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Biomedical subjects

S C Hu

Publications and source records attributed to S C Hu.

At least 55 records · Page 3Linked to original sources
PubMed1993

Computerized monitoring of emergency department patient flow.

To demonstrate the use of the computer as a tool for information storage and analysis in the emergency department (ED) with the objective of improving ED efficiency, the authors conducted a prospective study from April through September 1991. Information from charts of patients who came into the medical emergency department (MED) and surgical emergency department (SED) were checked and input into the computer. This information included triage classification, registration time, time seen, disposition, disposition time, physician's impression as well as the reasons for delayed disposition. For the 7,086 patients who entered the MED in this period, the waiting time from registration to seeing a physician was (three shifts, triage 3 and 4 patients, respectively) 37.47, 29.52, and 20.61 minutes; and 42.54, 35.85, and 18.75 minutes. Triage 3 and 4 patients comprised 69.42% and 12.41% of the total patients seen. However, of the 4,545 patients who entered the SED, the waiting time for triage 3 and 4 patients (79.23% and 9.79% of total, respectively) was 9.22 and 9.88 minutes, respectively. Disposition time was 2.3 to 3.3 hours in MED and 2.0 to 5.5 hours in SED. Reasons for delayed disposition in both MED and SED included finishing intravenous fluid, waiting for consultation, waiting for computed tomography available, and waiting for sonography available. A commitment to providing quality care in the ED sometimes results in unreasonable waiting times for triage 3 and 4 patients, causing patient dissatisfaction. Readjustment of staffing and space use is needed. Equipping the ED with facilities to provide sonography and computed tomography would enhance patient flow; this needs further study to evaluate cost effectiveness.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic Services↗
PubMed1993

Diagnostic and therapeutic utility of flumazenil in comatose patients with drug overdose.

From July 1, 1990 and June 30, 1991, 61 unconscious patients with drug intoxication were prospectively enrolled into this study in order to evaluate the efficacy and safety of flumazenil in the management of this patient population. Flumazenil was injected intravenously as a 0.3-mg bolus in the first minute followed by 0.2-mg and 0.3-mg doses every minute until a total dose of 1 mg was given or until the patient responded. The Glasgow coma scale and a sedation-level scoring system were checked prior to and at 1, 5, and 30 minutes after the dose eliciting response or on completion of the full dose of flumazenil. The patients were divided into two groups based on their response to flumazenil: group 1, responders (N = 55), and group 2, nonresponders (N = 6). Eleven patients from group 1 allowed us to retrieve drug information from these patients once mental status had recovered and patients were treated accordingly. In two cases endotracheal intubation and artificial ventilation were rendered unnecessary by the use of flumazenil. No undesirable hemodynamic effects were noted after flumazenil injection in this study, although none of the patients overdosed on antidepressants. Flumazenil may serve as a useful diagnostic and therapeutic tool in the management of selected cases of drug-induced coma.

Adolescent↗
PubMed1993

Effect of nitrogen dioxide on human nasal epithelium.

The nasal epithelium of young adult white men in good health was evaluated by electron microscopy in a condition blind fashion relative to exposures of 2 ppm nitrogen dioxide (NO2) or clean air for 4 h. The exposure protocol involved two separate exposures of the same individuals to NO2 or clean air approximately 3 wk apart. We found qualitative and quantitative evidence that luminal border membranes of ciliated cells were ultrastructurally altered in six of seven samples of nasal epithelium obtained following NO2 exposures, although subsequent morphometric statistical analyses were not significant. This alteration was characterized by cilia containing excess matrix in which individual or, more commonly, multiple ciliary axonemes were embedded, and by vesiculations of luminal border ciliary membranes, a pattern less common in clean air-exposed control specimens. Although these patterns were not widespread, their morphology was consistent with findings of previous animal studies involving acute and chronic exposure to NO2. Our findings suggest that adverse effects on mucociliary function in normal humans due to acute exposure to low levels of NO2 are most likely minimal. However, in view of other reports of NO2 exposure in laboratory animals documenting ciliary injury, our observations support a view that similar patterns might appear more prominently with higher NO2 levels and/or more extended exposure intervals.

