Biomedical subjects

Lai-Chu See

Publications and source records attributed to Lai-Chu See.

At least 19 recordsLinked to original sources

PubMed2006

Critical score of Glasgow Coma Scale for pediatric traumatic brain injury.

The aim of this study is to determine the predictive critical value of the Glasgow Coma Scale for use as a determinant of outcome for children with traumatic brain injuries. A total of 309 children, aged 2-10 years, were enrolled in this study. Each subject underwent the following assessments: Glasgow Coma Scale; clinical data; brain computed tomography; and Glasgow Outcome Scale assessments. The receiver operating characteristic curve indicated that a critical point of the Glasgow Coma Scale set at 5 was most strongly correlated with outcome of pediatric traumatic brain injury. Subarachnoid hemorrhage with brain swelling and edema, subdural, intracerebral hemorrhage, and basal ganglion lesions were associated with severe injury and poor outcome (P < 0.05). However, cortical lesions did not affect injury severity and outcome. In injuries associated with traumatic brain injuries, only chest trauma had a tendency to be associated with poor outcome (P < 0.05). Of the factors analyzed, the score of the Glasgow Coma Scale was the most effective predictor for outcome in pediatric traumatic brain injury. Furthermore, the predictive critical score of the Glasgow Coma Scale should be set at 5 for pediatric traumatic brain injury. The computed tomographic findings also were important in determining injury severity and predicting outcome.

Accidents, Traffic↗

PubMed2005

Improvement in left ventricular function following coronary stenting in patients with acute myocardial infarction: 6-month and 3-year follow-up.

BACKGROUND: This study assesses hemodynamic and angiographic changes in patients with a patent infarct-related artery (IRA) after acute myocardial infarction (AMI). METHODS: One hundred and seventy-seven patients with first AMI, who received a predischarge stenting to the IRA and sustained a patent IRA over 3 years, were stratified into 3 groups according to the baseline left ventricular ejection fraction (LVEF): group A included 63 patients with a LVEF of >49%, group B 73 patients with a LVEF of 40%-49%, and group C 41 patients with a LVEF of <40%. The hemodynamic and angiographic parameters were compared at baseline, 6-month and 3-year follow-up. RESULTS: The LV end-diastolic volume index increased 1, 4 and 4 ml/m(2) at 6 months and 4, 5 and 10 ml/m(2) at 3 years, respectively in group A, B and C. The LVEF increased 4%, 7% and 12% at 6 months and 6%, 8% and 14% at 3 years, respectively in group A, B and C. The stroke volume index increased 3, 7 and 12 ml/m(2) at 6 months and 6, 8 and 15 ml/m(2) at 3 years, respectively in group A, B and C. The LV wall motion score decreased 2, 3 and 3 at 6 months and was unchanged at 3 years, respectively in group A, B and C. The LV end-diastolic pressure decreased 2, 3 and 4 mm Hg, respectively in group A, B and C, at 6-month follow-up and remained stable at 3 years. CONCLUSIONS: Long-term beneficial effects in patients receiving a late predischarge intracoronary stenting following first AMI were seen and these may be related to patent IRA. A progressive improvement in left ventricular remodeling occurs in all patients regardless of their initial left ventricular function and the improvement continues for at least 3 years.

Aged↗

PubMed2005

The effect of changing reimbursement policies on quality of in-patient care, from fee-for-service to prospective payment.

OBJECTIVE: Using insurance claims for hemorrhoidectomies, we examined the effect of Taiwan's Bureau of National Health Insurance's case payment system, a fixed case payment rate method used to reimburse health care providers for in-patient care. DESIGN: This observational natural experimental study examined changes in medical care that occurred between two phases: the 9 months before case payment system was implemented on 1 October 1997 and the 9 months afterwards. The changes were analyzed by performing linear regressions with interaction between hospital type and the implementation of case payment system. SETTING: This study was based on total claim data from National Health Insurance. STUDY PARTICIPANTS: A total of 23 638 hemorrhoidectomy insurance claims. MAIN OUTCOME MEASURES: Length of stay, number of medical services, and number of drug prescriptions. Medical services were stratified into those that were considered minimal requirements and those considered optional by the Bureau of National Health Insurance. RESULTS: Over the 18-month period, the number of patients increased by 23.7%. After the case payment system was implemented, length of stay decreased by 0.59 days (P < 0.0001), the number of minimally required services increased by 2.19 to 4.24 items (P < 0.0001), the number of optional service items decreased by 0.32 items (P < 0.0001), and drug prescription decreased slightly by 0.58 to 0.99 items (P < 0.0001) per hospitalization. CONCLUSIONS: The case payment system successfully shortened length of stay without significantly sacrificing the provision of services.

