bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Retrospective Study on Imperforate Hymen and Haematometrocolpos in a Regional Hospital
Authors: Lui CT , Chan TWT , Fung HT , Tang SYH 
Published: December 2017

ObjectiveTo find out the characteristics and presentations of imperforate hymen in the local population in Hong Kong and to assess if diagnosis of imperforate hymen made in the emergency department can reduce time to operation and length of hospital stay.DesignRetrospective study.SettingA regional public hospital in Hong Kong.PatientsWe retrospectively collected data of all patients with the diagnosis of imperforate hymen (ICD 9 coding 752.42) from the period of January 1999 to June 2009. Demographics of the patients, their presenting symptoms and signs, the diagnostic process, investigation findings and time of operation were recorded and analysed.ResultsFifteen cases of imperforate hymen were reported during that period. All were adolescent girls aged from 10 to 15 years. A total of 13 patients presented to the accident and emergency department (AED). Seven patients had the diagnosis made in the AED and 2 patients received bedside pelvic ultrasound. More than half of them (8 patients) presented with acute retention of urine. Other presentations included lower abdominal pain, constipation, lower abdominal mass, and protruding introital mass. Most cases diagnosed in the AED (5 out of 7) were admitted to the gynaecology ward while the others were admitted to the surgical or urology wards. Five out of the 7 cases diagnosed in the AED received operation within 24 hours; whereas only 1 out of the 6 cases with the diagnosis made after admission had operation within 24 hours. The difference was statistically significant (p=0.035, Fisher's exact test). The mean length of stay of the group diagnosed in the AED was 1.9 days while the mean length of stay for the group diagnosed after admission was 4.2 days.ConclusionEarly diagnosis of imperforate hymen and haematometrocolpos in the AED for adolescent girls with primary amenorrhoea could have positive impact on proper admission to the gynaecology ward, prompt operation and shorter length of stay in hospital.
Reversible Increases in Qt Dispersion and P Wave Dispersion during Carbon Monoxide Intoxication
Authors: Cevik Y , Tanriverdi F , Delice O , Kavalci C , Sezigen S 
Published: December 2017

Objectives Carbon monoxide (CO) is a potent myocardial toxin. We investigated the association between acute CO intoxication and electrocardiographic QT interval (QTmax/QTmin), corrected QT interval (cQTmax/cQTmin), QT dispersion (QTd) and corrected QT dispersion (cQTd), P wave duration (Pmax/Pmin) and P wave dispersion (Pd), which were known as predictors of ventricular arrhythmias, atrial fibrillation and sudden death. Methods Electrocardiography with 12-leads and blood gas were taken from 65 patients with CO intoxication as well as 65 control patients with similar age and gender distribution at the admission time to the emergency department and at the 4th hour post-therapy. The carboxyhaemoglobin (COHb) levels and the relationships with electrocardiographic parameters were studied. Results The mean COHb levels were 21.43±6.85% and 1.37±0.98% in intoxicated patients and in the control group respectively. QTmax, QTd, cQTmax, cQTd, Pmax, and Pd were found significantly higher in intoxicated patients when compared to the control group (373.98±40.35 vs. 355.98±32.88, p=0.006; 49.29±22.66 vs. 20.43±11.16, p<0.001; 455.38±30.72 vs. 419.57±22.27, p<0.001; 60.88±25.99 vs. 25.75±13.13, p<0.001; 107.91±13.28 vs. 96.65±12.65, p<0.001, 46.85±13.49 vs. 35.22±10.07, p<0.001 respectively). In Pearson correlation analysis, there were significant correlations between COHb level and QTmax, QTd, cQTmax, cQTd, Pmax and Pd (r=0.211, p=0.016; r=0.610, p<0.001; r=0.599, p<0.001; r=0.628, p<0.001; r=0.458, p<0.001; r=0.414, p<0.001 respectively). Conclusion A correlation between reversible increases in QTd, cQTmax, cQTd, Pmax and Pd in the electrocardiogram and COHb can be observed in acute CO intoxication patients.
Mechanism of Injury and Clinical Variables in Thoracic Spine Fracture: A Case Control Study
Authors: Singh R , Taylor DM , D'Souza D , Gorelik A , Page P , Phal P 
Published: December 2017

