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Wei-Tien Chang

Publications and source records attributed to Wei-Tien Chang.

29 records · Page 2Linked to original sources
PubMed2004

QTc dispersion as a prognostic factor in intracerebral hemorrhage.

QTc dispersion in the electrocardiogram (ECG) is a new important prognostic factor for many diseases, but its role in intracerebral hemorrhage (ICH) is not clear. This study was performed to investigate the prognostic significance of QTc dispersion in the acute ICH patients. We studied the differences of QTc dispersion from the initial ECG in the ED between the survival to discharge and nonsurvival patients retrospectively. We found that the patients had lesser chance to survival to discharge if they had increased QTc dispersion, longer maximal QTc interval, lower Glasgow Coma Scale (GCS), and brainstem involvement in the univariate analyses. The QTc dispersion and GCS were the statistically significant independent predictors in the multiple logistic analyses. Increased QTc dispersion in the initial ED electrocardiograph is an important prognostic factor for ICH patients. More attention to the disposition and intensive care should be given for these patients.

Acute Disease↗
PubMed2004

Improving the rate of return of spontaneous circulation for out-of-hospital cardiac arrests with a formal, structured emergency resuscitation team.

OBJECTIVE: To assess the impact of a formal, structured resuscitation team in the emergency department (ED) on the success rate of cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. METHODS: This is a "three-phase" (organized, transitional, and re-organized), prospective study in which medical records of all OHCA patients who needed resuscitation in the ED during the three 6-month periods were reviewed and data were coded in out-of-hospital Utstein style formats. An organized resuscitation team existed in the organized and re-organized phases but not in the transitional phase. The study population consisted of adult patients with non-traumatic cardiac arrest (>18 years of age). RESULTS: The rates of return of spontaneous circulation (ROSC) were 51.3% for the organized phase, 31.0% for the transitional phase, and 53.1% for the re-organized phase ( P=0.013 ). The rates of ROSC from pulseless electrical activity (PEA)/asystole were significantly higher in periods with organized and re-organized teams ( P=0.007 ). The rates of ROSC for the ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) sub-groups were not significantly different in all three periods ( P=0.406 ). The chance of survival-to-discharge was 9.2% in the organized period, 11.2% in the transitional period, and 15.6% in the re-organized period ( P=0.496 ). The existence of a formal, structured emergency resuscitation team in the ED (odds ratio: 2.56, 95% confidence interval: 1.35-4.80) and witness at the scene (odds ratio: 2.45, 95% confidence interval: 1.34-4.45) were the only independent predictors of successful ROSC of OHCA patients by multiple logistic regression analysis. CONCLUSION: The establishment of a formal and structured emergency resuscitation team in the ED is associated with an increased rate of ROSC for OHCA patients.

Ambulances↗
PubMed2004

Hepatic portal venous gas associated with poor outcome in out-of-hospital cardiac arrest patients.

OBJECTIVES: To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA). METHODS: From April 2002 to January 2003, patients with non-traumatic OHCA were prospectively enrolled in a tertiary medical centre in Taipei, Taiwan. Emergency abdominal sonography during resuscitation was performed to detect the presence of HPVG within the first 10 min on arrival of the emergency department (ED). RESULTS: HPVG was detected in 16 (36%) of the 44 patients enrolled in this study. The patients with HPVG were older (P = 0.039), their cardiac arrest was witnessed less frequently (P = 0.01), they received more prolonged resuscitation (P = 0.008), and needed more accumulated doses of adrenaline (epinephrine) (P = 0.002). These patients had a considerably lower incidence of return of spontaneous circulation (ROSC) (P < 0.001), less survival to hospital admission (P < 0.001), less 24 h survival (P < 0.001) and less survival to discharge (P = 0.036). In a multiple regression analysis, HPVG was noted as an independent factor negatively associated with ROSC. CONCLUSION: HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients.

Aged↗
PubMed2004

Sudden death caused by dissecting thoracic aortic aneurysm in a patient with autosomal dominant polycystic kidney disease.

Among the fatal vascular complications associated with autosomal dominant polycystic disease (ADPKD), ruptured intracerebral aneurysm and ruptured abdominal aortic aneurysm are widely known. However, there are few reports on the dissecting thoracic aortic aneurysm as a fatal complication of ADPKD. We report a case of a 58-year-old man with a history of ADPKD who presented to the emergency department with out-of-hospital cardiac arrest. Immediate cardiopulmonary resuscitation restored a spontaneous circulation successfully and subsequent image study revealed a type I dissecting thoracic aortic aneurysm. Emergency aortic grafting was performed--but he died from postoperative haemorrhage. The surgical specimen of the aorta showed cystic medial necrosis. This rare case emphasizes the need to consider such a diagnosis in a patient with ADPKD who presents to the emergency department with sudden cardiac arrest. In addition, the histological finding indicates the aetiological role of a collagen defect in addition to chronic hypertension in the pathogenesis of aortic dissection in ADPKD patients.

Aortic Dissection↗
PubMed2004

SARS exposure and emergency department workers.

Of 193 emergency department workers exposed to severe acute respiratory syndrome (SARS), 9 (4.7%) were infected. Pneumonia developed in six workers, and assays showed anti-SARS immunoglobulin (Ig) M and IgG. The other three workers were IgM-positive and had lower IgG titers; in two, mild illness developed, and one remained asymptomatic.

Adult↗
PubMed2004

Acute acetaminophen intoxication in Taiwan: outcomes and risk factors.

