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Biomedical subjects

Cheng-Chung Fang

Publications and source records attributed to Cheng-Chung Fang.

At least 19 recordsLinked to original sources
PubMed2006

Underreporting of illicit drug use by patients at emergency departments as revealed by two-tiered urinalysis.

This study investigates the validity of questionnaire-based self-reports of illicit drug use by comparing with a two-tiered urinalysis among patients at emergency departments. Questions on the use of alcohol and drugs were administered to patients recruited on a continual basis for 2weeks at the emergency department of two hospitals in northern Taiwan. Positive tests of initial urinalysis using fluorescence polarization immunoassay were further confirmed by gas chromatography/mass spectrometry. In a total of 1502 patients interviewed, 632 (42%) also provided a urine sample. Among those with urine samples, the positive rate of urinalysis was 1.4% for amphetamine-type drugs and 1.6% for opiates. Among those with positive urinalysis, a false-negative rate ranged from 66.6% for amphetamines to 70.0% for opiates. Meanwhile, all the self-reported current uses of either amphetamines or opiates were confirmed by urinalysis. The results indicate that the false-negative rates of questionnaire-based, self-reported current use of illicit drug are around two thirds and the false-positive rates are negligible, which might be useful for the calibration of estimates from epidemiological surveys.

Adolescent↗
PubMed2006

Diltiazem suppresses collagen synthesis and IL-1beta-induced TGF-beta1 production on human peritoneal mesothelial cells.

BACKGROUND: After long-term treatment with continuous ambulatory peritoneal dialysis (CAPD), some patients may develop peritoneal fibrosis. Peritoneal mesothelial cells (PMCs) participate in the inflammatory reactions in the peritoneal cavity, and transforming growth factor-beta1 (TGF-beta1) and interleukin-1beta (IL-1beta) are involved in peritoneal fibrosis. Diltiazem is used frequently in patients with CAPD to treat hypertension. The objectives of this study were to examine the effects of diltiazem on collagen- and IL-1beta-induced TGF-beta1 production on human PMCs and the signalling pathway of diltiazem in this induction. METHODS: Human PMCs were cultured from the enzymatic disaggregation of human omentum. Collagen synthesis was measured by [3H]proline incorporation into pepsin-resistant, salt-precipitated collagen. The expression of collagen I and III, and TGF-beta1 mRNA was evaluated by northern blotting. The production of TGF-beta1 by human PMCs was measured by immunoassay. The changes of intracellular calcium level after adding Fura-2-AM were measured by fluorescence spectrophotometry. Western blotting was used to assess mitogen-activated protein kinase (MAPK) signalling proteins. RESULTS: We found that diltiazem (<0.2 mM) inhibited collagen I and III mRNA expression and collagen syntheses on a dose-dependent basis. Diltiazem (0.2 mM) suppressed IL-1beta- (5 ng/ml) induced TGF-beta1 production on human PMCs at both the protein and mRNA levels. Diltiazem (0.2 mM) also inhibited IL-1beta- (5 ng/ml) induced collagen I and III mRNA expression. Intracellular calcium levels did not change after the treatment with diltiazem, IL-1beta or both. The IL-1beta-treated human PMCs increased phospho-JNK (stress-activated c-Jun N-terminal kinase) and phospho-p38 MAPK expression, while diltiazem could suppress this phenomenon. CONCLUSIONS: Diltiazem suppressed collagen synthesis of human PMCs and inhibited IL-1beta-induced TGF-beta1 production on human PMCs. This signalling transduction may be through p38 MAPK and JNK pathways instead of intracellular calcium. These results suggest diltiazem to be a potential therapeutic regimen in preventing peritoneal fibrosis and support further in vivo studies.

Analysis of Variance↗
PubMed2006

Acute renal failure caused by mushroom poisoning.

