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Chong VH, Chong CF. Helicobacter pylori infection and colorectal neoplasm. QJM 2020; 113:589-590. [PMID: 31529089 DOI: 10.1093/qjmed/hcz235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V H Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam
- PAPRSB Institute of Health Science, Universiti Brunei Darussalam, Brunei Darussalam
| | - C F Chong
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam
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2
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Lin LW, Chong CF. Saliva ejector assisted laryngoscopy (SEAL) for protective intubation. Am J Emerg Med 2020; 43:270-271. [PMID: 32631772 PMCID: PMC7334141 DOI: 10.1016/j.ajem.2020.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 01/25/2023] Open
Affiliation(s)
- Li-Wei Lin
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan; School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan; CrazyatLAB (Critical Airway Training Laboratory), Taipei, Taiwan
| | - Chee-Fah Chong
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan; School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.
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Affiliation(s)
- Li-Wei Lin
- Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City
- School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City
- CrazyatLAB (Critical Airway Training Laboratory), Taipei City
| | - Chee-Fah Chong
- Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City
- School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City
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Affiliation(s)
- S Y Tan
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - C F Chong
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan, Brunei
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Tan SY, Chong CF, Chong VH. Response to: Approach to evaluation of choledocholithiasis in patient with or without acute cholangitis. QJM 2020; 113:449-450. [PMID: 32125414 DOI: 10.1093/qjmed/hcaa076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C F Chong
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
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Chong CF. Dividing the Emergency Department into Red, Yellow, and Green Zones to Control COVID-19 Infection; a Letter to Editor. Arch Acad Emerg Med 2020; 8:e60. [PMID: 32613202 PMCID: PMC7305635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
COVID-19, in certain respects, can be viewed as a CBRN (chemical, biological, radiological, or nuclear) event due to being a consequence of SARS-CoV2 virus (the "contaminant"). We, thus, reorganized our emergency department (ED) into 3 distinct zones (red, yellow, and green) for the purpose of infection control. Patients with high or medium risk of COVID-19 infection are managed in the red zones. Low-risk patients are managed in the yellow zones. All patients are prohibited to enter the green zones. Green zones are used by healthcare providers (HCPs) for personal protective equipment (PPE) donning, inventory, planning, and dining. Only HCPs who work in the red zones are required to use full level PPE (aerosol precaution). HCPs working in the yellow zones require less PPE (contact and droplet precaution). No PPE is required in the green zones. Establishing red, yellow, and green zones in the ED can be helpful in reducing cross-infections and minimizing demand for PPE.
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Affiliation(s)
- Chee-Fah Chong
- School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan. ,Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.,Corresponding author: Chee-Fah Chong, Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95, Wenchang Road, Shilin District. Taipei City 111, Taiwan. Tel: 886-2-28332211; Fax: 886-2-28353547, . ORCID ID: https://orcid.org/0000-0002-3665-8686
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Lin LW, Huang CC, Ong JR, Chong CF, Wu NY, Hung SW. The suction-assisted laryngoscopy assisted decontamination technique toward successful intubation during massive vomiting simulation: A pilot before-after study. Medicine (Baltimore) 2019; 98:e17898. [PMID: 31725637 PMCID: PMC6867733 DOI: 10.1097/md.0000000000017898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.
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Affiliation(s)
- Li-Wei Lin
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital
- School of Medicine, Fu Jen Catholic University
| | | | - Jiann Ruey Ong
- Emergency Department, Shuang-Ho Hospital, New Taipei City
- Department of Emergency Medicine, School of Medicine, Taipei Medical University
| | - Chee-Fah Chong
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital
- School of Medicine, Fu Jen Catholic University
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Wen Hung
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital
- School of Medicine, Fu Jen Catholic University
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Kao JS, Mao D, Wang RF, Chong CF, Chen KC. Confirmation of endotracheal tube placement with ultrasound - direct visualisation with anterior neck compression and continued surveillance. Anaesth Crit Care Pain Med 2019; 38:393-394. [PMID: 29800629 DOI: 10.1016/j.accpm.2018.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Jui Shih Kao
- Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, 95, Wenchang Road, Shilin District, Taipei, Taiwan
| | - Desmond Mao
- Acute and Emergency Department, Khoo Teck Puat Hospital, 90, Yishun Central, 768828 Yishun Singapore.
| | - Ruei-Fang Wang
- Emergency Department, Taipei City Hospital, Ren-Ai Branch, N(o) 10, Section 4, Ren'ai Road, Da'an District, Taipei, Taiwan
| | - Chee-Fah Chong
- Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, 95, Wenchang Road, Shilin District, Taipei, Taiwan
| | - Kuo-Chih Chen
- Emergency Department, West Garden Hospital, N(o) 270, Section 2, Xiyuan Road, Wanhua District, Taipei, Taiwan
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Chong VH, Chong CF. Pyogenic liver abscess and colorectal cancer screening: universal or selective? QJM 2019; 112:561-562. [PMID: 30657994 DOI: 10.1093/qjmed/hcz006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - C F Chong
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam
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Chong VH, Kosasih S, Chong PL, Chong CF. Pyogenic liver abscess diagnosis and complications: response to Dr Lai. QJM 2019; 112:553. [PMID: 31038707 DOI: 10.1093/qjmed/hcz097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - C F Chong
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam
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Hsieh YT, Lee TY, Kao JS, Hsu HL, Chong CF. Treating acute hypertensive cardiogenic pulmonary edema with high-dose nitroglycerin. Turk J Emerg Med 2018; 18:34-36. [PMID: 29942881 PMCID: PMC6009803 DOI: 10.1016/j.tjem.2018.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/13/2022] Open
Abstract
Acute pulmonary edema due to sympathetic surge and increased peripheral vascular resistance often present to the emergency department (ED) with markedly elevated blood pressure, severe dyspnea, and desaturation. This condition is known as “SCAPE” (sympathetic crashing acute pulmonary edema). We present three SCAPE patients who were successfully treated with high-dose nitroglycerin (NTG) and bilevel positive airway pressure (BiPAP) ventilation. All three patients presented with respiratory failure on arrival but rapidly improved after treatment and did not require endotracheal intubation or admission to the intensive care unit (ICU). SCAPE patients usually present to the ED with extreme respiratory distress associated with diaphoresis, restlessness, and high blood pressure. Emergency physicians must know how to manage SCAPE with high-dose nitrates and NIPPV (noninvasive positive pressure ventilation) because, when treated promptly, one will not only save a life but also obviate the need for endotracheal intubation and ICU admission.
