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J Kew

Publications and source records attributed to J Kew.

At least 19 recordsLinked to original sources
PubMed2001

Community-acquired pneumonia--implementation of a prediction rule to guide selection of patients for outpatient treatment.

The aim of this study was to determine the outcomes of outpatient treatment of community-acquired pneumonia (CAP) when a prediction rule was followed by emergency physicians to guide the selection of patients. This was a prospective observational study conducted at the emergency department of a university-affiliated hospital in Hong Kong, China. A clinical prediction rule was implemented to guide the selection of patients with CAP for outpatient treatment. All subsequent hospitalizations gial presentation were recorded, and the reasons were assessed. The utilization of the observation unit was incorporated into the treatment algorithm. Of 72 patients with CAP followed up as outpatients, 60 (83.3%) were treated successfully, nine (12.5%) required subsequent hospitalization within 30 days, and three (4.2%) were lost to follow-up. None of the patients died, and none required admission to the intensive care unit. Factors associated with subsequent hospitalization include: tuberculosis, underlying malignancy, persistent fever, comorbidity (rheumatoid arthritis and severe osteoporosis), intravenous drug addiction and alcoholism. The observation ward was utilized in 10 (16.7%) patients successfully treated as outpatients. It is concluded that the prediction rule can be safely implemented as a guide for emergency physicians. The short-stay observation unit may be usefully employed for treating low-risk CAP.

Adolescent↗
PubMed2001

X-linked sideroblastic anaemia with ataxia: another mitochondrial disease?

OBJECTIVES: The syndrome of X-linked sideroblastic anaemia with ataxia is rare, described only twice in the literature. The aim was to obtain clinical neurological and haematological data about this rare syndrome throughout adult life. METHODS: A family is described with two affected brothers and two affected maternal uncles. The family was evaluated clinically. Haematological investigations included full blood count, blood film, iron studies, free erythrocyte protoporphyrin (FEP) concentrations and a bone marrow examination where possible. RESULTS: Core neurological features included motor delay, ataxia evident from early childhood, and dysarthria. Neurological features were non-progressive until the fifth decade when slow progression became evident. Some family members showed mild spasticity. Patients usually have a mild asymptomatic anaemia or a borderline decreased mean corpuscular volume. Blood film examination showed Pappenheimer bodies. Bone marrow examination showed ring sideroblasts, indicating raised erythrocyte iron. Free erythrocyte protoporphyrin (FEP) concentrations were raised. CONCLUSIONS: Haematological features are subtle and can be easily overlooked, and individual patients may not display all the abnormal features. X-linked ataxias are rare and incorrect genetic advice may be given if the diagnostic haematological features of X-linked sideroblastic anaemia are overlooked. Males with early onset ataxia should have a haematological evaluation including a blood film, with a bone marrow examination if abnormal blood count indices and measurement of FEP concentrations raise suspicion. The condition has parallels with Pearson's syndrome and Friedreich's ataxia. All three conditions are associated with mitochondrial iron handling defects and ataxia. The human ATP binding cassette gene (hABC7) is a candidate gene and requires further investigation.

Aged↗
PubMed2001

Lateralized carotid artery: an unusual cause of pulsatile tinnitus.

We describe the case of a patient who had a pulsatile tinnitus that was caused by a laterally displaced internal carotid artery. Her condition was treated with the use of a hearing did, which suppressed the tinnitus. We also review the literature on laterally displaced internal carotid arteries, and discuss their differentiation from a congenitally aberrant artery.

Carotid Artery, Internal↗
PubMed2000

Dysphagia in treated nasopharyngeal cancer.