Adult↗

PubMed2005

Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis.

The aim of our study is to analyze the relationships between the characteristics of renal stones determined by unenhanced helical computed tomography (UHCT) and their outcomes after extracorporeal shock wave lithotripsy (ESWL) as well as to predict ESWL outcomes of renal stones by their UHCT characteristics with the use of multivariate analysis. During a 7-month period, 80 adult patients with renal stones underwent ESWL as well as UHCT both before and 3 months after ESWL. Of the 80 patients, 42 patients were classified as ESWL successes and 38 as ESWL failures based on their post-ESWL UHCT findings. For pre-ESWL UHCT, a stone number of more than 2 (P=0.0236), a maximal stone size of greater than 12 mm (P<0.0001), a stone burden of more than 700 mm3 (P<0.0001), a maximal stone density of more than 900 HU (P=0.0008) and nonround/oval stones (P=0.0007) were associated with ESWL failure outcomes. Multivariate analysis demonstrated that a stone burden of more than 700 mm3 (P=0.0003), the presence of nonround/oval stones (P=0.0072) and a maximal stone density of more than 900 HU (P=0.0430) were statistically significant predictors of a failure outcome for ESWL. Thus, the analysis of stone characteristics of renal stones by UHCT is helpful in selecting appropriate patients undergoing ESWL for favorable outcomes and reduces the overall costs of the treatment of renal stones.

Adult↗

PubMed2005

Does diabetes mellitus influence the efficacy of FDG-PET in the diagnosis of cervical cancer?

PURPOSE: Compared with computed tomography (CT) and magnetic resonance imaging (MRI), positron emission tomography (PET) may have additional value in the assessment of primary and recurrent cervical cancer. However, the degree of tumour uptake of (18)F-2-fluoro-2-deoxy-D: -glucose (FDG) uptake is sometimes influenced by diabetes mellitus (DM). Therefore, we conducted this prospective study to compare the diagnostic ability of FDG-PET in patients with cervical cancer complicated by DM and those without DM. METHODS: Patients with untreated locally advanced primary or clinically curable recurrent cervical carcinoma were enrolled. Both FDG-PET and MRI/CT scans were performed within 2 weeks. Patients were categorised into the following groups: hyperglycaemic DM (fasting blood sugar >126 mg/dl), euglycaemic DM and non-DM. The lesions were confirmed histologically or by clinical follow-up. The receiver operating characteristic curve method, with calculation of the area under the curve (AUC), was used to evaluate the discriminative power. RESULTS: From February 2001 to January 2003, 219 patients (75 with primary and 144 with recurrent cervical cancer) were eligible for analysis. Sixteen had hyperglycaemic DM, 12 had euglycaemic DM and 191 were in the non-DM group. The diagnostic power of PET in the hyperglycaemic DM, euglycaemic DM and non-DM groups did not differ significantly with regard to the identification of either metastatic lesions (AUC, 0.967/0.947/0.925, P>0.05) or primary tumours/local recurrence (AUC, 0.950/0.938/0.979, P>0.05). Considering all DM patients, PET showed a significantly higher detection power than MRI/CT scans in respect of metastatic lesions (AUC=0.956 vs 0.824, P=0.012). CONCLUSION: In comparison with its accuracy in non-DM patients, the accuracy of PET in cervical cancer patients with mild to moderate DM was not significantly reduced.

Adult↗

PubMed2005

Comparison of amniotic membrane graft alone or combined with intraoperative mitomycin C to prevent recurrence after excision of recurrent pterygia.