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Affiliation(s)
- Yi-Ting Hsieh
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Tai-Ying Lee
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Jui-Shih Kao
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Hsin-Lin Hsu
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Chee-Fah Chong
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Shih YT, Chua CH, Hou SW, Lin LW, Chong CF. Ultrasound diagnosis of cardiac rupture caused by mechanical chest compression. Turk J Emerg Med 2018; 18:82-84. [PMID: 29922738 PMCID: PMC6005916 DOI: 10.1016/j.tjem.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 11/24/2022] Open
Abstract
A 74-year-old male with chronic kidney disease presented to the emergency department with asystole. Mechanical chest compression was started immediately using a piston-type thumper device. The initial potassium level was 7.7 mEq/L and bedside point-of-care ultrasound (POCUS) revealed no pericardial fluid. With standard resuscitation and anti-hyperkalemia treatment, return of spontaneous circulation (ROSC) was achieved within 10 minutes of compressions. At 15 minutes post-ROSC, the patient went into pulseless electrical activity. A repeated POCUS discovered massive pericardial fluid suggesting the presence of cardiac tamponade. Bedside pericardiotomy was performed followed by open thoracotomy. Laceration of the right ventricular wall adjacent to the fracture site of sternum was found, implicating that it was the complication of mechanical chest compression. After surgical repair and intensive post-operative care, the patient survived with full conscious recovery at day 6 of admission. Our case emphasizes the importance of POCUS in resuscitation, especially when the patient's condition deteriorates unexpectedly.
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Affiliation(s)
- Ying-Tai Shih
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Chai-Hock Chua
- Department of Cardiovascular Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Sheng-Wen Hou
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Li-Wei Lin
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan
| | - Chee-Fah Chong
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Chong CF, Misra SL, Escardo-Paton JA, Dai S. Predictors of long-term neurological outcomes in non-accidental head injury. Eye (Lond) 2017; 32:608-614. [PMID: 29219962 DOI: 10.1038/eye.2017.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/25/2017] [Indexed: 11/09/2022] Open
Abstract
BackgroundNon-accidental head injury (NAI) is an inflicted injury usually on a child, often resulting in long-term neurological impairment and occasionally death. This study aimed to investigate the predictive values of acute findings, especially ocular, for long-term neurological outcomes.MethodsMedical records including retinal images of all children who attended the local Children's hospital with a diagnosis of NAI from over a period of 5 years were reviewed and data collected via the electronic patient record system. Patient demographics, injuries sustained, wide-field digital retinal images, visual acuity and sequalae, neurological function, and global function was noted. IBM SPSS software program was used for statistical analysis.ResultsOf the 38 patients (24 males, 14 females), 12 children died acutely from the head injury with the remaining 26 children available for long-term follow-up. A younger age of injury (P=0.004) was the only statistically significant predictor of good neurological outcome as compared with absence of macular retinoschisis, unilateral retinal haemorrhage, and unilateral subdural haemorrhage. Of the 38 children, 17 children had retinoschisis; 9 children with macular retinoschisis died acutely while 4 suffered a degree of developmental delay and only 4 were developmentally normal at the last follow-up. Long-term visual acuity data was available for 18 of the 26 survivors (range: NPL to Snellen 6/5). A statistical significance was noted between retinoschisis and worsened visual acuity (P<0.05).ConclusionsBilateral macular retinoschisis on acute presentation of NAI is associated with a seven-fold and unilateral with a four-fold increase in the development of a poor neurological outcome and eventual death. Conflicting to other studies, younger children presented better neurological outcomes.