OBJECTIVES: To investigate the prevalence of long-term dysphagia in patients treated for nasopharyngeal carcinoma (NPC) by radiotherapy. Study Design Questionnaire-based assessment, clinical examination, and videofluoroscopic assessment of 50 patients, ages 26 to 75 years (average, 49 years), treated for NPC 12 to 119 months (average, 56 months) previously with no evidence of disease recurrence. METHODS: Administered questionnaire assessment of patients eating and swallowing. Clinical examination by a single experienced clinician. Videofluoroscopy was used to record swallowing of solid, paste, and liquid bolus. Pharyngeal transit time (PTT) was recorded, and the video recordings were assessed by two experienced observers for abnormalities. RESULTS: Fifty patients completed the questionnaire and were examined. Seventy-six percent reported dysphagia, 97% had xerostomia, and 78% had no gag reflex. Forty-nine patients underwent videofluoroscopy. Abnormal pharyngeal contraction was observed on videofluoroscopy in 93% of the subjects. Silent aspiration was observed in 22% of the patients. PTT was prolonged from a normal of 1 second to 1.9 seconds for solid, 1.7 seconds for paste, and 1.3 seconds for liquid consistencies. CONCLUSIONS: Subjective and objective swallowing abnormalities are common after radiotherapy for NPC. The implications of this finding and possible causes are discussed.

Adult↗
PubMed2000

The effect of lung injury and excessive lung fluid, on impedance cardiac output measurements, in the critically ill.

OBJECTIVES: To investigate the relationship between the attenuation of impedance cardiac output (IC(co)) measurements and lung fluid content in critically ill patients. DESIGN: Observational study. SETTING: Intensive Care Unit of a major teaching hospital in Hong Kong. PATIENTS: Twenty-four critically ill patients who required a pulmonary artery catheter. MEASUREMENTS AND MAIN RESULTS: Triplicate thermodilution cardiac output (TD(co)) and BoMed NCCOM3 (IC(co)) measurements were made simultaneously on a single occasion in each patient. Lung fluid accumulation was assessed by: (a) thoracic impedance (Zo), (b) radiological assessment of chest X-rays using an alveolar consolidation score (0-4) and (c) scoring the degree of hypoxia and use of positive end-expiratory pressure (PEEP). Offsets (TD(co)-IC(co))/TD(co), expressed as percentage, were compared with these indices of excess lung fluid. Patients were divided into those with sepsis (n = 13), fluid balance problems (n = 5) and cardiothoracic problems (n = 6). Mean cardiac output values were: 6.7 l/min TD(co) (range 3.6-12.9) and 5.2 l/min IC(co) (range 2.7-9.0). Overall the TD(co) and IC(co) values showed great variance, with a bias and limits of agreement of 1.49 +/- 4.16 l/min, or +/- 69%. In septic patients, increasing offset was correlated with decreases in Zo (r = 0.73, P = 0.005) and increases in alveolar consolidation score (r = 0.72, P = 0.005). CONCLUSIONS: The BoMed under-estimates cardiac output in critically ill patients. In septic patients the degree of attenuation of IC(co) can be related to the extent of lung injury and fluid accumulation within the thorax.

Adult↗
PubMed2000

Longitudinal colour doppler study of superficial lymph nodes in non-Hodgkin's lymphoma patients on chemotherapy.

AIMS/METHODS: A longitudinal study of 22 malignant lymph nodes by colour Doppler (CD) and/or colour power (CP) ultrasonography was undertaken in 12 non-Hodgkin's lymphoma patients to delineate changes in vascularity, and correlate this response with clinical outcome. RESULTS: Reduced vascularity in response to chemotherapy was shown to be a positive prognostic sign. CONCLUSIONS: More persistent nodal vascularity may signify a less favourable prognosis.

Adult↗
PubMed2000

Differentiation of lymphadenopathy in different forms of carcinoma with Doppler sonography.

AIM: The aim of the study was to show whether it may be possible to characterize malignant nodes of different aetiologies with Doppler imaging. Non-Hodgkin's lymphoma (NHL) and nasopharyneal carcinoma (NPC) were used as the models. MATERIALS AND METHODS: A prospective study was undertaken using colour Doppler sonography in 60 enlarged peripheral lymph nodes of 34 patients with either lymphoma or NPC. The vascular distribution, peak systolic velocity (PSV), end diastolic velocity (EDV), resistivity index (RI) and the pulsatility index (PI) of the largest node on each side of the patient were investigated. RESULTS: The vascular distribution was predominantly 'capsular and central' or 'capsular' in 57 nodes, consistent with previous descriptions, but there was no significant difference in the mean PSV (lymphoma: 20.0 cm/s; NPC: 21.86 cm/s;P > 0.05) and mean EDV (lymphoma: 5.95 cm/s; NPC: 5.07 cm/s;P > 0.05). However, significant differences were shown in the mean RI (lymphoma: 0.71; NPC: 0.81;P < 0.05) and mean PI (lymphoma: 1.43; NPC: 1.88;P < 0.05) of these two groups of lymph nodes. CONCLUSIONS: There is significant difference in the Doppler waveform between malignant nodes affected by lymphoma or NPC, suggesting that further differentiation of malignant nodes may be possible.

