1.Current Trends in Emergency Tracheal Intubation and Prediction of Difficult Intubation in ED.
Sung Pil CHUNG ; Tai Ho IM ; Wen Joen CHANG ; Seung Ho KIM ; Hahn Shick LEE
Journal of the Korean Society of Emergency Medicine 1999;10(3):379-385
BACKGROUND: This study was designed to describe the current tends of emergency tracheal intubation and predict difficult airway intubations in emergency department (ED) at a teaching hospital in Korea. METHODS: All patients who was taken endotracheal incubation in ED during a 1-year period (Mar 1997 through Feb 1998) were included in the study population. Medical records of the patients were retrospectively reviewed. Among them, 56 patients were prospectively evaluated parameters to predict difficult airway intubations. RESULTS: During the study period, a total of 413 patients(1.5%) required endotracheal intubation. Except far 2 cases, all patients intubated orotracheally, and 298(72%) patients were intubated by emergency medicine resident. Pharmacologic adjuncts were used in 200(48%) patients, the neuromuscular blocking agent(NMBA) was used in 16(3.8%) Commonly used drugs were thiopental and vecuronium. The difficult incubation was not associated with presence of denture, length and circumference of neck, and mental status. The visibility of vocal cord on laryngoscopy significantly correlated to the difficult airway. CONCLUSION: At this institution, the majority of ED incubation were performed by emergency physicians and NMBA was not routinely used. The visibility of vocal cord during the direct laryngoscopy could be a predictor of difficult incubation in ED.
Dentures
;
Emergencies*
;
Emergency Medicine
;
Emergency Service, Hospital
;
Hospitals, Teaching
;
Humans
;
Intubation*
;
Intubation, Intratracheal
;
Korea
;
Laryngoscopy
;
Medical Records
;
Neck
;
Neuromuscular Blockade
;
Prospective Studies
;
Retrospective Studies
;
Thiopental
;
Vecuronium Bromide
;
Vocal Cords
2.Historical Overview of Taenia asiatica in Taiwan.
Hong Kean OOI ; Chau Mei HO ; Wen Cheng CHUNG
The Korean Journal of Parasitology 2013;51(1):31-36
An overview of the epidemiological, biological, and clinical studies of Taenia and taeniasis in Taiwan for the past century is presented. The phenomenal observations that led to the discovery of Taenia asiatica as a new species, which differ from Taenia solium and Taenia saginata, are described. Parasitological surveys of the aborigines in Taiwan revealed a high prevalence of taeniasis, which might be due to the culture of eating raw liver of hunted wild boars. Chemotherapeutic deworming trials involving many patients with taeniasis were discussed. Praziquantel was found to be very effective, but sometimes complete worms could not be recovered from the feces after treatment, probably due to the dissolution of the proglottids. Atabrine, despite some side effects, can still be used, in properly controlled dosages, as the drug of choice for human T. asiatica infection if we need to recover the expelled worms for morphological examinations. Research results on the infection of T. asiatica eggs from Taiwan aborigines in experimental animals were also noted. Since the pig serve as the natural intermediate host of T. asiatica and the predilection site is the liver, a differential comparison of other parasitic pathogens that might cause apparently similar lesions is also presented.
Animals
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Anthelmintics/therapeutic use
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Biomedical Research/history
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History, 20th Century
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History, 21st Century
;
Humans
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Taenia/*classification/*isolation & purification
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Taeniasis/drug therapy/*epidemiology/history
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Taiwan/epidemiology
3.Comparison on the adsorptive capacity of Fuller's earth, Actidose Aqua(R) and activated charcoal.
