bluuebunny/crossref_metadata_2025 huggingface dataset:
Aseptic Cerebral Venous Sinus Thrombosis in Early Pregnancy
Authors: Lim YH
Published: December 2017

This is a rare case of sagittal sinus thrombosis occurring in the first trimester of pregnancy. A literature review was performed.
Is There Any Relation between Ultrasonographic Estimation of Urinary Retention and Lower Urinary Tract Infection in Women?
Authors: Chan K , Ho PL
Published: December 2017

A study was conducted to determine whether ultrasonographic detection of urinary retention is associated with clinically suspected lower urinary tract infection (UTI). During a 6-month period (January-June 2007), women aged >16 years who presented to the emergency department of Queen Elizabeth Hospital with clinical symptoms of lower UTI were enrolled. Totally 187 patients participated and completed the study. The mean age was 50.8 ± 21.5 years. Sixty-eight (36.4%) had positive urine culture while 119 (63.6%) were negative. Defining a significant residual urine volume of greater than 50 ml had low sensitivity (17.7%) and high specificity (100%) for the detection of UTI. However, when taking into account those of smaller residual urine volume (less than 50 ml), overall 37.6% of the patients with UTI had detectable residual urine in the bladder and no significant residual urine was detected in all culture-negative patients.
Isolated Posterior Acute Myocardial Infarction Presenting to an Emergency Department: Diagnosis and Emergent Fibrinolytic Therapy
Authors: Lim HC , Goh SH , Fadil MF Mohd
Published: December 2017

Objectives

Isolated posterior acute myocardial infarction (AMI) is rare and possibly underdiagnosed. The incidence of misdiagnosis in the emergency department (ED) is unknown. Delayed diagnosis may prevent timely treatment, particularly emergent fibrinolytic therapy. We describe the experience of an urban ED on this rare condition.

Methodology

A six years and seven months case series of isolated posterior AMI of initial presentation (as identified by inpatient discharge/death ICD-9-CM diagnosis code) was studied. Patients not admitted from the ED, those who developed isolated posterior AMI only after admission and/or those with concomitant ST segment elevation AMI involving other anatomical locations of the heart (e.g. inferior or lateral walls), were excluded.

Results

Eleven cases were included in the study. All the nine cases with electrocardiograms available for review demonstrated features consistent with isolated posterior AMI. Eight out of the eleven (72.7%) cases were correctly diagnosed as isolated posterior AMI in the ED. The other three cases were treated as non-ST elevation myocardial infarction (NSTEMI). Nevertheless, their lack of the typical symptoms of acute coronary syndrome and delayed presentation (more than 12 hours) precluded them from fibrinolytics. Three of the eleven cases received fibrinolytics (all streptokinase). All three cases survived to discharge and there were no haemorrhagic complications. None of the cases underwent emergent percutaneous coronary intervention.

Conclusion

The majority of cases with isolated posterior AMI (72.7%) were diagnosed in the ED. Although three cases were interpreted as NSTEMI, the use of fibrinolytic reperfusion therapy was not affected.
Bleeding Pelvic Fractures: Updates and Controversies in Acute Phase Management
Authors: Lai CH , Kam CW
Published: December 2017

Background

The management of patients with haemodynamic instability related to pelvic fractures is a major challenge with high mortality and morbidity. The treatment priorities have long been a source of debate. Many advocate emergent external fixation (EX-FIX) as the first line of treatment, whereas another school favours the efficacy of transcatheter arterial embolisation (TAE). Decision-making within the ‘Golden Hour’ in the emergency department (ED) is crucial to patients' ultimate outcome. Our aim was to evaluate the current management pathways in our centre and to review the latest literature.

Methods

We present a 2-year case series (from January 2005 to December 2006) of patients with pelvic ring disruption and haemodynamic instability. Data were collected regarding patients' demographics, fracture patterns according to the Young & Burgess classification, concomitant intra-abdominal injuries, treatment pathway and the response to treatment.

Results

There were 7 patients identified. Five were males and 2 were females, with a mean age of 42 years. Fracture types included 3 lateral compression, 1 anteroposterior compression, 2 vertical shear, and 1 combined mechanism. Four patients had significant intraperitoneal haemorrhage identified by Focused Assessment by Sonography for Trauma (FAST). They all needed laporotomy and pelvic packing, initially or subsequently. EX-FIXs were offered to 6 patients as the primary intervention, and 4 of them subsequently required diagnosis with angiography followed by therapeutic embolisation to restore haemodynamic stability. Only 1 patient underwent a second angiographic study to control the arterial bleeding. Two patients died of severe intra-abdominal injuries within 24 hours after admission.