PURPOSE: Without effective adjunctive therapy, the recurrence rate after excision of recurrent pterygia is high. In an effort to determine a way to better reduce the recurrence of pterygia, we compared the efficacy and safety of amniotic membrane graft (AMG) alone and AMG combined with intraoperative mitomycin C after excision of recurrent pterygia. METHODS: Patients with recurrent pterygia were randomly assigned to receive excision of pterygia followed by AMG alone or AMG combined with intraoperative 0.025% mitomycin C for 3 minutes (AMG-mitomycin C). Patients who could be followed up for more than 12 months were entered for data analysis. Conjunctival (potential) and corneal (true) recurrence of pterygia and other complications were recorded. RESULTS: The group receiving AMG alone was made up of 48 eyes in 48 patients, and the group receiving AMG-mitomycin C consisted of 47 eyes in 46 patients. No significant difference was found in age distribution, sex distribution, or duration of follow-up between the 2 groups. Regarding the recurrence rates of each group, 6 conjunctival (12.5%) and 6 corneal (12.5%) recurrences developed in the AMG group, and 4 conjunctival (8.5%) and 6 corneal (12.8%) recurrences developed in the AMG-mitomycin C group. No significant difference was found in the conjunctival and corneal recurrence rate between the 2 groups (P=0.623 and 0.966, respectively; log rank test), and no major complications developed in either group. CONCLUSIONS: AMG alone can be considered an effective alternative adjunctive treatment of recurrent pterygia. The addition of intraoperative mitomycin C did not further reduce the recurrence rate.

Adult↗

PubMed2005

The prevalence, severity and seasonal variations of asthma, rhinitis and eczema in Taiwanese schoolchildren.

The prevalence of asthma is increasing in Taiwan but data remain limited. The aim of this study was to determine the prevalence, severity, demographic and seasonal variations of asthma, rhinitis, and eczema in Taiwan. Using a one-stage stratified cluster random sampling, first grade (aged 6-8) and eighth grade (aged 13-15) students from Taoyuan, northern Taiwan, were invited to participate in this survey. The results showed a total of 6190 students, 3079 aged 6-8 and 3111 aged 13-15, completed this survey. In general, children aged 6-8 had significantly higher prevalence rates of diagnosed asthma, rhinitis, and eczema than children aged 13-15 (12.2%, 29.8%, and 10.2% vs. 9.6%, 18.3%, and 4.7%, respectively). Similarly, children aged 6-8 had significantly higher proportions of allergic symptoms, except for exercise-induced wheezing (5.8% vs. 17.8%, p < 0.0001). Among those with allergic disorders, children aged 6-8 presented a greater severity of wheezing attacks in the last 12 months. As regards gender, boys aged 6-8 had a significantly higher proportion of asthma or rhinitis symptoms than girls aged 6-8 but not in children aged 13-15. In children aged 6-8, asthma and rhinitis peaked in winter, especially in December. However, children aged 13-15 had two peaks (winter and summer) for asthma or rhinitis.

Adolescent↗

PubMed2005

Intracranial space, brain, and cerebrospinal fluid volume measurements obtained with the aid of three-dimensional computerized tomography in patients with and without Crouzon syndrome.

OBJECT: The authors attempt to provide a standard for volumes of the intracranial space, brain, and cerebrospinal fluid (CSF) in healthy control individuals by using in vivo three-dimensional (3D) computerized tomography (CT) data and to compare these data with those obtained from a group with Crouzon syndrome. METHODS: Fifty-seven individuals underwent 3D head CT scanning for nonintracranial-related disease to produce a set of normal volumes for the intracranial space, brain, and CSF. Prediction limits of 95% were obtained to provide a range of acceptable volumes throughout the growing period and early adulthood. Eleven patients (seven boys and four girls, age range 2.2 months-13.4 years) with Crouzon syndrome underwent identical measurements, which were compared with those of the control patients. The control group comprised 35 boys and 22 girls who ranged in age from 0.26 months to 24.4 years. Intracranial space and brain volume showed a progressive increase with age, with three different slopes from birth to adulthood. Male patients were found to have larger volumes than female patients in the same age group. Volume patterns for CSF were not significantly different within a given age or sex. Six patients with Crouzon syndrome had intracranial and brain volumes within the 95% prediction limit, three patients measured above the limit, and two measured below. CONCLUSIONS: A standard for volumes of intracranial space and structures provides a guideline for the evaluation of patients with intracranial disease. Volumes in patients with Crouzon syndrome can be matched to their normal age- and sex-matched counterparts.

Adolescent↗

PubMed2005

Staging of untreated squamous cell carcinoma of buccal mucosa with 18F-FDG PET: comparison with head and neck CT/MRI and histopathology.