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Affiliation(s)
- C F Chong
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand.,Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - S Dai
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland, New Zealand.,Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Chen KC, Lin ACM, Chong CF, Wang TL. An overview of point-of-care ultrasound for soft tissue and musculoskeletal applications in the emergency department. J Intensive Care 2016; 4:55. [PMID: 27529031 PMCID: PMC4983782 DOI: 10.1186/s40560-016-0173-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/12/2016] [Indexed: 01/11/2023] Open
Abstract
Background The skin, soft tissue, and most parts of the musculoskeletal system are relatively superficial anatomical structures and ideal targets for ultrasound examination in the emergency departments. Soft tissue and musculoskeletal ultrasound applications are relatively underused compared to traditional emergency applications, such as trauma, abdominal aortic aneurysm, and chest and cardiovascular systems. Main text It is important to have knowledge about sonoanatomy and landmarks within the skin, soft tissue, and musculoskeletal systems. Portable machines equipped with high-resolution transducers are now available to fulfill this field of applications in many emergency departments. After needling practice, emergency physicians can not only diagnose and identify pathological findings but also provide interventional procedures and treatments. In this review, we will introduce point-of-care ultrasound (POCUS) applications regarding the soft tissue and musculoskeletal systems: soft tissue infections, joint effusions, foreign bodies, long bone fractures, muscle and tendon injuries, vascular occlusions, and procedures. Conclusions With POCUS, emergency physicians can visualize the structures beneath the skin and provide better and safer cares in the emergency departments. Electronic supplementary material The online version of this article (doi:10.1186/s40560-016-0173-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kuo-Chih Chen
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Aming Chor-Ming Lin
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chee-Fah Chong
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Tzong-Luen Wang
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No.95 Wen-Chang Road, Shih-Lin District, Taipei City, 111 Taiwan, Republic of China ; School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
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Chen KC, Chong CF, Wang TL. Point-of-care ultrasound is useful for the detection of proximal ureteral stone in the emergency department. Crit Ultrasound J 2015. [DOI: 10.1186/2036-7902-7-s1-a21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lin YT, Chen KC, Wang TL, Chong CF, Hung SW. Rectus sheath abscess caused by perforation of the small bowel by a fish bone. J Acute Med 2013. [DOI: 10.1016/j.jacme.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chao SL, Chen KC, Lin LW, Wang TL, Chong CF. Ultrasound phantoms made of gelatin covered with hydrocolloid skin dressing. J Emerg Med 2013; 45:240-3. [PMID: 23399392 DOI: 10.1016/j.jemermed.2012.11.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 06/26/2012] [Accepted: 11/05/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ultrasound-guided invasive procedures, such as central venous catheter insertion, soft-tissue abscess drainage, and foreign-body removal are essential competencies for Emergency Physicians. Such competencies can be trained using ultrasound phantoms. OBJECTIVE Our aim is to describe ultrasound phantoms that are easily made, inexpensive, reusable, and can withstand multiple punctures. METHODS Previously recommended gelatin-only ultrasound phantoms have inadequate surface tension resulting in surface disruption, and cannot tolerate multiple punctures when simulating cyst drainage. RESULTS By covering the gelatin phantom with a hydrocolloid skin dressing, we are able to minimize physical surface disruption (by transducer or needles) and might reduce biological breakdown due to bacterial propagation. CONCLUSIONS The elements required to construct homemade reusable ultrasound phantoms are inexpensive and can be easily obtained.
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Affiliation(s)
- Shao-Lun Chao
- Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
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Koh KS, Chong VH, Yapp SKS, Chong CF. A rare case of Dysphagia secondary to a large oesophageal lipoma. Med J Malaysia 2012; 67:522-523. [PMID: 23770871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Dysphagia is considered a warning symptom that requires exclusion of significant pathology such as oesophageal cancer, especially in elderly patients. Benign neoplasms of the oesophagus are rare. We report the case of a 69-year-old lady who presented with a five years history of infrequent intermittent dysphagia that had rapidly progressed over one month. This was associated with globus sensation, weight loss, intermittent episodes of stridor and aspiration pneumonia. Investigations revealed a large oesophageal lipoma in the proximal oesophagus extending down to the lower oesophagus. This was successfully resected via a left cervical approach. She remained well two years after the surgery.
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Affiliation(s)
- K S Koh
- Raja Isteri Pengiran Anak Saleha Hospital, Department of Medicine, Jalan Tutong, Bandar Seri Begawan, Brunei Muara BA 1710.
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Su YC, Chao CC, Wang TL, Chong CF, Chen CC. Age as a predisposing factor of respiratory alkalosis in accidental carbon monoxide poisoning. J Acute Med 2012. [DOI: 10.1016/j.jacme.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Cheng PL, Wang TL, Chong CF, Hou SW. Using ambulance diversion status to validate occupancy rate at an academic emergency department in Taipei, Taiwan. J Acute Med 2012. [DOI: 10.1016/j.jacme.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Irani Y, Pype JL, Martin AR, Chong CF, Daniel L, Gaudart J, Ibrahim Z, Magalon G, Lemaire M, Hardwigsen J. Noble gas (argon and xenon)-saturated cold storage solutions reduce ischemia-reperfusion injury in a rat model of renal transplantation. Nephron Extra 2012; 1:272-82. [PMID: 22470401 PMCID: PMC3290848 DOI: 10.1159/000335197] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Following kidney transplantation, ischemia-reperfusion injury contributes to adverse outcomes. The purpose of this study was to determine whether a cold-storage solution saturated with noble gas (xenon or argon) could limit ischemia-reperfusion injury following cold ischemia. METHODS Sixty Wistar rats were randomly allocated to 4 experimental groups. Kidneys were harvested and then stored for 6 h before transplantation in cold-storage solution (Celsior®) saturated with either air, nitrogen, xenon or argon. A syngenic orthotopic transplantation was performed. Renal function was determined on days 7 and 14 after transplantation. Transplanted kidneys were removed on day 14 for histological and immunohistochemical analyses. RESULTS Creatinine clearance was significantly higher and urinary albumin significantly lower in the argon and xenon groups than in the other groups at days 7 and 14. These effects were considerably more pronounced for argon than for xenon. In addition, kidneys stored with argon, and to a lesser extent those stored with xenon, displayed preserved renal architecture as well as higher CD-10 and little active caspase-3 expression compared to other groups. CONCLUSION Argon- or xenon-satured cold-storage solution preserved renal architecture and function following transplantation by reducing ischemia-reperfusion injury.
