Search PubMed⌕ Search

Biomedical subjects

D L Cheng

Publications and source records attributed to D L Cheng.

At least 55 records · Page 3Linked to original sources
PubMed1991

Tetanus: 20 years of clinical experience.

Tetanus remains a life-threatening disorder and its fulminating course always presents a challenge to the clinician. We retrospectively evaluated 56 patients with tetanus admitted to VGH-Taipei between 1971 and 1990. All of these patients with tetanus on admission showed typical features, with the most common initial complaints being lockjaw and dysphagia (82.6%). They were diagnosed on clinical identification rather than isolation of the causative agent. The laboratory tests were usually nonspecific and of limited value for diagnosis. Overall, 38 patients were seized with tetanus after an identified wound infection. The most common routes were puncture wound (28.3%) and abrasion wound (19.6%). The majority of patients became symptomatic within 10 days (56.5%) and the shorter interval reflected a more overwhelming course (p less than 0.05). Intravenous drug abusers and larger wounds had a poorer prognosis. The average mortality was 39.1% (18 out of 46 patients; male/female 12/6), with lack of statistical difference between sex and mortality (p greater than 0.5). The course of tetanus in the newborn and elderly was also more deadly (mortality rates of 83.3% and 55.6% respectively). Aspiration pneumonia and subsequent respiratory failure accounted for the most common cause (11 cases, 61.1%) of death. The mortality was still high (28.6%) from 1980-90 even with better supportive care and modern therapeutic equipment.

Adolescent↗
PubMed1991

Overview of viridans streptococcal endocarditis: clinical analysis of 99 cases.

A total of 99 cases of viridans streptococcal endocarditis encountered during the period of 1973 and 1990 at the Veterans General Hospital-Taipei were reviewed to evaluate its prognostic factors. Applying strict clinical and laboratory criteria, 24 cases were categorized as definite, 44 probable, 23 possible and 8 likely. The symptoms were frequently subtle and atypical but initial laboratory tests gave useful indications: 69.1% with leukocytosis, 78% with anemia, 58.5% with elevation of LDH level, 88.9% with elevation of ESR value and 100% with elevation of CRP level. Furthermore, 32.4% of the cases demonstrated proteinuria and 67.4% microscopic hematuria. Seventy-three of the subjects had a history of underlying heart disease, predominantly rheumatic heart disease. Histological examination and echocardiography revealed that 51 patients suffered from vegetative endocarditis, 7 (13.7%) of whom were found to have anatomically confirmed vegetations without initial echocardiographic evidence, Vascular events were seen in 61 cases (61.6%): peripheral stigmata (32 cases), cerebral vascular accidents (17 cases), pulmonary embolism (10 cases) and others (2 cases). The overall mortality rate was 18.2%. Congestive heart failure with embolization was the most common cause of death in this group. The presence of vegetation was not well correlated with embolic events. There was no statistically significant association between the mortality and the following characteristics: age, sex, underlying heart disease, evidence of echocardiographically detected vegetations, major surgical intervention and recurrent cases except for embolic events (p less than 0.01). In conclusion, viridans streptococcal endocarditis complicated embolic events usually presented with a fulminant course and a grave outcome.

Adolescent↗
PubMed1991

Serratia marcescens bacteremia.

Serratia marcescens bacteremia has become ubiquitous recently. S. marcescens bacteremia, either hospital- or community-acquired, can no longer be treated as insignificant. We reviewed 23 episodes of S. marcescens bacteremia in 1985. Among them, 17 patients (74%) were hospital-acquired infections, while 6 (26%) were community-acquired. Nine patients died, and the case fatality rate was 39%. Eleven patients (48%) had no clinically apparent source of infection, 5 (22%) had urinary tract infection, 3 (13%) had pneumonia, 2 (9%) had biliary tract infection, 1 (4%) had intra-abdominal infection, and 1 (4%) had skin and soft-tissue infection. Nosocomial isolates are often resistant to many antibiotics. Amikacin and the beta-lactamase-stable (third generation) cephalosporins are superior to gentamicin in the treatment of nosocomial S. marcescens bacteremia. We here emphasize that the awareness and treatment of S. marcescens bacteremia in daily clinical practice is unequivocally critical.

Adult↗
PubMed1991

Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients.

