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Biomedical subjects

Shyr-Chyr Chen

Publications and source records attributed to Shyr-Chyr Chen.

At least 37 records · Page 2Linked to original sources
PubMed2005

Ultrasound may decrease the emergency surgery rate of incarcerated inguinal hernia.

OBJECTIVE: Manual reduction is the standard procedure for incarcerated inguinal hernia reduction. The role of ultrasound in incarcerated inguinal hernia reduction has not been defined. The aim of this study was to determine whether ultrasound can improve the ability to reduce incarcerated inguinal hernia safely when manual reduction fails and thereby decrease the emergency surgery rate. MATERIAL AND METHODS: Between January 1994 and December 2003, 112 adult patients with incarcerated inguinal hernias were admitted to a university medical center and classified into two groups. Group I consisted of 61 patients who received emergency surgical reduction after the failure of two attempts at manual reduction. In Group II, comprising 51 patients, ultrasound-guided reduction was performed when two attempts at manual reduction failed. Emergency surgical reduction was scheduled if both ultrasound-guided reduction and two attempts at manual reduction failed. The difference in emergency surgery rates between groups I and II was compared. RESULTS: In group I, manual reduction was successful in 55 cases (90.2%) and 6 patients underwent emergency surgery. In group II, manual reduction was successful in 45 cases, ultrasound-guided reduction in 4 cases, 1 reduction was avoided after ultrasonic examination, and 1 patient underwent emergency surgery. The emergency surgery rates in groups I and II were 9.8% and 2.0%, respectively. CONCLUSIONS: Ultrasound can improve the ability to reduce incarcerated inguinal hernia safely when manual reduction fails and may decrease the rate of emergency surgery.

Adult↗
PubMed2005

Effect of different resuscitation fluids on cytokine response in a rat model of hemorrhagic shock.

This study was designed to determine the effects of different resuscitation fluids on the production of proinflammatory and anti-inflammatory cytokines in an animal model of hemorrhagic shock. Wistar male rats (n = 24; 8/group) were subjected to a volume-controlled hemorrhagic shock for 30 minutes and resuscitated as follows: (1) sham group without resuscitation, (2) lactated Ringer solution (LR), 3:1; (3) 4% hydroxyethyl starch (HES) solution, 1:1; and (4) 4% modified fluid gelatin (GEL), 1:1. Hemodynamic parameters were recorded, and blood samples were collected at 0 min and 30, 90, 150, 210, 270, and 330 min after hemorrhage for plasma levels of IL-6, IL-10, and TNFalpha. The circulating concentrations of IL-6 at 90, 150, 210, 270, and 330 min and TNFalpha levels at 150, 210, and 270 min after hemorrhage were significantly elevated in animals resuscitated with GEL compared with HES or LR (P < 0.05). At 210, 270, and 330 min, IL-10 concentration was decreased significantly in GEL-resuscitated rats compared with rats resuscitated with LR or HES (P < 0.05). Mean blood pressure and serum levels of lactate after resuscitation were not different among three kinds of fluids. LR, HES, and GEL are comparable in volume efficacy for resuscitation of hemorrhagic shock but are associated with different postresuscitation immune responses. Resuscitation with GEL may be associated with cytokine production favoring a proinflammatory response. The marked elevation of IL-6 observed in the GEL-treated animals may play a role in the relatively high frequency of anaphylactoid reaction in clinical use of GEL.

Animals↗
PubMed2005

Best evidence topic report. Nebulised furosemide in acute adult asthma.

A short cut review was carried out to establish whether the addition of nebulised furosemide to beta-agonist therapy improves outcomes in acute asthma. Altogether 87 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. A further relevant paper was found on scanning the references of these papers. The author, date and country of origin, patient group studied, study type, relevant outcome, results, and study weaknesses of the best papers are tabulated. There is currently insufficient evidence to support the routine addition of nebulised furosemide to standard beta agonist therapy in acute asthma in adults.

Acute Disease↗
PubMed2004

Sequential symptomatic analysis in probable severe acute respiratory syndrome cases.

STUDY OBJECTIVE: Previous reports on severe acute respiratory syndrome (SARS) described mainly its symptoms. However, the time sequence of symptom development was rarely discussed. The objective of this study is to chronologically document the time sequence of symptom development in probable SARS cases and compare that of the febrile non-SARS cases, thus providing valuable information for early recognition of the disease. METHODS: This prospective, descriptive, cohort study was conducted in an academic university hospital in Taipei, Taiwan, from March 14 through May 12, 2003. Patients presenting to the emergency department (ED) with a temperature of at least 38.0 degrees C (> or =100.3 degrees F) and exposure history were evaluated with a structured protocol. Detailed time sequences of individual symptoms were recorded, and chest radiography and laboratory test results were obtained. Probable SARS cases were determined by the Center of Disease Control Taiwan. Children younger than 15 years and suspected SARS patients with negative polymerase chain reaction results were excluded from final analysis. RESULTS: Seventy-nine SARS and 220 non-SARS cases were analyzed. The major clinical symptoms of SARS patients on ED presentation were myalgia, loose stool or diarrhea, nonproductive cough or dyspnea, headache, and chills. Upper airway symptoms, including rhinorrhea and sore throat, were rarely seen in the SARS patients but were common in the non-SARS group. Characteristic symptom sequence, consisting of initial fever accompanied by diarrhea and myalgia and then progressive respiratory symptoms, was identified in 55 SARS patients (69.6%; 95% confidence interval [CI] 0.60 to 0.80) but only 7 (3.2%; 95% CI 0.008 to 0.05) non-SARS patients. Chest radiographic abnormality may precede lower respiratory tract symptoms in some SARS patients. CONCLUSION: During an outbreak period, recognition of possible SARS cases depends on the heightened awareness of its clinical presentation. Aside from travel and contact history, the time sequence of the accompanying symptoms of SARS should help first-line physicians screen SARS patients at an early stage.

