[Show abstract][Hide abstract] ABSTRACT: Hydrogen sulfide inhibits mitochondrial cytochrome c oxidase, thereby causing tissue bioenergetic failure and respiratory paralysis. Brain injury that resembles hypoxic ischemic encephalopathy may thus ensue. Therapeutic hypothermia seems capable of reducing the severity of hypoxic ischemic encephalopathy in ventricular arrhythmia induced cardiac arrest patients. We report a case of hydrogen sulfide poisoning who developed central nervous system manifestations but was successfully treated with therapeutic hypothermia.
Full-text · Article · Feb 2015 · American Journal of Emergency Medicine
[Show abstract][Hide abstract] ABSTRACT: Excessive opening of the adenosine triphosphate-sensitive potassium channel in vascular smooth muscle is implicated in the vasodilation and vascular hyporeactivity underlying septic shock. Therapeutic channel inhibition using sulfonylurea agents has proved disappointing, although agents acting on its pore appear more promising. We thus investigated the hemodynamic effects of adenosine triphosphate-sensitive potassium channel pore inhibition in awake, fluid-resuscitated septic rats, and the extent to which these responses are modulated by the high sympathetic tone present in sepsis. Temporal changes in ex-vivo channel activity and subunit gene expression were also investigated.
In vivo and ex vivo animal study.
University research laboratory.
Male adult Wistar rats.
Fecal peritonitis was induced in conscious, fluid-resuscitated rats. Pressor responses to norepinephrine and PNU-37883A (a vascular adenosine triphosphate-sensitive potassium channel inhibitor acting on the Kir6.1 pore-forming subunit) were measured at 6 or 24 hrs, in the absence or presence of the autonomic ganglion blocker, pentolinium. The aorta and mesenteric artery were examined ex vivo for rubidium efflux as a marker of adenosine triphosphate-sensitive potassium channel activity, and for adenosine triphosphate-sensitive potassium channel subunit gene expression using quantitative reverse transcription-polymerase chain reaction.
A total of 120 rats (50 sham-operated controls, 70 septic) were included. Septic rats became hypotensive after 12 hrs, with a 24-hr mortality of 51.7% (0% in controls). At 6 hrs, there was an attenuated pressor response to norepinephrine (p < .01) despite blood pressure being elevated (p < .01). PNU-37883A had no pressor effect, except in the presence of pentolinium (p < .01). Kir6.1 subunit mRNA increased significantly in the mesenteric artery while rubidium efflux was increased in both the aorta and mesenteric artery at 24 hrs.
Despite evidence of increased adenosine triphosphate-sensitive potassium channel activity in sepsis, it appears to be inhibited in vivo by high sympathetic tone. This may explain, at least in part, the reduced efficacy of adenosine triphosphate-sensitive potassium channel blockers in human septic shock.
No preview · Article · Apr 2012 · Critical care medicine
[Show abstract][Hide abstract] ABSTRACT: Guillain-Barre syndrome is a leading cause of acute weakness in young and middle-aged people [1,2], but it can affect patients of all ages. The main features of Guillain-Barre syndrome are ascending limb weakness which is relatively symmetric and progresses rapidly, with or without involvement of respiratory or cranial nerve-innervated muscles. In typical cases, possible initial symptoms include pain, numbness, paraesthesia, or weakness of the limbs [3,4]. Guillain-Barre syndrome also has a significant mortality in the first month [5,6]; however, this condition is often initially misdiagnosed , because the initial symptoms are often nonspecific, and many clinical variants may present . Therefore, it is mandatory to maintain a high index of suspicion for this disease so as to prompt early diagnosis and treatment. Herein, we reported a case of Guillain-Barre syndrome who rapidly progressed to respiratory failure with an initial presentation of only acute urinary retention.
No preview · Article · Jul 2011 · The American journal of emergency medicine
[Show abstract][Hide abstract] ABSTRACT: Metaldehyde, a cyclic tetramer of acetaldehyde, is a widely used molluscicide. Although cases with acute metaldehyde poisoning have been reported, the occurrence of severe poisoning is uncommon. To provide more information on human metaldehyde poisoning, we reviewed 15 cases of metaldehyde exposure reported to the Taiwan National Poison Control Center at the Taipei Veterans General Hospital between 1991 and 2002. While 7 patients were asymptomatic, the other 8 patients, including 4 who coingested alcohol or other poisons, exhibited toxic manifestations of abdominal pain, dizziness, nausea, irritation of oral mucosa, and seizures after oral exposure. One patient died after ingesting 12 g (or 258.6 mg/kg) of metaldehyde. Although the toxicity from metaldehyde is largely mild, the clinical course of metaldehyde poisoning may be rapidly deteriorating and fatal on rare occasions. Physicians should therefore be cautious in managing patients with metaldehyde poisoning, and vigorous supportive measures should be promptly instituted in patients who manifest severe toxicity.
