Treatment of baclofen overdose by haemodialysis: a pharmacokinetic study.
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Aged↗
Biomedical subjects
Cheng-Chung Fang
Publications and source records attributed to Cheng-Chung Fang.
Health-related quality of life of hemodialysis patients in Taiwan: a multicenter study.
BACKGROUND/AIMS: Health-related quality of life (HRQOL) is an important determinant of treatment effectiveness in dialysis patients. To our knowledge, there are no reports evaluating HRQOL of hemodialysis (HD) in Chinese patients. The purpose of this study is to present our results about HRQOL using the 36-Item Short-Form (SF-36) questionnaire on Taiwanese hemodialysis patients. METHODS: HRQOL was measured by using the SF-36 questionnaire in 497 HD patients in five hospitals. RESULTS: The following attributes, male gender, age <50 years old, higher education level (HEL), marriage status, employment status (EPS), less comorbid medical condition (CMC), and non-diabetic patients (NDP) were all predicted on a better Physical Component Scale (PCS). Age <50 years old, body mass index >18.5, HEL, EPS and NDP were all predicted on a higher Mental Component Scale (MCS). Scales contributing to a summary measure of physical health, the PCS score was significantly lower in women (35.0 +/- 12.3) than in men (37.9 +/- 12.3). However, there was no difference in the MCS score between women and men. In multivariate analysis, age, CMC, diabetes, serum creatinine (SCr), and erythropoietin responsiveness were significant independent predictors of PCS. Diabetes, educational level, SCr, and erythropoietin responsiveness were significant independent predictors of MCS. All of the individual scales were lower in Taiwanese HD patients than in both the general Taiwanese and US population. Each of the individual scales and MCS scores were substantially lower in the Taiwan HD group than in the US HD cohort. However, the bodily pain of PCS was significantly higher in the Taiwan HD group, although the mean PCS scores for the Taiwan HD group and the US HD study participants were nearly equal at 36.3 and 36.1, respectively. CONCLUSION: The physical and mental aspects of quality of life are substantially lower for Taiwanese HD patients, except for higher bodily pain tolerance. A number of demographic and clinical characteristics have a significant impact on HRQOL in Taiwanese HD patients.
Adult↗
Elevated plasma cyanide level after hydroxocobalamin infusion for cyanide poisoning.
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Antidotes↗
Hepatic portal venous gas associated with poor outcome in out-of-hospital cardiac arrest patients.
OBJECTIVES: To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA). METHODS: From April 2002 to January 2003, patients with non-traumatic OHCA were prospectively enrolled in a tertiary medical centre in Taipei, Taiwan. Emergency abdominal sonography during resuscitation was performed to detect the presence of HPVG within the first 10 min on arrival of the emergency department (ED). RESULTS: HPVG was detected in 16 (36%) of the 44 patients enrolled in this study. The patients with HPVG were older (P = 0.039), their cardiac arrest was witnessed less frequently (P = 0.01), they received more prolonged resuscitation (P = 0.008), and needed more accumulated doses of adrenaline (epinephrine) (P = 0.002). These patients had a considerably lower incidence of return of spontaneous circulation (ROSC) (P < 0.001), less survival to hospital admission (P < 0.001), less 24 h survival (P < 0.001) and less survival to discharge (P = 0.036). In a multiple regression analysis, HPVG was noted as an independent factor negatively associated with ROSC. CONCLUSION: HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients.
Aged↗
Sudden death caused by dissecting thoracic aortic aneurysm in a patient with autosomal dominant polycystic kidney disease.