Conclusion

In patients with pelvic fractures and hypotension, EX-FIX is currently the first line of treatment, with variable efficacy. On the other hand, the high successful embolisation rate and reasonable safety profile of TAE in our patients have been impressive. The latter offers a much better alternative to surgical intervention in selected patients. However, precautions should be taken including proper pelvic stabilisation by non-invasive devices, creation of a safe environment in the angiography suite, and early multidisciplinary decision in the ED.
Injury Pattern and Factors Affecting the Performance in Oxfam Trailwalker 2006
Authors: Au CKH , Ho HF
Published: December 2017

A total of 3844 walkers took part in Oxfam Trailwalker 2006 and 3257 (84.7%) walkers finished the 100 km trail. There were 239 nurses plus other healthcare providers providing medical support for the event; 1639 walkers had medical contact with the nurses and 699 (42.6%) visited the medical tents more than once. Most walkers attended for minor complaints with muscle cramp (60.8%), blisters (25.8%) and wounds (5.6%). Seventeen cases were sent to hospitals and only 4 were admitted. In general, successful walkers had more medical complaints: 25.5% of the successful walkers complained of muscle cramp while 19.5% of the dropouts complained of muscle cramp (p=0.0020); 13.6% of the successful walkers complained of blisters while 10.6% of the dropouts complained of blisters (p=0.0515); 4.5% of the successful walkers complained of wound as compared to 2.6% of the dropouts (p=0.0292) and 4.7% of the successful walkers had other complaints while 2.2% of the dropouts had other complaints (p=0.0074). Other complaints included a variety of conditions like vomiting, diarrhoea, fever, and tiredness. Ankle sprain was the only exception: 3.4% of the dropouts complained of ankle sprain while 3.3% of the successful walkers had ankle sprain. Nevertheless, the finding was not statistically significant (p=0.8317). It seems that higher proportions of muscle cramp, blister, wound and other complaints were found among successful walkers. The odds ratios of muscle cramp (1.15) and other complaints (1.69) were statistically significant. Among the successful walkers muscle cramp (p=0.0008), blisters (p=0.0039) and ankle sprain (p=0.0298) slowed the finishing time. Linear regression analysis showed that only blister mattered (p=0.0372).
A Man with Head Injury
Authors: Fung HS , Chiu JLF , Shu SJ , Chan MK , Lai AKH , Wong WK , Chan SCH
Published: December 2017

Head injury is common and can be associated with significant morbidity and mortality. We report a 71-year-old man with typical imaging findings of depressed skull fracture on plain film and computed tomography with images in multi-planar reformat and 3-dimensional volume rendering technique, followed by a brief review of the literature.
A Case of Emphysematous Cystitis
Authors: Wan CK , Tang CL , Tsui SH , Tong HK
Published: December 2017

Emphysematous cystitis (EC) is an uncommon but potentially life‐threatening urinary tract infection. Diagnostic difficulty exists because of the variable presentations. We report the case of a 73‐year‐old woman who presented with diarrhoea and malaise, and emphysematous cystitis was revealed on the abdominal X‐ray. As she was treated for EC, the diarrhoea and the radiographic abnormalities of EC also resolved. The evaluation and management of this complicated urinary tract infection are discussed.
Acute Aluminium Phosphide Poisoning: An Update
Authors: Wahab A , Zaheer MS , Wahab S , Khan RA
Published: December 2017

Acute aluminium phosphide poisoning is an extremely lethal poisoning. Ingestion is usually suicidal in intent, uncommonly accidental and rarely homicidal. Unfortunately the absence of a specific antidote results in very high mortality and the key to treatment lies in rapid decontamination and institution of resuscitative measures. This article aims to identify the salient features and mechanism of aluminium phosphide poisoning along with its management strategies and prognostic variables.
Bier'S Block for Emergency Department Management of Distal Radius Fractures
Authors: Richards CH , Graham CA , Munro PT
Published: December 2017

Background

Distal radius fractures commonly present to emergency departments (ED). Optimum treatment methods remain unclear and individual hospital practices differ.

Objectives

To ascertain the number and success rate of manipulation under intravenous regional anaesthesia (IVRA) of distal radius fractures, and to determine the re-manipulation rate.

Methods

Retrospective observational study of patients undergoing manipulation of distal radius fracture under IVRA in the ED from January 2003 to January 2004. The resuscitation room procedure log, hospital computer records, ED records and theatre records were examined for each patient.

Results

A total of 84 manipulations were performed. Complete information was available for 74 procedures (73 patients). Manipulation was successful in 73.5% with only 19 out of 73 patients requiring operation. All patients were manipulated under IVRA with middle grade or consultant supervision; and 52 (71.2%) patients were managed entirely as outpatients.

Conclusion

Our policy of manipulating displaced distal radius fractures under IVRA in the ED has a high success rate and allows the majority of patients to be managed as outpatients. This policy may lead to cost savings from a health service financing perspective.
Hepatic Capsular Enhancement: Is it a Hallmark for the Diagnosis of Fitz-Hugh-Curtis Syndrome?
Authors: Oh JH
Published: December 2017

Introduction

Hepatic capsular enhancement on contrast-enhanced computed tomography (CT) is regarded as a typical finding of the Fitz-Hugh-Curtis syndrome. Nevertheless, similar hepatic capsular enhancement may occur in peritoneal carcinomatosis.

Clinical picture

A 67-year-old man presented with diffuse abdominal pain. CT showed hepatic capsular enhancement and a mass in the sigmoid colon.

Treatment

As the patient was inoperable, supportive care was provided.

Outcome

He was transferred to a regional hospital for hospice care.

Conclusion

When we see a patient with hepatic capsular enhancement on contrast-enhanced CT, we should seek other causes of perihepatitis, in addition to the Fitz-Hugh-Curtis syndrome.
Free Fluid Accumulation following Blunt Abdominal Trauma: Potential for Expansion of the Fast Protocol
Authors: Simpson N , Page P , Taylor DM
Published: December 2017

Objective

To determine sites of free intra‐peritoneal fluid collection following blunt abdominal trauma, with a view to refinement of the Focused Assessment by Sonography for Trauma (FAST) protocol.