Septic metastatic endophthalmitis from Klebsiella pneumoniae liver abscess, first reported in seven cases treated at the Veterans General Hospital, Taipei, Taiwan, between 1981 and 1985, was seen in six similar cases at the same hospital in the subsequent 2 years. We conducted a retrospective search for factors that might be associated with these complications of pyogenic liver abscess. A total of 23 cases with septic metastatic lesions from pyogenic liver abscess were found between 1981 and 1987, and 164 cases of pyogenic liver abscess without septic metastatic lesions were identified as a comparison group. Klebsiella pneumoniae liver abscess, bacteremia, and the underlying diabetes mellitus were significantly more common in the study group than in the comparison group. Of the 23 patients with septic metastatic lesions, there were 14 cases (60.8%) of endophthalmitis or uveitis, 10 cases (43.4%) of pulmonary abscess and/or emboli, six cases (26.0%) of brain abscess and/or purulent meningitis, five cases (21.7%) of bacteriuria and/or prostate abscess, two cases (8.6%) of osteomyelitis and/or pyogenic arthritis, and one case (4.3%) of psoas abscess.

Adult↗
PubMed1990

Nonenterococcal group D streptococcal septicemia: association with unrecognized endocarditis.

68 patients presented to the Veterans General Hospital, Taipei with nonenterococcal group D streptococcal septicemia in the years 1985-1987. 36 patients (53%) had nonenterococci as part of a polymicrobial bacteremia. The large intestine was not examined in most patients. Five patients (7%) had associated colonic carcinoma, and 17 patients (25%) had colorectal diseases. Only 7/68 patients (10%) were clinically diagnosed as having infective endocarditis by the doctors in charge. The others were regarded as having septicemia. The charts of these patients were reviewed retrospectively to diagnose infective endocarditis based on strict definitions. One (1%) had definite endocarditis proved at autopsy. 16 patients (24%) had probable endocarditis due to the presence of either a new regurgitant murmur or both a predisposing heart disease and embolic phenomena; 39 (57%) had possible endocarditis based on evidence of having either a predisposing heart disease or embolic phenomena; and only 12 (18%) had no evidence of endocarditis. 27 patients (40%) had at least one predisposing heart disease associated with endocarditis. 51 patients (75%) had at least one lesion suggesting embolic phenomena. 30 patients (44%) had electrocardiographic abnormalities. This high incidence of arrhythmia in nonenterococcal septicemia is of particular interest and could be related to cardiac involvement in some patients. The overall mortality, 62% (42/68), was extremely high in our series, but in those who were clinically diagnosed and treated as infective endocarditis, the mortality was low, 14% (1/7). We suggest all patients with nonenterococcal septicemia associated with either heart disease or lesions of CNS, lung, heart, kidney or limbs suggesting embolic phenomena should be regarded as having possible or probable endocarditis. Treating such patients as having infective endocarditis may reduce the mortality in nonenterococcal septicemia.

Adult↗
PubMed1990

Short-course treatment of bacteremia with ceftriaxone monotherapy.

The efficacy of short-course ceftriaxone monotherapy in treatment of bacteremia was evaluated in an open protocol. Patients with laboratory-proven bacteremia were randomly treated with one of three dosing schedules for a duration of 5 to 7 days. Fifty-seven (62%) out of the 92 evaluable infections had successful results. Successful responses were seen in 20 (59%) out of 34 infections given 4 g every 24 hours, 15 (54%) out of 28 given 2 g every 12 hours, and 22 out (73%) of 30 given 2 g every 24 hours. The results showed no significant differences. The cases evaluated as failures were largely due to infections with resistant organisms or inadequate drainage of the primary infectious foci. Forty-nine (94%) of the 52 infections had successful results with one of the short-course treatment regimens, provided that they had no factors indicative of a poor prognosis. We stress the importance of anti-microbial susceptibility and adequate removal of the primary foci in the treatment of bacteremia. Our experience indicates that once-daily administrations of 2 g ceftriaxone as monotherapy is preferred for short-course treatment of bacteremia since it is equally effective, but more economical than higher dose regimens.

Adult↗
PubMed1990

Pyogenic liver abscess: clinical manifestations and value of percutaneous catheter drainage treatment.

One hundred and sixty-two patients with solitary or multiple pyogenic liver abscesses received surgical or medical treatment in the past 8 years. Fifty-seven patients were treated medically (medical group), 62 patients received medical treatment plus sonogram-guided percutaneous drainage (PCD group), and 43 patients received surgical drainage (surgical group). Aerobic gram-negative rods were the predominant causative microorganisms. Klebsiella pneumoniae was the most common microorganism, occurring in 46.9% (76/162) of the cases. Anaerobes occurred in 16.7% (27/162) of the cases. In the evaluation of treatment, the success rates for these three groups were: medical group, 59.6% (34/57); PCD group, 90.3% (56/62); and surgical group, 83.7% (36/43). This retrospective study confirms evidence from a small series that medical treatment plus percutaneous catheter drainage is efficient and more convenient than conventional surgical drainage for pyogenic liver abscesses. The frequent severe septic emboli to distant organs noted in this series (11.1%; 18/162) are quite unusual and should be anticipated in the future.

Adult↗
PubMed1990

Fungemia: analysis of 43 cases.