UNLABELLED: This prospective, nonrandomized, case-control study evaluated the impact of (18)F-FDG PET in staging untreated squamous cell carcinoma of the buccal mucosa (BSCC) and compared the results with CT/MRI and histopathology. METHODS: Between January 2002 and April 2004, 102 untreated BSCC patients with cM0 (no evidence of distant metastatic focus on chest radiograph, liver ultrasonograph, and bone scan) were enrolled with either conventional work-up (CWU, n = 51) or PET (CWU+PET, n = 51). All were monitored for at least 6 mo. The comparative diagnostic efficacies of PET and CT/MRI were evaluated using the area under the receiver-operating-characteristic curve (AUC). The primary endpoint was the percentage reduction in futile surgery (preoperative detection of distant metastatic lesions). The secondary endpoint was the 2-y cumulative recurrence rate among study participants (with PET) compared with that of comparable control subjects (without PET). RESULTS: Significant benefits of PET compared with those of CT/MRI for BSCC patients were in the detection of locoregional (AUC, 0.973 vs. 0.928; P = 0.026), regional (AUC, 0.939 vs. 0.837; P = 0.026), and level II (AUC, 0.974 vs. 0.717; P = 0.02) lymph nodes. Two percent (1/51) of the patients experienced a reduction in futile surgery in the CWU+PET group compared with 0% (0/51) in the CWU group. However, no statistical difference was found in the 2-y locoregional control rate between the CWU and the CWU+PET groups. CONCLUSION: The role of (18)F-FDG PET for BSCC with cM0 is limited. Although PET is superior to CT/MRI in identifying cervical nodal metastases, it does not improve locoregional recurrence.

Adult↗

PubMed2005

An appropriate indicator for diagnosing gestational diabetes.

BACKGROUND: This study was intended to simplify the diagnostic procedure for gestational diabetes mellitus (GDM) through using a single plasma glucose level, after a 100 g oral glucose tolerance test (OGTT), as the most appropriate indicator for diagnosing GDM in pregnant women with a positive 50 g, 1-hour oral glucose challenge test (GCT) in Northern Taiwan. METHODS: A total of 973 native Taipei metropolitan pregnant women with a positive GCT, who underwent a 100 g, 3-hour OGTT were retrospectively surveyed. GDM was defined according to the standards of National Diabetes Data Group. Plasma glucose levels, obtained 1 hour following a GCT and at multiple timing following a 100 g oral glucose load, were used to plot receiver operative characteristic curves to determine the most appropriate indicator for diagnosing GDM. RESULTS: In the 973 pregnant women with a positive GCT, a 2-hour plasma glucose level above 165 mg/dl revealed a sensitivity and specificity of 91.2% and 90.3%, respectively. CONCLUSIONS: To simplify the diagnostic procedure for GDM, we suggest that a 2-hour plasma glucose level above 165 mg/dl after a 100 g OGTT might be an appropriate indicator for diagnosing GDM in women with a positive GCT.

Adult↗

PubMed2004

Positron emission tomography for unexplained elevation of serum squamous cell carcinoma antigen levels during follow-up for patients with cervical malignancies: a phase II study.

BACKGROUND: During follow-up for patients with cervical carcinoma, elevation of serum squamous cell carcinoma antigen (SCC-Ag) levels in the absence of detectable recurrent lesions presents a diagnostic and therapeutic challenge. In the current prospective study, the authors evaluated the use of fluorine-18-labeled fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) to detect disease recurrence in this setting. METHODS: Women with cervical carcinoma who experienced complete responses to primary treatment or salvage therapy and who had no evidence of recurrent disease as detected by conventional methods but had serum SCC-Ag levels > or = 2.0 ng/mL on 2 consecutive occasions were eligible for the study. PET was performed within 2 weeks after the completion of conventional studies for the assessment of recurrence. RESULTS: Twenty-seven consecutive patients were registered for the current study. PET findings were positive for 19 patients: 14 who had a distant lesion or lesions, 2 who had a local lesion or lesions, and 3 who had both local and distant lesions. Of these 19 patients, 17 were confirmed to have recurrent disease; the remaining two were found to be free of disease but had severe anthracosis in the PET-positive mediastinal lymph nodes. Seven of the eight patients with negative PET findings were not found to have recurrent disease on follow-up. Overall, PET detected FDG-avid lesions in 17 (94%; P < 0.001) of the 18 patients with recurrent disease. Seven of these 18 patients received therapy with curative intent; complete control was achieved in 6, four of whom currently are alive and free of disease. The addition of PET in the current setting curbed the use of futile curative therapy and significantly increased overall survival for patients in the current cohort compared with a historical group of 30 consecutive patients who had elevated SCC-Ag levels as a first sign of recurrence. CONCLUSIONS: PET expedited the detection of recurrent cervical carcinoma in patients with unexplained elevation of SCC-Ag levels. Such expedited detection may have positive effects on patient survival.

