CRASH2 in Germany [ISRCTN86750102].
Explore the source record for details and available documents.
Letter↗
Biomedical subjects
C H Chung
Publications and source records attributed to C H Chung.
'Fracture' of the penis: a case series.
OBJECTIVES: To examine the epidemiology of penile 'fracture' and its presenting characteristics in the local population. DESIGN: Retrospective study. SETTING: District hospital, Hong Kong. PATIENTS: Patients with a discharge diagnosis of 'fractured' penis during a 7-year period from August 1998 to August 2005. MAIN OUTCOME MEASURES: Age, time of attendance, cause, symptoms, signs, emergency department diagnosis, site of rupture, operative findings, and final outcome. RESULTS: A total of 11 patients were identified. The mean age was 44 years (range, 30-63 years). The interval between time of injury and presentation ranged from 17 minutes to 7 days. Seven (64%) cases were attributed to sexual intercourse, three (27%) to penile manipulation, and one (9%) to rolling over the erect penis during sleep. Ten patients underwent surgery; all had primary suturing of the tunica tear, while two also required primary urethral repair. At follow-up, three (27%) patients had erectile dysfunction, one had mild penile deformity and one had a mild urethral stricture. CONCLUSION: Emergency physicians and surgeons, as well as family physicians, should be familiar with the presentation of 'fractured' penis, as prompt diagnosis and early surgical repair are instrumental in ensuring a successful outcome with minimal complications. The public should also be educated to seek medical attention immediately, as delay or failure to report may result in permanent physical and psychological disabilities that could otherwise have been avoided.
Adult↗
Intrahepatic cholestasis as a paraneoplastic syndrome associated with pheochromocytoma.
Pheochromocytoma is a rare tumor of chromaffin cells that secrete catecholamines and several cytokines. The clinical manifestations are protean and may include hypertension, weight loss, sweating, palpitation, headache, anxiety, tremor, nausea, vomiting, and hypercalcemia. The tumor can mimic many unrelated diseases, leading to significant delay and difficulty in diagnosis. We report a case of a 37-yr-old male admitted with jaundice, dark urine, fever, and signs of a systemic inflammatory response. Abdominal computed tomography revealed a heterogeneously enhancing tumor between the pancreatic tail and left kidney. There was no evidence of obstruction to bile flow, neoplastic involvement of the liver or bile ducts, or infectious etiology. The tumor was removed and found to be a pheochromocytoma. Immunohistochemical analysis revealed the presence of interleukin-1beta in the tumor cells. After surgery, the jaundice resolved without further treatment, leading us to the conclusion that it was a paraneoplastic phenomenon possibly related to interleukin-1beta production. We suggest that occult pheochromocytoma should be added to the differential diagnosis of unexplained intrahepatic cholestasis.
Adrenal Gland Neoplasms↗
Isomaltooligosaccharide increases cecal Bifidobacterium population in young broiler chickens.
A newly developed compound derived by fermentation, isomaltooligosaccharide (IMO), was hypothesized to enrich cecal bifidobacterial populations and reduce colonization levels of Salmonella in the ceca of broiler chickens. Broiler starter diets were prepared with final IMO concentrations of 1% (wt/wt), 2% (wt/wt), and 4% (wt/wt) and a control diet without IMO supplementation. Chickens were divided into 4 groups and challenged with 10(8) cell of Salmonlella enterica ser. Typhimurium with 200 microg/mL nalidixic acid resistant (S. Typhimurium Nalr) after 7 d of placement. The experiment was done in 3 replications. IMO-supplemented diets resulted in significantly higher cecal bifidobacteria compared with the control diet (P < 0.05). However, there was no significant difference in bifidobacteria counts among the treatment groups. Chickens fed diets with 1% IMO had a significant 2-log reduction in the level of inoculated S. Typhimurium Nalr (P < 0.05) present in, the ceca compared with the control group, but no differences were found between the control group and the groups fed 2 or 4% IMO for S. Typhimurium Nalr. No differences in feed consumption, feed conversion, or feed efficiency compared with the control group were observed; however, the result showed a significant reduction in weight for birds fed 1% IMO diet compared with those fed the control diet.
Animal Nutritional Physiological Phenomena↗
Long-term synaptic plasticity in deep layer-originated associational projections to superficial layers of rat entorhinal cortex.
