Factor -
Article: Anaplastic large-cell lymphoma presenting as an endobronchial polypoid tumor.
Journal of Clinical Oncology 10/2008; 26(29):4845-7. · 18.37 Impact Factor -
Article: Application of ultrasound-guided pigtail catheter for drainage of pleural effusions in the ICU.
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ABSTRACT: Little is known about the effectiveness of the pigtail catheter for drainage of pleural effusions in the intensive care unit (ICU). We conducted a retrospective review of adult patients (>/=18 years) who underwent ultrasound-guided pigtail catheter drainage of pleural effusions in the ICUs from January 2005 to July 2007 in a university hospital. Among the 133 enrolled patients, there were 93 (70%) males and 40 (30%) females, with a mean age of 63.7 +/- 15.4 years old. The reasons for pigtail drainage were as follows: thoracic empyema (n = 59, 44%), massive transudative pleural effusions (n = 33, 25%), postoperative pleural effusion (n = 29, 15%), malignant pleural effusion (n = 18, 14%) and traumatic hemothorax (n = 3, 2%). In comparing the total amount of fluids drained, the duration of drainage, success rate and complication rate among these different causes of pleural effusion, pigtail drainage for massive transudative pleural effusion yielded the largest amount of pleural fluids (5,382 +/- 4,844 ml), provided the longest duration of drainage (9 +/- 7 days), and had the highest complication rate (18%). The success rate was highest when used to treat traumatic hemothorax (100%) and postoperative pleural effusions (85%); drains inserted for empyema were more likely to fail (overall success rate, 42%). No significant insertion complications, such as hollow organ perforation, were caused by this procedure. The ultrasound-guided pigtail catheter inserted by intensivists is a well-tolerated and effective method of draining all kinds of pleural effusions in critically ill patients. We suggest that pigtail catheter drainage be considered as the initial treatment of choice in the ICU.European Journal of Intensive Care Medicine 10/2008; 35(2):350-4. · 5.17 Impact Factor -
Article: Clinical outcome and prognostic factors of patients with pyogenic liver abscess requiring intensive care.
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ABSTRACT: Despite improvements in diagnosis and treatment, pyogenic liver abscess remains a life-threatening disease. This study evaluated clinical outcome and prognostic factors in patients with pyogenic liver abscess admitted to the intensive care unit. Retrospective study. Medical and surgical intensive care unit in a 1,700-bed university-based hospital. Four hundred and thirty-six adult patients (> or = 18 yrs) with a diagnosis of pyogenic liver abscess were reviewed, and 72 patients with pyogenic liver abscess who required intensive care were enrolled in the study. None. Twenty of 72 enrolled patients died, yielding an intensive care unit mortality rate of 28%. The most common underlying disease was diabetes mellitus (51%), and the most common microorganism was Klebsiella pneumoniae (74%). Compared with survivors, nonsurvivors had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (22.2 +/- 9 vs. 13.7 +/- 6, p < .001), higher serum creatinine levels (2.9 +/- 2 vs. 1.9 +/- 2 mg/dL, p = .02), and longer prothrombin times (21 +/- 5 vs. 16 +/- 5 s, p = .01) on the first day of intensive care unit admission. In addition, factors associated with mortality included inadequate antibiotic therapy (p = .026), septic shock (p = .002), acute respiratory failure (p < .001), and acute renal failure (p = .043) on the first day of intensive care unit admission. On multivariate logistic regression analysis, factors that independently correlated with mortality were the presence of acute respiratory failure (p = .003, relative risk = 18.7) and APACHE II score > 16 (p = .026, relative risk = 7.43). In patients with pyogenic liver abscess requiring intensive care, variables including size of liver abscess, pathogens, comorbidity, and most laboratory data were not associated with mortality. Only the presence of acute respiratory failure and APACHE II score >16 on the first day of intensive care unit admission were significant prognostic factors.Critical care medicine 05/2008; 36(4):1184-8. · 6.37 Impact Factor -
Article: A feasible approach for extraction of dental prostheses from the airway by flexible bronchoscopy in concert with wire loop snares.