Antigens, Neoplasm↗

PubMed2004

Restaging of recurrent cervical carcinoma with dual-phase [18F]fluoro-2-deoxy-D-glucose positron emission tomography.

BACKGROUND: The clinical value of positron emission tomography (PET) with [18F]fluoro-2-deoxy-D-glucose (FDG) for primary staging in cervical carcinoma appears to be promising. The authors sought to evaluate the diagnostic efficacy and benefit of PET in restaging cervical carcinoma at the time of first recurrence. METHODS: Forty patients with cervical carcinoma who experienced confirmed treatment failure but who were feasible candidates for curative salvage therapy were enrolled prospectively in the current study. Restaging was performed with PET and with computed tomography and/or magnetic resonance imaging (CT/MRI). Dual-phase PET was performed by adding 3-hour-delayed images to the 40-minute scans. The results of the PET and CT/MRI scans were compared. Lesion status was determined by pathologic findings or by clinical follow-up. The receiver operating characteristic curve method with calculation of area under the curve (AUC) was used to evaluate diagnostic efficacy. The primary endpoint was percent improvement in restaging (with improvement indicated by treatment modification) after PET. The secondary endpoint was 2-year overall survival among study participants compared with comparable previously treated patients who did not undergo disease restaging with PET. RESULTS: Twenty-two patients (55%) had their treatment modified due to PET findings. PET was significantly superior to CT/MRI (sensitivity: 92% vs. 60%; AUC: 0.962 vs. 0.771; P<0.0001) in identifying metastatic lesions. For individuals receiving primary surgery, a significantly better 2-year overall survival rate was observed among study participants compared with patients who underwent disease restaging without PET (HR, 0.21 [95% confidence interval, 0.05-0.83]; P=0.020). CONCLUSIONS: Dual-phase FDG-PET is superior to CT/MRI in the restaging of recurrent cervical carcinoma. Restaging with PET provides benefit by allowing the physician to offer optimal management of recurrent cervical carcinoma.

Adult↗

PubMed2004

Acute and long-term clinical and angiographic outcomes of coronary stenting using Palmaz-Schatz stent and ACS Multi-Link stent.

Acute and long-term (>/= 3 years) outcomes of coronary artery stenting using Palmaz-Schatz and Multi-Link stent implantations between November 1995 and October 1999 were analyzed. There were 655 Palmaz-Schatz stent implantations in 577 lesions on 477 patients (group A) and 428 Multi-Link stent implantations in 381 lesions on 326 patients (group B). The baseline characteristics were similar in the two groups. Group B had more complex lesions, longer stenotic lesions, and larger reference vessel sizes than group A. However, both groups had a similar in-hospital cardiac events. Four hundred and two patients with 488 lesions in group A and 260 patients with 307 lesions in group B underwent a 6-month follow-up coronary angiography. The restenotic rate per lesion was 16% in both groups (P = 0.872). A 3-year angiographic follow-up was performed in 262 patients of group A (301 lesions) and 139 patients of group B (162 lesions), and restenosis was noted in only 3 patients (1.36%) in group A and 5 patients (4%) in group B, in which the lesion was patent at the 6-month angiographic follow-up. Significant increase in minimal luminal diameter was noted from 2.23 +/- 0.66 mm at 6 months to 2.33 +/- 0.64 mm in group A (P < 0.01), and insignificant increase from 2.23 +/- 0.77 to 2.28 +/- 0.82 mm was noted in group B (P = 0.27). No differences were noted between the two groups in mortality, reinfarction, recurrent angina, target lesion angioplasty, or elective coronary artery bypass surgery during a follow-up period of 60 +/- 3 months. Forty-five patients (9.4%) in group A and 18 patients (5.5%) in group B received additional stenting procedures for newly developed lesions. The overall cardiac event-free survival was 66% in group A and 72% in group B (P = 0.844). In conclusion, the procedural success rate, in-hospital morbidity, 6-month angiographic results, and long-term (>/= 3 years) clinical and angiographic outcomes were similar with coronary stenting using either Palmaz-Schatz or Multi-Link stent. The stented lesions were stable; however, late regression of minimal luminal diameter was noted in both groups, and progression of atherosclerotic change in the nonstented site was noted during long-term follow-up.