Despite the abundance of wild mushrooms growing in a variety of habitats in Taiwan, mushroom poisoning is rarely reported. Here, we report two cases of mushroom poisoning, possibly due to Amanita smithiana or a related species. A 54-year-old man and his 52-year-old wife presented with acute anuric renal failure 1 day after ingesting some white mushrooms they had collected when mountain climbing; they made a full recovery following hemodialysis and supportive treatment. Although rare, mushroom poisoning should be considered in the differential diagnoses of acute renal failure.

Acute Kidney Injury↗
PubMed2005

Urinothorax associated with VURD syndrome.

VURD syndrome is a congenital genitourinary anomaly combining posterior urethral V alves, U nilateral vesicoureteral R eflux and renal D ysplasia. We report on a case of VURD syndrome presenting with acute renal failure and respiratory distress syndrome due to urinothorax. Urinothorax is a rarely reported complication of obstructive uropathy, but has not been linked to VURD syndrome. The diagnosis of urinothorax was confirmed by demonstration of a pleural fluid to serum creatinine ratio greater than one. Without tube thoracotomy drainage, urinothorax resolved rapidly after urinary catheterization and the renal recovery was also excellent after primary valve ablation. We discuss the diagnosis and management of urinothorax and the possible protective effect of urinoma, urinothorax, and unilateral vesicoureteral reflux on the renal function. We consider that urinothorax and urinoma may be deemed to be the extension of the clinical spectrum of VRUD syndrome. Excellent renal prognosis in our case also favors the protective effect provided by the buffer of pressure from unilateral vesicoureteral reflux, urinoma and urinothorax.

Exudates and Transudates↗
PubMed2005

Progressive increase of bowel wall thickness is a reliable indicator for surgery in patients with adhesive small bowel obstruction.

PURPOSE: The aim of this study was to determine whether progressive increase of bowel wall thickness during nonoperative treatment is a reliable indicator for surgery in patients with adhesive small bowel obstruction. METHODS: The study consisted of a prospective case series of 121 patients with adhesive small bowel obstruction who underwent an abdominal ultrasonographic examination. The results of ultrasonographic examinations were classified into two groups according to the presence (Group I) or absence (Group II) of bowel wall thickening. Bowel wall thickening was recognized as a visible small bowel wall > or =3 mm in width as seen by ultrasonographic examination. The findings of subsequent ultrasonographic examinations taken 24 hours later were compared with those taken at admission. Surgery was determined based on the presence of any toxic signs or the failure of nonoperative treatment. The number of patients who had successful nonoperative treatment, the number of patients who underwent surgeries, and the number of complications in each group were calculated to correlate with the ultrasonographic findings. RESULTS: There are 49 and 72 patients in Groups I and II, respectively. The number of patients who had successful nonoperative treatment and number of patients who underwent surgeries in Group I are 40 (81.6 percent) and 9 (18.4 percent) and in Group II the numbers are 68 (94.4 percent) and four (5.6 percent), respectively (P = 0.036). All 12 (100 percent) patients with progressive increase of bowel wall thickness underwent surgery. Progressive increase of bowel wall thickness as an indicator for surgery has a sensitivity of 92.3 percent (95 percent confidence interval, 62.1-99.6 percent) and a specificity of 100 percent (95 percent confidence interval, 95.7-100 percent). CONCLUSIONS: Patients with initial bowel wall thickening have a higher incidence of surgery, and progressive increase of bowel wall thickness that appears 24 hours later is a reliable indicator for surgery in patients with adhesive small bowel obstruction.

Adolescent↗
PubMed2005

ED presentation of acute porphyria.