Young Hwan CHOI ; Jin Ho OHO ; Sung Pil CHUNG ; Tae Sik HWANG ; Wen Joen CHANG ; Seung Ho KIM
Journal of the Korean Society of Emergency Medicine 2000;11(1):137-143
BACKGROUND: Activated charcoal has been widely used as an adsorbent for the management of drug intoxicated patients in the emergency department(ED). Although there are several commercial ready-mixed charcoal suspension preparations in the market, we are using custom-made suspension from hospital grade bulk charcoal powder. We designed this study to compare the adsorptive capacity of the Actidose Aqua(R), which is a commercial charcoal product, Fuller's earth, and custom-made activated charcoal used in our ED. METHODS: First, we performed modified USP methylene blue adsorption test which is a standard adsorption test for activated charcoal. Then, the drug adsorption test for phenobarbital, acetaminophen, salicylate, and aminophylline was done. Graded amount of three adsorptives were added to the stock solutions of each drugs. The adsorption test were performed as follows: The vials containing drugs and adsorptives were shaken for 30 minutes to ensure adsorption equilibrium, then the suspension was filtered through in-line filter. The filtrates were analyzed by ultraviolet spectroscopy to determine the residual drug concentrations. Finally we examined and compared the surface area and the structure of activated charcoal and Fuller's earth using scanning electron microscopy. RESULTS: In methylene blue adsorption test, the adsorption rate was 60.1% in Actidose Aqua(R) and 59.0% in custom-made charcoal, and 70.2% in Fuller's earth. For the phenobarbital, acetaminophen, and sallcylate, the adsorption rate of Actidose Aqua(R) and custom-made charcoal was greater than 90% with the ratio o adsorptives to drugs over 10:1. For aminophylline, two charcoal products showed excellent adsorption in 5:1 ratio. But Fuller's earth showed poor adsorption in all rages. CONCLUSION: Custom-made activated charcoal showed a comparable adsorption capacity to Actidose Aqua(R). Fuller's earth showed a poor performance to be used as a substitute for activated charcoal in acute drug poisoning otherwise paraquat.
Acetaminophen
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Adsorption
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Aminophylline
;
Charcoal*
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Emergencies
;
Humans
;
Methylene Blue
;
Microscopy, Electron, Scanning
;
Paraquat
;
Phenobarbital
;
Poisoning
;
Rage
;
Spectrum Analysis
4.A retrospective review of the Do-Not-Resuscitate Patients.
Sung Pil CHUNG ; Cheon Jae YOON ; Jin Ho OH ; Soo Young YOON ; Wen Jeon CHANG ; Hahn Shick LEE
Journal of the Korean Society of Emergency Medicine 1998;9(2):271-276
BACKGROUND: Do-Not-Resuscitate(DNR) order has been used without specific legislation commonly in hospitals of Korea. We designed this study to assess the current use of DNR order in the emergency department and to make a database for establishing a policy for DNR order, especially in ER. METHODS: We retrospectively reviewed medical records of 164 patients who expired in the emergency department of Severance hospital from Sep. 1996 to Aug. 1997. We evaluated age, sex, diagnosis, specific department involved, whether written orders were made and medical care after decision of DNR. The patients were divided into 2 groups : DNR vs CPR. To determine factors influencing DNR decision, we searched for presence of malignancy, irreversible shock, unconsciousness and chronic illness. The logistic regression analysis was used for statistical significance. RESULTS: We found that 102(62.2%) out of 164 expired patients had a DNR order. But only in 59% of cases, were written DNR order on the chart. Factors which had the most influence on decision of DNR were malignancy and age. The sex, chronic illness, irreversible shock, and unconsciousness were not significant factors. CONCLUSION: We found malignancy and old age as an important factor when DNR order had been made. But further evaluation of other factors may be necessary to establish definitely a policy for DNR order.
Cardiopulmonary Resuscitation
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Chronic Disease
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Diagnosis
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Emergency Service, Hospital
;
Humans
;
Korea
;
Logistic Models
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Medical Records
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Retrospective Studies*
;
Shock
;
Unconsciousness
5.Clear-cell variant of calcifying epithelial odontogenic tumor (Pindborg tumor) in the mandible.
Ching-Yi CHEN ; Chung-Wei WU ; Wen-Chen WANG ; Li-Min LIN ; Yuk-Kwan CHEN
International Journal of Oral Science 2013;5(2):115-119
We present an uncommon case (female patient aged 59 years) of the clear-cell variant of calcifying epithelial odontogenic tumor (CEOT) (also known as Pindborg tumor) in the mandible. The clinical characteristics and probable origins of the clear tumor cells of previously reported cases of clear-cell variant of intraosseous CEOT are also summarized and discussed.