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Affiliation(s)
- Y Irani
- Department of Plastic and Reconstructive Surgery, Jouy-en-Josas, France
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Ong JR, Chong CF, Chen CC, Wang TL, Lin CM, Chang SC. Comparing the performance of traditional direct laryngoscope with three indirect laryngoscopes: A prospective manikin study in normal and difficult airway scenarios. Emerg Med Australas 2011; 23:606-14. [PMID: 21995476 DOI: 10.1111/j.1742-6723.2011.01441.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate the performance of three indirect laryngoscopes, Truview EVO2 laryngoscope, Clarus Levitan fiberoptic stylet and AirwayScope AWS, in comparison with direct Macintosh laryngoscope (ML) when performed in normal and difficult airway scenarios. METHODS This prospective comparative study recruited 30 emergency physicians familiar with direct laryngoscopic intubation. Intubations were performed on manikin and were repeated twice for both scenarios. The primary end points were intubation time and rate of failed intubation. Glottis visualization was graded on Cormack and Lehane score and VAS. RESULTS In normal airway scenario: AWS had shortest intubation time (6.0 s) followed by ML (8.7 s); VAS score of ML and AWS was lower (easier to use) than the other two devices; Cormack and Lehane score was similar for all devices. In difficult airway scenario: AWS had shortest intubation time (5.9 s); VAS score of AWS was lower than the other three devices; TVL, FOS, AWS had better Cormack and Lehane score than ML. Intubation time, rate of failed intubation, and Cormack and Lehane score were similar between attempts in both scenarios. Learning effect was significant in FOS in both scenarios and in TVL in normal airway scenario. CONCLUSIONS AWS performed best in normal and difficult airways. ML performed better than TVL and FOS in normal airways. Performances of ML, TVL and FOS were similar in difficult airways. Skills with AWS could be mastered rapidly. TVL and FOS required more practice to gain expertise.
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Affiliation(s)
- Jiann-Ruey Ong
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan
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Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, Tan LT, Ang SH, Telisinghe PU. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J 2011; 52:340-345. [PMID: 21633767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The accuracy of the Alvarado score in diagnosing acute appendicitis in an Asian population has been disappointingly low. We prospectively compared the RIPASA score with the Alvarado score for the diagnosis of acute appendicitis. METHODS 200 consecutive patients who presented to the Accident and Emergency Department with right iliac fossa pain were recruited in the study. Both the RIPASA and Alvarado scores were derived, but decisions for appendicectomy were based on clinical judgement. Receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for both scoring systems were calculated. RESULTS Only 192 out of the 200 patients who satisfied the inclusion and exclusion criteria were included in the analysis. At the optimal cut-off threshold score of 7.5 derived from the ROC, the sensitivity, specificity, PPV, NPV and diagnostic accuracy of the RIPASA score were 98.0 percent, 81.3 percent, 85.3 percent, 97.4 percent and 91.8 percent, respectively. At the cut-off threshold score of 7.0 for the Alvarado score, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 68.3 percent, 87.9 percent, 86.3 percent, 71.4 percent and 86.5 percent, respectively. The RIPASA score correctly classified 98 percent of all patients confirmed with histological acute appendicitis to the high-probability group (RIPASA score greater than 7.5) compared with 68.3 percent with the Alvarado score (Alvarado score greater than 7.0; p-value less than 0.0001). CONCLUSION The RIPASA score at a cut-off threshold total score of 7.5 is a better diagnostic scoring system than the Alvarado score for the diagnosis of acute appendicitis in our local setting.
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Affiliation(s)
- C F Chong
- Department of Surgery, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam.
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Chong VH, Telisinghe PU, Yapp SKS, Chong CF. Tuberculous appendix: a review of clinical presentations and outcomes. Singapore Med J 2011; 52:90-93. [PMID: 21373734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Tuberculous appendix is surprisingly rare, even in countries where this infection is common. We report our experience with tuberculous appendix over a 15-year period. METHODS A search for cases of tuberculous appendix was conducted from January 1995 to December 2009 on the databases of the National Tuberculosis Centre and the Departments of Pathology and Surgery of Raja Isteri Pengiran Anak Saleha Hospital. RESULTS There were five cases of tuberculous appendix, giving a cumulative incidence of 0.08 percent of all appendectomies (n is 6,593), 0.2 percent of tuberculosis (TB) cases (n is 2,876) and 8.6 percent of abdominal TB (n is 58). Three patients were male and two were female, with a median age of 27 (range 25-48) years. Four patients presented with symptoms of acute appendicitis and one with an appendiceal mass following treatment for acute gastroenteritis. Only one patient had constitutional symptoms. Four patients had appendectomies (one laparoscopic and three open) within the same admission and one had interval appendectomy. Operative findings included perforated appendix (n is 1), appendiceal mass (n is 1) and acute appendicitis (n is 3). In all cases, the diagnoses were made only after review of the histology. None of the patients had pulmonary TB. Delay in initiating anti-TB treatment in one patient resulted in the development of an ileocutaneous fistula following appendectomy. This was resolved by excision, followed by anti-TB treatment. CONCLUSION Tuberculous appendix can present as acute appendicitis, and the diagnosis is often made after surgery. Any delay in treatment can lead to significant complications.
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Affiliation(s)
- V H Chong
- Gastroenterology and Hepatology Unit, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam.