Adult↗
PubMed2000

Radiation induced sarcomas of the head and neck following radiotherapy for nasopharyngeal carcinoma.

AIM: To report the radiological findings of radiation induced sarcomas (RIS) in the head and neck following radiotherapy for nasopharyngeal carcinoma. MATERIALS AND METHODS: The clinical notes and radiological studies (MR n = 3, CT n = 4) of four patients were reviewed retrospectively. RESULTS: RIS developed 5 to 10 years following radiotherapy. Two patients had tumours arising from the alveolar process of the maxilla, one from the nasal cavity, and one patient had a tumour at two sites, involving the external auditory canal and the uvula. Three of the four patients had large tumours at diagnosis with a 3.5-6 cm predominately homogeneous soft tissue mass, complete destruction of bone and extensive local invasion. One was small and localized to the nasal turbinate. Radiation osteitis was identified in two of the four (50%) patients. CONCLUSION: The site of RIS following radiotherapy for NPC is variable but is invariably within the high dose zone of the radiotherapy. These sarcomas tend to present late with a large soft tissue mass. Radiation osteitis is not a constant feature. As surgery provides the only chance of cure, imaging has an important role in the pre-operative mapping of the extent of tumour. et al.

Adult↗
PubMed2000

Intranasal anatomy of the nasolacrimal sac in endoscopic dacryocystorhinostomy.

Intranasal surface anatomy is fundamental to the technique of endoscopic dacryocystorhinostomy. In the current literature the lacrimal sac is described as being situated anterior to the anterior end of the middle turbinate with between 0% and 20% of the sac above the insertion of the middle turbinate on the lateral nasal wall (the axilla of the middle turbinate). The aim of this study was to use CT dacryocystograms (DCGs) and CT scans to establish the relationship of the lacrimal sac to the lateral nasal wall. Forty-seven individual lacrimal sacs were measured in relation to the common canaliculus, and 76 were measured in relation to the insertion of the middle turbinate. Measurements taken from the long axis of the sac showed the mean height of the sac above the middle turbinate insertion was 8.8 mm (SD = 0.2, 95% CI = 1.3) and below it was 4.1 mm (SD = 2.3, 95% CI = 1.1). The average measurement of the sac above the com-mon canaliculus on CT DCGs was 5.3 mm (SD = 1.7, 95% CI = 0.56), whereas the average measurement below the common canaliculus was 7.7 mm (SD = 2, 95% CI = 1.3) (n = 47 CT DCGs). The findings in this study show that a major portion of the sac is locat-ed above the insertion of the anterior end of the middle turbinate and, in addition, that a significant part of the sac lies above the entry point of the common canaliculus. Knowledge of these findings can ensure that the sac is adequately exposed during dacryocystorhinostomy by removal of sufficient bone and mucosa above the anterior insertion of the middle turbinate.

Adult↗
PubMed2000

Thoracic paravertebral block: radiological evidence of contralateral spread anterior to the vertebral bodies.

We report contralateral spread of contrast medium anterior to the vertebral bodies after injection of contrast through a thoracic paravertebral catheter that was used to manage pain in a patient with multiple fractured ribs. We review the literature and propose that the anatomical basis for this observation is spread in the extrapleural compartment of the thoracic paravertebral space along the subserous fascial plane.

Aged↗
PubMed2000

Vascularised bone grafting for fibrous dysplasia of the upper limb.