Methods

This was a retrospective observational study of CT scans of subjects who had suffered blunt abdominal trauma and had free intra‐peritoneal fluid detected on CT scan within 24 hours. The depth from the skin and amount of fluid at 14 abdominal sites were determined.

Results

CT scans of 105 patients were examined: 68 (64.8%) were male, mean age 36.7±18.4 years, mean injury severity score 25.4±11.6. Fluid collected most commonly at three sites: right mid‐axillary line at the level of the xiphisternum (52 patients, 49.5%), lateral margin of the right rectus muscle at the level of the anterior superior iliac spine (49 patients, 46.7%) and right mid‐axillary line at the level of the umbilicus (40 patients, 38.1%). Mean depth of fluid at these sites were 3.6, 3.6 and 4.2 cm, respectively.

Conclusions

Free fluid collects commonly in the area of the right iliac fossa following blunt abdominal trauma. The inclusion of this site in the FAST protocol may increase the ultrasonographic detection of free fluid in the acute trauma setting.
Clinical Predictors of Intra‐Abdominal Injury in Severe Blunt Trauma Patient
Authors: Goh PL , Schull MJ
Published: December 2017

Introduction

The early recognition of intra‐abdominal injury (IAI) in patients with blunt trauma is essential, yet physical examination is often unreliable. Computed tomography (CT) scans are used widely to further evaluate possible IAI but these require time and expense. IAI may be associated with certain objective risk factors or other specific injuries, but this association has not been widely studied. Identification of such risk factors will help to prioritize patients in need for further evaluation of possible IAI.

Methods

A retrospective chart review was conducted of all 622 adult severe blunt trauma patients (Injury Severity Score [ISS] >12) presenting to a level 1 trauma centre in 2004. Various clinical predictors of IAI were analyzed statistically with univariate and multivariate analysis using SAS software.

Results

In multivariate analysis, four significant predictors of IAI were found: positive focused assessment with sonography for trauma (FAST) (OR=48.5, p<0.0001), presence of pelvic fracture (OR=2.4, p=0.0002), chest tube insertion (OR=1.8, p=0.0211), and systolic blood pressure (SBP), where every 10 mmHg decrease indicates a 14% increase in risk (OR=0.986, p=0.001). The absence of all four predictors predicted the absence of IAI with a specificity of 0.776 (95% CI 0.741 to 0.808) and a LR of 2.7 (95% CI 2.0 to 3.5).

Conclusion

This study suggests that positive FAST, presence of pelvic fracture, chest tube insertion, and SBP are significant predictors of IAI in adult blunt trauma patients with ISS > 12. The absence of all four predictors is associated with a reduced risk of IAI.
Spontaneous Lateral Abdominal Wall Haematoma Presenting with Grey‐Turner'S Sign
Authors: Yuen CK , Chau YM , Hon SK , Kan PG , Wong YT
Published: December 2017

We describe a 93‐year‐old patient presenting with Grey‐Turner's sign due to spontaneous lateral abdominal wall haematoma. It is a rare entity. Bedside high resolution ultrasound scan is valuable in the emergency setting to investigate a patient with Grey‐Turner's sign. CT abdomen often confirms the diagnosis. These haematoma are usually benign but can have fatal complications. Management may vary from conservative treatment to intravascular embolisation or open evacuation with ligation of the bleeding vessel.
Preferences and Perceptions of Patients Attending Emergency Departments with Low Acuity Problems in Hong Kong
Authors: Graham CA , Kwok WO , Tsang YL , Rainer TH
Published: December 2017

Objective

To explore why patients in Hong Kong seek medical advice from the emergency department (ED) and to identify the methods by which patients would prefer to be updated on the likely waiting time for medical consultation in the ED.

Methods

The study recruited 249 semi‐urgent and non‐urgent patients in the ED of Prince of Wales Hospital from 26th September 2005 to 30th September 2005 inclusive. A convenience sample of subjects aged ≥15 years old in triage categories 4 or 5 were verbally consented and interviewed by research nurses using a standardized questionnaire.

Results

From 1715 potential patients, 249 were recruited ad hoc (mean age 44 years [SD18]; 123 females). About 63% indicated that an acceptable ED waiting time was less than or equal to two hours, and 88% felt that having individual number cards and using a number allocation screen in the ED waiting area would be useful. Perceived reasons for attending the ED rather than other health care providers such as primary health care or the general outpatient clinic (GOPC) included: a desire for more detailed investigations (56%); a perception that more professional medical advice was given in the ED (35%); patients were under the continuing care of the hospital (19%); and patients were referred to the ED by other health care professionals (11%). Notably, 26% of participants had considered attending the GOPC prior to attending the ED. Patients educated to tertiary level expected a shorter waiting time than those educated to lesser degrees (p=0.026, Kruskal‐Wallis test). Suggestions were made on how to provide a more pleasant ED environment for the wait for consultations, which included the provision of a television screen with sound in the waiting area (43%), more comfortable chairs (37%) and health care promotion programs (32%).

