Clinical features of emergency department patients with depression who had attempted to commit suicide by poisoning.

BACKGROUND: Many patients present to the emergency department (ED) complaining of intentional poisoning. Of those, some have major depressive disorder (MDD) in their medical history. The aim of this study was to investigate the prevalence of MDD patients who were treated for poisoning in the ED. MATERIALS AND METHODS: A retrospective review was performed on 268 patients who were treated with poisoning between July 2007 and November 2011. Of these patients, we only included those who were over 18 years of age. Information regarding age, gender, cause, time of ingestion, type of drug, history of attempting suicide, and outcome, among other characteristics, was collected and compared to patients who did not have MDD. RESULTS: A total of 244 patients were included in this study. Of those, 52 patients (21.3%) had a history of MDD. Compared to non-MDD patients, a majority (34.6% vs. 19.8%) of those in the MDD group had a history of suicide attempts (P = 0.027), and 34 (65.4% in the MDD group vs. 34.4% in the non-MDD group) took more than two types of drugs (P < 0.001). There were no differences in age, sex, time of ingestion or disease severity between MDD and non-MDD patients. CONCLUSION: In poisoning patients with MDD, physicians in the ED must consider that they have a higher tendency to show suicidal behavior and to have ingested multiple types of drugs.

The clinical usefulness of initial serum procalcitonin as an aggravation predictor in a hepatobiliary tract infection at emergency department.

BACKGROUND AND OBJECTIVES: The ability to predict future clinical deterioration early in patients who present to an emergency care center with a hepatobiliary tract infection is difficult. We studied the clinical usefulness of the initial serum levels of procalcitonin in a hepatobiliary tract infection as an indicator for predicting aggravation in the early stages. METHODS: Of the patients who presented with the clinical symptoms of a hepatobiliary tract infection, 99 were diagnosed with a hepatobiliary tract infection by imaging studies and subsequently enrolled in the study. Laboratory tests were obtained in the early stage of disease after presentation to an emergency care center. We assessed and compared the serum levels of many early inflammatory markers (white blood cell [WBC] counts, C-reactive protein and procalcitonin) between patients whose symptoms were initially stable upon arrival to an emergency care center but then deteriorated to, those whose symptoms remained consistently stable. Thus, we examined if the above serum markers are useful in predicting the possibility of future symptom aggravation. RESULTS: Of a total of 99 patients, 27 were assigned to the symptom aggravation group. The serum levels of WBC counts and C-reactive protein in the aggravation group were elevated. However, the median value (interquartile range) of procalcitonin was relatively increased at 2.28 (0.41-7.84 ng/ml), demonstrating a significant difference. CONCLUSIONS: In conclusion, initial serum levels of procalcitonin might be used as an indicator for aggravation in patients with hepatobiliary tract infection at the emergency department, even though there is hemodynamic stability.

Application of nasal continuous positive airway pressure to early extubation in very low birthweight infants.

Using a preset protocol for early extubation, 50 babies were randomly selected to post-extubation headbox or post-extubation nasal continuous positive airway pressure (N-CPAP). All infants weighed less than 1500 g, had a gestational age of less than 34 weeks, and had been weaning from mechanical ventilation within seven days of life. The criteria for extubation included stable condition, fraction of inspired oxygen (FIO2) of < or = 35%, peak inspiratory pressure (PIP) of < or = 15 cm H2O (1.47 kPa), and ventilator rate of 6/minute. Before extubation, a loading dose of aminophylline was given followed by maintenance treatment. If reintubation was not required within 72 hours of the initial extubation the procedure was considered successful. The reintubation criteria included FIO2 > or = 70% to maintain arterial oxygen tension (PaO2) of > or = 50 mm Hg (6.67 kPa) or pulse oximetry between 90-96% and pH of < 7.25, and arterial carbon dioxide tension (PACO2) of > 60 mm Hg (8.00 kPa) and severe or recurring apnoea. The overall success rate of early extubation was 66% (33/50). The individual successful extubation rate of post-extubation in the N-CPAP group and the post-extubation headbox group were 84% (21/25) and 48% (12/25), respectively (p = 0.017; chi 2). There were no significant differences in clinical characteristics between the two groups. The most common cause of failure in early extubation was apnoea, and most occurred in the headbox group (9/12). These results suggest that application of N-CPAP to a preset protocol for extubation can achieve a better success rate of early extubation in very low birthweight (VLBW) infants.

Liveborn twin with intrauterine death of one twin: report of two cases.