Biopsy
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Diagnosis, Differential
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Female
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Follow-Up Studies
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Humans
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Keratins
;
analysis
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Mandibular Neoplasms
;
diagnosis
;
pathology
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Middle Aged
;
Odontogenic Tumors
;
diagnosis
;
pathology
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Radiography, Panoramic
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Skin Neoplasms
;
diagnosis
;
pathology
6.CT Assessment of Myocardial Perfusion and Fractional Flow Reserve in Coronary Artery Disease: A Review of Current Clinical Evidence and Recent Developments
Chun-Ho YUN ; Chung-Lieh HUNG ; Ming-Shien WEN ; Yung-Liang WAN ; Aaron SO
Korean Journal of Radiology 2021;22(11):1749-1763
Coronary computed tomography angiography (CCTA) is routinely used for anatomical assessment of coronary artery disease (CAD). However, invasive measurement of fractional flow reserve (FFR) is the current gold standard for the diagnosis of hemodynamically significant CAD. CT-derived FFRCT and CT perfusion are two emerging techniques that can provide a functional assessment of CAD for risk stratification and clinical decision making. Several clinical studies have shown that the diagnostic performance of concomitant CCTA and functional CT assessment for detecting hemodynamically significant CAD is at least non-inferior to that of other routinely used imaging modalities. This article aims to review the current clinical evidence and recent developments in functional CT techniques.
7.Factors in Delayed Arrival at the Emergency Department in Patients with Suspected Acute Stroke.
Shin Ho LEE ; Yoo Seok PARK ; Sung Pil CHUNG ; In Cheol PARK ; Hyun Soo CHUNG ; Sun Haeng CHOI ; Wen Joen CHANG
Journal of the Korean Society of Emergency Medicine 2006;17(5):431-437
PURPOSE: Acute stroke is a leading cause of serious, longterm disability and mortality in Korea. Two major refractory problems limiting effective stroke management are patient delays in recognizing stroke symptoms and reluctance to take action. The purpose of this study was to evaluate the actors influencing delayed arrival at the hospital in patients with suspected acute stroke. METHODS: One hundred and seventy-one patients with symptoms of acute stroke who presented to the emergency department (ED) between November 2004 and April 2005 were enrolled in the study. A questionnaire prospectively surveyed by emergency medicine residents was used in evaluating patients for inclusion. RESULTS: Fifty-eight patients (34% of the total) arrived at the hospital within 3 hours of symptom onset. As suggested by univariate analysis, initial symptoms (mental change and speech disturbance), presence or absence of bystanders at the time of symptom onset, utilization of an emergency medical service (EMS) system and inter-hospital transfer all seemed to be associated with the time interval between detection and ED arrival. Further evaluation using multiple linear regression indicated that severity of initial neurologic symptoms, use of EMS transport, the necessity of interhospital transfer, and score on the abnormal Los Angeles Prehospital Stroke Scale (LAPSS) were statistically significant factors affecting arrival time. CONCLUSION: Factors that were associated with earlier ED arrival were severe initial symptoms, utilization of the EMS system, direct arrival from the site of symptom onset, and abnormal LAPSS. Therefore, continuous public education and paramedic training is required to promote early detection and delivery of patients with acute stroke to an appropriate facility.
Allied Health Personnel
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Education
;
Emergencies*
;
Emergency Medical Services
;
Emergency Medicine
;
Emergency Service, Hospital*
;
Humans
;
Korea
;
Linear Models
;
Mortality
;
Neurologic Manifestations
;
Prospective Studies
;
Surveys and Questionnaires
;
Stroke*
;
Time Factors
8.Injury Data Comparison between National and Local Emergency Centers in Korea.