Full-text · Article · Jul 2004 · Veterinary and human toxicology
[Show abstract][Hide abstract] ABSTRACT: The seeds of cycads contain cycasin and neocycasin, which belong to the family of cyanogenic glycosides. These glycosides of cycads are considered pseudocyanogenic with little potential to liberate hydrogen cyanide as other cyanogenic glycosides do. This study investigated the clinical spectrum of Cycas seed poisoning and its cyanogenic potential.
This was a retrospective chart review conducted at the Poison Control Center in Taiwan (PCC-Taiwan) from 1990 to 2001.
Twenty-one cases of Cycas seed poisoning were identified. The reasons for seed ingestion were misuse as an edible food (70%), health promotion (10%), cancer prevention (10%), cosmetic use (5%), and gastrointestinal discomfort (5%). All patients had eaten the seeds after washing and cooking them. The time from ingestion to the onset of symptoms ranged from 30 min to 7 h (mean 2.8 h); patients had ingested between 1 to 30 seeds. Respiratory depression did not occur. Severe vomiting was the most striking symptom. All patients except one presented with gastrointestinal disturbance, and 90% sought medical care at the emergency department. Within 24 h, all patients had recovered. Six patients had blood cyanide or thiocyanate levels measured. Although the levels were higher than normal, they did not reach the toxic range.
The cyanogenic potential of Cycas seeds is documented in our cases. The gastrointestinal symptoms were severe enough that most patients sought medical attention but recovery was quick and complete.
No preview · Article · Feb 2004 · Journal of toxicology. Clinical toxicology
[Show abstract][Hide abstract] ABSTRACT: Procalcitonin (PCT) has been proposed as a marker of infection in critically ill patients; its level is related to the severity of infection. We evaluated the value of PCT as a marker of bacterial infection for emergency department patients.
This prospective observational study consecutively enrolled 120 adult atraumatic patients admitted through the emergency department of a 3000-bed tertiary university hospital in May 2001. Fifty-eight patients were infected and 49 patients were not infected. The white blood cell counts, the serum C-reactive protein (CRP) level (mg/l), and the PCT level (ng/ml) were compared between the infected and noninfected groups of patients.
A white blood cell count >12,000/mm3 or <4000/mm3 was present in 36.2% of the infected patients and in 18.4% of the noninfected patients. The best cut-off serum levels for PCT and CRP, identified using the Youden's Index, were 0.6 ng/ml and 60 mg/l, respectively. Compared with CRP, PCT had a comparable sensitivity (69.5% versus 67.2%), a lower specificity (64.6% versus 93.9%), and a lower area under the receiver operating characteristic curve (0.689 versus 0.879). PCT levels, but not CRP levels, were significantly higher in bacteremic and septic shock patients. Multivariate logistic regression identified that a PCT level >/= 2.6 ng/ml was independently associated with the development of septic shock (odds ratio, 38.3; 95% confidence interval, 5.6-263.5; P < 0.001).
PCT is not a better marker of bacterial infection than CRP for adult emergency department patients, but it is a useful marker of the severity of infection.
Preview · Article · Feb 2004 · Critical care (London, England)
[Show abstract][Hide abstract] ABSTRACT: Acute spontaneous tumor lysis syndrome (STLS) presenting with hyperuricemic acute renal failure (ARF) is a rare disease which can be overlooked in patients with neoplasic disorders, requiring prompt recognition and aggressive management. This study examined the incidence, clinical characteristics and prognosis of this condition.
A retrospective study was performed, reviewing the records of all patients who developed ARF at Chang Gung Memorial Hospital between 1st July 1999 and 30th October 2002. Acute STLS was diagnosed based on pretreatment hyperuricemic ARF, ratio of urinary uric acid to creatinine (Cr) >1.0, and significantly elevated lactate dehydrogenase (LDH) (>500 units/L), together with a pathologically proven malignancy. Clinical course, metabolic parameters, response to therapeutics and outcome were assessed in all patients.