Conclusion

Patients chose ED services because they believed they would receive more detailed investigations and more professional medical advice than available alternatives. Clear notification of the likely waiting times and enhancement of comfort before consultation are considered desirable by patients. Enhanced public education about the role of the ED and making alternatives to ED care more accessible may be useful in reducing inappropriate ED attendances in Hong Kong.
Two Cases of the Purple Urine Bag Syndrome
Authors: Lam TSK , Wong OF , Au CWK , Fung HT
Published: December 2017

The purple urine bag syndrome, purple discoloration of urine, is an uncommon and alarming condition in patients requiring long‐term urinary catheterization but the clinical course is usually benign. We report two cases of the syndrome with a literature review on its aetiology and management.
Penetrating Atherosclerotic Ulcer ‐ an Increasingly Recognized Entity of the Acute Aortic Syndrome: Case Report and Literature Review
Authors: Lee WMM , Wong OF , Fung HT
Published: December 2017

With the advance in diagnostic radiology, penetrating atherosclerotic ulcers of the aorta become increasingly recognised in our daily practice. However, their natural history and treatment are not well defined. We report a case of penetrating atherosclerotic ulcer at the aortic arch and review the literature.
Acute Epidural Haematoma Due to Contrecoup Head Injury: A Case Report
Authors: Cakir Z , Cakir M , Emet M , Aslan S , Saritas A
Published: December 2017

Epidural haematoma (EH) is a traumatic accumulation of blood between the inner table of the skull and the dural membrane. Epidural haematoma that occurs at the opposite side of the site of injury, namely contrecoup EH, is a rare entity. We present a 56‐year‐old man who sustained head injury. The initial examination showed a laceration at his left frontotemporal region. Computed tomography of brain showed left frontotemporal linear fracture and right temporoparietal contrecoup EH. The EH was operated on and the patient was discharged uneventfully. Acute EH is a neurosurgical emergency, early diagnosis and prompt treatment are essential for optimal outcomes.
A Fatal Case of Iatrogenic Bilateral Pneumothorax after Acupuncture
Authors: Lam CW , Ng CP , Chung CH
Published: December 2017

We report a case of fatal iatrogenic pneumothorax after acupuncture. A patient with motor neurone disease presented with shortness of breath after acupuncture. Bilateral pneumothoraces were detected. Bilateral chest drains were inserted. However, the patient succumbed 41 days after admission. On reviewing the literature, pneumothorax was not uncommonly seen after acupuncture, and most patients recovered uneventfully. However, fatal cases still happened.
A Case Report of Ocular Injury by Euphorbia Plant Sap
Authors: Lam TSK , Wong OF , Leung CH , Fung HT
Published: December 2017

Ocular injuries in the working place are usually related to exposure to industrial chemical substances e.g. acid and alkaline, radiation energy e.g. ultra‐violet light or even direct trauma. Ocular injuries by saps of plants are uncommon but can result in serious ocular complications. We report a case of ocular injury of a gardener caused by the sap of a Euphorbia plant, Euphorbia trigona. The ocular complications and management of Euphorbia plant sap‐associated eye injuries are reviewed.
Association of Renal Dysfunction with Stroke Subtypes in Acute Stroke Patients
Authors: Kavalci C , Guldiken B , Ustundag S , Guldiken S
Published: December 2017

Objectives

There are conflicting published data about the association of renal dysfunction with cerebrovascular diseases. Both diseases have shared risk factors such as hypertension, diabetes mellitus and smoking. In the present study, the relationship of renal dysfunction with stroke subtypes and stroke severity was investigated.

Materials and methods

One hundred and sixty‐two acute stroke patients without known history of renal disease and 148 control subjects were enrolled in the study. Serum urea, serum creatinine level and glomerular filtration rate (GFR) as estimated by the Modification of Diet in Renal Disease formula were used to evaluate renal dysfunction. Stroke patients were divided into two groups as haemorrhagic and ischemic stroke, the latter being further subdivided into small and large vessel disease subtypes according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Stroke severity was assessed by the modified Rankin Scale.

Results

Serum creatinine and urea levels were significantly higher and GFR was significantly lower in the stroke group than the controls (p<0.001, p<0.001, p<0.001, respectively). Serum creatinine level was found significantly higher in haemorrhagic stroke than ischaemic stroke subtypes (p<0.001). There was no difference between ischemic subtypes regarding the measured renal parameters. Stroke severity correlated with increased creatinine levels (p<0.001, β=0.404, 95% CI=1.85‐3.50).

Conclusion

Acute stoke patients have impaired renal function. Renal dysfunction is particularly more prominent in haemorrhagic stroke and exists probably prior to the stroke. Whether renal dysfunction is an independent risk factor for stroke needs to be clarified by large population studies.
How Useful is Transcutaneous Carbon Dioxide Monitoring in the Adult Emergency Department?
Authors: Lim BL , Kelly AM
Published: December 2017

Transcutaneous carbon dioxide (PtCO2) monitoring offers a potential non‐invasive and continuous means to determine the arterial carbon dioxide tension (PaCO2). Studies investigating the use of PtCO2 monitoring in the adult emergency department (ED) are limited. To date, the lack of ED studies, especially those looking at clinical outcome and treatment alteration, some technical and cost limitations make it difficult to recommend widespread use of PtCO2 monitoring in the ED. However, there is a potential future use of PtCO2 monitoring in combination with peripheral venous blood gas (pVBG) values in ED patients with acute exacerbations of chronic obstructive pulmonary disease.
Hong Kong Poison Information Centre: Annual Report 2007
Authors: Chan YC , Tse ML , Lau FL
Published: December 2017

Objective

To report the poisoning data of Hong Kong Poison Information Centre (HKPIC) in 2007.