Adult↗
PubMed2004

Validation of a novel severe acute respiratory syndrome scoring system.

STUDY OBJECTIVE: In a pilot study conducted during March 14 to April 2, 2003, 2 severe acute respiratory syndrome (SARS) screening scores were developed for predicting SARS among febrile patients presenting to the emergency department (ED). The objective of this study is to validate these scoring systems with a different set of patients. METHODS: All adult patients with documented fever, measured at home or at the hospital, and presenting to the ED of National Taiwan University Hospital, a 2,400-bed tertiary care teaching hospital in northern Taiwan, were prospectively enrolled. Two previously developed SARS screening scores were applied to all patients. The final diagnosis of SARS was made by the Expert Committee of the Center for Disease Control Taiwan, Republic of China, according to the criteria of Centers for Disease Control and Prevention, Atlanta, GA. RESULTS: A total of 239 adult patients, including 117 men and 122 women, were enrolled. Eighty-two patients were finally diagnosed with SARS. Compared with the SARS patients in the derivation cohort, those in the validation cohort were older (44.5+/-15.9 versus 33.9+/-15.9 years), more likely to acquire the disease locally (76.8% versus 37.5%), and more likely to have cough before or during fever. For the non-SARS patients, cases in the validation cohort presented with less cough and coryza but more diarrhea. For the 4-item symptom score, the sensitivity reached 96.3% (95% confidence interval [CI] 89.7% to 98.7%) and the specificity 51.6% (95% CI 43.8% to 59.3%). For the 6-item clinical score, the sensitivity reached 92.6% (95% CI 84.8% to 96.6%) and the specificity 71.2% (95% CI 63.6% to 77.7%). When the clinical score was applied to patients with a positive symptom score, the combined sensitivity reached 90.2% (95% CI 82.0% to 95.0%), and the combined specificity reached 80.1% (95% CI 73.2% to 85.6%). CONCLUSION: This prospective study validated the scoring system previously developed by using a different cohort. The scoring systems could be applied to settings where mass screening of SARS is needed during future outbreaks.

Adolescent↗
PubMed2004

Predictive model of diagnosing probable cases of severe acute respiratory syndrome in febrile patients with exposure risk.

STUDY OBJECTIVE: Since the World Health Organization issued a global alert about severe acute respiratory syndrome (SARS) on March 12, 2003, the illness has become a major public health challenge worldwide. The objective of this study is to identify the clinical risk factors of SARS and to develop a scoring system for early diagnosis. METHODS: The detailed clinical data of all patients presenting to the emergency department (ED) with a temperature higher than 38.0 degrees C (100.3 degrees F), documented at home or at the ED, and risks of exposure to SARS within 14 days were assessed. The diagnosis of probable SARS was made according to the definition of the Centers for Disease Control and Prevention. Items with significant differences among symptoms, signs, and laboratory tests on presentation between SARS and non-SARS groups were determined and used to develop the scoring system. RESULTS: Seventy patients were enrolled and 8 were diagnosed as probably having SARS. None of the initially discharged patients or their relatives developed SARS. Compared with the non-SARS group, the SARS group was younger (33.9+/-15.9 years versus 44+/-9.8 years; P=.02), had a higher percentage of fever prolonged more than 5 days (87.5% versus 6.5%; P<.01), myalgia (75% versus 27.4%; P=.01), and diarrhea (50% versus 9.7%; P=.02); had less occurrence of cough before or during fever (0% versus 64.5%; P=.01); and had lower absolute lymphocyte (0.9+/-0.3x10(9)/L versus 1.5+/-1.1x10(9)/L; P<.01) and platelet counts (144.1+/-36.3x10(9)/L versus 211.6+/-78.8x10(9)/L; P=.02). A 4-item symptom score based on the presence of cough before or concomitant with fever, myalgia, diarrhea, and rhinorrhea or sore throat detects SARS with 100% sensitivity and 75.9% specificity; a 6-item clinical score based on lymphopenia (<1.0x10(9)/L), thrombocytopenia (<150x10(9)/L) and the 4 symptom items detects SARS with 100% sensitivity and 86.3% specificity. CONCLUSION: Certain symptoms and laboratory tests indicate higher risk of febrile probable SARS. In nonendemic areas, the febrile patients with recent contact with SARS or travel history to endemic areas could be screened for the probability of SARS by the use of clinical and symptom scores.