Superficial layers of the entorhinal cortex (EC) relay the majority of cortical input projections to the hippocampus, whereas deep layers of the EC mediate a large portion of hippocampal output projections back to other cortical areas, suggesting a functional segregation between superficial and deep layers of the EC as input and output structures of the hippocampus, respectively. However, deep layers of the EC send associational projections to superficial layers, suggesting a potential interaction between neocortical input and hippocampus-processed output in superficial layers. This possibility was investigated by examining whether deep to superficial EC projections support long-term synaptic plasticity, and whether they interact with other pathways in superficial layers in rat medial EC slice preparations. Synaptic responses of the deep-to-superficial layer projections were verified based on field potential profiles, paired-pulse facilitation, physical separation between superficial and deep layers, and pharmacological manipulation. Long-term potentiation (LTP) was reliably induced in the deep-to-superficial layer projections by burst stimulations that emulated theta or sharp wave electroencephalogram (EEG),and it was blocked by an N-methyl-d-aspartate receptor antagonist (D-2-amino-5-phosphonopentanoic acid) and a calcium channel blocker (nifedipine). Prolonged low frequency stimulation induced long-term depression. A weak stimulation of deep layers, which induced a small degree of LTP by itself, generated a much larger degree of LTP when paired with a strong stimulation of superficial layers, indicating that the deep-to-superficial layer projections cooperate with other pathways in the superficial EC to enhance synaptic weights. Our results suggest that neocortical input and hippocampal output information are integrated in superficial layers of the EC.
6-Cyano-7-nitroquinoxaline-2,3-dione↗
Efficacy of Leuconostoc mesenteroides (ATCC 13146) isomaltooligosaccharides as a poultry prebiotic.
The complex dietary carbohydrates, called prebiotics, have been used to control Salmonella and improve intestinal bacterial balance in broilers. Leuconostoc mesenteroides (ATCC 13146) isomaltooligosaccharides (IMO) stimulate growth of Bifidobacterium and Lactobacillus and are not used by Salmonella or Escherichia coli. We tested the efficacy of these IMO as a prebiotic. IMO, compared with fructooligosaccharides (FOS) as sole carbon source, promoted growth of chicken cecal isolates and Bifidobacterium. Cecal isolates and Salmonella typhimurium grown in mixed culture on IMO reduced the Salmonella population. Cecal isolates grown on IMO showed higher viable counts and faster growth than Salmonella, indicating a potential value for these oligomers for poultry intestinal microflora modification.
Animals↗
Transient hypotension after high-speed head-on motor vehicle collision.
A 43-year-old woman was taken to the accident and emergency department after a high-speed motor vehicle collision. She had only minor external injuries, but developed an episode of hypotension, which rapidly responded to fluid infusion. Chest X-ray showed a widened superior mediastinum. Computed tomography confirmed thoracic aortic injury. In patients with high-speed deceleration injury, even transient hypotension should be taken seriously and a diligent search for the source of bleeding should be immediately undertaken.
Accidents, Traffic↗
Subtle perforation of the oesophagus by a foreign body.
A case of subtle oesophageal perforation caused by a foreign body is described. A 48-year-old woman had had a chicken bone impacted in the upper oesophagus for 4 days. At presentation, the bone was dislodged at endoscopy, and two small round depressions at opposite sides of the oesophageal wall were visible. The chest X-ray findings were normal. Computed tomography of the thorax detected a small amount of air in the mediastinum. The water-soluble contrast swallow test showed no evidence of leakage. The patient was successfully treated using conservative measures.
Esophageal Perforation↗
Small bowel perforation after radiotherapy for cervical carcinoma.
Radiotherapy is the treatment of choice for carcinoma of the uterine cervix. We report on a 62-year-old Chinese woman with cervical carcinoma, in whom a small bowel perforation developed 5 months after radiotherapy. Ten centimetres of small bowel, including the perforation site, were resected. No bowel adhesion was detected during the operation. The postoperative course was uneventful, and the patient was discharged home 7 days after surgery. Histological examination confirmed post-irradiation injury. The presenting complaints of patients with bowel perforation following radiotherapy vary, and signs of peritonitis may be absent. Emergency physicians must be alert for these complications in patients who have been treated with radiotherapy.
Female↗
Adult acute epiglottitis and foreign body in the throat - chicken or egg?
A 53 year old man presented with the chief complaint of having a fish bone stuck in the throat for about 1 h. There was no dysphagia or respiratory symptoms. Plain lateral neck X-ray, direct laryngoscopy and oesophagogastroduodenoscopy showed a grossly swollen epiglottis with narrowing of the laryngeal lumen. No foreign body was found. His condition improved rapidly with intravenous antibiotic therapy. As acute epiglottitis may be a sudden life-threatening condition, a high index of suspicion should be maintained for patients who present with alleged foreign bodies in the throat.