ObjectiveTo determine the mechanisms of injury and clinical findings significantly associated with traumatic thoracic spine (T-spine) fractures.MethodsThis was a case-control study in a tertiary adult trauma centre. Cases were patients admitted with traumatic T-spine fractures between January 1999 and August 2007, inclusive. Each case had two controls matched for gender, age and injury severity. Data were collected from patient medical records and the trauma service database. Factors potentially associated with T-spine fracture were derived from the literature, expert consensus and univariate analysis. Multivariate logistic regression was employed to determine factors significantly associated with T-spine fracture.ResultsTwo hundred and sixty one cases and 512 controls were enrolled. Univariate analysis showed the mechanisms of fall from a height ≥2 meters (m) and motorbike accident ≥60 kilometers per hour were significantly associated with T-spine fracture (p<0.001). The clinical findings of thoracic back pain, tenderness, intoxication, step deformity and abnormal neurological symptoms were also significantly associated with T-spine fracture (p<0.05). Multivariate analysis indicated that falls from a height of ≥2 m and thoracic back pain were significantly and positively associated with T-spine fracture (p<0.001). However, intoxication was negatively associated with T-spine fracture.ConclusionsPatients with T-spine injury are significantly more likely to have fallen from a height ≥2 m or to have had thoracic back pain but less likely to be intoxicated. These findings should be validated prospectively prior to development of clinical guidelines for the identification of patients who may benefit from CT screening of the thoracic spine.
Management of Suspected Deep Venous Thrombosis in an Emergency Medicine Ward in Hong Kong
Authors: Hung KKC , Graham CA , Yim WT , Yam ESF , Cheung NK , Rainer TH 
Published: December 2017

Introduction Clinical signs and symptoms can vary for patients with deep venous thrombosis (DVT). DVT is an important diagnosis to recognise as it can lead to proximal embolism into the pulmonary circulation resulting in sudden collapse and death. The objective of this study is to describe the management of patients with suspected DVT in the emergency medicine ward (EMW) setting in Hong Kong using a standardised clinical pathway. Methods A retrospective review was conducted for patients with suspected DVT admitted to the EMW from April to December 2008 using a standardised protocol. The use of a clinical prediction rule and diagnostic tests (including the modified Well's score, D-dimer and ultrasound examination) and outcomes (including the length of stay and secondary admission rate) were investigated. Results A total of 100 patients with suspected DVT were admitted to the EMW in the nine-month study period. DVT was confirmed in 30% using ultrasonography. Fifty-two percent of patients were in the high-risk category according to the modified Well's score. Seventy-six percent of patients had positive D-dimer results. Ten percent of patients were safely discharged without an ultrasound examination. Mean length of stay in the EMW was 1.99 days. Thirteen percent of patients required second admission to other specialties. Conclusions This study suggests that a standardised clinical pathway based in the EMW can be used for patients with suspected DVT to reduce hospital admission.
A Retrospective Study on Mucocele of the Appendix Presented with Acute Abdomen or Acute Appendicitis
Authors: Yakan S , Caliskan C , Uguz A , Korkut MA , Çoker A 
Published: December 2017

Objective We reported the demographic, clinical, radiologic, preoperative and postoperative characteristics and outcomes on patients of appendix mucocele that presented with or operated for acute appendicitis or acute abdomen. Methods A retrospective study. Patients who were presented or operated for acute appendicitis or acute abdomen and had an operative histopathological diagnosis as appendix mucocele (simple mucocele, mucinous cystadenoma, mucinous cystadenocarcinoma) were included. Demographic, clinical, radiologic, preoperative and postoperative data of eligible cases were evaluated. Results From January 2003 to February 2010, a total of 2120 patients with the pre-operative diagnosis of acute appendicitis were treated in our center, and nine (0.42%) patients were diagnosed to have mucocele of the appendix. Seven patients (78%) were female. Average age of the patients was 59.5 (range=25-74). Major complaint was right lower quadrant pain in eight (89%) patients. In preoperative ultrasonographic examination of the patients, appendiceal cystic masses (mucocele) were diagnosed in four (44.5%) patients. In histopathologic examination, the number of patients diagnosed to have simple mucocele was two (22%), mucinous cystadenoma was four (45%), and mucinous cystadenocarcinoma was three (33%). No postoperative morbidity or mortality was noted. Conclusion Appendix mucocele is a rare disease and it is usually diagnosed histopathologicaly in appendectomy specimens. When a cystic mass in appendix is seen during operation, appendiceal mucocele should be kept in mind to avoid iatrogenic perforation causing pseudomyxoma peritonei and possible concomitant malignancies should be searched.
How Useful are Vital Signs in Identifying Patient with Ruptured Ectopic Pregnancy? A Retrospective Correlation Study
Authors: Wong WY , Tsui KL , Tang YH 
Published: December 2017

