An integrated healthcare enterprise information portal and healthcare information system framework.

The paper presents an integrated, distributed Healthcare Enterprise Information Portal (HEIP) and Hospital Information Systems (HIS) framework over wireless/wired infrastructure at National Taiwan University Hospital (NTUH). A single sign-on solution for the hospital customer relationship management (CRM) in HEIP has been established. The outcomes of the newly developed Outpatient Information Systems (OIS) in HIS are discussed. The future HEIP blueprints with CRM oriented features: e-Learning, Remote Consultation and Diagnosis (RCD), as well as on-Line Vaccination Services are addressed. Finally, the integrated HEIP and HIS architectures based on the middleware technologies are proposed along with the feasible approaches. The preliminary performance of multi-media, time-based data exchanges over the wireless HEIP side is collected to evaluate the efficiency of the architecture.

[Control of cisplatin-induced delayed emesis].

Despite excellent control of acute-stage emesis, some patients are still bothered by delayed emesis occurring more than 24 hours after cisplatin administration. We report 19 patients with 61 courses of cisplatin-based chemotherapy. They all received high-dose metoclopramide, dexamethasone and lorazepam on the day of cisplatin treatment. After 24 hours, they were treated with intravenous dexamethasone 8 mg once and metoclopramide 50 mg twice on day 2, and oral metoclopramide 10 mg qid on days 3-5. Delayed vomiting and nausea were noted in 27.9% and 39.4% respectively, as compared with 69.8% of delayed emesis and 79.4% of delayed nausea in 63 courses of 15 patients without receiving any antiemetics on days 2-5. The statistics showed significant difference (both P less than 0.001). Side effects were mild and acceptable. Therefore, this regimen is highly effective in preventing delayed vomiting and nausea.

[Combined pregnancy: a case report and literature review].

Combined or heterotopic pregnancy has been regarded as extremely rare in the past three decades. If it continues without diagnosis, a life-threatening situation may occur. A case of eight-week gestation is presented in which there was threatened abortion. The patient underwent exploratory laparotomy for internal bleeding. Upon operation, combined pregnancy, with a ruptured ectopic pregnancy, was diagnosed. Left salpingectomy was performed uneventfully. Neither chronic salpingitis nor administration of ovulation-induction agents was part of past history. A viable ongoing intrauterine pregnancy continued after operation, and a normal male was delivered by cesarean section after a 39-week gestation where labor progressed too slowly for normal delivery.

[Pulmonary edema in transcervical endometrial ablation: a case report].

The use of the transcervical resectoscope for endometrial ablation and/or resection of myomas is a relatively new technique in gynecologic surgery. Although complications are uncommon with this procedure, they can occasionally appear and lead to potential hazard. Here a patient presenting for endometrial ablation is described; 1.5% glycine was used as the irrigation solution to enhance visibility and to wash away blood and tissue particles. Unfortunately, a large amount of glycine was absorbed by the open vessels in the myometrium during operation, leading to pulmonary edema and dilutional hyponatremia. After administration of diuretics, sodium supplement and 100% oxygen, complications improved progressively. The patient was discharged on postoperative day 5 without any sequelae.

[Chlamydia trachomatis infection in women with ectopic pregnancy].

Chlamydia trachomatis infection, presumably sexually transmitted, has been implicated in the spread of tubal infertility and ectopic pregnancy. In searching evidence of Chlamydia trachomatis infection as a possible cause of tubal ectopic pregnancy, we enrolled 40 consecutive pathologically proven tubal ectopic women and 37 normal early intrauterine pregnant women from our OPD and ward from Jan. 1989 to July 1989. All cases underwent a structured interview giving particular attention to past reproductive history, contraception history and past history of STD. The levels of serum antibody IgG to Chlamydia trachomatis in all cases were determined. Seven ectopic women with wearing IUD in situ (group A) and 33 ectopic women with no identical factor (group B) were compared with 37 normal early intrauterine pregnant women (control group). The result showed group B more often had IgG antibody to Chlamydia trachomatis than control group (P = 0.001). Group A had higher antibody to Chlamydia trachomatis than control group but the difference was not statistically significant (P greater than 0.05). We concluded that the above findings add to the evidence that Chlamydia trachomatis infection is a major cause of tubal ectopic pregnancy.

[Improved control of cisplatin-induced emesis with high-dose metoclopramide, dexamethasone and lorazepam].

Despite treatment, emesis remains a major problem with cisplatin chemotherapy. Three potent antiemetics, metoclopramide, dexamethasone and lorazepam, were combined in prophylaxis of 18 patients receiving cisplatin based combination chemotherapy. In 75 courses of chemotherapy, 57% experienced complete protection from vomiting and 89% of treatment courses had two or fewer vomiting episodes. Complete protection and mild episodes from nausea was 47% and 53% respectively. Toxicities were mild and infrequent. It was concluded that combination of high-dose metoclopramide, dexamethasone and lorazepam was highly efficacious in preventing nausea and vomiting in moderate or high-dose cisplatin chemotherapy with little side effects.

[Twin pregnancy complicated by single intrauterine death. Report of six cases and literature review].

From 1982 to 1991, six twin pregnancies, in which one of the fetuses died in utero, have been encountered. The causes of antepartum death in twin gestation could be identified in four cases; one with abruptio placenta, one with twin-to-twin transfusion syndrome, one with twisting of cord and one with velamentous insertion of cord. All six surviving infants had no abnormality in the follow-up of two to seven years. Although a conclusion about the prognosis could not be drawn from such a small series, these good results may have resulted from 1) 2 cases having been dichorionic twins, and 2) the other 4 monochorionic twins of 31-36 gestation weeks were delivered 1 to 5 days after the diagnosis. Conservative treatment was usually suggested until the fetal lung was mature enough for induction of labor. One case was treated after the death of its counterpart with tocolytic agent for a further 15 days because of prematurity. Cesarean section was performed finally for fetal distress resulting from chronic abruption placenta. The other five cases were delivered through vaginal route. According to experience as well as literature review, to improve the prognosis, obstetricians should be familiar with the management of one fetal death in twin pregnancy, especially in those with monchorionic twins.