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You CF, Chong CF, Wang TL, Chen CC. Subcapsular renal hematoma complicating acute pyelonephritis. J Emerg Med 2010; 39:440-442. [PMID: 18394849 DOI: 10.1016/j.jemermed.2007.10.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 12/08/2006] [Accepted: 10/28/2007] [Indexed: 05/26/2023]
Abstract
Subcapsular renal hematoma (SRH) is an extremely rare complication of acute pyelonephritis (APN). We report a case of SRH complicating APN with a ureteral stone, together with a review of the literature.
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Affiliation(s)
- Chi-Fang You
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Chong VH, Zainal-Abidin Z, Hassan H, Chong CF. Rare complications of pyogenic liver abscess. Singapore Med J 2010; 51:e169-e172. [PMID: 21103806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pyogenic liver abscess (PLA) is still associated with significant morbidity and mortality. With advances in imaging, most cases are now diagnosed early and effectively treated. However, complications, although considered rare, may still occur. We report three cases of PLA that were associated with rare and significant complications. Two patients had an abscess rupture that resulted in pyopericardium in one patient and sub-diaphragmatic abscess in the other. Another patient with Klebsiella pneumoniae PLA had bilateral endophthalmitis that resulted in blindness. Death secondary to overwhelming sepsis occurred in the patient with Escherichia coli-related pyopericardium. Delay in diagnosis contributed to the complications in two of the patients.
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Affiliation(s)
- V H Chong
- Gastroenterology Unit, Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam.
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28
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Chong VH, Telisinghe PU, Chong CF. Tuberculous aorto-duodenal fistula: a rare cause of upper gastrointestinal bleeding. Singapore Med J 2010; 51:e85-e88. [PMID: 20593135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Aorto-enteric fistulas are rare and are associated with significant mortality. Infective causes usually occur within the setting of post-graft repair. Aorto-enteric fistula secondary to tuberculosis is extremely rare despite the high prevalence of this infection. Unfortunately, the diagnosis is often not suspected until surgery or at post-mortem. We report a case of an elderly Malay man presenting with massive gastrointestinal bleeding secondary to a tuberculous aorto-duodenal fistula in association with a saccular abdominal aortic aneurysm. This was successfully managed with an aortobifemoral graft repair and standard anti-tuberculous treatment for six months. A literature review of this rare condition is presented.
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Affiliation(s)
- V H Chong
- Gastroenterology Unit, Internal Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam
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Chong CF, Adi MIW, Thien A, Suyoi A, Mackie AJ, Tin AS, Tripathi S, Jaman NH, Tan KK, Kok KY, Mathew VV, Paw O, Chua HB, Yapp SK. Development of the RIPASA score: a new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J 2010; 51:220-225. [PMID: 20428744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Acute appendicitis is one of the most common surgical emergencies. The Alvarado and modified Alvarado scores have been developed to aid diagnosis, but both scoring systems have poor sensitivity and specificity when applied in Middle Eastern and Asian populations. The aim of this study was to develop a new scoring system that is suitable for the local population. METHODS Clinical data from 312 patients who had undergone an emergency appendicectomy was retrospectively collected and used to generate 15 parameters. The probability was calculated and a score of 0.5, 1.0 or 2.0 was allocated to each parameter. The receiver operating curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the new scoring system were derived using the StatsDirect statistical software. RESULTS The 15 parameters and the scores generated were age (less than 40 years is 1 point; greater than 40 years is 0.5 point), gender (male is 1 point; female is 0.5 point), right iliac fossa (RIF) pain (0.5 point), migration of pain to RIF (0.5 point), nausea and vomiting (1 point), anorexia (1 point), duration of symptoms (less than 48 hours is 1 point; more than 48 hours is 0.5 point), RIF tenderness (1 point), guarding (2 points), rebound tenderness (1 point), Rovsing's sign (2 points), fever (1 point), raised white cell count (1 point), negative urinalysis (1 point) and foreign national registration identity card (1 point). The optimal cut-off threshold score from the ROC was 7.5, with a sensitivity of 88 percent, a specificity of 67 percent, a PPV of 93 percent and an NPV of 53 percent. The negative appendicectomy rate decreased significantly from 16.3 percent to 6.9 percent, which was a 9.4 percent reduction (p is 0.0007). CONCLUSION The new appendicitis scoring system looked promising when applied to our settings, and had a better sensitivity and specificity than the Alvarado score when applied to Asian populations. A significant reduction in the negative appendicectomy rate was also predicted. A prospective evaluation of this new appendicitis scoring system, referred to as the RIPASA score, is ongoing.
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Affiliation(s)
- C F Chong
- Department of Surgery, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam.
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Chen KC, Hung TY, Wang TH, Wang TL, Chong CF. Rapid diagnosis of jejunojejunal intussusception by an emergency physician–performed bedside ultrasound. Am J Emerg Med 2010; 28:117.e5-7. [DOI: 10.1016/j.ajem.2009.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 04/01/2009] [Indexed: 11/27/2022] Open
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Abstract
We report a case of liver abscess caused by Gemella morbillorum. G. morbillorum was isolated and confirmed from both pus and blood. The patient recovered uneventfully after catheter drainage and treatment with cefmetazole. This is the first case report of liver abscess caused by G. mobillorum in the English literature.