Objectives To determine whether initial vital signs correlate with the amount of haemoperitoneum in patient with ruptured ectopic pregnancy presenting to accident and emergency department. Method A retrospective study in a regional public hospital in Hong Kong. We retrospectively collected data of all patients with the diagnosis of rupture ectopic pregnancy (ICD-9-CM 633) from the period of January 2006 to December 2007. Demographics of the patients, gestational ages, triage vital signs (pulse rate and blood pressure), emergency department ultrasound record and operation record were reviewed. Mean arterial pressure and shock index were calculated accordingly. Different vital signs were used to correlate with the amount of haemoperitoneum by using Pearson correlation analysis. Results Ninety-three patients with ruptured ectopic pregnancy were recruited. Mean age of patients was 30 years (range 17-47, ±6 SD). Mean week of gestation was 6.7 week (range 3-12, ±2 SD). Forty-two patients (47%) had intraperitoneal free fluid shown in emergency department ultrasound scan. Pearson correlation coefficients between vital signs and amount of haemoperitoneum were: systolic blood pressure (-0.44, p<0.001), diastolic blood pressure (-0.24, p=0.01), mean arterial pressure (-0.37, p<0.001), pulse (0.18, p=0.05) and shock index (0.45, p<0.001). Conclusion None of the vital signs showed good correlation with the amount of haemoperitoneum. Doctors should consider fluid resuscitation and urgent referral to gynaecologist for immediate operation even though the vital signs are normal, as patient may already have significant intraperitoneal bleeding.
Rectus Sheath Haematoma: A Rare Cause of Abdominal Pain
Authors: Akay S , Caliskan C , Gonullu H , Dal O , Korkut MA , Erkan N 
Published: December 2017

Objective Rectus sheath haematoma (RSH) is a rare entity described as accumulation of blood within the rectus muscle. Patients can present with varying symptoms and signs, mimicking acute abdominal conditions. Failure to diagnose can result in unnecessary diagnostic procedures and surgical interventions. Methods We presented a series of 14 cases of RSH presenting to two emergency departments (ED) within a period of 3 years. Their demographic characteristics, medical history, presenting signs, symptoms and treatment were analyzed. Results Fourteen cases were diagnosed RSH. Seven cases were on warfarin treatment. Three RSH cases were diagnosed by ultrasonography (USG) only while the remainders had additional computed tomography (CT). Two cases had surgery due to haemoperitoneum, and the rest were treated conservatively with bed rest, analgesics and reversal of anticoagulation therapy. All patients were discharged from hospitals. Conclusions RSH is an important entity which must be considered in patients with known risk factors presenting to ED with abdominal pain. In elderly patients with a history of cough, anticoagulant use with palpable mass on abdominal wall, RSH must be considered as a possible diagnosis for unexplained abdominal pain. USG, together with CT in selected cases, should be performed to reveal this rare disease entity.
Hot Water Immersion Therapy with a Thermal Isolator in Patient with Marine Envenomation
Authors: Lau KK , Chan CK , Tse ML , Lau FL 
Published: December 2017

ObjectiveHot water immersion (HWI) has been proven to be effective for the treatment of pain due to marine envenomation. Our preliminary study by simply measuring the temperature change over time on the hot water in our conventional metal tray method revealed a too rapid fall in water temperature that happened in minutes. The aim of this study was to review the current practice of HWI for patients with marine envenomation in the emergency departments in Hong Kong, and to look for the optimal equipment in performing HWI.MethodWe first conducted a phone survey to 16 registered nurses or nursing officers from 16 emergency departments of public hospitals in Hong Kong for the current practice of hot water immersion. The second part of our study was an in‐vitro experiment done in observation room that a healthy subject immersed a hand into the water bath in metallic tray, sharp box and thermal isolator with and without covering of aluminum foil or plastic foil. The temperature change of the water bath in these containers was serially monitored.ResultsIn our phone survey, 14 respondents used plastic tray or sharp box for hot water immersion. Nine of them claimed that they commonly encountered inadequate wound pain relief and early cooling of the hot water bath. The experiment showed that the water temperature dropped out of optimal range for 5 minutes and 15 minutes in metallic tray and sharp box respectively. The thermal isolator kept the optimal temperature throughout 30 minutes of the study time.ConclusionOur purposed thermal isolator is a safe, practical and effective device for HWI therapy.
Acute Pyelonephritis in Emergency Medicine Ward: A Four Years Retrospective Review
Authors: Chan TWT , Lam SK , Fung HT 
Published: December 2017