Adolescent↗
PubMed1993

Demographics and social security.

"This paper considers the welfare implications of the interactions between demographic changes and social security in an overlapping generations model in which retirement decisions are endogenous. Both a pay-as-you-go system and an actuarially-fair system are examined." The geographical focus is on the United States.

Americas↗
PubMed1993

[Study of patients arriving by ambulance in Taipei City].

Owing to different cultural backgrounds, epidemiological disease patterns as well as economic status, it is important to collect local data regarding Emergency Medical Services (EMS), in order to direct our planning and to establish an appropriate EMS policy. This study was conducted from 1 July 1991 through 30 June 1992. During the 109 days of the study, 12502 prehospital records from Taipei city's 119 ambulances were collected and analyzed. The data entered into our computer included: date, age, district, time call received, arrival time on the scene, departure time form the scene, arival time at the hospital, items for basic life support care, cases requiring advanced life support (ALS), cases requiring cardiopulmonary resuscitation (CPR), items used for ALS care, trauma mechanisms, cases of abuse, name of emergency medical technician (EMT) unit, receiving hospital, and resons for non-transportation. The results provided the following information: 1) in 7.41% of the ALS cases, ECG monitoring accounted for 3.13%, CPR for 3.55%, and IV injections for 0.73%; 2) cases needing the use of an ambulance accounted for 16.26% of the total; 3) the response time was 4.89 minutes on average; 4) time spent on the scene was 3.78 minutes; 5) the transportation time was 9.76 minutes; and 6) the percentage of abuse was 29.09%. Based on these results we recommend the following: 1) in enacting the EMS law, the policy stipulating that one ambulance should be expected to serve a population of 50 thousand should be modified because of limited daily emergency calls; and 2) education of the lay public is needed to prevent ambulance abuse. These are the main issues that need to be focused on in the development of our EMS system.

Ambulances↗
PubMed1993

[Hypothermia in the patients of emergency department].

In a 3-month period (January to March, 1992), patients with rectal temperature below 35 degrees C detected by an electrical rectal thermometer (Diatek, Inc, San Diego, CA) were enrolled. In addition to treatment of the underlying diseases, the patients were rewarmed with either a heating lamp (core temperature > 32 degrees C) or warm fluid intravenous infusion and/or gastric lavage (core temperature < 32 degrees C). Patients' vital signs, serum potassium, pH, initial temperature, mean weather temperature, underlying disease and outcome were recorded and compared between survivors and non-survivors. We collected 23 cases with mean age of 71.6 years and mean core temperature, 33.32 degrees C (29.4-34.9 degrees C). The diagnosis included hypoglycemia in 7 cases, sepsis in 3 cases, active TB in 2 cases, HHNK in 1 case, DKA in 1 case, UGI bleeding in 1 case, parkinsonism in 1 case, intracerebral hemorrhage in 1 case, urinary tract infection in 1 case, brain tumor post operation in 1 case, arrhythmia in 1 case, senile dementia in 1 case, COPD in 1 case and lung CA in 1 case. 12 (52%) cases died during admission. No significant difference in clinical parameters was noted between survivors and non-survivors. In conclusion, although in subtropic area, the hypothermic patients in our country cannot be overlooked. As patients are usually elder and have other diseases, the prognosis is correlated with the severity of the underlying disease. Alert, intensive care, prevention and treatment of the complications that arouse, and careful rewarming are necessary for management of such patients.

Adult↗
PubMed1993

[Kimura's disease: a case report].

Kimura's disease is endemic in Orientals. The pathogenesis of Kimura's disease is currently unknown, and the methods of treatment are undefined. The patient was a 21-year-old male, suffering from neck mass left over the parotid region of which the mass gradually increased and which combined with lymphadenopathy and pruritus over both lower limbs more than two years. The patient was diagnosed with Kimura's disease by neck lymph node biopsy, then received simple excision of mass and oral prednisolone therapy. The symptoms of lymphadenopathy and pruritus were improved without recurrence of neck mass.

Adult↗
PubMed1992

Simulation of ozone uptake distribution in the human airways by orthogonal collocation on finite elements.

