Risk factors for the outcome of cirrhotic patients with soft tissue infections.

Goal: The aims of this study were to identify risk factors that influence outcomes of cirrhotic patients with soft tissue infections and to describe specific management for such patients.

Background: Soft tissue infections account for 11% of infections overall in cirrhotic patients and the severe form of necrotizing infection carries a high mortality rate. It is essential that clinicians make an early diagnosis and start appropriate treatment to improve outcomes of cirrhotic patients with soft tissue infections.

The use of Charlson comorbidity index for patients revisiting the emergency department within 72 hours.

Background: To validate the use of the Charlson Comorbidity Index (CCI) for predicting admission of patients revisiting the Emergency Department (ED) within 72 hours.

Methods: Non-trauma patients aged above 17 years old who revisited an urban ED within 72 hours during January of 2004 were included in this retrospective observational study. Demographic data, diagnosis, CCI, in-hospital mortality rate and length of hospital stay were reviewed, and comparisons were made between the patients who were admitted or discharged on their return visits.

Hemorrhagic bullae represent an ominous sign for cirrhotic patients.

Hemorrhagic bullae are a clinical manifestation of many underlying diseases, especially soft-tissue infection. The aim of this study was to evaluate the characteristics and prognosis of cirrhotic patients with hemorrhagic bullae. Fifteen patients with liver cirrhosis and hemorrhagic bullae had been admitted to Chang Gung Memorial Hospital, Kaohsiung, from January to December 2003.

Management of ventricular dysrhythmia secondary to trazodone overdose.

Torsades de pointes (TdP), a life-threatening ventricular dysrhythmia, was recorded in a 30-year-old woman who had taken a deliberate overdose of trazodone. The patient was successfully defibrillated to normal sinus rhythm and given intravenous magnesium sulfate according to Advanced Cardiovascular Life Support guidelines. The patient was discharged and experienced no further complications.

Status epilepticus induced by star fruit intoxication in patients with chronic renal disease.

Star fruit has been reported as containing neurotoxins that often cause severe neurological complications in patients with chronic renal disease. We report two patients with chronic renal failure at a pre-dialyzed stage who developed refractory status epilepticus after ingestion of star fruit. In addition, we review 51 cases in the literature.

Fatal aeromonas hydrophila infection of soft tissue after endoscopic injection sclerotherapy for gastric variceal bleeding.

Aeromonas hydrophila, an anaerobic gram-negative bacillus, can cause severe infections in immune-compromised patients. We present a 45-year-old cirrhotic man who suffered from hematemesis and received emergency endoscopic injection sclerotherapy (EIS) for gastric variceal bleeding. Twenty-one hours after EIS, painful swelling of the bilateral lower extremities and fever occurred.

Massive pulmonary embolism in a young patient on clozapine therapy.

Clozapine-associated induction of venous thromboembolism has potentially catastrophic consequences. We report a case of sudden death caused by bilateral main pulmonary trunk thrombosis in a 31-year-old man receiving clozapine therapy. The patient presented with general weakness and exertional dyspnea.

Case reports of leptospirosis in southern Taiwan.

Leptospirosis, a zoonotic disease with worldwide distribution, is often overlooked in Taiwan. Clinicians at our medical center in southern Taiwan became alert to the potential for leptospirosis after the first documented case of severe leptospirosis--Weil's syndrome was diagnosed at our emergency department in early September 2000. Four additional cases of leptospirosis were subsequently diagnosed within a 2-month period.