BACKGROUND: Fever in patients can provide an important clue to the etiology of a patient's symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients. To determine whether emergency department triage temperatures detected fever adequately when compared to a rectal temperature. METHODS: A retrospective chart review was made of 27130 adult patients in a high volume, urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal temperature. RESULTS: The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F (P<0.001), with 25.9% of the patients having higher rectal temperatures ≥2 °F, and 5.0% having higher rectal temperatures ≥4 °F. The mean difference among the patients who received oral, axillary, and temporal temperatures was 1.2 °F (P<0.001), 1.8 °F (P<0.001), and 1.2 °F (P<0.001) respectively. About 18.1% of the patients were initially afebrile and found to be febrile by rectal temperature, with an average difference of 2.5 °F (P<0.001). These patients had a higher rate of admission (61.4%, P<0.005), and were more likely to be admitted to the hospital for a higher level of care, such as an intensive care unit, when compared with the full cohort (12.5% vs. 5.8%, P<0.005). CONCLUSIONS: There are significant differences between rectal temperatures and non-invasive triage temperatures in this emergency department cohort. In almost one in five patients, fever was missed by triage temperature.

ABSTRACT The effects of cyclopiazonic acid (CPA) on the Ca2+ -dependent ourward K+-cur-rent [IK(ca)] were studied using whole-cell and single-channel patch-clamp techniques. Depolarization (pipette potential range from - 20 to - 120 mV)induced a outward Ik(ca) with a conductance of about 40 pS in the cultural aortic smooth muscle cells from SHR and WKY. 10 ?mol ? L-1 CPA significantly enhanced these currents and prolonged the mean open time of the channels. This effect of CPA was completely blocked by glybenclamide, a K+-channel block-er. In the whole cell recording experiments, CPA increased the amplitude of outward K+-current. This effect of CPA was Ca2+-dependent and completely blocked by glybenclamide. There was no any significant difference between the effects of CPA in SHR and in WKY. These results suggest that the functional change of vascular smooth muscle in SHR doesn't appear to be related to Ik(ca).

Asthma ; drug therapy ; epidemiology ; physiopathology ; prevention & control ; Humans ; Pediatrics ; Singapore ; epidemiology

Thoracoscopic sympathicotomy is effective in treating not only palmar hyperhidrosis, but, also in treating axillary hyperhidrosis. In previous studies in Korea, sympathicotomy was focused on combinations including the 2nd to 4th sympathetic chains (R2,3,4). Using a minimally invasive technique, the results of sympathicotomy of the 4th and 5th chains (R4,5) of five patients, from February to August, 2002, for axillary hyperhidrosis without osmidrosis, were reviewed. All patients had a successful operation, their profuse sweating ceased. Three patients suffered from some degree of compensatory sweating. Among the three patients, only one patient suffered from moderate compensatory sweating over his back and thighs. Thoracoscopic R4,5 sympathicotomy offers a very appealing method in the treatment for axillary hyperhidrosis in patients who have profuse axillary sweating.
Humans ; Hyperhidrosis* ; Korea ; Sweat ; Sweating ; Thigh

To evaluate the clinical significance of the prostatic intraepithelial neoplasia (PIN) in prostatic tumors, we reviewed the clinical data of digital rectal examination (DRE), transrectal ultrasonography (TRUS) prostate specific antigen (PSA) and PIN from the patients of 50 benign prostatic hyperplasia (BPH) and 100 prostate cancers who were pathologically confirmed. The prostate nodules were palpated at DRE in 53% of prostate cancers. The 59% of the prostate cancer patients showed hypoechoic areas on TRUS and they were diagnosed with ultrasound guided directed prostate biopsy. Remaining 41% of the cancers were diagnosed at the directed or random biopsy or the hyperechoic or isoechoic area. Hypoechoic areas were detected from the 12 BPH patients and the PIN were detected at 7 of them at directed biopsies. The level of serum prostate specific antigen (PSA) less than 4ng/ml were 82% of BPH and 57% of prostate cancer. The major PIN grade in BPH patients were 62% for grade 1, 22% for grade 2 and 16% for grade 3 and in the prostate cancer, 9% for grade 1, 27% for grade 2 and 64% for grade 3. The distribution of PIN were even throughout the prostate in BPH but 17% of the prostate cancer showed PINs exclusively at peripheral zone. The remaining cancer patients were multifocal and 52% of total prostate cancers showed more than two thirds of the total PINs were located at peripheral zone. Among the 8 BPH patients who had the PIN grade 3, 3 were diagnosed as the prostate cancer at follow up. We assume that the nodules palpated at DRE and the hypoechoic areas TRUS are highly specific for the prostate cancer but the serum PSA values of 4ng/ml as the upper normal limit is not significantly reliable for the study for high risk group and early detection of prostate cancer. The combined application of DRE, TRUS, PSA and biopsy, including directed and random, would improve the results of prostate cancer diagnosis than single application. And the BPH patients with grade 3 PIN should be regarded as the high risk group for prostate cancer development and should be followed regularly.
Biopsy ; Diagnosis ; Digital Rectal Examination ; Follow-Up Studies ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Intraepithelial Neoplasia* ; Prostatic Neoplasms ; Ultrasonography