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Affiliation(s)
- Chen-Yang Hsu
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Huang TY, Lau BH, Lin LW, Wang TL, Chong CF, Chen CC. Ovarian cyst torsion in a toddler. Am J Emerg Med 2009; 27:632.e1-3. [PMID: 19497486 DOI: 10.1016/j.ajem.2008.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 09/03/2008] [Indexed: 11/28/2022] Open
Abstract
Acute abdominal pain in children is encountered frequently, and the differential diagnosis is extensive. Acute ovarian torsion in children is rare, especially at a very young age, and a difficult diagnosis to make. Infarction caused by ovarian torsion will result if the twist is not unwound spontaneously or surgically in a timely fashion. We presented a case of acute ovarian cyst torsion in a 2-year-old girl who originally presented to the emergency department with abdominal pain and vomiting. Ultimately, she was found to have a 2-cm cyst of the right ovary with concomitant torsion. Because acute ovarian torsion in a very young child is not encountered frequently, timely diagnosis is required to prevent mortality and minimize morbidity. It is important to keep ovarian torsion in the differential of any female children with acute abdominal pain. Emergency physicians should be aware that the potential of acute ovarian torsion in a very young child has a high index of suspicion and seek early operative intervention.
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Affiliation(s)
- Ting-Yun Huang
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan R.O.C
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Chao CC, Wang TL, Chong CF, Lin YM, Chen CC, Tang GJ, Yen DHT. Prognostic value of QT parameters in patients with acute hemorrhagic stroke: a prospective evaluation with respect to mortality and post-hospitalization bed confinement. J Chin Med Assoc 2009; 72:124-32. [PMID: 19299219 DOI: 10.1016/s1726-4901(09)70037-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND This prospective study was performed to evaluate the prognostic prediction value of QT parameters and clinical characteristics exhibited by patients with acute hemorrhagic stroke at the time of presenting to the emergency department (ED). METHODS One hundred and sixty-six patients admitted to the ED of Taipei Veterans General Hospital from January 2006 to October 2006 because of acute hemorrhagic stroke were enrolled. Glasgow Coma Scale (GCS) scores between 3 and 8 were taken to indicate severe neurologic deficits. QT parameters (QT max, QT min, QT dispersion, QTc max, QTc min, QTc dispersion) and other pertinent clinical variables were determined on admission. Logistic regression model was applied to evaluate prognostic prediction values. RESULTS Mortality was higher among stroke patients with low GCS scores (p < 0.01). Leukocyte counts and systolic blood pressures were significantly higher among non-surviving patients (p = 0.04). No association was found between QT parameters and mortality (all p > 0.05). Among survivors, post-hospitalization bed confinement was required for those significantly older (p = 0.01) and those with higher QT max and QTc max values in multivariate analyses (p = 0.04 and p < 0.01, respectively). CONCLUSION Low GCS scores, increased leukocyte counts, and elevated systolic blood pressures predict increased mortality for subjects with acute hemorrhagic stroke. Advanced age and prolongations in QTc and QT max at the time of stroke predicted poor functional recovery for these subjects.
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Affiliation(s)
- Chun-Chieh Chao
- Department of Emergency Medicine, Zhong-Xiao Branch, Taipei City Hospital, Taipei, Taiwan, Republic of China
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Hung TY, Seow VK, Chong CF, Wang TL, Chen CC. Gabapentin toxicity: an important cause of altered consciousness in patients with uraemia. BMJ Case Rep 2009; 2009:bcr11.2008.1268. [PMID: 21686382 DOI: 10.1136/bcr.11.2008.1268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gabapentin toxicity should be considered one of the differential diagnoses of altered consciousness in patients with compromised renal function, even after a single dose. We report a 57-year-old woman with diabetes mellitus and uraemia on regular haemodialysis who developed severe dizziness and lethargy after a single recommended dose of gabapentin for bilateral leg dysthesia. Because of progressive drowsiness and decreasing level of consciousness, one session of haemodialysis was performed and clinical recovery was dramatic. The adverse effects of gabapentin seem to vary from person to person and should be viewed with a high degree of suspicion, especially in patients taking this drug at the beginning.
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Affiliation(s)
- T Y Hung
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Huang CF, Ong JR, Hung SW, Chen CC, Wang TL, Chong CF. Acute urinary retention secondary to perforated diverticulitis misdiagnosed as acute prostatitis. Am J Emerg Med 2008; 26:842.e3-4. [PMID: 18774067 DOI: 10.1016/j.ajem.2008.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Accepted: 01/28/2008] [Indexed: 11/29/2022] Open
Abstract
Abdominal abscess resulting from a perforated diverticulitis has never been reported as a cause of acute urinary retention. Our patient is the first case to be reported. Because of the atypical presentation, he was initially misdiagnosed and treated as having acute prostatitis. Emergency physicians should have a high index of suspicion. Detailed history, abdominal sonography, and digital examination are helpful in diagnosing this disease.
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Affiliation(s)
- Chang-Feng Huang
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City 111, Taiwan
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Hou SW, Chen CC, Chong CF, Wang TL, Su YC. Shortness of Breath and Chest Pain in Two Females. Ann Emerg Med 2008; 52:306, 310. [DOI: 10.1016/j.annemergmed.2008.01.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Revised: 12/23/2007] [Accepted: 01/28/2008] [Indexed: 10/21/2022]
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Seow VK, Ko SY, Huang MK, Chong CF. Neurogenic Pulmonary Oedema Misdiagnosed as Acute Myocardial Infarction in a Comatose Patient. Ann Acad Med Singap 2008. [DOI: 10.47102/annals-acadmedsg.v36n8p684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Introduction: We report a case of neurogenic pulmonary oedema (NPO) following massive left cerebral infarct, which was initially misdiagnosed as acute myocardial infarction (AMI).