This report reviews the cases of 43 patients with 48 episodes of fungemia, and examines the clinical significance of fungemia and the results of treatment. All episodes were nosocomial infections. Candida albicans (60.4%), Candida parapsilosis (16.7%), and Candida tropicals (14.6%) were the most common fungal pathogens isolated from blood cultures. Patients with Candida albicans had a better survival rate than those with other species (p = 0.011). Polymicrobial fungemia was noted in 5 patients (11.6%). Most patients had underlying diseases and predisposing factors. Intravascular catheters (100%), broad-spectrum antibiotics administration (100%), surgical procedures (46.5%) and total parental alimentation (41.9%) were the most common predisposing factors. The clinical manifestations were not characteristic and consisted of nonspecific signs of sepsis. The overall mortality rate was 79%. We did not find any improvement in the mortality rate of our patients treated with amphotericin B. Early recognization, immediate removal of predisposing factors, and correction of underlying conditions is most important for patients with fungemia. We also suggest that fungal infection should be considered early when a febrile patient at high risk dose not improve with broad-spectrum antibacterial therapy.

Adolescent↗
PubMed1990

Klebsiella pneumoniae bacteremia: analysis of 100 episodes.

In 1985, 100 episodes of klebsiella pneumoniae bacteremia in 98 patients were treated at the Veterans General Hospital--Taipei. The disease was community acquired in 58% and nosocomially acquired in 42%; unimicrobial in 86% and part of a polymicrobial bacteremia in 14%. Medical records of 90 episodes were available and were analyzed. Portals of entry, in decreasing order of frequency, were hepatobiliary (24%), respiratory (20%), and urinary tract (19%). Diabetes mellitus, which was found in 25 (28%) patients, was the most common underlying disease, followed by malignancies in 13 (14%), biliary tract abnormalities in 9 (10%), and cirrhosis of the liver in 8 (9%). The most frequent clinical findings were fever (89%) and leukocytosis (60%), followed by thrombocytopenia (27%), jaundice secondary to bacteremia (22%) and shock (21%). The course of one (1%) patient, who was diabetic and had a liver abscess, was complicated by metastatic septic endophthalmitis and meningitis. Overall case fatality was 46%. Poor prognostic factors included inappropriate antibiotic therapy, respiratory tract as a portal of entry and the presence of shock. Cephalosporins and aminoglycosides were the most active antibiotics. The use of one or more antibiotics, which included at least one cephalosporin, with in vitro activity against the corresponding isolate, with adequate dosage and an appropriate route of administration significantly reduced deaths directly attributed to K. pneumoniae septicemia, 32% (18/57), compared with 88% (21/24) in patients who were not treated appropriately (p less than 0.001). Combination therapy with a cephalosporin and aminoglycoside in conjunction with surgery in selected cases is the treatment of choice for K. pneumoniae bacteremia.

Adolescent↗
PubMed1989

Ludwig's angina: an analysis of 14 cases.

Ludwig's angina remains a potentially lethal disease entity as it causes rapidly progressive airway obstruction, although the current mortality rate is low. Early surgical intervention should be carried out in severe cases which show signs of fluctuation, abscess formation or other serious complications. We report our experience with 14 cases of Ludwig's angina, 12 of which (86%) were of dental origin. Only one case was complicated with Klebsiella pneumoniae septicemia which resolved upon treatment. There were no deaths. Surgical procedures including incision and drainage and tooth extraction were performed in 11 cases (78%). Antibiotics were administered to all patients. Most of them were treated with crystalline penicillin with or without an aminoglycoside. Only one patient received a tracheostomy in this series. The number of tracheostomies or intubations carried out was much lower than in previous reports. We suggest that an aggressive antimicrobial therapy, early surgical intervention and careful monitoring of the respiratory symptoms would reduce both the need for tracheostomy and the mortality rate.

Adult↗
PubMed1989

Clostridium perfringens septicemia with massive hemolysis.

Massive hemolysis with acute renal failure occurred in a previously healthy 69-year-old patient as a complication of Clostridium perfringens septicemia secondary to gall bladder empyema. To our knowledge, this is one of the few patients with C. perfringens septicemia and massive intravascular hemolysis who survived the episode and regained a normal renal function.

Acute Kidney Injury↗
PubMed1989

Branhamella catarrhalis pneumonia: report of 4 cases.

This is the first time Branhamella Catarrhalis has been identified as a lower respiratory tract pathogen in Taiwan. All 4 patients with B. catarrhalis pneumonia reported herein had a certain degree of underlying pulmonary dysfunction. Two patients had pure B. catarrhalis infection, whilst the other two had concomitant infections with Haemophilus influenzae or Viridans streptococci. Amongst the 3 strains of B. catarrhalis examined, all were capable of producing beta-lactamase. By using the Kirby-Bauer method, 2 of these strains were observed as penicillin resistant. Therefore, patients with poor clinical response to penicillin, ampicillin, and cephapirin were treated effectively with trimethoprim/sulfamethoxazole or ofloxacin. B. catarrhalis should no longer be regarded as a normal flora of the sputum in patients with lower respiratory tract infections. Beta-lactamase production should be tested for each isolated strain to avoid failure of penicillin therapy due to bacterial resistance.