Angioplasty, Balloon, Coronary↗

PubMed2004

Time to peak velocity measurements by pulsed wave Doppler tissue imaging to quantify ischemia-related regional myocardial asynchrony.

A total of 173 patients with chest pain but without visually discernible wall-motion abnormalities by 2-dimensional echocardiography underwent pulsed wave Doppler tissue imaging examination before angiography. Segmental longest time to peak contraction velocity (Tpv) was acquired through 3 apical views. The longest time period from electrocardiographic R wave to peak velocity on segmental velocity integrals of nonapical segments was measured. Receiver operating characteristic curve analysis was performed for correlation analysis between segmental Tpv and significant (>or=50% luminal diameter stenosis) coronary artery stenosis. Analysis of variance test was used to compare among different patient groups with 0, 1, 2, and 3 coronary artery stenoses. Delay in Tpv on any 1 or more of the 12 nonapical segments was noted in 72 of 116 patients with angiographically significant coronary stenosis. When the longest segmental Tpv of >or=340 milliseconds was selected as a cut-off value for identification of a significant left circumflex or multivessel coronary artery stenosis, the area under receiver operating characteristic curve was 0.69 and 0.72, respectively (P =.000 and.0013, respectively). In conclusion, pulsed wave Doppler tissue imaging technique provides objective quantitative information for identification of multivessel or left circumflex coronary artery stenosis in patients with chest pain but without apparent wall-motion abnormalities on echocardiography.

Adult↗

PubMed2004

Elevated maternal midtrimester serum free beta-human chorionic gonadotropin levels in vegetarian pregnancies that cause increased false-positive Down syndrome screening results.

OBJECTIVE: The aim of this study was to examine whether midtrimester maternal serum free beta-human chorionic gonadotropin and alpha-fetoprotein levels for Down syndrome screening differed in vegetarian pregnancies and omnivore pregnancies and to evaluate whether maternal serum vitamin B(12) concentration affected these maker levels. STUDY DESIGN: Ninety-eight vegetarian and 122 omnivore singleton pregnancies were studied. Reference levels of free beta-human chorionic gonadotropin and alpha-fetoprotein were based on a population of 6312 singleton euploid pregnancies that had been surveyed previously. Serum free beta-human chorionic gonadotropin and alpha-fetoprotein levels were measured by enzyme immunoassay or radioimmunoassay. Multiples of the median values were calculated to determine whether different diet habits affected serum biomarker levels. Maternal serum vitamin B(12) levels were determined with radioimmunoassay. RESULTS: The free beta-human chorionic gonadotropin multiples of the median values were elevated significantly in the vegetarian pregnancies group (1.28 multiples of the median) compared with that of the reference population (1.00 multiples of the median) (P<.001). A negative association between the serum free beta-human chorionic gonadotropin multiples of the median values and the concentration of maternal serum vitamin B(12) was observed in the vegetarian pregnancies. No correlation was found between the alpha-fetoprotein multiples of the median values and the maternal serum vitamin B(12) concentration. CONCLUSION: The current data showed that the midtrimester maternal serum free beta-human chorionic gonadotropin levels increased in vegetarian pregnancies and led to an elevated false-positive rate in screening for Down syndrome compared with pregnant women with regular diet and resulted in unnecessary invasive procedures. It is necessary to establish vegetarian pregnancy alpha-fetoprotein and beta-human chorionic gonadotropin reference levels to correct increased false-positive screening results.

Adult↗

PubMed2004

An outbreak of methicillin-resistant Staphylococcus aureus infections related to central venous catheters for hemodialysis.