Ozone transport in a rigid single-pathway anatomic model of the lung was analyzed by a stable convergent numerical algorithm, the method of orthogonal collocation on finite elements. The simulations predicted the dynamic behavior of gas phase concentration profiles for both ozone and an insoluble inert gas. An internal quasi-stationary diffusion front was observed during early inspiration for both gases. In addition, the absorptive distribution of ozone in lung airways was computed as a total dose as well as a tissue dose. The total dose of ozone decreased along the airway path from the mouth. However, the tissue dose of ozone increased along the conducting airways, reached a maximal dose in the terminal bronchioles, and decreased sharply in the respiratory airways.

Algorithms↗
PubMed1992

Longitudinal distribution of ozone absorption in the lung: quiet respiration in healthy subjects.

The objective of this research was to develop a bolus-response method for the noninvasive determination of O3 distribution in the human lung. A previously developed O3 analyzer and bolus generator were incorporated in a computer-controlled inhalation system, and measurements of O3 absorption from inhaled 10-ml boluses with a peak O3 concentration of 4 ppm were carried out on nine previously unexposed healthy male subjects engaged in quiet oral breathing. The fraction of O3 absorbed during a single breath was measured over a range of airway penetrations from 20 to 200 ml, with inspiratory and expiratory flows fixed at a nominal value of 250 ml/s. The resulting data indicated that 50% of the inhaled O3 was absorbed at a penetration of 70 ml, which roughly corresponds to the upper airways, and essentially complete absorption occurred at a penetration of 180 ml, which roughly corresponds to the 16th airway generation, the beginning of the proximal alveolar region. This compares favorably with the results of direct-sampling methods, which indicated that 40.4% of continuously inhaled O3 is removed by the extrathoracic airways (Gerrity et al. J. Appl. Physiol. 65: 393-400, 1988). The computation of an absorption rate constant, Ka, revealed that the efficiency of O3 uptake increased with longitudinal position throughout most of the conducting airways but began to fall off at a penetration of 160 ml.

Absorption↗
PubMed1992

Endoscopy for upper gastrointestinal bleeding at emergency unit.

From November 1, 1990 to January 31, 1991, 381 patients visited our emergency unit with the chief complaints of hematemesis (n = 153) and melena (n = 228). Of these patients, 298 (78.2%) received UGI endoscopy at the emergency unit, 29 (7.6%) received examination after they were admitted to wards, 3 (0.8%) received endoscopy at outpatient clinic and 51 (13.4%) did not have endoscopy. The percentages of endoscopic diagnoses in 330 patients who had UGI endoscopy were gastric ulcer (GU) 33.6%, duodenal ulcer (DU) 32.7%, esophageal varices (EV) 17.0%, and others 15.5%. Negative findings were noted in 3 cases and no definite bleeding source was found in 1 patient who had blood retention in stomach. The diagnostic rate of endoscopy was 98.8%. Of the 56 patients with EV, 45 (80.4%) had hematemesis; in contrast, 85 of the 108 DU patients (78.8%) complained of melena only. Of the 219 patients with bleeding GU/DU, 64 (29.2%) had endoscopic therapies and 7 (3.2%) needed operation. Sixty-four (29.2%) of them received UGI endoscopy within 6 hours after arrival. They had significantly higher frequency of stigmata of recent hemorrhage (SRH) and more endoscopic therapies than the remaining patients. The overall mortality rate in our patients was 6.0%; the mortality rate in patients with EV was much higher than that of the patients with GU/DU (19.6% vs. 1.8%, P less than 0.001). Of the 23 expired cases, only 11 died of hypovolemic shock. The remaining 12 patients died of deterioration or complications of their underlying diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Flumazenil as an emergency management of patients with acute mental disorder].