Methods

From 1st January 2007 to 31st December 2007, all poisoning cases received by HKPIC were retrieved from its database (DATOX) for analysis.

Results

2842 poisoned cases were analyzed. There were 1199 male and 1610 female patients and more than two‐thirds of the cases were between 20 and 59 years old. Common causes of exposure were suicidal attempt, accident and abusive use. Non‐benzodiazepine sedative‐hypnotic, household products and paracetamol were common poisons exposed. The majority of the patients were managed conservatively, with 8.4% and 6.4% treated by decontamination and antidotes respectively. Most cases had uneventful recovery; less than 1% of the poison exposure resulted in death and about 5% of the exposure had major outcomes.

Conclusions

This 2007 annual report provided updated epidemiological information on the poisoning pattern in Hong Kong and highlighted some changes in comparison to the situation in 2006.
Ipsilateral Scapular Fracture and Contralateral Fracture‐Dislocation of the Humeral Head Due to Electrocution
Authors: Cevik Y , Memis M , Sahin H , Kilicarslan K , Kavalci C
Published: December 2017

Scapular fractures and shoulder fracture‐dislocations as a result of electrocution are rarely seen and reported. We present the case of a 31‐year‐old man who sustained an ipsilateral scapular fracture and contralateral shoulder fracture‐dislocation after electrocution.
Differences in Attitude towards Cadaveric Organ Donation: Observations in a Multiracial Malaysian Society
Authors: Loch A , Hilmi IN , Mazam Z , Pillay Y , Choon DSK
Published: December 2017

Background

Willingness to donate organs is affected by socio‐cultural and religious values. The Malaysian society is made up of three ethnic groups: Malay, Chinese, and Indian, with Islam, Buddhism and Hinduism as their religions respectively. This study examined the knowledge and perception towards organ donation for each group.

Methods

This study was conducted at University Malaya Medical Centre, Kuala Lumpur, Malaysia. Relatives of patients awaiting treatment at the emergency department answered a questionnaire on knowledge and attitude on organ transplantation.

Results

A total of 904 questionnaires were completed; 90.6% would accept organs, 43.6% would donate, and 4.0% carried donor cards. The reasons for reluctance to donate included: fear of organs being used for research (18.8%), desire to be buried whole (18.0%), fear of less active treatment if patient is known to be a donor (12.8%). Malays were less willing to accept organs from a different race (63.5%) compared to Chinese (83.3%) and Indians (83.8%) (OR=0.35, 95%CI: 0.23‐0.54 and OR=0.34, 95%CI: 0.22‐0.51 respectively) and also less likely to donate organs (29.8%) as compared to Chinese (42.1%) and Indians (63.2%) (OR=0.57, 95%CI 0.40‐0.83 and OR=0.24, 95%CI 0.17‐0.35 respectively). Malays were less willing to donate organs to another race compared to Chinese or Indians (OR=0.48, 95%CI 0.33‐0.70 and OR=0.22, 95%CI 0.15‐0.31 respectively). Only 34.7% of Muslims are aware of fatwa supporting organ donation.

Conclusions

The awareness of organ donation was low. Clear differences exist among ethnic groups. Cultural‐religious attitudes and lack of trust in the medical systems were reasons for reluctance to donation. Identifying socio‐cultural barriers and reassuring donors regarding medical care are required.
Caffeic Acid Phenethyl Ester Decreases Oxidative Stress Index in Blunt Spinal Cord Injury in Rats
Authors: Kavakli H Sahin , Alici O , Koca C , Ilhan A , Isik B
Published: December 2017

Objective

The aim of this study was to investigate the total oxidant status and total antioxidant status of caffeic acid phenethyl ester and methylprednisolone in blunt spinal cord injury in rats.

Methods

Twenty‐four adult Wistar albino rats were randomised into three groups. Spinal cord injury was performed by the weight‐drop model. Group 1 underwent laminectomy followed by spinal cord injury and received no medication (control group). Group 2 underwent laminectomy followed by spinal cord injury and received caffeic acid phenethyl ester (10 µmol/kg) by intraperitoneal injection. Group 3 underwent laminectomy followed by spinal cord injury and received methylprednisolone (30 mg/kg) by intraperitoneal injection. Twenty‐four hours later, all rats were sacrified and after that total oxidant status, total antioxidant status and oxidative stress index levels were determined in spinal cord tissues and the obtained results were compared.

Results

The highest total antioxidant status level was observed in the caffeic acid phenethyl ester group and the highest total oxidant status level was observed in the control group. Oxidative stress index levels in the control group were statistically higher than the caffeic acid phenethyl ester and methylprednisolone groups (p<0.01).