Clinical Picture: This 52-year-old man presented with acute loss of consciousness with normal brain computed tomography (CT). He was treated as non-ST-elevation AMI complicated with pulmonary oedema based on findings of chest radiograph (bilateral pulmonary oedema), electrocardiogram (marked ST-T changes in leads V3 to V6), and cardiac enzymes [elevated creatinine kinase (CK) and CK-MB]. However, coronary angiogram and serial cardiac enzymes were inconclusive. Anisocoria developed after admission and a repeat brain CT was evident for large left cerebral infarct.
Treatment: Decompressive craniectomy was carried out.
Outcome: Mortality.
Conclusions: The diagnosis of NPO can be challenging when it occurs without abnormal findings on preliminary brain CT. It can be mistaken for cardiogenic pulmonary oedema secondary to AMI.
Key words: Cerebral infarction, Neurogenic pulmonary oedema, Stroke
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Affiliation(s)
| | - Shih-Yu Ko
- Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan
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Chong CF, Chong VH, Jalihal A, Mathews L. Bronchobiliary fistula successfully treated surgically. Singapore Med J 2008; 49:e208-e211. [PMID: 18756335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Bronchobiliary fistula is a rare condition, arising as a complication of hydatid disease of the liver, hepatic tuberculosis, hepatic malignancy, chronic pancreatitis, hepatic trauma or surgery. Patients characteristically present with recurrent bilioptysis, and in the chronic stage, develops bronchiectasis of the affected segment of the lung. Conservative treatment is directed at non-surgical approaches of relieving biliary obstruction to allow for normal flow of bile into the duodenum via endoscopy or percutaneous routes. However in complicated cases which failed conservative non-surgical therapy, surgical intervention is usually required. We report a 29-year-old Malay man who presented with chronic bilioptysis from a bronchobiliary fistula resulting from occlusion of a biliary stent inserted to treat intrahepatic biliary strictures. This was successfully treated surgically with a right medial lobectomy and interposition of a piece of viable tissue between the fistula stump on the dome of the diaphragm and the remaining lung.
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Affiliation(s)
- C F Chong
- Department of General Surgery, Thoracic Unit, RIPAS Hospital, Bandar Seri Begawan BA 1900, Brunei Darussalam.
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Hou SW, Chen CC, Chen KC, Ko SY, Wong CS, Chong CF. Sonographic diagnosis of spontaneous intramural small bowel hematoma in a case of warfarin overdose. J Clin Ultrasound 2008; 36:374-376. [PMID: 18196594 DOI: 10.1002/jcu.20442] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A 38-year-old man who had been treated with warfarin since mitral valve replacement 10 years earlier presented with acute onset of epigastralgia and melena. Coagulation tests were abnormal with a prolonged prothrombin time of >60 seconds and a prolonged activated partial thromboplastin time of >120 seconds. Abdominal sonographic examination revealed duodenal intramural hematoma that was confirmed on CT. Warfarin therapy was stopped and the patient was treated conservatively with vitamin K and fresh frozen plasma. Recovery was uneventful, and the patient was re-warfarinized 2 weeks later. Duodenal hematoma can be readily diagnosed with bedside sonography.
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Affiliation(s)
- Sheng-Wen Hou
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Rd, Shi Lin District, Taipei 111, Taiwan, ROC
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40
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Viswanathan R, Khee TK, Chong CF. Perigraft infections due to Salmonella after abdominal aortic aneurysm repair. Singapore Med J 2008; 49:e183-e185. [PMID: 18695853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 70-year-old man with abdominal aortic aneurysm repair presented with fever accompanied by rigors and abdominal pain one month after the procedure. Radiological investigations showed a perigraft collection. The collection was drained and the abscess cavity was lavaged. Cultures of pus and blood both yielded Group D Salmonella (non-typhi), which was treated with ceftriaxone and ciprofloxacin. The patient was followed-up for the past eight months without any further symptoms. Perigraft infections post abdominal aortic aneurysm repair could be caused by enteric organisms and must be treated with long-term appropriate antibiotics, depending on the microbiological finding, besides surgical drainage and lavage.
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Affiliation(s)
- R Viswanathan
- Department of Laboratory Services, RIPAS Hospital, Ministry Of Health, Bandar Seri Begawan, Brunei Darussalam.
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Wang RF, Chao CC, Wang TL, Chen KC, Chong CF, Huang KH, Chen CC. The effect of different relieving methods on the outcome of out-of-hospital cardiac arrest patients with nontraumatic hemopericardium in the ED. Am J Emerg Med 2008; 26:425-32. [DOI: 10.1016/j.ajem.2007.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 06/20/2007] [Accepted: 07/10/2007] [Indexed: 10/22/2022] Open
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Wu BH, Chen CC, Wang TL, Chong CF, Hsu CY. An avoidable abdominal surgery: pneumatosis coli. Am J Emerg Med 2008; 26:517.e1-2. [PMID: 18410833 DOI: 10.1016/j.ajem.2007.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2007] [Accepted: 08/23/2007] [Indexed: 10/22/2022] Open
Abstract
We report on the case of a 90-year-old man who presented to the emergency department with constipation for 1 week and abdominal fullness for 2 days. Abdominal plain film radiography disclosed intramural air in the colon, which indicated pneumatosis coli (PC). Exploratory laparotomy was performed immediately under the impression of ischemic bowel disease. Through examination of the mesentery, the intestine and colon revealed no sign of perforation and ischemia. Surgery for PC is limited to patients with signs of perforation, peritonitis, intra-abdominal abscess, or bowel ischemia. Conservative treatment with oxygen supply, hyperbaric oxygen therapy, and antibiotics remain to be the mainstay for most patients with PC.
