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S-H Tsai

Publications and source records attributed to S-H Tsai.

5 recordsLinked to original sources
PubMed2007

Acute renal infarction: a 10-year experience.

The diagnosis of acute renal infarction (ARI) is often delayed or unrecognised because of its non-specific presentation and the rarity of the disease. We evaluated the clinical presentations, laboratory findings, underlying medical conditions and treatment of 18 Chinese patients with ARI who presented to the emergency department (ED) of a tertiary teaching hospital from 1995 to 2004. We identified 14 non-trauma and four trauma patients with ARI. The mean duration from the onset of symptoms to the diagnosis of ARI was 1.9 days. The prevalence of concurrent events was 39%. About 64.5% of non-trauma patients had histories of atrial fibrillation, structural heart diseases or previous embolic events. The laboratory characteristics were neither specific nor sensitive for the diagnosis of ARI. Conservative treatment, local intra-arterial thrombolytic and i.v. thrombolytic therapies were provided in nine, five and two patients respectively. Decreased effective renal plasma flow in affected kidneys was found in three of three patients. Serum creatinine (Cr) was normal or elevated not more than 25% of baseline in 16 cases. ARI may resemble many non-renal diseases; however, repeated evaluation and a high index of suspicion are required for early diagnosis. Concurrent injuries or thromboembolism in other foci should be noticed. Early contrast-enhanced computerized tomography scan should be considered for high-risk patients. Patients with ARI should be followed by functional studies rather than serum Cr level.

Acute Disease↗
PubMed2006

Multiparametric analysis of cerebral substrates and nitric oxide delivery in cerebrospinal fluid in patients with intracerebral haemorrhage: correlation with hemodynamics and outcome.

BACKGROUND: There is no information regarding the possible role of cerebral substrates in the pathogenesis of neuronal injury in intracerebral haemorrhages (ICHs). Purposes of this prospective study were to clarify whether changes in substrates are the consequence of the initial brain damage in ICH and to elucidate the relationship among the biochemical mechanisms and clinical course of patients with ICH. METHOD: During a period of two years, patients (GCS < or =8) who had ICH secondary to an aneurysm (SAH), stroke (sICH), or trauma (tICH) and underwent ventriculostomy with ICP monitoring and/or underwent cranial surgery were randomly enrolled in this study. Extracellular concentrations of glutamate, aspartate, glycine, GABA, lactate, lactate/pyruvate ratio, and glucose in the CSF were measured by use of high-performance liquid chromatography (HPLC). The nitric oxide (NO) concentration in the CSF was analyzed by chemiluminescence. FINDINGS: There were 75 patients (38 women and 37 men) with ICH included in this study. Twenty-one patients had SAH, 28 sICH, and 26 tICH. In tICH patients, there was a 30-fold increase in glutamate and a 10-fold in aspartate over reference values. The levels of glutamate, aspirate, GABA, lactate, glucose, and NO differed significantly among the three groups (p<0.001). There were no significant differences in glycine and L/P ratio among the groups. The initial GCS, the mean CPP and outcome six months after the insult were all significantly correlated with the concentration of substrates (p<0.01), both within groups and among the total sample. The CSF levels of glutamate lactate, NO and glucose correlated significantly with outcome (p<0.005). CONCLUSIONS: This study confirms the correlation between the level of EAAs and the outcome of ICHs, suggesting that neurochemical monitoring of these substances may have a role in caring for patients.

Adult↗
PubMed2006

Listerial meningitis in a patient with undiagnosed acquired immunodeficiency syndrome: ampicillin should be added to the empirical antibiotic coverage.

Meningitis is an important differential diagnosis in patients with fever, headache, and/or altered consciousness in the emergency department (ED). With human immunodeficiency virus (HIV) infection becoming increasingly common, patients with acquired immunodeficiency syndrome (AIDS) need to be recognised promptly to facilitate the choice of appropriate antibiotic therapy for potential opportunistic infections. Physicians should be able to recognise a patient with undiagnosed AIDS who presents to the ED and perform further confirmational tests without violating the rights of the patient. Additional tests focusing on discovering potential opportunistic pathogens should be performed. Ampicillin should be added to the empirical regimen for the coverage of Listeria meningocerebritis, which should be considered in all potentially immunocompromised hosts with suggestive clinical presentations. Failure to recognise patients with AIDS and provide antibiotics active against L monocytogenes in such hosts may lead to a catastrophic outcome.

AIDS-Related Opportunistic Infections↗