Acute Disease↗
Patient absconding behaviour in a public general hospital: retrospective study.
OBJECTIVE: To identify characteristics of patients who abscond from general hospital wards, and to determine patient outcomes. DESIGN: Retrospective study. SETTING: In-patient wards of a public general hospital, Hong Kong. SUBJECTS AND METHODS: Incident reports of 116 absconding episodes over a 20-month period from 1 November 1998 to 30 June 2000 were reviewed. Clinical characteristics, time and reason for absconding, destination of patient, outcomes, and adverse events were recorded. RESULTS: The majority of patients who absconded were middle-aged males admitted through the Accident and Emergency Department to the specialty of general medicine. Most incidences occurred within 24 hours of admission while in the emergency admission wards. Twelve percent of incidents were repeated episodes of absconding. The most common clinical diagnoses given to this patient group were drug overdose, intoxication, and soft tissue injury. Known drug addicts (29.3%) formed a substantial proportion of the patient group. Forty- seven patients returned to the ward within a few hours, while a further nine (7.8%) re-attended the Accident and Emergency Department of the hospital within 4 days. Several adverse outcomes were recorded: one patient died following a fall from height and two patients committed criminal offences. CONCLUSION: Patient absconding incidents are an important issue in hospital risk management. They can delay the delivery of appropriate medical treatment and may lead to other adverse patient outcomes, in addition to potential medicolegal consequences.
Adolescent↗
Group A streptococcal infection in patients presenting with a sore throat at an accident and emergency department: prospective observational study.
OBJECTIVES: To determine the prevalence of group A streptococcal infection and to evaluate the predictive value of clinical findings and rapid streptococcal antigen detection testing in patients presenting with a sore throat or suspected clinically to have acute pharyngitis. DESIGN: Prospective observational study. SETTING: Accident and emergency department of a public hospital, Hong Kong. PATIENTS: All patients presenting with a sore throat as the chief complaint, or suspected clinically to have acute pharyngitis, from April to September 2000. MAIN OUTCOME MEASURES: Demographic data, clinical features, microbiological throat culture results, and rapid streptococcal antigen detection (Accustrip) test results. RESULTS: Of 1449 patients recruited during the 6-month study period, only 44 (3.0%) had positive throat cultures for group A beta-haemolytic streptococcus. The majority of group A beta-haemolytic streptococci were isolated from patients between the age of 3 and 60 years. Clinical findings other than an absence of cough were found to be unhelpful in predicting group A beta-haemolytic streptococcal throat infection. The sensitivity of the rapid group A streptococcal antigen detection test was 52.6% and the specificity was 98.2%. CONCLUSIONS: The prevalence of group A beta-haemolytic streptococcus in patients presenting with a sore throat, or suspected clinically of having acute pharyngitis, was low. If empirical antibiotics were given to all such patients, 97% of them would be unnecessarily treated. Age and absence of cough were the only clinical findings helpful in predicting the presence of group A beta-haemolytic streptococcal throat infection. The rapid group A streptococcal antigen detection test can provide a quick guide to clinicians on the necessity of antibiotic therapy. However, a confirmatory throat culture backup is recommended for patients with a negative test result.
Acute Disease↗
Corrosive oesophageal injury following vinegar ingestion.
A 39-year-old woman drank one tablespoon of white vinegar in order to 'soften' crab shell stuck in her throat. Endoscopy revealed inflammation of the oropharynx and second-degree caustic injury of the oesophagus extending to the cardia. She had an uneventful recovery. This case report confirmed that vinegar could cause ulcerative injury to the oropharynx and oesophagus. The folklore application of vinegar 'dislodging' a foreign body in the throat should be strongly discouraged.
Acetic Acid↗
A returned traveller with persistent fever due to murine typhus.
Murine (endemic) typhus is a notifiable disease in Hong Kong, but its diagnosis can be difficult. We report a case of murine typhus in a middle-aged man who presented with persistent fever, headache, and skin rash 2 weeks after returning from a visit to China. The diagnosis of murine typhus requires a high index of suspicion for a febrile patient with a history of potential exposure to the disease vector (rat flea) in an endemic area. The importance of early recognition lies in the potential for early therapeutic intervention, leading to decreases in morbidity and duration of stay in hospital.
Anti-Bacterial Agents↗
Hip pain and childhood malignancy.
