Myocardial injury was associated with neurological sequelae of acute carbon monoxide poisoning in Taiwan.

BACKGROUND: Carbon monoxide (CO) poisoning has recently become a serious health problem in some Asian countries, including Taiwan. The aims of this study are to evaluate the changing trend of CO poisoning and to demonstrate the association between myocardial injury and neurological sequelae of CO poisoning in Taiwan between 1990 and 2011. METHODS: This retrospective cohort study included all eligible patients with acute CO poisoning reported to the Taiwan National Poison Control Center during the study period. The changing trend of CO poisoning and its impacts on the primary outcomes, i.e., persistent neurological sequelae (PNS) and delayed neurological sequelae (DNS), were then assessed. RESULTS: 786 CO poisoned cases were reported. Among them, 467 cases were intentional. Intentional CO exposure started to become the major cause of CO poisoning in Taiwan in 2002. Increase in the number of intentional CO poisoning significantly correlated with the increase in the overall number of CO poisoning (r = 0.972, p < 0.001). Patients who took tranquilizer (OR = 3.89; 95% CI:1.94-7.77), had myocardial injury (OR = 1.70; 95% CI:1.03-2.82), had been stayed in intensive care unit (OR = 2.03; 95% CI:1.13-3.62), presented with GCS less than 9 (OR = 4.05; 95% CI:2.32-7.08) and had abnormal brain image (OR = 14.46; 95% CI:5.83-35.83) had a higher risk of PNS. Moreover, patients who were older age (OR = 1.04; 95% CI:1.02-1.07), had psychiatric disorder history (OR = 2.82; 95% CI:1.35-5.89), had myocardial injury (OR = 1.33; 95% CI:1.16-1.53), and presented with GCS less than 9 (OR = 3.23; 95% CI:1.65-6.34) had a higher risk of DNS. CONCLUSION: The pattern of CO poisoning had changed markedly during the study period, with a significant increase in both the numbers of intentional and overall CO poisoning. Moreover, intentional CO poisoning was associated with a higher risk of neurological sequelae, which was mediated by various indicators of poisoning severity such as myocardial injury and GCS less than 9.

A rare presentation of systemic emphysematous infections secondary to Klebsiella pneumoniae bacteremia in a diabetic patient.

BACKGROUND: Diabetic patients are at an increased risk of developing Klebsiella pneumoniae pyogenic liver abscess (KLA) and its extrahepatic complications. This is the first case report depicting the concurrence of pyogenic liver abscess, emphysematous pyelonephritis, and necrotizing fasciitis in 1 patient. CASE REPORT: A 29-year-old male with a history of poorly controlled diabetes presented to the emergency department with lower back pain and right lower leg pain for 1 week. Abdominal ultrasound and computed tomography revealed pyogenic liver abscess, bilateral emphysematous pyelonephritis, and right lower-extremity necrotizing fasciitis. The patient then received emergent fasciectomy and bilateral percutaneous nephrostomy. K. pneumoniae was isolated from the blood culture, right nephrostomy tube, and right lower-extremity wound, indicating that it was the cause of these infections. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In diabetic patients diagnosed with KLA, an emergency physician must perform thorough examinations to exclude potential systemic extrahepatic infections. KLA seeding infections are usually hematogenous in origin, as bacteremia is significantly more common in KLA than other pyogenic liver abscess. Documented sites of KLA seeding include eyes, lungs, kidneys, brain, meninges, soft tissues, and bone.

Treatment of tibial pilon fractures using the Link May Anatomic Bone Plate.

BACKGROUND: The tibial pilon fracture is a relatively uncommon but a most difficult fracture to manage. Most orthopedic surgeons agree that the goal of treating such kind of fracture should be anatomic restoration of the articular surface, rigid and stable fixation, early restoration of joint motion, and finally, good functional recovery. We report our experience in managing the fracture and evaluate the operative results for patients who were treated with the Link May Anatomic Bone Plate. METHODS: A retrospective study was performed for tibial pilon fracture from January 1997 to February 2000. A total of thirty patients underwent surgical treatment using Link Distal Fibular Anatomic May Bone Plate, including twenty males and ten females with an average age of 42.6 years (range, 18 to 88 years). According to Rüedi-Allgöwer classification, the fracture patterns were type I in 30% (n = 9), type II in 53.3% (n = 16), and type III in 16.7% (n = 5). Twenty-two fractures (73.3%) were closed type; three (10%) were classified (Gustilo) as grade I open fracture; and five (16.7%) as grade II open fracture. Associated injuries included multiple fractures in five cases and head injury in four cases. All patients were evaluated clinically and radiologically after a mean time of 27.1 months (range, 17 to 39 months). RESULTS: Satisfactory results were obtained in 83.3% of cases. Complications were found in four patients (13.3%), with one nonunion, two superficial wound infections and one deep wound infection. CONCLUSIONS: We concluded that this plating system is one choice of treatment for tibial pilon fracture which provides relatively good outcome.