Mao Lung SUN ; Sang Chul KIM ; Ho Sung JUNG ; Yun Kwon KIM ; Jin Young KIM ; Nam Ho KIM ; Hun Jong CHUNG ; Yang Ju TAK ; Wen Joen CHANG
Journal of the Korean Society of Emergency Medicine 2012;23(2):181-188
PURPOSE: The incidence and severity of injuries differs between each region of Korea due to socioeconomic differences. The comparative analysis between national injury data and the evaluation of regional epidemiologic characteristics is useful in establishing an injury prevention strategy for a regional community. This study was conducted in order to provide basic data for the establishment of an injury prevention strategy by priority through comparison between national injury data collected by National Emergency Department Information System (NEDIS) and injury data from regional emergency centers located in small cities, in Korea. METHODS: The study subjects were the injury patients who visited a total of 117 regional, specialized and local emergency centers from April 2009 to March 2010, as well as those who visited Konkuk University Chungju Hospital during the same period. We collected national data from the Injury Surveillance Report published by Korea Centers for Disease Control and Prevention and compared these with study hospital data collected by our own injury registration system to include gender, ratio, age, and mechanism and severity of patient injury. RESULTS: Of 3,931,573 patients who visited 117 emergency centers and 23,671 patients who visited the study hospital during the study year, the number of injury patients was 786,006 (20.0%) versus 6,177 (26.1%), respectively. 485,521 (62.0%) of the nation-wide subjects versus 4,046 (65.5%) of the study hospital subjects were male, and 298,197 (38.0%) of the nation-wide subjects versus 2,128 (34.5%) of the study hospital subjects were female. The comparison by age of the injury subjects was as follows: below 9 years (22.4% versus 16.8%), twenties (14.5% versus 16.3%) and forties (14.5% versus 15.2%). In the comparison of injury mechanism, blunt injury was higher (20.4%) in nation-wide subjects followed by slip injury (20.0%) and transport accident (19.0%). Transport accidents produced the highest cause of injury (26.0%) in the study subjects followed by slip injury (20.1%) and bunt injury (16.1%). In the severity comparison, 641,344(81.6%) versus 4797(77.8%) were mild injury patients, 139,260(17.7%) versus 1299(21.1%) were severely injured, and 3114 (0.4%) versus 69(1.1%) were fatal injuries. The causes of severe injury nation-wide included intoxication (46.3%), falls (34.8%) and machine accidents (33.3%) versus machine (46.0%), asphyxia (44.4%), intoxication (39.3%) in the study hospital, and the causes of fatal injuries nation-wide were intoxication (5.2%), drowning (4.3%), and asphyxia (4.2%), versus drowning (11.1%), asphyxia (5.6%) and intoxication (4.9%) in the study hospital. CONCLUSION: Through the comparison between study hospital with national injury data, we found that the percentage of severe and fatally injured patients was higher in the nationally with transportation related accidents being highest in terms of mechanism. The construction of a regional injury data system with ongoing comparison with national injury data may be useful in the establishment of a regional injury intervention strategy by priority.
Accident Prevention
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Asphyxia
;
Centers for Disease Control and Prevention (U.S.)
;
Drowning
;
Emergencies
;
Female
;
Humans
;
Incidence
;
Information Systems
;
Korea
;
Male
;
Population Surveillance
;
Transportation
;
Wounds, Nonpenetrating
9.Image-guided radiofrequency ablation of liver malignancies: experience at Singapore General Hospital.
Shoen C S LOW ; Richard H G LO ; Te-Neng LAU ; London Lucien P J OOI ; Chee-Keong HO ; Bien-Soo TAN ; Alexander Y F CHUNG ; Wen-Hsin KOO ; Pierce K H CHOW
Annals of the Academy of Medicine, Singapore 2006;35(12):851-857
UNLABELLEDThe aim of this paper was to study the efficacy, side effects and complications of radiofrequency (RF) ablation of primary and metastatic liver malignancies.