From July 1, 1990 to June 30, 1991, 55 adult patients with acute alteration of mental status of unknown etiology were enrolled into this study in order to evaluate the diagnostic and therapeutic role of flumazenil in the management of this disorder. Patients who were pregnant or had severe head injury, hemodynamic instability or a provisional diagnosis of hypoglycemia, meningitis or acute cerebrovascular event were excluded. Flumazenil was injected intravenously first in a regimen of 0.3 mg followed by alternative 0.2 mg and 0.3 mg doses every minute until a total dose of 1 mg was given or until the patients responded. These patients were divided into 2 groups based on their response to flumazenil: Group 1, responders (N = 26) and Group 2, nonresponders (N = 29). Good response in Group 1 allowed the cancellation or discontinuation of brain CT scan in 18 patients; intubation and artificial ventilation in 2 and vasopressor infusion in one. The hospital stay was shortened significantly as compared with historical information in uncomplicated benzodiazepine intoxication patients who were admitted before flumazenil was introduced. The Group 2 patients who were with a great span of levels of severity in clinical courses, had higher admission and mortality rate than Group 1 (p < 0.01). We concluded that flumazenil may serve as a useful tool in the diagnosis and management of carefully selected patients. The use of flumazenil with our selective criteria will be cost effective, achieve rapid diagnosis and reduce laborious care in certain cases.

Acute Disease↗
PubMed1991

Inhibition of the delayed-type hypersensitivity response by staphylococcal enterotoxin B-induced suppressor T cells.

Staphylococcal enterotoxin B (SEB) is a member of a family of gram-positive bacterial exotoxins which act as superantigens in both mouse and man. The administration of this toxin has been shown to inhibit antibody responses in vivo. We have previously shown that SEB is a potent inducer in vitro of multiple T suppressor cell populations. The present studies show that administration of microgram quantities of this toxin result in a reduced capacity to manifest a delayed-type hypersensitivity (DTH) response. In addition, we find that the failure to generate a normal DTH response appears to be due to the generation of a T suppressor cell population following SEB administration. Adoptive transfer studies show that the suppressor cells bear the CD5+ I-J+ CD4- CD8- Thy 1+ surface phenotype. The relationship of these cells to suppressor T cell populations generated following in vitro activation by SEB is discussed.

Animals↗
PubMed1991

Ozone absorption into excised porcine and sheep tracheae by a bolus-response method.

The absorption of ozone (O3) into excised porcine and sheep tracheae was characterized by a bolus-response experiment in which a bolus with a peak O3 concentration of 1 ppm was rapidly injected into a steadily flowing airstream entering the trachea. Using a fast-responding chemiluminescent analyzer of our design, the O3 concentration curves at the proximal end (i.e., the bolus input) and at the distal end (i.e., the response) of the trachea were monitored. Each concentration curve was numerically integrated, and the fraction of O3 absorbed in the trachea was obtained by subtracting from unity the ratio of the response integral to the bolus input integral. Average values of ozone-absorbed fraction decreased from about 0.50 to 0.15 at increasing airflows from 50 to 200 ml/sec. A diffusion theory that includes the effects of bulk convection, axial dispersion, and first-order absorption was developed to relate the fractional absorption to an overall mass transfer coefficient (K). The results indicate that K is independent of airflow, suggesting that the diffusion resistance in mucus is much greater than that in the gas phase. The time-weighted integrals of the concentration curves were also computed, allowing the mean residence time of O3 in the trachea (delta tau) to be determined. As predicted by the diffusion theory, delta tau was inversely related to the rate of O3 absorption.

Absorption↗
PubMed1991

Ultrasonography to diagnose and exclude intussusception in Henoch-Schönlein purpura.

Abdominal pain is a frequent symptom in the child with Henoch-Schönlein purpura and raises the suspicion of intussusception or perforation. One hundred and fifty two children with a diagnosis of Henoch-Schönlein purpura over 11 years were reviewed. Of these 60 had abdominal pain, 19 gastrointestinal bleeding, and nine were suspected intussusception. Intussusception was confirmed in two of these cases with ultrasonography. Ultrasound is an important tool in the early diagnosis of intussusception complicating Henoch-Schönlein purpura. Where the intussusception appears loose an expectant policy, with careful monitoring, may allow spontaneous reduction. It may also be used in monitoring patients for postoperative recurrence of intussusception, mural haematoma, and uncomplicated intestinal vasculitis with oedema.

Child↗
PubMed1991

Attachment of influenza A virus to ferret tracheal epithelium at different maturational stages.