Conclusion

Based on our results, it is concluded that caffeic acid phenethyl ester might be a promising neuroprotective agent after spinal cord injury via its antioxidant effects.
A Rare Case of Fahr'S Disease Presenting as Epileptic Seizure in the Emergency Department
Authors: Sogüt O , Kaya H , Gökdemir MT , Solduk L , Sayhan MB
Published: December 2017

Fahr's disease (striato‐pallido‐dentate calcifications) is a rare neurodegenerative disorder characterised by bihemispherical and symmetrical calcium deposits in certain areas of the brain, particularly in the basal ganglia. We report an unusual case of Fahr's disease in a 36‐year‐old man who presented with generalised seizure in our emergency department. Basing on clinical, radiological, and endocrinological aspects, the patient was diagnosed as Fahr's disease associated with hypoparathyroidism. Administration of parenteral calcium and calcitriol supplementation were started in the emergency department. The clinical outcome was favourable after the treatment. The case illustrates that Fahr's disease, though rarely seen, has to be considered in a patient with convulsive state associated with calcifications of the basal ganglia. Systematically searching for dysparathyroidism in such patients is extremely important.
A Case of Risperidone‐Associated Neuroleptic Malignant Syndrome in a Patient Receiving Long‐Term Haloperidol Treatment
Authors: Wee JCP , Wong E , Annathurai A
Published: December 2017

We report a case of risperidone‐associated neuroleptic malignant syndrome. A 53‐year‐old gentleman with mental retardation, psychosis and hypertension who was on long term haloperidol, lorazepam and atenolol treatment presented to the Department of Emergency Medicine of the Singapore General Hospital with hyperthermia, generalised rigidity, impaired consciousness and diaphoresis five weeks after adding on risperidone. Biochemical investigations revealed hyponatremia, raised creatine kinase levels and myoglobinuria. Chest X‐ray showed consolidative changes in the right upper and middle zones and left middle zone. He was diagnosed as neuroleptic malignant syndrome with rhabdomyolysis, and aspiration pneumonia. He was discharged well after 13 days.
Simultaneous Sudden Infant Death Syndrome: Case Report
Authors: Cevik Y , Eroglu M , Onay M
Published: December 2017

Simultaneous sudden infant death syndrome (SSIDS) is death of both twins within 24 hours which is compatible with the sudden infant death syndrome criteria and death is independent of each other. A pair of twin babies, approximately two months old, was found dead in the supine position in bed by their mother. After scene, autopsy, toxicological and histopathological investigations, specific cause of death could not be found. There were 41 pairs of twin babies with SSIDS reported in the literature between 1900 and 1998. This is the second case report from Turkey.
The Use of Ambulatory Electrocardiography in the Emergency Medicine Ward to Assess Patients with Symptoms Possibly Related to Cardiac Arrhythmia: A Sharing of Experience in a Local Hospital
Authors: Chu CKK , Lee EFT , Leung CS , Lit ACH
Published: December 2017

Ambulatory electrocardiography (AECG) or Holter has a long history of use in patients with suspected symptomatic arrhythmia. In Hong Kong, patients with AECG monitoring were entirely under the care of internal medicine in the past. This report described a pioneer trial on the use of AECG in a local emergency setting under the supervision of emergency physicians. A departmental guideline for AECG use on suitable patients was drawn up and patients underwent AECG monitoring in the emergency medicine ward. The AECG results were reported preliminarily by emergency physicians and then confirmed with additional comments by cardiologists. This report presented the clinical features, AECG results and clinical outcomes of all patients recruited from the start of the protocol in May 2008 to July 2009.
Daytime versus Night Time Intentional Drug Overdose: The Outcome is Different
Authors: Lee KL , Ng HW , Tse ML , Lau FL
Published: December 2017

Introduction

In drug overdose, it is generally perceived that the dosage can predict the clinical outcome. Are the dosages of intentional drug overdosing the same between day and night? If so, are these overdoses followed by similar clinical outcomes? Answers to these two questions might affect resource allocation and clinical judgment. The present study was performed to establish whether daytime patients and night time patients report similar drug doses, and see which group of patients would have a higher incidence of severe outcomes.

Method

A retrospective observational study on intentional drug overdose was performed. The reported numbers of total tablets ingested and the incidences of major outcomes, in terms of death and intensive care unit admissions, were compared between daytime and night time.

Results

A total of 400 patients were included. The reported number of ingested tablets in daytime had no statistical difference with that at night time. The numbers of severe outcomes had no differences between the patients presenting to the emergency department at daytime or night time. Yet overdosing at night time was more likely associated with severe outcomes.

Conclusions

We advise a higher index of suspicion at the emergency department on the reliability of the dosages reported by patients who overdose during night time. The larger number of severe outcomes may also be related to more toxic drug exposures in the night time. More resources in the community could be allocated to self-harm prevention at night time.
Spigelian Hernia: A Complication of Laparoscopic Cholecystectomy
Authors: Mahdi SA , Jawad M , Nazir A , Naroo GY
Published: December 2017

Spigelian hernia is a rare abdominal wall hernia. It constitutes about 0.12% of all abdominal wall herniae; the peak occurrence being between the ages of 40-70 years with a male to female ratio of 1:1.18. Owing to the rarity of the disease, lack of physician experience and absence of typical hernia-like symptoms, it is a fairly difficult condition to diagnose. There is a 20% incidence of strangulation reported in the literature. The elective treatment of a Spigelian hernia is surgical: open or laparoscopic. The latter is preferred due to reduced mortality, shorter hospital stay, better cosmetic result and perhaps a lower recurrence rate. Reported here is a case of Spigelian hernia that presented to our institution, a level 1 trauma centre, as a complication of laparoscopic abdominal surgery.
Oral Mucosal Irritating Plant Ingestion in Hong Kong: Epidemiology and Its Clinical Presentation
Authors: Pang CT , Ng HW , Lau FL
Published: December 2017

Objective

To study the local epidemiology and clinical presentation after ingestion of oral mucosal irritating plants.