Adolescent ; Attention Deficit Disorder with Hyperactivity ; diagnosis ; etiology ; therapy ; Behavior Therapy ; Central Nervous System Stimulants ; therapeutic use ; Child ; Humans ; Methylphenidate ; therapeutic use ; Young Adult

A four-month cross-sectional study found five species of parasitoids parasitizing puparia of filth flies breeding at the Taman Beringin landfill in Kepong and a poultry farm in Sungai Pelek, Sepang, Selangor. Effect of monthly rainfalls towards density of flies and percentage of parasitoids emerging from collected puparia were also analyzed. Spalangia sp. was the most common, consisting of Spalangia endius Walker, S. cameroni Perkins and S. gemina Boucek. Other parasitoids collected were Pachycrepoideus vindemmiae Rondani and Exoristobia phillipinensis Ashmead. The parasitized fly hosts were Musca domestica Linn. and Chrysomya megacephala Fabricius. S. endius was the most common parasitoid attacking M. domestica at both locations. M. domestica was the most common fly found at the Sg. Pelek poultry farm whereas C. megacephala was the most numerous at the Taman Beringin landfill. During heavy rainfall month of November 2003, density of flies were high whereas the emerging parasitoids were low at both landfill and poultry farm. The present study revealed the endemic presence of parasitoids especially S. endius in both poultry farm and garbage landfill and the potential of the parasitoid species in fly control in Malaysia.

INTRODUCTION: Young individuals with colorectal cancer (CRC) tend to be diagnosed at advanced stages and are not routinely included in screening programmes. This study describes the incidence, disease pattern and factors affecting overall survival in young-onset CRC. METHODS: A retrospective study of young-onset CRC patients diagnosed between 2010 and 2017 in a tertiary hospital was conducted. RESULTS: There were 99 patients, 69.7% had left-sided while 30.3% had right-sided CRC. The mean age was 43.3 years (43.3±5.0) and 62 patients (62.6%) were male. The incidence of young-onset CRC has been on the rise since 2014. Out of 99 patients, 65 (65.7%) underwent elective surgery, 30 (30.3%) underwent emergency surgery and the remainder 5 (4.0%) were palliated. The most common presenting complaints for patients who underwent elective surgery were abdominal pain, per-rectal bleeding and altered bowel habits. For patients who required emergency surgery, 20 (66.6%) presented with intestinal obstruction and 10 (33.3%) had intestinal perforation. There were 42 (42.4%) stage III CRC and 20 (20.2%) stage IV CRC. The most frequent metastatic site was the liver (20/20, 100%). Five patients had signet ring cells (5.1%) in their histology while 15 (15.2%) had mucinous features. The overall 5-year survival of young-onset CRC was 82.0%. Advanced overall stage (hazard ratio (HR) 6.1, CI 1.03-3.62) and signet ring histology (HR 34.2, CI 2.24-5.23) were associated with poor prognosis. CONCLUSION Young-onset CRC tend to be left-sided with advanced presentations. However, their 5-year survival remains favourable as compared to the general population.

This study was designed to investigate whether sectioning of the transverse carpal ligament (TCL) modifies the biomechanical behavior of the finger flexion in respect to dynamic changes of the wrist. Changes of work, load, and excursion of the flexor tendons were measured using fresh frozen cadaver hands with the wrist in 30° flexion, neutral, and 30° extension before and after division of the TCL. Change in work efficiency between intact and cut TCL groups was noted most with the wrist in flexed position (12.5%) compared to 3% in neutral wrist position and no change in wrist extension. The extended wrist group as a whole had greatest increase in the efficiency of work and load with greater than 16.2% and 14.8% changes, respectively. The significant decrease in the excursion efficiency of the flexor tendons was demonstrated when the wrist was in the flexed position. This effect was accentuated when the TCL was divided causing the bow-stringing phenomenon. The increase in the excursion of the flexor tendons could clinically result in decreased grip strength when the wrist is flexed. Furthermore, the effects of TCL division were least significant when wrist position was in extension. One could conclude from this that post-operative management after carpal tunnel release procedures should include placing the wrist in moderate extension.
Cadaver ; Fingers ; Hand ; Hand Strength ; Ligaments ; Tendons ; Wrist

Acupuncture is recognized as a component of alternative medicine and is increasingly used worldwide. Many studies have shown the various effects of acupuncture around the eyes for ophthalmologic or nonophthalmologic conditions. For ophthalmologic conditions, the effect of acupuncture on dry eye syndrome, glaucoma, myopia, amblyopia, ophthalmoplegia, allergic rhinoconjunctivitis, blepharospasm, and blepharoptosis has been reported. Recently, several studies on dry eye syndrome have been reported and are in the spotlight. However, given the variety of study designs and reported outcomes of periocular acupuncture, research is still inconclusive, and further studies are required. In addition, although a systematic and reliable safety assessment is required, to the best of our knowledge, there have been no reports of a literature review of ocular complications resulting from periocular acupuncture. This review collected cases of ocular injury as severe adverse events from previously published case reports of periocular acupuncture. A total of 14 case reports (15 eyes of 14 patients) of adverse events published between 1982 and 2020 were identified. This review article provides a summary of the reported cases and suggestions for the prevention and management of better visual function prognosis.