MATERIALS AND METHODSWe retrospectively reviewed 57 patients (39 men, 18 women; mean age, 63 years; age range, 44 to 83 years) who underwent RF ablation for liver malignancies from January 2002 to December 2004. A total of 87 tumours were ablated - 71 (81.6%) hepatocellular carcinomas and 16 (18.4%) metastases (from primaries in the colon, stomach and pancreas). RF ablation was performed either percutaneously (n = 71) under conscious sedation or intraoperatively (n = 16) under general anaesthesia. Follow-up ranged from 1 month to 41 months (mean, 15.2) and included computed tomography (CT) 1 day, 1 month and 3 months after ablation, and half-yearly thereafter. Patients were observed for local tumour progression and for the emergence of new tumours.
RESULTSFour patients with a total of 5 tumours were lost to follow-up. Of the remaining 82 tumours treated, complete ablation was attained in 66 tumours after a single procedure, giving a primary effectiveness rate of 80.5%. Seven (8.5%) required 2 procedures to achieve complete ablation, giving a secondary effectiveness rate of 89% after 2 ablations. One tumour (1.2%) required 3 procedures to achieve complete ablation. One tumour required 4 procedures to date, with the latest follow-up CT still demonstrating incomplete ablation. Two tumours (2.4%) had an initial RF ablation and subsequent transarterial chemoembolisation (TACE). One tumour had an initial RF ablation followed by 32Phosphorus-biosilicon (BrachySil) injection, the latter as part of a Phase IIA trial. One tumour required 2 RF ablations and a subsequent TACE. Lastly, 3 tumours received initial RF ablation but subsequent local tumour progression was not treated as the patients were deemed unfit for repeat ablation. No procedure-related deaths or major complications were encountered. Minor complications were reported in 2 patients (3.8%) - subcapsular haematoma and thermal injury to the adjacent gastric antrum, both not necessitating surgical intervention.
CONCLUSIONSRF ablation is an effective, safe and relatively simple procedure for the treatment of unresectable liver malignancies.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; mortality ; secondary ; surgery ; therapy ; Catheter Ablation ; Chemoembolization, Therapeutic ; Combined Modality Therapy ; Female ; Hospitals, General ; Humans ; Liver Neoplasms ; mortality ; secondary ; surgery ; therapy ; Male ; Middle Aged ; Retreatment ; Retrospective Studies ; Singapore ; Surgery, Computer-Assisted
10.Association of AXIN1 With Parkinson’s Disease in a Taiwanese Population
Hwa-Shin FANG ; Chih-Ying CHAO ; Chun-Chieh WANG ; Wen-Lang FAN ; Po-Jung HUANG ; Hon-Chung FUNG ; Yih-Ru WU
Journal of Movement Disorders 2022;15(1):33-37
Objective:
A meta-analysis of locus-based genome-wide association studies recently identified a relationship between AXIN1 and Parkinson’s disease (PD). Few studies of Asian populations, however, have reported such a genetic association. The influences of rs13337493, rs758033, and rs2361988, three PD-associated genetic variants of AXIN1, were investigated in the present study because AXIN1 is related to Wnt/β-catenin signaling.
Methods:
A total of 2,418 individuals were enrolled in our Taiwanese cohort for analysis of the genotypic and allelic frequency. Polymerase chain reaction–restriction fragment length polymorphism analysis was employed for rs13337493 genotyping, and the Agena MassARRAY platform (Agena Bioscience, San Diego, CA, USA) was used for rs758033 and rs2361988 genotyping in 672 patients with PD and 392 controls. Taiwan Biobank data of another 1,354 healthy controls were subjected to whole-genome sequencing performed using Illumina platforms at approximately 30× average depth.
Results:
Our results revealed that rs758033 {odds ratios [OR] (95% confidence interval [CI]) = 0.267 [0.064, 0.795], p = 0.014} was associated with the risk of PD, and there was a trend toward a protective effect of rs2361988 (OR [95% CI] = 0.296 [0.071, 0.884], p = 0.026) under the recessive model. The TT genotype of rs758033 (OR [95% CI] = 0.271 [0.065, 0.805], p = 0.015) and the CC genotype of rs2361988 (OR [95% CI] = 0.305 [0.073, 0.913], p = 0.031) were less common in the PD group than in the non-PD group.
Conclusion
Our findings indicate that the rs758033 and rs2361988 polymorphisms of AXIN1 may affect the risk of PD in the Taiwanese population.