Twin pregnancies carry a greater mortality and morbidity rate than singleton pregnancies. In case of an intrauterine fetal death (IUFD), the risk of mortality and morbidity of the surviving twin is increased. The pathogenesis is usually due to twin to twin transfusion. The donor twin is hypovolemic, anemic and often shows a growth retardation or even severe enough to cause an IUFD. The recipient twin is hypervolemic, polycythemic and weighs more than its co-twin. In this paper we reported two cases of liveborn twin complicated by an IUFD of its co-twin. Both cases were monochorionic twins. The first case was born at 29 weeks and 6 days of gestation, a male infant weighed 1054 g. His co-twin was stillborn and weighed 722 g. At birth the surviving infant showed respiratory distress syndrome (RDS), anemia and bilateral periventricular echogenicity (PVE). The second case was a female infant with a gestational age of 26 weeks and 2 days and weighed 850 g. Her stillborn co-twin weighed 804 g. Both twins showed signs of hydrops, and the liveborn infant had RDS, marked anemia (Hb 6 g/dl) and hypoalbuminemia. We will discuss the possible pathogenesis in our cases and also review some literature.

Nasal continuous positive airway pressure following surfactant replacement for the treatment of neonatal respiratory distress syndrome.

To evaluate whether nasal continuous positive airway pressure (N-CPAP) could be an alternative to ventilator treatment in infants with severe respiratory distress syndrome (RDS) after surfactant treatment, we performed the trial on 15 newborn babies with birth weight > or = 1500 g. All babies were put on N-CPAP as soon as the diagnosis of RDS was established. The N-CPAP system that we used in this study consisted of no ventilator. When FiO2 > or = 0.7 was required for maintaining PaO2 > 50 mmHg, surfactant treatment was decided. After the tracheal instillation of surfactant (120 mg/kg body weight), the babies were randomly assigned into 2 groups. In the ventilator group (n = 7), the babies were connected to mechanical ventilation following surfactant instillation. In the N-CPAP group (n = 8), the babies were extubated immediately after instillation of surfactant and were connected to N-CPAP. There was a marked improvement in the ratio of arterial PO2 to alveolar PO2 (a/A PO2) immediately following surfactant treatment and the effect was sustained during the study period of 72 hours in both groups. No significant differences in a/A PO2 were noted in 2 groups. There was a significantly higher PaCO2 in the N-CPAP group than in the ventilator group. PaCO2 declined significantly in the ventilator group 8 hours after surfactant treatment. A delayed decline in PaCO2 until 48 hours after surfactant instillation in the N-CPAP group was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Doppler assessment of physiological stenosis at the bifurcation of the main pulmonary artery: a cause of functional murmur in neonates.

A systolic heart murmur is not infrequently recognized in healthy newborn infants, especially those with a low birth weight. This study aimed at assessing the hemodynamics at the bifurcation of the main pulmonary artery using Doppler echocardiography and to correlate the results with this murmur. The peak velocities of main pulmonary artery (MPAV) and right pulmonary artery (RPAV) were studied in 25 low-birth-weight infants who had recovered from acute stage and presented with a systolic murmur, and the ratio of RPAV/MPAV was calculated. Another compatible 25 healthy low-birth-weight infants without a murmur were enrolled as the control group. The initial MPAV values were 79.8 +/- 20.7 (range 51-152) cm/s and 80.7 +/- 14.2 (range 60-111) cm/s in the heart murmur group and in the control group, respectively (p > 0.05). The initial RPAV values were 193.4 +/- 60.2 (range 118-388) cm/s and 99.8 +/- 15.5 (range 76-132) cm/s in the heart murmur group and in the control group, respectively (p < 0.0001). The initial RPAV/MPAV ratios were 2.46 +/- 0.61 (1.59-3.92) and 1.25 +/- 0.14 (0.94-1.47) in the heart murmur group and in the control group respectively (p < 0.0001). When the murmur disappeared after a period of 2-5 months, no significant differences in the last RPAV and RPAV/MPAV ratios between both groups could be found. The RPAV in the heart murmur group faded significantly to 118.7 +/- 16.9 cm/s, and so did the RPAV/MPAV ratio to 1.24 +/- 0.12 (p < 0.0001). A transient functional murmur recognized in healthy premature infants at about 1 month of age is caused by the pressure gradient that implies a physiological stenosis at the bifurcation of the main pulmonary artery. The RPAV is higher than the MPAV, and the RPAV/MPAV ratio is usually over 1.5. The RPAV became slower, and the RPAV/MPAV ratio fell as the murmur faded with age.

Clinical experience in using a new type of nasal prong for administration of N-CPAP.

Nasal continuous positive airway pressure (N-CPAP) has been used in infants with decreased lung compliance for increasing the functional residual capacity (FRC), decreasing the work of breathing and improving the PaO2/PAO2 (arterial-alveolar PO2 ratio) without intubation. However, the currently available nasal prongs for administration of N-CPAP have presented some problems in fixation, and lesions to the nasal septum or nostrils might be induced by aggressive pressure intended to fix them. We would therefore like to report our experience in using a new type of nasal prong for administration of N-CPAP therapy. The nasal prongs we used were provided by Dr. Wung of Columbia University in New York, who first designed them, and have been used safely, effectively and without any complications.