Methodology

Cases presenting with immediate oral mucosal irritation after plant product ingestion from July 2005 to June 2009 were retrieved from the Hong Kong Poison Information Centre's clinical database. Their clinical features and management were reviewed.

Results

Thirty cases were retrieved and analysed, including 14 males and 16 females. Poisoning occurred all year round with no seasonal predilection. Vomiting and dysphagia were the two most common symptoms other than immediate oral mucosal irritation. Half of the cases could be managed with symptomatic treatment and discharged after a few hours of observation. Six patients presented with angioedema and were managed initially with the use of intravenous steroid, antihistamine and with or without adrenaline. Urgent airway assessment with laryngoscope was performed in 3 patients. No patient required endotracheal intubation.

Conclusion

Oral mucosal irritating plant ingestion is not uncommon in Hong Kong. Its clinical feature can mimic angioedema on presentation. Immediate and localized oral mucosal symptoms after plant product ingestion are the key to diagnosis.
Unexplained Massive Pneumoperitoneum following Cardiopulmonary Resuscitation
Authors: Kim YI , Han SK , Park SW
Published: December 2017

Pneumoperitoneum following cardiopulmonary resuscitation (CPR) had been described as a rare complication. Pneumoperitoneum after CPR could be due to gastric perforation or intrathoracic air tracking into the abdominal cavity via the diaphragm as a result of bag-valve-mask ventilation, external chest compression or improper intubation. In most reported cases, the specific injuries could be identified. We reported an unusual case of pneumoperitoneum following CPR in which the specific cause was not definitely established. Emergency physicians should be aware of the mechanism and clinical signs suggesting of pneumoperitoneum during or after CPR.
Non-Traumatic Pericardial Effusion Presenting as Shortness of Breath
Authors: Annathurai A , Lateef F
Published: December 2017

Dyspnoea is a very common presentation in the emergency department (ED). Although cardiac and respiratory failures are common causes, we demonstrated the importance to consider non-traumatic pericardial effusion as a differential diagnosis for dyspnoea. Use of the ultrasound in the ED setting can help reach the diagnosis and provide timely and appropriate care for the patient.
Superior Mesenteric Artery Syndrome Leading to Acute Gastric Dilatation in a Woman with Bulimia
Authors: Park YS , Kim JS , Hwang JY
Published: December 2017

Superior mesenteric artery (SMA) syndrome is a rare clinical disease defined as compression of the third part of the duodenum between the aorta and the SMA. Severe complications of SMA syndrome include acute gastric dilatation which is uncommon but potentially fatal and requires immediate intervention. This report describes a 29‐year‐old woman with SMA syndrome complicated by acute gastric dilatation. It was diagnosed by computerized tomography. The patient had a history of treatment of bulimia nervosa but defaulted 3 months ago. She presented with severe abdominal distension and extreme abdominal pain due to massive gastric dilatation after an eating binge. Gastric decompression was successful with a modified gastric lavage tube with additional large holes at the tip.
Delayed Diagnosis of Rupture of Brachial Artery Due to Closed Posterior Elbow Dislocation
Authors: Guler F , Baz AB , Kose O , Cicek EI , Akalin S
Published: December 2017

Posterior elbow dislocations complicated with brachial artery rupture are rare, especially in the absence of an accompanying fracture. Severe acute ischaemia is not clearly evident in some cases and the diagnosis of arterial damage may not be realised because the collateral circulation around the elbow might mask signs of acute arterial disruption. We report a patient with brachial artery rupture due to closed posterior elbow dislocation. The diagnosis of arterial injury was delayed because the hand was well perfused and radial pulse was present at initial presentation. Our case emphasizes the need for repeated vascular examinations in elbow dislocations, moreover, hospitalisation and observation for at least 24 hours for further possible changes in the vascular status.
A Retrospective Survey on the Clinical Presentation of Ketamine Abusers in a Hong Kong Emergency Department
Authors: Lee HKH , Ng HW , Tse ML , Lau FL
Published: December 2017

Objective

Ketamine is one of the commonest abusing agents in Hong Kong. Our study aims to identify their clinical pattern of presentations to emergency departments.

Method

This is a retrospective survey study. The studied group was ketamine abusers being referred to us from a source out of emergency department (ED). Control group was randomly selected from patients attending our ED. The electronic records of the ketamine abusers and the controls in the past 3 years (1st April 2004‐31st March 2007) were reviewed and analysed.

Result

Total 91 subjects (48 in ketamine group, 43 in control group) were included. The mean age of ketamine abusers and control group are 21 and 22.2 year‐old respectively. Most of them (97.9%) did not declare their background of ketamine abuse. The mean 3‐year attendance rate for the ketamine group was 2.38 and for control group was 0.91, with a difference of 1.47 (95% CI 0.54‐2.41, p=0.003). Most of their illnesses were diagnosed as epigastric pain (25%), followed by upper respiratory tract infection (18.8%), head injury (10.4%) and urinary tract infection (10.4%). Significantly higher number of ketamine abusers presented with epigastric pain compared with control group (odds ratio 143, p<0.001).