BACKGROUND AND PURPOSE: There is a paucity of information about acetaminophen intoxication from Taiwan. This study investigated the outcome and risk factors for acetaminophen-induced hepatotoxicity and validated the Rumack- Matthew nomogram in Taiwanese patients with acute acetaminophen intoxication. METHODS: A total of 75 patients with acetaminophen intoxication admitted through the emergency department were included in this retrospective analysis. Patients with a serum acetaminophen concentration above the possible risk line on the nomogram were treated with oral N-acetylcysteine. The primary outcome measure was the development of major hepatotoxicity, which was defined as a serum aminotransferase concentration greater than 1000 IU/L. Patient outcomes in the possible risk group and probable risk group were plotted on the modified Rumack-Matthew nomogram for validation. The risk factors for acetaminophen-induced hepatotoxicity were identified by multiple logistic regression analysis. RESULTS: No hepatotoxicity developed in patients with an initial acetaminophen concentration below the possible risk line on the nomogram. One out of 8 patients in the possible risk group developed major hepatotoxicity; 8 out of 22 patients in the probable risk group developed major hepatotoxicity, representing an incidence of 12.5% and 36.4%, respectively. Patients in the major hepatotoxicity group were older (32.5 vs 24.2 years, p = 0.019), and had a longer time to presentation (28.1 vs 6.7 hours, p < 0.01) than those in the non/minor hepatotoxicity group. Multiple logistic regression revealed that age and time to presentation were independent risk factors for hepatotoxicity (p = 0.033 and p = 0.002, respectively). CONCLUSIONS: The results of outcome analysis confirm that the modified Rumack-Matthew nomogram has a high sensitivity for identifying Taiwanese patients at risk for acetaminophen-induced hepatoxicity. Patient age and time to presentation were independent risk factors for acetaminophen-induced hepatotoxicity.

Acetaminophen↗
PubMed2003

Left ventricular dysfunction is associated with CD4 lymphocyte count rather than opportunistic infection in human immunodeficiency virus infection.

BACKGROUND AND PURPOSE: Left ventricular (LV) dysfunction is often found in the early stage of human immunodeficiency virus (HIV) infection and deteriorates with disease progression. CD4 lymphocyte count and opportunistic infection are the major indicators for the clinical staging of HIV infection. This study investigated the association of these indicators with LV dysfunction in the clinical course of HIV infection. METHODS: HIV-positive patients without cardiac manifestations consecutively admitted from May 1998 to April 1999 were enrolled in the study. Echocardiographic LV function evaluation and measurement of CD4 lymphocyte count were performed. Parameters for LV systolic and diastolic functions were compared between patients with CD4 lymphocyte count >or= 200/microL and those with CD4 < 200/microL. In patients with CD4 < 200/microL, LV function was further correlated with the presence or absence of opportunistic infections. RESULTS: Ninety eight HIV-positive patients including 52 with CD4 >or= 200/microL and 46 with CD4 < 200/microL were studied. One half of the 46 patients with CD4 < 200/microL had active opportunistic infections. We found that LV fractional shortening, ejection fraction, and isovolumic relaxation time were all significantly lower in the patients with CD4 < 200/microL compared with those with CD4 >or= 200/microL. Moreover, these LV systolic and diastolic dysfunctions were positively correlated with decreased CD4 lymphocyte count. In contrast, no difference was found in these parameters between patients with and without opportunistic infections. In multiple regression analysis, CD4 lymphocyte count was found to be the only factor for predicting the LV systolic and diastolic dysfunction. CONCLUSIONS: Both LV systolic and diastolic function deteriorate as the CD4 lymphocyte count decreases in HIV infection. Opportunistic infection seems to have a limited role in the pathogenesis of LV dysfunction in advanced HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed2002

Factors influencing the outcomes after in-hospital resuscitation in Taiwan.

BACKGROUND: The effects on prognosis of some advanced interventions established before cardiopulmonary resuscitation are not clear. The outcomes and patterns of various factors of in-hospital resuscitation are also influenced by different disease patterns in different areas. We studied the factors related to outcomes in an oriental country. MATERIALS AND METHODS: We studied the in-hospital resuscitation events in a tertiary medical center in Taipei city, Taiwan. All events and variables were recorded using the Utstein style for in-hospital resuscitation. We measured the influence of patients and event variables on the outcomes of return of spontaneous circulation (ROSC) and survival to discharge. RESULTS: The rate of establishing a ROSC was 67% and the rate of survival to discharge was 17% in the studied population. The 1-year survival rate was 3.9%. Only 17% of the patients resuscitated had coronary artery disease. VT/VF was the initial rhythm in only 13.6% patients. Nearly half (49%) of the resuscitation attempts took place in emergency department (ED). Patients who were already intubated or had received mechanical ventilation before resuscitation had reduced chances of achieving ROSC. (P<0.05). Favorable prognostic factors of survival to discharge were shorter time intervals from patient collapse to arrival of the resuscitation team (69 vs. 154 s, P<0.05) and to confirmation of arrest (93 vs. 217 s, P<0.05). CONCLUSION: Intubation and mechanical ventilation already established before arrest implies an underlying critical illness and reduce the chances of ROSC. Shorter intervals from collapse to resuscitation improve the chance of survival to discharge. The high proportion of resuscitation events occurring in the ED, reflecting ED overcrowding, and low frequency of pre-existing coronary artery disease are unique to our country.

Aged↗