Among the fatal vascular complications associated with autosomal dominant polycystic disease (ADPKD), ruptured intracerebral aneurysm and ruptured abdominal aortic aneurysm are widely known. However, there are few reports on the dissecting thoracic aortic aneurysm as a fatal complication of ADPKD. We report a case of a 58-year-old man with a history of ADPKD who presented to the emergency department with out-of-hospital cardiac arrest. Immediate cardiopulmonary resuscitation restored a spontaneous circulation successfully and subsequent image study revealed a type I dissecting thoracic aortic aneurysm. Emergency aortic grafting was performed--but he died from postoperative haemorrhage. The surgical specimen of the aorta showed cystic medial necrosis. This rare case emphasizes the need to consider such a diagnosis in a patient with ADPKD who presents to the emergency department with sudden cardiac arrest. In addition, the histological finding indicates the aetiological role of a collagen defect in addition to chronic hypertension in the pathogenesis of aortic dissection in ADPKD patients.
Aortic Dissection↗
Acute acetaminophen intoxication in Taiwan: outcomes and risk factors.
BACKGROUND AND PURPOSE: There is a paucity of information about acetaminophen intoxication from Taiwan. This study investigated the outcome and risk factors for acetaminophen-induced hepatotoxicity and validated the Rumack- Matthew nomogram in Taiwanese patients with acute acetaminophen intoxication. METHODS: A total of 75 patients with acetaminophen intoxication admitted through the emergency department were included in this retrospective analysis. Patients with a serum acetaminophen concentration above the possible risk line on the nomogram were treated with oral N-acetylcysteine. The primary outcome measure was the development of major hepatotoxicity, which was defined as a serum aminotransferase concentration greater than 1000 IU/L. Patient outcomes in the possible risk group and probable risk group were plotted on the modified Rumack-Matthew nomogram for validation. The risk factors for acetaminophen-induced hepatotoxicity were identified by multiple logistic regression analysis. RESULTS: No hepatotoxicity developed in patients with an initial acetaminophen concentration below the possible risk line on the nomogram. One out of 8 patients in the possible risk group developed major hepatotoxicity; 8 out of 22 patients in the probable risk group developed major hepatotoxicity, representing an incidence of 12.5% and 36.4%, respectively. Patients in the major hepatotoxicity group were older (32.5 vs 24.2 years, p = 0.019), and had a longer time to presentation (28.1 vs 6.7 hours, p < 0.01) than those in the non/minor hepatotoxicity group. Multiple logistic regression revealed that age and time to presentation were independent risk factors for hepatotoxicity (p = 0.033 and p = 0.002, respectively). CONCLUSIONS: The results of outcome analysis confirm that the modified Rumack-Matthew nomogram has a high sensitivity for identifying Taiwanese patients at risk for acetaminophen-induced hepatoxicity. Patient age and time to presentation were independent risk factors for acetaminophen-induced hepatotoxicity.
Acetaminophen↗
Methylene 3, 4 dioxymethamphetamine-induced acute myocardial infarction.
Methylene 3, 4 dioxymethamphetamine (MDMA) has been gaining popularity as a recreational drug over the past few decades around the globe. Although once thought to be safer than its mother compound, amphetamine, several life-threatening adverse reactions have been reported. Among the cardiovascular toxicities documented, MDMA commonly causes various forms of arrhythmia and heart failure. However, MDMA-induced acute myocardial infarction is rarely reported. We report a case of acute myocardial infarction in a young man shortly after taking MDMA. Massive thrombosis over the right coronary artery was demonstrated by means of emergency angiography. After treatment with intravenous glycoprotein IIb/IIIa inhibitor and intracoronary urokinase infusion, the coronary artery was shown to be patent without any apparent stenotic lesions. The mechanism of MDMA-induced acute myocardial infarction was discussed.
Administration, Oral↗
Antibiotics induce apoptosis of human peritoneal mesothelial cells.