Abdominal pain is a common complaint for visits to ED. Among the causes of abdominal pain, the acute porphyria may confuse emergency physicians. With wide range of unspecific symptoms and signs, acute porphyria is rarely considered as a differential diagnosis of acute abdomen in ED. Some patients even receive unnecessary surgery. There are 32 patients who visited the ED of National Taiwan University Hospital because of acute porphyric attacks over the past 13 years. Ten patients (3 males and 7 females) were diagnosed with acute porphyria for the first time at ED. The onset of age ranged from 17 to 55 years (mean, 32 years). All of our patients presented with abdominal pain but without fever, dermatologic, and neurologic symptoms that are typically presented in acute porphyria. On the average, most of them repeatedly sought for medical help because of persistent symptoms for 4 times before being definitely diagnosed and thus receiving the optimal treatment. Meanwhile, all patients needed at least 2 kinds of analgesic, and most of them needed narcotic analgesia for pain control before diagnosis. The most commonest point of tenderness is over epigastrium (7 of 10 patients). The laboratory and image studies of our patients were of no diagnostic value for acute porphyria, except for Watson-Schwartz test. In summary, our study revealed that when a patient after puberty with repetitive visits because of severe abdominal pain without reasonable causes and needs narcotics for pain control, acute porphyria should be taken into consideration.

Abdominal Pain↗
PubMed2005

A patient-tailored N-acetylcysteine protocol for acute acetaminophen intoxication.

BACKGROUND: Hepatotoxicity as a result of acetaminophen(APAP) intoxication has become an important problem, but early intervention with N-acetylcysteine (NAC) is effective in preventing hepatic injury. Two NAC regimens are currently approved for acute APAP intoxication: NAC administered orally every 4 hours for 72 hours, and NAC administered intravenously for 20 hours within 8 to 10 hours after ingestion of a potentially hepatotoxic amount of APAP. However, clinical observations suggest that a variable treatment duration may be more appropriate than use of these predetermined, fixed-duration protocols. OBJECTIVES: This study investigated the tolerability and efficacy of a patient-tailored NAC protocol for acute APAP intoxication by comparing the incidence of hepatotoxicity in patients receiving this protocol and in historical controls receiving 1 of 2 fixed-duration protocols: oral NAC for 72 hours and intravenous NAC for 20 hours within 8 to 10 hours after ingestion of a potentially hepatotoxic amount of APAP. METHODS: This was a retrospective case series study that included all patients admitted through the emergency department (ED) of the National Taiwan University Hospital with a diagnosis of APAP intoxication between October 1997 and October 2002. According to the patient-tailored protocol, which had been used in the ED since 1997, patients with a serum APAP concentration above the limit for possible risk based on a modified Rumack-Matthew nomogram received oral treatment with NAC 140 mg/kg, followed by maintenance doses of 70 mg/kg every 4 hours. NAC treatment was discontinued when the APAP concentration was <10 mg/L and serum aspartate aminotransferase (AST) was <40 IU/L. For the purposes of assessing clinical outcomes, patients were divided into 3 groups based on duration of treatment: the short-course group (</=36 hours), the intermediate-course group (37-72 hours), and the long-course group (>/=73 hours). The primary outcome measure was development of hepatotoxicity, defined as a serum AST or alanine aminotransferase concentration >1000 IU/L. RESULTS: Twenty-seven patients were included in the study, 17 in the short-course group, 4 in the intermediate-course group, and 6 in the long-course group. The mean (SD) durations of NAC treatment in the respective groups were 22.1 (5.5) hours, 45.0 (8.2) hours, and 97.3 (33.2) hours. All 6 patients (22%) in the long-course group had hepatotoxicity (peak AST range, 1083-9770 IU/L); their treatment duration ranged from 80 to 164 hours. No patients in the short- or intermediate-course group had evidence of hepatotoxicity. One woman in the long-course group in whom initiation of NAC treatment was delayed by 28 hours died of fulminant hepatic failure. The overall incidence of hepatotoxicity was similar to that in the historical controls. CONCLUSIONS: In this retrospective case series inpatients who received patient-tailored NAC therapy for acute APAP intoxication, the incidence of hepatotoxicity was low and comparable to that in historical controls who received treatment with 1 of 2 fixed-duration regimens. Use of this protocol may have the potential to shorten hospital stays without increasing the risk to patients. However, the sample size was small, and the findings require confirmation in prospective clinical trials.

Acetaminophen↗
PubMed2005

Treatment of fibrate-induced rhabdomyolysis with plasma exchange in ESRD.