STLS-induced acute uric acid nephropathy was identified in 10 out of 926 ARF patients (1.08%) studied. Most presentations were non-specific or related to malignancy symptoms. All patients had advanced tumors with large tumor burden, and abdominal organ involvement in 80% of patients. The 10 hyperuricemic patients became oliguric despite conservative therapy, and remained hyperuricemic (mean +/- SD: 20.7 +/- 5.0 mg/dL) until dialysis initiation. Seven patients (70%) developed diuresis, with an associated resolution of hyperuricemia, azotemia and metabolic derangements following dialysis initiation. The patients who developed diuresis had mean serum uric acid levels 9.3 +/- 3.1 mg/dL and median levels 9.8 mg/dL. Three patients (30%) survived, with two patients suffering residual renal function impairment.
Acute STLS presenting with hyperuricemic ARF is a rare cause of acute uric acid nephropathy in patients with bulky or occult neoplastic disorders. The tumors that developed STLS had advanced stage or large tumor burden. Frequent abdominal organ involvement and non-specific initial presentations can obscure the nature of the disease and delay diagnosis. Unlike hyperuricemia and oliguria, which are constant findings, azotemia or impaired renal function is not always manifest on initial presentation. Poor outcomes in patients with STLS developing acute uric acid nephropathy make early recognition, aggressive management and prompt dialysis mandatory.
No preview · Article · Nov 2003 · Journal of nephrology
[Show abstract][Hide abstract] ABSTRACT: Secondary aortoenteric fistula (SAF) is now recognized as an uncommon but exceedingly important complication of abdominal aortic reconstruction. The complication often occurs months to years after the original surgery. The main clinical manifestation of the disease is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. The mortality is high if no prompt operation. We present a case of secondary aortoduodenal fistula (SADF) found 20 days after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding. Even immediate exploratory laparotomy was performed, the patient died 48 hrs after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with SAF will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this actually life-threatening event.
Full-text · Article · Oct 2002 · Chang Gung medical journal
[Show abstract][Hide abstract] ABSTRACT: This investigation evaluates the feasibility of using C-reactive protein (CRP) levels as an indicator of bacterial infection of adult patients in the Emergency Department (ED), by comparing them with clinical signs and routine laboratory tests.
One hundred and fifty adult atraumatic patients admitted through the ED of Linkou Chang Gung Memorial Hospital were consecutively enrolled. Seventy-nine patients had documented infection, and 58 had no infection. Body temperature (BT), white blood cell (WBC) count, CRP levels, and the presence of systemic inflammatory response syndrome (SIRS) were compared between the infected and uninfected groups.
SIRS was the most sensitive indicator of bacterial infection (sensitivity 84.8%), but it had a 37.9% false-positive rate. BT and WBC count were more specific (at 89.7% and 84.5%) but less sensitive (at 48.1% and 43.0%, respectively). Using Youden's Index, the best cut-off value for CRP was 60 mg/l (sensitivity 67.1%, specificity 94.8%, positive predictive value 94.6%, and negative predictive value 67.9%). The area under the receiver operating characteristics (ROC) curve was highest for CRP (at 0.88), followed by BT (at 0.77) and WBC (at 0.67) (all p < 0.05).
CRP is a better indicator of bacterial infection than either BT or WBC count for adult atraumatic ED patients. A low serum CRP level cannot safely be used to exclude the presence of infection.
Preview · Article · Aug 2002 · Chang Gung medical journal
[Show abstract][Hide abstract] ABSTRACT: Button batteries represent a distinct type of foreign body. Serious complications can be resulted, particularly when the battery is impacted in the esophagus. The potentially detrimental effects of button battery ingestion have often been overlooked in Taiwan. We surveyed patients following button battery ingestion to define the characteristics and outcomes of this population.
The records of 25 patients with button battery ingestion that had been reported to the Taipei Veterans General Hospital Poison Control Center from July 1988 through January 1998 were retrospectively reviewed.
Button battery ingestion occurred most commonly in male children (N=20; 80%) and children under 3 years of age (N= 19; 76%). Most children were asymptomatic (N=22; 88%). Two children suffered abdominal pain, and one suffered dyspnea and stridor. Reported complications included black stools (N=3) and tracheoesophageal fistula formation (N= 1). Two children underwent endoscopic battery removal, and batteries passed the entire gastrointestinal tract in all other subjects. The interval between battery ingestion and passage when documented (N= 16) was never more than 5 days.
Most ingested batteries passed through the gastrointestinal tract without any adverse effects. An initial roentgenogram should be obtained promptly to determine battery location and diameter, and the battery's chemical composition should be determined when possible. Esophageal impaction of the batteries requires emergency endoscopic or surgical removal. For patients without esophageal impaction, conservative intervention is recommended in the absence of symptoms and signs of injury.