Chang Gung medical journal
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To examine nurse-physician inter-observer agreement on triage categorization and analyze their differences for future reference. ⋯ The overall nurse-physician agreement with triage categorization was poor. The lack of agreement on triage decision making has important implications for EDs in which the priority of care is based on nursing triage categorization. Detailed chart recording and continued work is necessary to improve the agreement between nurse-physician triage categorization.
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Case Reports
Infantile hepatic hemangioendothelioma presenting as early heart failure: report of two cases.
Hepatic hemangioendothelioma is rare. We report on hepatic hemangioendotheliomas in 2 young infants, with initial manifestations of respiratory distress and congestive heart failure. Serum alpha-fetoprotein (alphaFP) level was as high as 26,343 microg/l at 14 days old in 1 case, but was only 18 microg/l in the other case. ⋯ Spontaneous regression has been reported. However, without early recognition and therapeutic intervention, progression to decompensated heart failure may lead to death. Furthermore, it is necessary to differentiate infantile hepatic hemangioendothelioma (IHH) from hepatic malignancies.
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An epiglottic cyst causing airway obstruction is rare in an adult. Early definitive diagnosis and management obviate an unnecessary tracheostomy. We report a case of a 64-year-old woman who arrived at our hospital with progressive stridor and foreign body sensation when swallowing for 6 weeks. ⋯ An epiglottic cyst in an adult seldom causes upper airway obstruction and is easily ignored by clinicians. We emphasize that complete airway evaluation including routine check-up of the larynx is mandatory for patients with intractable obstructive airway disease. Endoscopic laser surgery is effective in the surgical removal of an epiglottic cyst.
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Button batteries represent a distinct type of foreign body. Serious complications can be resulted, particularly when the battery is impacted in the esophagus. The potentially detrimental effects of button battery ingestion have often been overlooked in Taiwan. We surveyed patients following button battery ingestion to define the characteristics and outcomes of this population. ⋯ Most ingested batteries passed through the gastrointestinal tract without any adverse effects. An initial roentgenogram should be obtained promptly to determine battery location and diameter, and the battery's chemical composition should be determined when possible. Esophageal impaction of the batteries requires emergency endoscopic or surgical removal. For patients without esophageal impaction, conservative intervention is recommended in the absence of symptoms and signs of injury.
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Prosthetic aortic valve replacement for aortic valve endocarditis remains a primary practice of most cardiac surgeons. Usually it cures endocarditis and restores cardiac function. However, in advanced aortic valve endocarditis with complex annular destruction, complications following prosthetic aortic valve replacement do occur and present a formidable challenge for reoperation. ⋯ The postoperative course was unremarkable, and the patient, during a follow-up of 2 years, remained in New York Heart Association functional class I. Aortic root pseudoaneurysm following prosthetic aortic valve replacement for infective endocarditis is rare in clinical practice and can cause rapid hemodynamic deterioration which requires imminent reoperation. Homograft aortic root replacement has proven to be a versatile treatment option of this complex disease.