Adolescent↗
PubMed2004

SARS exposure and emergency department workers.

Of 193 emergency department workers exposed to severe acute respiratory syndrome (SARS), 9 (4.7%) were infected. Pneumonia developed in six workers, and assays showed anti-SARS immunoglobulin (Ig) M and IgG. The other three workers were IgM-positive and had lower IgG titers; in two, mild illness developed, and one remained asymptomatic.

Adult↗
PubMed2004

Mesenteric adenitis caused by Salmonella enterica serovar Enteritidis.

Mesenteric adenitis is a self-limited condition characterized by fever, localized right lower quadrant abdominal pain, and frequent leukocytosis, making it difficult to differentiate from appendicitis. We report a case of mesenteric adenitis in an 8-year-old boy who presented at the emergency department with right lower quadrant abdominal pain, diarrhea, and fever up to 40 degrees C. Acute appendicitis was initially suspected, but further abdominal ultrasound and contrast enhanced computed tomography studies showed a normal appendix with marked mesenteric adenopathy. Symptomatic treatment was given and pain and fever subsided 2 days later. Follow-up sonography showed resolution of adenopathy, confirming the diagnosis of mesenteric adenitis. The admission stool cultures grew Salmonella enterica serovar Enteritidis (S. Enteritidis). Unlike previous reports in western countries where Yersinia species prevails and was thought to be self-limited, S. Enteritidis carries potential risk for serious systemic complications, such as meningitis or septic arthritis. The isolation of this unusual microbiological species thus has both therapeutic and epidemiological implications for mesenteric adenitis in Taiwan.

Child↗
PubMed2004

Cost-effectiveness of treatment strategies for osteoarthritis of the knee in Taiwan.

OBJECTIVE: To evaluate the cost-effectiveness of 3 treatment strategies for osteoarthritis (OA) of the knee: naproxen, celecoxib, and hyaluronan. METHODS: We developed a decision model to estimate the costs and effectiveness of 3 treatment strategies: 250 mg naproxen 3 times daily for 26 weeks, 100 mg celecoxib twice daily for 26 weeks, and 25 mg hyaluronan by intraarticular injection once per week for 5 weeks followed by conventional treatment for 21 weeks. The probabilities and utility data were obtained by surveying the literature and consulting experts. Cost data were obtained from insurance reimbursement data of National Taiwan University Hospital and were converted to 2002 US dollars. The timeframe of the decision tree was 26 weeks. Outcomes were expressed in aggregated costs, quality-adjusted life-years (QALY), and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed on most variables. RESULTS: The expected total costs for the naproxen, celecoxib, and hyaluronan strategies were US$498.98, US$547.80, and US$678.00, respectively. The ICER of the celecoxib strategy compared with the naproxen strategy was US$21,226 per QALY gained. The ICER of the hyaluronan strategy versus the celecoxib strategy was US$42,000 per QALY gained. The ICER of the hyaluronan strategy decreased to about US$25,000 per QALY gained if the weekly treatment cost of hyaluronan was decreased to US$31. CONCLUSION: Celecoxib treatment results in a reasonable cost-effectiveness ratio for patients with OA of the knee. Hyaluronan treatment, however, may not be an economically attractive choice under the current healthcare scenario in Taiwan.

Adjuvants, Immunologic↗
PubMed2003

A cost-effectiveness analysis of treatment strategies for acute uncomplicated pyelonephritis in women.

UNLABELLED: At least 250,000 episodes of acute uncomplicated pyelonephritis are treated annually in the emergency department (ED). Trimethoprim-sulfamethoxazole (TMP-SMX) and norfloxacin have both been used as treatments for acute uncomplicated pyelonephritis. OBJECTIVES: To investigate the cost-effectiveness of two outpatient treatment strategies, TMP-SMX and norfloxacin, for acute uncomplicated pyelonephritis in adult women between the ages of 18 and 65 years. METHODS: Common principles of cost-effectiveness analysis were used for this evaluation. The authors developed a decision tree to estimate the costs and effectiveness of two different treatment strategies: TMP-SMX 160/800 mg twice per day for 10 days and norfloxacin 400 mg twice per day for 10 days. The time frame of the decision tree was 11 days. Outcomes were expressed in U.S. dollars, quality-adjusted life-days (QALDs), and dollars per QALD. Sensitivity analyses were performed on most variables. RESULTS: Norfloxacin is more effective and less costly than the alternative, TMP-SMX. Norfloxacin treatment will save $195.85 per patient, resulting in an aggregate saving of more than $40 million annually. Patients are expected to enjoy a better quality of life with an incremental 0.0601 QALD per patient, if they are treated with norfloxacin. These results are robust across a wide range of probabilities and costs. CONCLUSIONS: In this analysis, norfloxacin 400 mg twice a day was a more cost-effective treatment than TMP/SMX 160/800 mg twice a day for women with pyelonephritis.

Acute Disease↗