In children, neuroblastoma can mimic various orthopaedic pathologies and this may create difficulties for doctors in reaching the correct diagnosis. Stage IV neuroblastoma was initially diagnosed as transient synovitis in this case report of a 7-year-old girl presenting with hip and low back pain.
Abdomen↗
Tumor necrosis factor-alpha supports the survival of osteoclasts through the activation of Akt and ERK.
Differentiated osteoclasts have a short life span. We tested various cytokines and growth factors for the effects on the survival of purified mature osteoclasts. In the absence of any added factors, osteoclasts exhibited the survival rate of less than 25% after a 24-h incubation. Among the tested factors, tumor necrosis factor-alpha (TNF-alpha) was found to increase the survival rate to approximately 80%. The TNF-alpha-enhanced survival of osteoclasts appeared to be associated with reduction in apoptosis and suppression of caspase activation. The antiapoptotic signaling pathways involved in the TNF-alpha-induced osteoclast survival were investigated. TNF-alpha treatment increased the phosphorylation of Akt in osteoclasts, which was suppressed by a phosphatidylinositol 3-kinase inhibitor LY294002 and an Src family kinase-selective inhibitor PP1. These inhibitors also attenuated the TNF-alpha stimulation of osteoclast survival. In addition an increase in the phosphorylation of ERK was observed upon TNF-alpha stimulation. PD98059, a specific inhibitor of the ERK-activating kinase MEK-1, abolished the TNF-alpha-induced ERK phosphorylation and osteoclast survival, and in these responses the involvement of Grb2 and ceramide was observed. These results suggest that TNF-alpha promotes the survival of osteoclasts by engaging the phosphatidylinositol 3-kinase Akt and MEK/ERK signaling pathways.
Adaptor Proteins, Signal Transducing↗
Arsenite induces oxidative DNA adducts and DNA-protein cross-links in mammalian cells.
Arsenic is generally recognized as a nonmutagenic carcinogen because sodium arsenite induces DNA damage only at very high concentrations. In this study we demonstrate that arsenite concentrations above 0.25 microM induce DNA strand breaks in both human leukemia cells and Chinese hamster ovary cells. Therefore, DNA damage may be involved in arsenic-induced carcinogenesis. Formamidopyrimidine-DNA glycosylase and proteinase K greatly increased DNA strand breaks in arsenite-treated cells, providing evidence that a large portion of arsenite-induced DNA strand breaks come from excision of oxidative DNA adducts and DNA-protein cross-links. Because DNA strand breaks appear only temporarily during excision repair, the level of detectable DNA strand breaks will be low at any given time point. For this reason many previous studies have only detected low levels of DNA strand breaks. We also show that catalase, and inhibitors of calcium, nitric oxide synthase, superoxide dismutase, and myeloperoxidase, could modulate arsenite-induced DNA damage. We conclude that arsenite induces DNA adducts through calcium-mediated production of peroxynitrite, hypochlorous acid, and hydroxyl radicals.
Animals↗
Aggretin, a C-type lectin protein, induces platelet aggregation via integrin alpha(2)beta(1) and GPIb in a phosphatidylinositol 3-kinase independent pathway.
Aggretin purified from Calloselasma rhodostoma venom was previously identified as alpha(2)beta(1) agonist in triggering platelet aggregation, and exists as a heterodimer sharing a great homologous sequence to GPIb binding proteins. We show here that binding to GPIb is also required in aggregation-inducing activity of aggretin. A2-IIE10, an anti-integrin alpha(2) monoclonal antibody, delayed platelet aggregation while agkistin, a GPIb antagonist, only slightly inhibited platelet aggregation caused by aggretin. However, the aggretin-induced platelet aggregation was completely abolished by a combination of A2-IIE10 and agkistin. Either A2-IIE10 or agkistin significantly inhibited the binding of FITC-aggretin toward fixed platelets. Aggretin and collagen induced a similar signal transduction in platelets involving a time-dependent tyrosine phosphorylation of p125(FAK) and PLCgamma2, but aggretin caused a much-delayed tyrosine-phosphorylation of PI 3-kinase compared with collagen. LY294002, a PI 3-kinase inhibitor, showed a significant inhibitory effect on collagen, but not aggretin-stimulated platelet aggregation. These findings indicate aggretin induces platelet aggregation via binding of alpha(2)beta(1) and GPIb, causing phosphorylation of p125(FAK) and PLCgamma2 leading to platelet activation without the involvement of PI 3-kinase activation.
Antibodies, Monoclonal↗