The peritoneal mesothelial cell is a critical component of the peritoneal membrane. The intraperitoneal use of several antibiotics to treat bacterial peritonitis is current clinical practice. Our previous study showed that cephalothin (CPL) and cefotaxime (CFT) have cytotoxic effects on human peritoneal mesothelial cells (HPMC), however, the exact mechanism of cytotoxicity has not been elucidated. In the present study, flow cytometry, TdT-mediated dUTP nick-end labelling (TUNEL) staining and electron microscopy were used to detect the apoptosis of HPMCs. Immunofluorescent staining was used to evaluate the cytochrome c distribution pattern. Western blotting was used to assess apoptotic signalling proteins. We found that CPL (0.5 mg/mL) and CFT (1 mg/mL) induced apoptosis of HPMCs, whereas cefazolin (0.5 mg/mL) and ceftriaxone (0.5 mg/mL) failed to induce apoptosis of HPMCs. While the DNA content of CFT- or CPL-treated cells was reduced, as determined by flow cytometry, cefazolin and ceftriaxone had no such effect. The CFT- or CPL-treated cells displayed the features of apoptosis both under the electron microscope and by using TUNEL staining. However, cefazolin and ceftriaxone produced the same result as the medium controls. Furthermore, CFT and CPL increased the expression of Bax and p53, and caused the translocation of cytochrome c from the mitochondria to the cytoplasm. The HPMC treated by CFT but not by CPL induced the cleavage of procaspase-3 to form active caspase-3. In conclusion, cefotaxime and cephalothin induce apoptosis of HPMCs in vitro. Signal transduction may be through the mitochondrial pathway.
Anti-Bacterial Agents↗
Effects of pentoxifylline on peritoneal fibroblasts and silica-induced peritoneal fibrosis.
BACKGROUND: Peritoneal fibrosis is a long-term complication following continuous ambulatory peritoneal dialysis (CAPD). Peritoneal fibroblasts may play an important role in peritoneal fibrosis. Up to now, the treatment of peritoneal fibrosis in patients with CAPD remains unsatisfactory. Pentoxifylline (PTX) is a xanthine derivative and is used in the treatment of peripheral vascular and cerebrovascular diseases. Several studies have demonstrated that PTX can ameliorate fibrosis of the skin, liver, and kidney. OBJECTIVE: To investigate the effect of PTX on in vitro growth and collagen synthesis of human peritoneal fibroblasts (HPFBs), and to evaluate the effects of PTX on silica-induced peritoneal fibrosis in vivo. DESIGN AND MEASUREMENTS: In the in vitro study, HPFBs were cultured from human omentum. The effect of PTX on the growth of serum-stimulated HPFBs was evaluated by MTT assay. The effect of PTX on the collagen synthesis of HPFB was measured by [3H]-proline incorporation. Expression of type I and type III collagen mRNA was evaluated by Northern blotting. The effects of PTX on matrix metalloproteinase (MMP) activity and cAMP level in HPFBs were measured by immunoassays. In the in vivo study, Wistar rats were randomly divided into five groups. All rats received intraperitoneal (IP) injection of silica suspension (250 mg/100 g body weight) on day 0. The rats of group 1 (control group) were injected with vehicle IP every day for 14 days. The rats of groups 2, 3, and 4 were injected with PTX (4 mg/100 g body weight) IP every day for 3, 7, and 14 days, respectively. The rats in group 5 received an intravenous infusion of PTX (8 mg/100 g body weight) every day for 7 days. On the 15th day after silica injection, all rats were sacrificed. Their parietal and visceral peritoneums were removed and processed for pathology, and the severity of fibrosis was measured and scored. RESULTS: In vitro, PTX inhibited serum-stimulated HPFB growth (maximum was 93% at 1 mg PTX/mL) in a dose-dependent manner. Collagen synthesis by HPFB was reduced (47% at 1 mg PTX/mL), and collagen I and III mRNA expression in HPFBs was suppressed by PTX. The PTX did not affect the MMP (including MMP-1, MMP-8, and MMP-13) activities of HPFBs. The mechanism of PTX was through increasing cAMP by its phosphodiesterase inhibiting activity. In vivo, the severity of fibrosis was significantly reduced in groups 4 and 5 compared to group 1 (p < 0.05). CONCLUSION: These results suggest that PTX can inhibit growth of and collagen synthesis by HPFBs in vitro. The fibrosis derived from silica-induced peritonitis in vivo was also ameliorated by PTX. Therefore, pentoxifylline may have the potential to be used to treat peritoneal fibrosis in patients on CAPD.
Animals↗