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ABSTRACT: Tracheobronchial foreign body (FB) aspiration is a common problem worldwide, and the aspired objects can be very difficult to remove. Bronchoscopic removal of airway FBs can be safely accomplished with both rigid as well as flexible bronchoscopes. It is well known that a rigid bronchoscope more easily removes large FBs located in the central bronchi. A wide variety of instruments, such as biopsy forceps, Fogarty balloon catheters, alligator forceps, or wire baskets, are commonly available for removal. Herein, we report the case of a 75-year-old man with an airway dental prosthesis, the shape and composition of which complicated its extraction from the nearly totally occluded left main bronchus, using biopsy forceps and wire baskets. We describe the successful extraction of the challenging FB with a flexible bronchoscope in concert with wire loop snares and the avoidance of rigid bronchoscopy or thoracotomy.The Laryngoscope 08/2007; 117(7):1280-2. · 1.75 Impact Factor -
Article: Different bacteriology and prognosis of thoracic empyemas between patients with chronic and end-stage renal disease.
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ABSTRACT: Bacterial infections are a well-documented complication in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). However, there are no previous studies of the empyemas that can develop in these patients. This retrospective study investigated the bacteriology and outcomes of empyema in stage 4 CKD (predialysis) and ESRD patients receiving long-term dialysis and treated in a tertiary university hospital from January 2001 to March 2006. Eighty-four stage 4 CKD patients and 40 ESRD patients had empyemas. Most empyemas (n = 77, 62%) were secondary to pneumonia. Empyema culture findings were positive in 102 patients (82%): 87 microorganism were isolated in pleural fluid from 67 stage 4 CKD patients, and 39 microorganisms were isolated in pleural fluid from 35 ESRD patients. Aerobic Gram-negative organisms (n = 58, 67%), especially Klebsiella pneumoniae (n = 20, 34%), were the predominant pathogens in stage 4 CKD patients; aerobic Gram-positive organisms (n = 21, 54%), especially Staphylococcus aureus (n = 14, 67%), were the main pathogens in ESRD patients. Compared to stage 4 CKD patients, ESRD patients had a significantly higher percentage of catheter infections (p = 0.002) and aerobic Gram-positive organism bacteremia (p = 0.001), as well as a lower aerobic Gram-negative organism infection rate (p < 0.001) and a lower infection-related mortality rate (p = 0.022). Stage 4 CKD patients and ESRD patients with empyema have different causative pathogens and outcomes. In ESRD patients, the dialysis catheter or the dialysis process appear to alter the microbiological flora responsible for empyema. This finding has clinical implications that clinicians need to consider.Chest 08/2007; 132(2):532-9. · 5.25 Impact Factor -
Article: Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults.
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ABSTRACT: It is still uncertain if large-bore chest tubes (20F-28F) is superior to pigtail catheter (10F-14F) in terms of the management of secondary spontaneous pneumothoraces (SSP). This study was designed to compare the efficacy and safety associated with placement of large-bore chest tubes vs pigtail catheters in adults experiencing the first episode of SSP. We conducted a retrospective chart review of 91 patients experiencing the first episode of SSP in a university hospital over a 3.5-year period who received treatment by either a large-bore chest tube or a pigtail catheter. Any patient who was younger than 18 years or experiencing mechanical ventilation-related barotraumas or pyopneumothorax was excluded from this study. Various parameters including demographical characteristics, size of pneumothorax, complications, time of pigtail or chest tube extubation, and length of hospital stay were collected and analyzed. Among the enrolled 91 patients, including 76 (83.5%) men with a mean age of 60 +/- 19 years, 69 were initially treated with a pigtail, and 22 patients received conventional chest tubes. Fifty patients (72.5%) undergoing the pigtail drainage and 16 (72.7%) undergoing large-bore chest tube treatment of SSP were successfully treated (P = .88). In addition, there was no significant difference in terms of length of hospital stay, extubation time, recurrence rate, and complication. Pigtail catheters offer a safe and effective alternative for large-bore chest tubes to adult patients experiencing the first episode of SSP, and we strongly suggested that pigtail tube drainage should be considered as the initial treatment of choice.American Journal of Emergency Medicine 12/2006; 24(7):795-800. · 1.98 Impact Factor
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2007–2012
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China Medical University Hospital
Taichung, Taiwan, Taiwan
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