Hypertriglyceridemia is a common metabolic disorder in patients with chronic renal failure. Fibrate derivatives are often used for lipid lowering in this population with adjusted dosage. However, fibrate-related adverse reaction still occasionally occurs. The authors report a case of end-stage renal disease in a patient who underwent hemodialysis regularly, taking a reduced dosage of bezafibrate (200 mg/d) for refractory hypertriglyceridemia. She did not take any statins, cyclosporine, monoamine oxidase inhibitors, or warfarin concurrently. Rhabdomyolysis was complicated along with an increased serum bezafibrate level. Plasma exchange was performed, which dramatically decreased the level of bezafibrate, and rhabdomyolysis resolved rapidly thereafter. A lower dose of bezafibrate, 200 mg every third day, was prescribed with cautious monitoring of symptoms and laboratory parameters, and better triglyceride control was achieved uneventfully. This is the first report using plasma exchange to remove excessive bezafibrate, a highly protein-bound molecule that is unlikely to be cleared by hemodialysis in an end-stage renal disease patient with serious adverse reaction caused by accumulation of bezafibrate. In contrast to a traditional wait-and-see strategy, plasma exchange seems to be a safe and effective treatment in addition to supportive care for rhabdomyolysis in such clinical scenarios.

Bezafibrate↗
PubMed2005

Ultrasound may decrease the emergency surgery rate of incarcerated inguinal hernia.

OBJECTIVE: Manual reduction is the standard procedure for incarcerated inguinal hernia reduction. The role of ultrasound in incarcerated inguinal hernia reduction has not been defined. The aim of this study was to determine whether ultrasound can improve the ability to reduce incarcerated inguinal hernia safely when manual reduction fails and thereby decrease the emergency surgery rate. MATERIAL AND METHODS: Between January 1994 and December 2003, 112 adult patients with incarcerated inguinal hernias were admitted to a university medical center and classified into two groups. Group I consisted of 61 patients who received emergency surgical reduction after the failure of two attempts at manual reduction. In Group II, comprising 51 patients, ultrasound-guided reduction was performed when two attempts at manual reduction failed. Emergency surgical reduction was scheduled if both ultrasound-guided reduction and two attempts at manual reduction failed. The difference in emergency surgery rates between groups I and II was compared. RESULTS: In group I, manual reduction was successful in 55 cases (90.2%) and 6 patients underwent emergency surgery. In group II, manual reduction was successful in 45 cases, ultrasound-guided reduction in 4 cases, 1 reduction was avoided after ultrasonic examination, and 1 patient underwent emergency surgery. The emergency surgery rates in groups I and II were 9.8% and 2.0%, respectively. CONCLUSIONS: Ultrasound can improve the ability to reduce incarcerated inguinal hernia safely when manual reduction fails and may decrease the rate of emergency surgery.

Adult↗
PubMed2005

Near-fatal methemoglobinemia after recreational inhalation of amyl nitrite aerosolized with a compressed gas blower.

Adverse effects associated with recreational inhalation of nitrites are usually mild and rarely life-threatening. We report a rare case of near-fatal methemoglobinemia after inhalation of amyl nitrite after aerosolizing the liquid using a compressed gas blower designed to clean photographic equipment that employed hydrofluoroalkane-134a as a propellant. A 31-year-old previously healthy male became dyspneic and fainted soon after the recreational inhalation of amyl nitrite aerosolized using a compressed gas blower. He was brought to the emergency department with severe cyanotic appearance and profound shock. Oxygen saturation was 82%, unresponsive to oxygen supply. His methemoglobin blood level was 52.2%. After 100 mg of methylene blue (2 mg/kg body weight) was administered intravenously, he recovered consciousness, and dyspnea and cyanosis subsided gradually. This case illustrates the extraordinary hazard of the use of a compressed gas blower in the recreational inhalation of nitrites. Prompt recognition and rapid antidotal treatment may adequately correct near-fatal overdose associated with recreational use of amyl nitrite.

Adult↗