Influenza virus attaches primarily to ciliated cells in mature airways epithelium. This process is mediated by a viral envelope glycoprotein (hemagglutinin) that binds to sialic acid-containing receptors in the apical membrane of host cells. The purpose of this study was to determine the cellular distribution of these receptors as a function of tracheal epithelial maturation in the ferret, which is susceptible to influenza virus infection at all ages and undergoes postnatal ciliation. To assay for virus attachment, tracheal strips from ferrets at ages 0, 7, 14, and 28 d were incubated at 4 degrees C for 1 h with a concentrated suspension of influenza A virus. Transmission electron microscopy demonstrated virus attachment to the apical surface of 77 to 87% of ciliated cells, but only to 1 to 9% of nonciliated surface epithelial cells at all ages, including the newborn, which has few ciliated cells (less than 10% of total cells). Virions also attached to most of the preciliated cells identified. Pretreatment of tracheal strips with neuraminidase virtually eliminated viral attachment. These findings demonstrate preferential influenza virus binding to sialylated receptors on ciliated cells and their immediate precursors. The sparsity of ciliated cells with no evidence for increased influenza virus binding per cell in newborn ferret tracheas suggests that the previously demonstrated high risk of death from influenza infection in newborn ferrets is due to factors other than increased susceptibility to virus attachment. Influenza virus receptors appear to be selective membrane markers for ciliated cells and may be particularly useful for the identification of preciliated cells.

Animals↗
PubMed1991

A study on the pre-admission characteristics of patients with acute myocardial infarction.

To clarify an appropriate policy to implement Emergency Medical Services (EMS) in Taiwan based on the profiles of patients with acute myocardial infarction (AMI), and to compare the differences of clinical features accompanied by AMI between Orientals and Westerners, 63 consecutive patients with definite AMI entering the emergency room (ER) from September 1989 through January 1990 were studied. Several interesting facts were found: 1) 9.5% (6/63) of patients took public ambulance to seek medical help; 2) 89% came from out of our jurisdiction, and 62% (39/63) were referred from general practitioners or the ER of community hospitals; 3) There were 5 truly delayed cases (7.9%) owing to a lack of sense of danger in case of chest pain; 4) 50% of our cases occurred during sleeping; 5) The time of onset peaked from 0 AM to 6 AM; 6) While 63.5% of patients visited ER within 6 hours after the onset of acute symptoms, only 12.7% were treated with thrombolytic therapy; and 7) AMI patients stayed in ER for an average of over 4 hours. With limited cases, although trends were evident, firm conclusions were not warranted. The following crucial recommendations are suggested: 1) EMS system in terms of caring of AMI patients still needs a well-designed study to map out an appropriate policy; 2) The strengthening education to physicians working in ER or to all primary care physicians of an early use of thrombolytic agents in indicated cases should be warranted to offer timely therapy when necessary; 3) General public should be educated to call for medical help as soon as possible in case of chest pain.

Ambulances↗
PubMed1991

Clinical and demographic characteristics of 13,911 medical emergency patients.

In order to provide better quality of care at Taipei Veterans General Hospital, 13,911 emergency patients coming into the medical emergency room were studied using the computer to key in all demographic data including registration time, time to be seen, desposition time, impression, triage category, discipline as well as daily dynamic status in the observation room from August through December 1989. The study showed that 8.6% were triage category 1 (life-threatening cases) and 22.08% were triage 4 (pseudo-emergency patients). Of the average 101 studied patients seen per day, 20 (20.27%) should have been theoretically admitted, but only 14.7% were admitted, and 18 (18.08%) were sent to the observation room. In general, the daily dynamic status of the patients in the observation room were: (1) Out of 45 overnight patients, 12 (27%) were waiting for admission; and (2) 9 (20.14%) were waiting for a transfer to other convalescent hospitals. We conclude that less than one-tenth of the emergency patients were really emergencies in such a large and busy emergency department, and there was enormous patients stasis in the observation room causing overcrowding of the emergency department, which is the main issue we have to resolve if the quality assurance of the emergency department is to be improved.

Computers↗