Adult↗
PubMed1989

Cytomegalovirus interstitial pneumonitis in a bone marrow transplant recipient.

A 15-year-old girl suffering from acute lymphoblastic leukemia developed cytomegalovirus interstitial pneumonitis 34 days after an allogenic bone marrow transplantation. The disease was diagnosed by open lung biopsy. Histopathologic examination disclosed intranuclear and intracytoplasmic inclusion bodies, as well as, a positive cytomegalovirus antigen detected by an immunofluorescence stain using a cytomegalovirus monoclonal antibody. The virus culture also eventually produced cytomegalovirus. Because of the lack of ganciclovir in this country, antiviral therapy of a non-specific nature was given to this patient. However, the treatment was ineffective and she subsequently died. There is an association between the immunologic events of a graft-versus-host disease and the development of cytomegalovirus interstitial pneumonitis. The pathogenesis of cytomegalovirus interstitial pneumonitis in a bone marrow transplant recipient is evidence of an immunopathologic disease, rather than that of a purely infectionus disease. years, the treatment modality of cytomegalovirus interstitial pneumonitis in bone marrow transplant recipients has become a combination of specific antiviral and immune therapy.

Adolescent↗
PubMed1989

Causal bacteria of pyogenic liver abscess.

This is a review of bacteriologic data on 175 patients with pyogenic liver abscesses seen over a period of 8 years at Veterans General Hospital, Taipei, Taiwan. Positive cultures were obtained from liver aspirates in 151 of the 163 patients in which cultures were taken. One hundred and twenty patient specimens grew one isolate and 31 specimens grew two or more isolates. A total of 149 aerobic gram-negative rods, 25 aerobic cocci and 29 anaerobes were isolated. Ninety of the 159 patients from whom blood was taken had positive cultures. In 11 patients, two or more isolates were grown concurrently from the blood. A total of 87 aerobic gram-negative rods, 7 aerobic cocci and 10 anaerobes were isolated. Klebsiella pneumoniae was the most common microorganism, accounting for 50.8% of the cases. Other major pathogens were Escherichia coli (27.4%), anaerobes (15.4%), and viridans streptococci (6.2%).

Adolescent↗
PubMed1989

Septicemia in adults: II. Factors in prognosis.

Over the period of 2 months between October and November, 1987, 190 episodes of septicemia in adults were monitored at Veterans General Hospital-Taipei. The most common causative microorganisms were Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus. The most frequent sources of infection came from intra-abdominal (gastro-intestinal as well as hepato-biliary), urinary and respiratory tract. Its overall mortality was 34.7%. Factors associated with a higher mortality from septicemia were old age, rapidly fatal underlying disease, hospital acquired infection, hypothermia, hypotension/shock, high-risk source of infection (from respiratory tract, skin/soft tissue, surgical wound or other unknown source), high-risk microorganisms (Candida species, Ps. aeruginosa or K. Pneumoniae) and inappropriate antimicrobial therapy. Identification of these factors may help early correction of reversible factors and improve its prognosis.

Adult↗
PubMed1988

Chromatographically purified vancomycin: therapy of serious infections caused by Staphylococcus aureus and other gram-positive bacteria.

Fourteen patients with serious infections caused by Staphylococcus aureus and other gram-positive bacteria were prospectively treated with chromatographically purified vancomycin in an open-label, nonrandomized study, between December 1986 and June 1987. Five patients were excluded from the evaluation of efficacy. Among the nine evaluable patients, cure was achieved in six patients--a success rate of 67%. One patient had a relapse of osteomyelitis, and cultures of draining pus were positive for oxacillin-resistant S aureus within three weeks after the discontinuation of vancomycin therapy. One patient failed to respond to vancomycin therapy for S aureus-induced endocarditis, meningitis, and osteomyelitis; in another patient, the treatment failed to reverse the course of S aureus septicemia. No serious drug toxicity, for example, nephrotoxicity, was encountered in any patient. One patient (7%) experienced mild ototoxicity. Four patients (29%) had mild phlebitis, two patients (14%) had a transiently positive Coombs' test, and one patient (7%) had a "red neck syndrome" and "pain and spasm syndrome." Chromatographically purified vancomycin is an effective antibiotic in the treatment of serious infections caused by susceptible gram-positive bacteria. Some minor side effects of vancomycin may not be due to impurities in the preparation but rather to the vancomycin itself.

Adolescent↗