OBJECTIVES: To determine risk factors for hemodialysis catheter-related bloodstream infections (HCRBSIs) and investigate whether use of maximal sterile barrier precautions would prevent HCRBSIs. SETTING: Tertiary-care medical center hemodialysis unit. DESIGN: Open trial with historical comparison and case-control study of risk factors for HCRBSIs. METHODS: Prospective surveillance was used to compare HCRBSI rates for 1 year before and after implementation of maximal sterile barrier precautions. A case-control study compared 50 case-patients with HCRBSI with 51 randomly selected control-patients. RESULTS: The HCRBSI rate was 1.6% per 100 dialysis runs (CI95, 1.1%-2.3%) in the first year and 0.77% (CI95, 0.5%-1.1%) in the second year (P = .0106). The most frequent cause of HCRBSI was MRSA in the first year (15 of 32) and MSSA in the second year (13 of 18). Ten MRSA blood isolates in the first year were identical by PFGE. Diabetes mellitus was a risk factor for HCRBSI. Age, gender, site of hemodialysis central venous catheter (CVC), other underlying diseases, coma score, APACHE II score, serum albumin level, and cholesterol level were not associated with HCRBSI and did not change between the 2 years. Hospital stay was prolonged for case-patients (32.78 +/- 20.96 days) versus control-patients (22.75 +/- 17.33 days), but mortality did not differ. CONCLUSIONS: Use of maximal sterile barrier precautions during the insertion of CVCs reduced HCRBSIs in dialysis patients and seemed cost-effective. Diabetes mellitus was associated with HCRBSI. An outbreak of MRSA in the first year was likely caused by cross-infection via medical personnel.

Case-Control Studies↗

PubMed2004

Gastric emptying function changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy.

BACKGROUND: Hypothyroidism is commonly thought to cause decreased gastric emptying but is mostly associated with autoimmune disease. In the present study the gastric emptying function of thyroid cancer patients with severe hypothyroidism of short duration was evaluated with a radionuclide solid meal gastric emptying study. METHODS: Twenty-two patients who had undergone surgical operation and (131)I ablation for thyroid cancer participated in solid meal gastric emptying studies before the withdrawal of thyroxine and then again 4 weeks after the withdrawal of thyroxine. Eleven patients had an additional gastric emptying study at 6 weeks after withdrawal of thyroxine. Gastric emptying curves and emptying parameters were calculated. Student's paired t-test was used for statistical analysis of data for all cases between the baseline and at 4 weeks after withdrawal. An additional repeated measure anova with multiple comparisons was performed on data between baseline, 4 weeks and 6 weeks after withdrawal for the other 11 patients. All P values presented are two-tailed and the significance level is 0.05. RESULTS: Hypothyroidism status was confirmed by the marked change of the serum thyroxine and thyroid-stimulating hormone 4 weeks and 6 weeks after withdrawal of the thyroxine replacement (P < 0.001). The gastric half-emptying time and emptying rate changed significantly after short-term severe thyroid hormone deficiency (P < 0.005). However, the length of the lag phase did not have a statistically significant change at 4 weeks or 6 weeks after withdrawal of the thyroxin replacement (P = 0.219 and 0.142). CONCLUSIONS: Hypothyroidism following the withdrawal of the thyroxine replacement in thyroid cancer patients preparing for (131)I cancer work-up can significantly prolong gastric half-emptying time and emptying rate.

Acute Disease↗

PubMed2004

Hirayama flexion myelopathy: neutral-position MR imaging findings--importance of loss of attachment.

PURPOSE: To investigate the sensitivity and specificity of various neutral-position magnetic resonance (MR) imaging findings in the diagnosis of Hirayama flexion myelopathy. MATERIALS AND METHODS: The neutral-position cervical MR images of 46 patients and 51 control subjects were evaluated for the following findings: localized lower cervical cord atrophy, asymmetric cord flattening, abnormal cervical curvature, loss of attachment (LOA) between the posterior dural sac and subjacent lamina, and noncompressed intramedullary high signal intensity on T2-weighted MR images. The difference in frequency of these findings between the control and patient groups was examined by means of the chi(2) test. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of these MR imaging findings in the diagnosis Hirayama disease were calculated. Multivariate analysis of these findings was also performed. RESULTS: There was a significant difference in the frequency of these MR imaging findings between the control and patient groups (all comparisons, P </=.002). Among the MR imaging findings, localized lower cervical cord atrophy, asymmetric cord flattening, and LOA had accuracy of more than 80% in identification of the disease. After multivariate analysis, LOA was the only significantly important predictor of the disease, with odds ratio of 716.7 (95% CI: 71.9, 7,145.2). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of LOA were 93.5%, 98.0%, 97.7%, 94.3%, and 95.9%, respectively. CONCLUSION: LOA from posterior dural sac and subjacent lamina is the most valuable finding in the diagnosis of Hirayama disease at neutral-position MR imaging.

Adolescent↗