Objective To study the characteristics of patients with acute pyelonephritis (AP) admitted to the emergency medicine ward (EMW) and sensitivity pattern of bacteria cultured from urine as well as to find out which antibiotic should be the best empirical treatment. Methods This was a retrospective study. All patient diagnosed with AP admitted to the EMW in Tuen Mun Hospital from January 2007 to December 2010 were included in this study. Data on patients' demographics, length of stay, urine culture and antibiotic sensitivity results as well as the types of antibiotics administered to them were collected and analysed. Results Altogether 308 patients were admitted to the EMW during the study period, accounting for 58% of all hospital admissions with the same diagnosis. There were comparatively more female patients (p<0.001) and fewer patients with diabetes (p<0.001) admitted to the EMW compared with other departments. The mean length of stay in EMW (2.2 days) was significantly shorter than that in other departments (7.1 days) (p<0.001). E. Coli was the commonest cultured bacterium, accounting for 94% of all positive growths. Cefuroxime sodium had high sensitivity (84%) in treating AP, which was significantly higher than that of amoxicillin-clavulanate (75%) (p<0.001). Levofloxacin also had high sensitivity (86%) but the difference between cefuroxime sodium and levofloxacin was not statistically significant (p=0.67). Conclusions Patients with AP admitted to local EMWs should be given either cefuroxime sodium intravenously or levofloxacin orally (if they can tolerate oral intake) as empirical treatments. Oral levofloxacin can be continued upon discharge.
Is There Any Difference in Cardiopulmonary Resuscitation Performance According to Different Instructional Models of Cardiopulmonary Resuscitation Education for Junior and Senior High School Students?
Authors: Kim SE , Lee SJ , Noh H , Lee DH , Kim CW 
Published: December 2017

Objective This study aims to determine whether or not cardiopulmonary resuscitation (CPR) skills differ according to different instructional models for CPR education and training for junior and senior high school students. Methods This was a prospective and randomised study including 519 junior and senior high school students. After the lecture on CPR, students practiced the skill on the manikin. Group 1 used model 1 and Group 2 used model 2 for practical training and practical skills and CPR performance quality were evaluated. Results Data from skill tests were analysed in 229 students in group 1 and 210 students in group 2. The total score of sequence skill tests was 17.8±2.0 points. During 2 cycles, no chest elevation was observed in 33.3% and was significantly lower in group 1. There were no significant differences in the frequency of proper ventilation and in ventilation volume between the 2 groups. Excessive ventilation was more frequently observed in group 1 and insufficient ventilation was observed more frequently in group 2. The percentage of the frequency of a proper chest compression rate was 80.5±31.2% and there were no significant differences in proper and insufficient depths, mean rate and recoil of the chest in chest compression between the 2 groups. Conclusions There were differences in CPR skills according to different CPR training manikins. Therefore, certain conditions seem to be considered in selection of instructional models for CPR psychomotor skills. (Hong Kong j.emerg.med. 2011;18:375-382)
Effects of Ketamine on Icam-1 Expression during Lipopolysaccharide Induced Acute Lung Injury in Rats
Authors: Hong S , Kim J , Jeong S , Park K , Song D , Baik T , Kim J , Cho B , Lee S 
Published: December 2017

