J Formos Med Assoc
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Asians may be less vulnerable to thrombotic disease than Caucasians. Optimum international normalized ratio (INR) anticoagulant therapy guidelines for Asian populations remain to be established. This study investigated the risk factors for major bleeding or thromboembolism (TE) in Taiwanese patients receiving mechanical aortic and/or mitral valve replacement, including INR < or > 2.0. ⋯ Our data suggest that low-intensity anticoagulant therapy (INR < 2.0) in Taiwanese patients was not associated with increased TE and bleeding rates compared to higher intensity anticoagulant therapy. Follow-up age over 60 years and valve replacement at the mitral site were associated with increased rate of overall events.
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Case Reports
Spontaneous hemothorax caused by a ruptured intercostal artery aneurysm in von Recklinghausen's neurofibromatosis.
Aneurysms arising from an intercostal artery are very rare vascular malformations in von Recklinghausen's neurofibromatosis, which often have a silent clinical presentation and are difficult to diagnose before rupture. We report a case of von Recklinghausen's neurofibromatosis with massive hemothroax caused by spontaneous rupture of an intercostal artery aneurysm in a 29-year-old man. ⋯ During a 10-month follow-up period, the patient had a satisfactory recovery. This case illustrates that angiography and possible endovascular embolization should be the first strategy in managing hemothorax in patients with von Recklinghausen's disease.
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Severe acute respiratory syndrome (SARS) is a life-threatening and highly contagious disease caused by the novel SARS coronavirus (SARS-CoV). Immunohistochemical staining for SARS-CoV in the tissue sections of SARS patients is helpful in investigations of the biologic behavior of this virus in human tissue, and to determine the target cells of this virus in different organs. ⋯ SARS-CoV is mainly present in the cytoplasm of type II pneumocytes and can only be detected in the lung tissue during the early stage of the disease. In the patient who had symptoms of diarrhea, SARS-CoV staining was also identified in the mucosal epithelium of the colon.
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The value of the Pneumonia Severity Index (PSI) in predicting the mortality of patients with community-acquired pneumonia has not been reported in Taiwan. This study investigated the value of this scoring system in estimating mortality of inpatients with community-acquired pneumonia. ⋯ The PSI provided a useful prediction of medical outcome in patients with community-acquired pneumonia. To decrease unnecessary admission, further prospective studies are needed to determine whether outpatient therapy is appropriate for class I or class II patients with community-acquired pneumonia.
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Severe acute respiratory syndrome (SARS) is characterized by fever with rapid progression to acute respiratory distress and it is associated with substantial morbidity and mortality. Transmission patterns suggest spread by respiratory droplet or close person-to-person contact. To elucidate the correlation of clinical presentation to the pathogenesis and course of the disease, we reviewed the pulmonary pathologic specimens of SARS patients taken at different stages of the disease. ⋯ The histologic evolution of SARS coincided with the different stages of DAD: acute, proliferative organizing, and fibrotic stages. SARS cannot be differentiated from the other etiologies of DAD by morphologic examination alone. The absence of DAD does not rule out the possibility of SARS-CoV infection, particularly in the early stage of the disease.