Conclusion

Most teenage ketamine abusers do not declare their background of drug abuse when they present to emergency departments. They tend to have a higher frequency of attendances. Most of their presenting problems are related to gastrointestinal system.
Evaluation of the Appropriateness of Acute Hospitalisations in Hong Kong
Authors: Leung LP , Cheng YW , Fan KL
Published: December 2017

Objective

To test the validity of the Hong Kong version of Appropriateness Evaluation Protocol and estimate the prevalence of inappropriate acute hospitalisations in Hong Kong.

Methods

A retrospective chart review of two hundred randomly selected patients admitted to the specialty of Internal Medicine and General Surgery via the Accident & Emergency department of 2 regional hospitals in 2008. Comparison between the Hong Kong version of Appropriateness Evaluation Protocol and the consensus of an expert panel on appropriateness of admissions was made. The extent of agreement between the reviewer using the protocol and the expert panel was measured.

Results

The kappa coefficient for agreement was 0.73 (95% confidence interval: 0.63-0.83). The prevalence of inappropriate acute hospitalisations was 29%.

Conclusions

The Hong Kong version of Appropriateness Evaluation Protocol is a valid tool for assessing the appropriateness of acute hospitalisations.
Effects of Erdosteine in Experimental Sepsis Model in Rats
Authors: Kavakli H Sahin , Alici O , Koca C , Altintas ND , Aydin M
Published: December 2017

Objective

Erdosteine is a mucolytic agent that is known to possess antioxidant effects. This study investigated the effects of erdosteine on endothelin-1 (ET-1) levels and oxidative stress parameters superoxide dismutase (SOD) and malondialdehyde (MDA) in a rat sepsis model.

Methods

Four groups of Wistar albino rats (n=8 per group) were randomly allocated to the following groups: sham (group 1), sepsis (group 2), erdosteine control (group 3) and a sepsis group pretreated with erdosteine (group 4). Sepsis was induced using E. Coli ATCC 25922 inoculation. Serum ET-1, liver tissue SOD and MDA levels were determined in all groups.

Results

ET-1 levels were significantly higher in group 2 compared to groups 1, 3 and 4 (p<0.001, p=0.002 and p<0.001, respectively). Similarly, MDA levels in groups 1, 3 and 4 were significantly lower relative to group 2 (p<0.001, p=0.022 and p=0.010, respectively). Additionally, SOD activities in these same three groups were found to be significantly higher than those in group 2 (p<0.001, p=0.004 and p=0.028, respectively).

Conclusion

In conclusion, erdosteine decreases ET-1 levels and ameliorates oxidative stress parameters induced by sepsis in an experimental rat model of sepsis.
Prognostic Value of Avr Lead and the Well-Known Risk Factors in Acute St-Segment Elevated Myocardial Infarction
Authors: Eren SH , Aktas C , Korkmaz I , Karcioglu O , Coskun A , Guven FM Kukul
Published: December 2017

Objective

The present study was designed to analyse the effect of ST segment changes in aVR lead and the well-known risk factors in ST-segment elevated myocardial infarction (STEMI) patients.

Materials and Methods

A total of 250 patients who were admitted between 2009 and 2010 with STEMI and ≥1 mm ST-segment elevation in aVR lead were enrolled in the study. The patients were followed for life-threatening events like acute pulmonary oedema, atrial fibrillation, AV block, ventricular tachycardia, length of stay in hospital and death.

Results

Among the enrolled patients, 222 were discharged and 28 died. Pulmonary oedema and mortality rates were significantly higher in patients with ST-segment elevation in aVR lead (both p=0.001).

Conclusions

There is a correlation of ST-segment elevation in aVR lead with poor outcome in STEMI. Therefore aVR lead must be analysed as well as the other leads and well-known risk factors while it estimates the prognosis.
Total Anomalous Pulmonary Venous Connection Draining into the Portal Vein in a 2-Month-Old Infant: Multidetector Computed Tomography Angiography Diagnosis
Authors: Onbas O , Koplay M , Kandis H , Besir FH , Erdogmus B
Published: December 2017

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac anomaly in which the pulmonary veins fail to connect with the left atrium and connect directly to the right atrium or to one of the systemic veins. Early diagnosis and surgical correction is highly important for survival. In the evaluation of TAPVC, imaging methods such as echocardiography, computed tomography (CT) angiography, magnetic resonance (MR) angiography, and catheter angiography have been used. We reported a rare case of infracardiac type of TAPVC draining into the portal vein at 2-mounth-old infant who was admitted to the hospital with shortness of breath and mild cyanosis. The images demonstrating TAPVC between the portal vein and the pulmonary veins with multidetector computed tomography (MDCT) angiography were also shown.
Traumatic Asphyxia
Authors: Uzkeser M , Aydin Y , Emet M , Cakir Z , Aslan S , Ozturk G , Akoz A
Published: December 2017

Traumatic asphyxia is a clinical syndrome related to cervicofascial cyanosis, petechiae, subconjunctival haemorrhages and neurological symptoms. This syndrome occurs after a transient, severe and compressive blunt thoracic trauma. Here, we presented two cases of traumatic asphyxia. They both had prominent petechiae on upper parts of their bodies. The prognosis was excellent in the boy. Contrary, second case was dead in emergency department due to subarachnoid haemorrhage and intracerebral petechial haemorrhages. Traumatic asphyxia alone does not predict morbidity and mortality. It is the concomitant cardiovascular, pulmonary and neurologic injuries that affect the outcome.