Kaohsiung J Med Sci
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Kaohsiung J Med Sci · Aug 1997
Case ReportsHepatic portal venous gas associated with acute mesenteric infarction--a case report.
Hepatic portal venous gas (HPVG) is considered as an ominous prognostic sign and indicates the need for urgent surgical intervention. It has been associated with a wide variety of abdominal catastrophes, but the commonest and most serious one is infarcted bowel. This disease entity is difficult to be detected by conventional radiography. ⋯ We report a case of HPVG associated with acute mesenteric infarction, which was detected early by ultrasonography. The computed tomography done later not only showed typical features of HPVG, but also disclosed intramural gas in the small intestine and gas in the superior mesenteric veins, which were diagnostic clues for acute mesenteric infarction. The patient survived after urgent surgery.
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A retrospective analysis of emergency ambulance transports in the EMS-Tainan was made to evaluate the utilization of emergency medical system by the elderly and to determine the factors that may influence these transports. The study group consisted of 4,090 emergency ambulance transports from 1/1/1195 to 30/4/1995. 1,017 patients (24%) were aged over 65. The main characteristics of these elderly patients were as follows: more non-trauma cases, higher severity of triage, and longer total transport time (23.0 +/- 0.5 vs. 18.9 +/- 0.2 minutes) were noted. ⋯ Based on these results, we recommended make efficient transport in order to provide better emergency care for the elderly. A network linking the elder users with EMS dispatch center should improve the efficiency in fulfilling the EMS calls, and further investigation about the value of such a network is warranted. It is also important to establish a competent and countrywide database for EMS users and to pursue ongoing planning in order to evaluate and investigate the needs of EMS for elderly patients in the future.
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Kaohsiung J Med Sci · Dec 1996
Comparative Study[Comparison between of TRISS and ASCOT methods--in Tainan area. Trauma and Injury Severity Score. A Severity Characterization of Trauma].
In this study, we compare the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT) models by using NCKUH trauma registry to assess the performance of correct prediction in terms of sensitivity, specificity and misclassification rate. The database has accumulated to 5,672 cases, NCKUH 2,490; Chi-Mei 3,182 respectively. Blunt trauma mechanism was composed of 4, 892 (86.2%) while 552 (9.7%) were pertinent to penetrating. ⋯ It is our hope to develop a mixed, revised model to better predict patients survival probability. Therefore, it is feasible to adopt ASCOT methodology in prediction of trauma patients in Taiwan. Expanded database and better methodology need to be developed in further study.
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Kaohsiung J Med Sci · Apr 1996
Early diagnosis of necrotizing fasciitis by utilization of ultrasonography.
Necrotizing fasciitis is a rare and rapid progression soft tissue infection. The only identifiable feature is tissue necrosis along a single fascia plane. Because the skin is initially spared, it is difficult for early recognition prior to extensive tissue destruction. ⋯ The ultrasonographic findings of necrotizing fasciitis included: 1) irregularity of the fascia; 2) abnormal fluid collections along the fascia plane; and 3) diffuse thickening of the fascia when compared with the control site in the normal limb. However, in severe infectious cellulitis, the above mentioned findings were not observed. Our results indicate the usefulness of the ultrasonography for early diagnosis of necrotizing fasciitis.
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Kaohsiung J Med Sci · Mar 1996
Case Reports[Unusual spontaneous dural cavernous sinus fistula between right external carotid artery and left cavernous sinus--a case report].
A 64 year-old female had left exophthalmos which resulted from a spontaneous dural cavernous sinus fistula between the right external carotid artery and left cavernous sinus. The left cavernous sinus was fed directly from internal maxillary branches of right external carotid artery with the sparing of right cavernous sinus and intracavernous sinus. ⋯ Although this kind of spontaneou dural cavernous sinus fistula is very rare. The possibility of arterial feeding from contralateral carotid artery should not be ignored in any patient that is suffered from dural cavernous sinus fistula while angiographic study is performed.