We describe our experience with vascularised bone grafting for the treatment of fibrous dysplasia of the upper limb in eight patients, five men and three women, aged between 17 and 36 years. The site was in the humerus in six and the radius in two. Persistent pain, progression of the lesion and pathological fracture with delayed union were the indications for surgical intervention. We used a vascularised fibular graft after curettage of the lesion. Function and radiological progress were serially monitored. Early radiological union of the graft occurred at periods ranging from 8 to 14 weeks. The mean period for reconstitution of the diameter of the bone was 14 months (12 to 18) predominantly through inductive formation of bone around the vascularised graft, which was a prominent feature in all patients. There were no recurrences and none of the grafts sustained a fracture or failed to unite. After operation function was excellent in three patients and good in five. Vascularised bone grafts provide a safe and reliable means of ensuring good continuity of bone with little risk of recurrence and failure.

Adolescent↗
PubMed2000

Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients.

STUDY OBJECTIVES: To determine the frequency of and potential risk factors for catheter-related deep venous thrombosis (DVT) in critically ill adult patients. DESIGN: Prospective, controlled, observational cohort study. SETTING: A mixed medical and surgical ICU in a university hospital. PATIENTS: All adult patients undergoing femoral vein catheterization. INTERVENTIONS: None. MEASUREMENTS: ICU diagnosis, underlying disease, demographic data, type of catheter, complications during cannulation, use of anticoagulants, coagulation status, medications infused, and duration of catheterization were recorded. Compression and duplex Doppler ultrasound studies of both femoral veins were performed prior to insertion, at 12 h after insertion, and daily until catheter removal. Follow-up investigation was performed at 24 h and 1 week after removal. RESULTS: Of 140 cases entered into the study, 124 were evaluated. Fourteen patients developed iliofemoral vein DVTs. Two were clinically obvious. Twelve (9.6%) were line related (uncannulated leg normal) and two (1.6%) occurred only in the uncannulated leg (p = 0.011; relative risk, 6.0; confidence interval, 1.5 to 23.5). Line-related DVT can occur any time from the day after insertion to 1 week after removal. The incidence of catheter-related DVT was unrelated to number of insertion attempts, arterial puncture or hematoma, duration of catheterization, coagulation status, or type of infused medications. No other predisposing or protective factors were identified. Three of the 12 patients with catheter-related DVT died. In no patient was clinical pulmonary embolus suspected. CONCLUSION: Although the femoral route is convenient and has potential advantages, the use of femoral lines increases the risk of iliofemoral DVT. Catheter-related DVT may occur as soon as 1 day after cannulation and is usually asymptomatic. This increased risk should be carefully considered when the femoral route of cannulation is chosen.

Adult↗
PubMed2000

Middle ear effusions after radiotherapy: correlation with pre-radiotherapy nasopharyngeal tumor patterns.

OBJECTIVE: The purpose of this study was to assess whether pretreatment tumor patterns of nasopharyngeal carcinoma (NPC) can predict the status of the middle ear after radiation treatment. MATERIALS AND METHODS: Pretreatment and follow-up magnetic resonance imaging (MRI) was performed in 32 patients (64 ears) who had radiation therapy for NPC. For the purpose of analysis, the ears were placed into their pre-radiation therapy tumor pattern groups and the presence of middle ear effusion (MEE) with regard to eustachian tube (ET) invasion or displacement was identified. RESULTS: MEEs were present in 31 (48.4%) ears after radiation therapy. All of the MEEs that resolved were in the preradiation therapy groups where tumor invasion of the eustachian tube was present irrespective of the amount of ET displacement. There was, however, no significant difference for resolved MEEs between ears with ET invasion or displacement (p = 0.32 and p = 0.71, respectively, Fisher's exact test). The MEEs occurred with significantly greater frequency in ears with minor ET displacement than in those with major ET displacement (p = 0.013, Fisher's exact test) as well as in previously normal ears compared with other groups (p = 0.008, Mann-Whitney U test). CONCLUSION: A pre-radiation therapy NPC tumor pattern was not found that clearly predicted the outcome of MEE after radiation treatment. The findings, however, suggest that approximately one third of MEEs in patients with invasion of ET or paratubal structures, irrespective of the amount of ET displacement, resolve after therapy. The MEEs that were present in ears with ET displacement and no invasion did not resolve despite reversal of the displacement after treatment, which suggests that ET position plays a less important role than invasion in the resolution of MEE. It is, however, difficult to be certain, because ears with invasion were invariably associated with ET displacement, and the contribution of radiation therapy to the development of MEE further complicates the issue.

Adult↗