IntroductionIntercellular adhesion molecule-1 (ICAM-1) serves very important roles in lung injury, and increases in ICAM-1 are associated with severity of lung injury. We intended to examine whether ketamine could have favourable effects on ICAM-1 expression in lipopolysaccharide (LPS)-induced acute lung injury in the rat.MethodsThe acute lung injury was induced by instilling LPS into the tracheas of 72 anaesthetised rats. The animals were divided into four groups including a sham group with intratracheal saline, an LPS group with intratracheal LPS and intraperitoneal saline, and two ketamine treatment groups with intratracheal LPS and treated with 1 mg/kg or 10 mg/kg doses of intraperitoneal ketamine hydrochloride. Half of the animals were sacrificed at three hours and the remaining animals were sacrificed at six hours. Real time PCR was performed on the lung tissues obtained. Concentration of the soluble ICAM-1 was measured in the bronchoalveolar lavage fluid. Expression of ICAM-1 was measured.ResultsThe transcriptional activity of ICAM-1 mRNA increased 9.92 fold in the LPS group compared to the sham group but decreased by 84.1% and 83.3%, respectively, in the 1 and 10 mg/kg ketamine treatment groups. The concentration of soluble ICAM-1 in bronchoalveolar lavage fluid increased 2.23 fold in the LPS group compared to the sham group while decreasing by 75.0% and 74.5% respectively in the 1 mg/kg and 10 mg/kg ketamine treatment groups. The intensity of immunohistochemical staining for ICAM-1 was also decreased in both ketamine treatment groups.ConclusionKetamine attenuates ICAM-1 expression during acute lung injury in rats. (Hong Kong j.emerg.med. 2011;18:397-405)
Pain and Pain Management in a Hong Kong Emergency Department
Authors: Wong MT , Ip M , Graham CA 
Published: December 2017

Background The prevalence of pain is high in emergency departments (ED), according to previous studies. There is little information on the epidemiology of pain in Hong Kong EDs. This study aimed to explore the epidemiology of pain in a single academic ED in Hong Kong, and to evaluate the pain management policy in the ED. Methods Retrospective case review study with explicit record review of ED clinical records; records obtained by means of systematic sampling of a seven-consecutive-day period attendance. Data on the prevalence and location of pain, waiting time for drugs for pain relief, and pain drug prescription rates were obtained. Descriptive data analysis was performed. Results A total of 494 ED clinical records were reviewed. The prevalence of pain was 60.7% (300/494) during the study period. 72.3% (217/300) of patient attendances with pain had duration of pain not exceeding three days; 79.0% (237/300) of them were classified as ‘semi-urgent’ or ‘non-urgent’. 41.7% (125/300) of patients suffering from pain were given drugs for pain relief. The median time for patients to receive analgesic drugs was 56.0 (IQR 25.0-104.5) minutes after registration. Pain assessment using a numerical rating scale was positively associated with drug prescriptions for pain relief. Conclusion The prevalence of pain in ED patients was high, and comparable with the figures from studies in other EDs. Patients attending with pain had to wait more than 60 minutes for drugs for pain relief on average. (Hong Kong j.emerg.med. 2011;18:406-411)
Outcome and Prognostic Factors of Patients in Out‐Of‐Hospital Cardiac Arrests Presenting with Non‐Shockable Rhythm in Hong Kong
Authors: Leung KL , Lui CT , Cheung KH , Tsui KL , Tang YH 
Published: December 2017

ObjectiveTo obtain the recent local epidemiological data and evaluate factors associated with outcomes of adult patients in non‐traumatic non‐shockable out‐of‐hospital‐cardiac‐arrest (OHCA) in Hong Kong.MethodsIt was a cross‐sectional study lasting for nine months (from July 2009 to March 2010) in two emergency departments (ED) which served a population of 1.1 million. All non‐traumatic OHCA patients aged equal or greater than 18 years presented with non‐shockable cardiac rhythms to ED without postmortem changes were included. The pre‐hospital factors, managements and outcomes were recorded in a standardised data entry form at the time of patient consultation. Logistic regression was used to evaluate the relationship between survival to admission (STA) and various prognostic factors.ResultsA total of 348 patients fulfilled the inclusion criteria. The mean age was 75.9 years old. Overall, there were 61 patients (17.5%) with restoration of spontaneous circulation and 58 patients (16.7%) had STA. The survival to hospital discharge (STD) rate was 0.86% (3 patients). Factors independently associated with better prognosis in terms of STA were initial pulseless electrical activity arrest (PEA) rhythm in ED (OR=4.72, 95% CI 2.30‐9.69), witnessed arrest (OR=8.00, 95% CI 3.38‐18.96) and non‐cardiac cause of arrest (OR=2.17, 95% CI 1.00‐4.67).ConclusionSTA for adults presenting with non‐traumatic non‐shockable OHCA in our centre is 16.7%. Witnessed non‐shockable OHCA patients presenting with initial PEA arrest rhythm and with a presumed non‐cardiac in etiology are significantly associated with higher STA rate.