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Affiliation(s)
- Bor-Hen Wu
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
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Chen YC, Chen LK, Tsai MD, Chiu HC, Chiu JS, Chong CF. Fingerprint verification on medical image reporting system. Comput Methods Programs Biomed 2008; 89:282-288. [PMID: 18178287 DOI: 10.1016/j.cmpb.2007.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2007] [Revised: 10/05/2007] [Accepted: 11/18/2007] [Indexed: 05/25/2023]
Abstract
The healthcare industry is recently going through extensive changes, through adoption of robust, interoperable healthcare information technology by means of electronic medical records (EMR). However, a major concern of EMR is adequate confidentiality of the individual records being managed electronically. Multiple access points over an open network like the Internet increases possible patient data interception. The obligation is on healthcare providers to procure information security solutions that do not hamper patient care while still providing the confidentiality of patient information. Medical images are also part of the EMR which need to be protected from unauthorized users. This study integrates the techniques of fingerprint verification, DICOM object, digital signature and digital envelope in order to ensure that access to the hospital Picture Archiving and Communication System (PACS) or radiology information system (RIS) is only by certified parties.
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Affiliation(s)
- Yen-Cheng Chen
- Department of Medical Informatics, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
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Tsai TY, Seow VK, Shen TC, Chuang CH, Lee YK, Chong CF, Wang TL. Painless aortic dissection masquerading as brainstem stroke with catastrophic anticoagulant use. Am J Emerg Med 2008; 26:253.e1-2. [PMID: 18272133 DOI: 10.1016/j.ajem.2007.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 04/23/2007] [Indexed: 11/19/2022] Open
Abstract
Painless aortic dissection with only focal neurological symptoms and signs can be a great challenge to the emergency physician. Inadvertently and erroneous treatment of stroke may threaten patient's life. We present a patient with painless aortic dissection (DeBakey I), which was initially misdiagnosed as brainstem stroke with catastrophic anticoagulant use. Finally, the patient died of multiorgan failure after surgical intervention.
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Affiliation(s)
- Tung-Yao Tsai
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, ROC
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45
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Liu CL, Su YC, Chen CC, Chong CF, Wang TL. Ruptured cervical arteriovenous fistulas presenting with subarachnoid hemorrhage and quadriplegia: an uncommon case. Am J Emerg Med 2008; 26:249.e1-2. [PMID: 18272125 DOI: 10.1016/j.ajem.2007.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 04/13/2007] [Indexed: 10/22/2022] Open
Abstract
Nontraumatic subarachnoid hemorrhage is a neurologic emergency, and prompt treatment is necessary to avoid catastrophic result. We present a patient with subarachnoid hemorrhage caused by ruptured cervical intradural extramedullary arteriovenous fistulas, which rapidly progressed to quadriplegia. Because of the timely management, the patient had a good recovery. This is a rare but important case that emergency physicians should be aware of.
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Affiliation(s)
- Chien-Liang Liu
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City 111, Taiwan ROC
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Lin HC, Wang RF, Chen CC, Wang TL, Chong CF. An emerging and devastating acute abdomen in a patient under peritoneal dialysis: encapsulating peritoneal sclerosis. Am J Emerg Med 2008; 26:245.e3-4. [PMID: 18272118 DOI: 10.1016/j.ajem.2007.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 03/27/2007] [Indexed: 10/22/2022] Open
Abstract
Peritoneal dialysis (PD) has been applied to patients with end-stage renal disease for more than 2 decades. It should raise physicians' concern about the serious complications of prolonged PD therapy, particularly encapsulating peritoneal sclerosis (EPS), the most potentially life-threatening one. The prevalence and mortality rate of EPS increase as PD duration increases. We report a case of EPS presented with blood-tinged effluents and abdominal pain.
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Affiliation(s)
- Hsin-Chi Lin
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan
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Wang RF, Hung TY, Chong CF, Wang TL, Chen CC. Central cyanosis due to severe pulmonary hypertension combined with pericarditis as the initial manifestation of systemic lupus erythematosus. Am J Emerg Med 2008; 26:248.e1-2. [DOI: 10.1016/j.ajem.2007.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Accepted: 04/08/2007] [Indexed: 11/25/2022] Open
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48
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Lu KC, Chao CC, Wang TL, Chong CF, Chen CC. A differential diagnosis in postural headache: herniation of a giant posterior fossa arachnoid cyst. Am J Emerg Med 2008; 26:247.e1-3. [DOI: 10.1016/j.ajem.2007.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2007] [Revised: 04/05/2007] [Accepted: 04/05/2007] [Indexed: 11/30/2022] Open
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49
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Cheng PL, Hung SW, Lin LW, Chong CF, Lau CI. Amantadine-induced serotonin syndrome in a patient with renal failure. Am J Emerg Med 2008; 26:112.e5-6. [PMID: 18082803 DOI: 10.1016/j.ajem.2007.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 07/19/2007] [Indexed: 11/29/2022] Open
Affiliation(s)
- Po-Liang Cheng
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, ROC
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50
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Seow VK, Lin ACM, Lin IY, Chen CC, Chen KC, Wang TL, Chong CF. Comparing different patterns for managing febrile children in the ED between emergency and pediatric physicians: impact on patient outcome. Am J Emerg Med 2007; 25:1004-8. [DOI: 10.1016/j.ajem.2007.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 03/01/2007] [Indexed: 11/26/2022] Open
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