Che-Kim Tan

Readmission to the intensive care unit: An indicator that reflects the potential risks of morbidity and mortality of surgical patients in the intensive care unit

PurposeTo investigate the characteristics and outcomes of surgical patients who were readmitted to the intensive care unit (ICU).MethodsThe data were collected for all readmissions to the surgical ICUs in a tertiary hospital in the year 2003.ResultsOf all the 945 ICU discharges, 110 patients (11.6%) were readmitted. They had a longer initial ICU stay (8.05 ± 7.17 vs 5.22 ± 4.95, P < 0.001) and were older and in a more severe condition than those not readmitted, but with a longer hospital stay and higher mortality rate (40% vs 3.6%, P < 0.001). A total of 26.4% of the readmission patients had an early readmission (<48 h), with a lower mortality rate than those with a late readmission (24.1% vs 45.7%, P = 0.049). A total of 46.4% of the patients were readmitted with the same diagnosis while the rest were readmitted with a new complication. Respiratory disease was the most common diagnosis for patients readmitted with a new complication (66.1%). The nonsurvivors had a significantly higher second Acute Physiology and Chronic Health Evaluation (APACHE II) score (22.1 ± 8.8 vs.14.6 ± 7.4, P < 0.001) and second Therapeutic Intervention Scoring System (TISS) score (30.1 ± 8.7 vs 24.7 ± 7.6, P = 0.001) and a longer stay in the first ICU admission (10.4 ± 9 days vs 6.4 ± 5 days, P = 0.010). A multivariate analysis showed that the first ICU length of stay and the APACHE II score at the time of readmission were the two risk factors for mortality.ConclusionThe mortality of surgical patients with ICU readmission was high with respiratory complications being the most important issue.

Propofol-related green urine

C-K Tan, C-C Lai and K-C Cheng Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan and Department of Internal Medicine, Yi-Min Hospital, Taipei, Taiwan Correspondence: C-K Tan, Department of Intensive Care Medicine, Chi-Mei Medical Center, Yungkang, Tainan 710, Taiwan. E-mail: chekim.tan@gmail.com

Purple urine bag syndrome

A 58-year-old man with an indwelling urinary catheter began producing urine with a deep purple colour ([Figure 1][1]). The urine was alkaline (pH 7.8), and Proteus mirabilis urinary tract infection was diagnosed. This so-called purple urine bag syndrome resolved after treatment with ceftazidime. The

Chronic contained rupture of an abdominal aortic aneurysm with vertebral erosion

![Figure][1] nnComputed tomography scan of the abdomen of a 67-year-old man with a 6-month history of low-back pain.nnnnA 67-year-old man presented with a 6-month history of low-back pain despite having sought medical treatment. He had no fever, and his blood pressure was 136/64 mm Hg on

Arthritis caused by Mycobacterium terrae in a patient with rheumatoid arthritis

To date, few cases of human joint infection caused by the Mycobacterium terrae complex have been reported. Because M. terrae infection is a relatively uncommon problem, it can be mistaken for a noninfectious inflammatory joint condition. The most common presentation of M. terrae complex infection is tenosynovitis of the hand; infections in bones other than those of the hands are rarely reported. Here, we describe a patient with arthritis of the knee caused by M. terrae and review data from other cases reported in the medical literature.

Fracture of a pacemaker lead

A 68-year-old man had intermittent dizziness after participating in a Judo competition. The patient had a dual-chamber pacemaker that had been implanted 2 years earlier for a high-grade atrioventricular block ([Figure 1A][1]).nnnn![Figure][2] nnFigure 1: (A) Radiograph of the chest of a 68-year

Clinical features and short-term outcome of critically ill patients with head and neck cancer in the medical intensive care unit.

Objectives:To investigate the clinical features, especially cancer-related complications, and short-term outcome of critically ill patients with head and neck cancer (HNC) in the medical intensive care unit. Methods:We reviewed 57 patients with a diagnosis of HNC in the medical intensive care unit (≥24 hours) of a tertiary-care medical center between January 1999 and December 2005. Results:Thirty-two (56.1%) patients had advanced cancers (stage III/IV), and 21 (36.8%) remained uncontrolled (ie, relapsed or progressive). Twenty-five (43.9%) patients had cancer-related complications, including airway obstruction, tumor bleeding, or wound infection. Among 47 (82.4%) patients with acute respiratory failure, 25.5% of them were caused by cancer-related life-threatening airway complications. After excluding 5 already tracheostomized acute respiratory failure patients, difficult intubation was encountered in 26.2% (11/42); and 72.7% (8/11) of them required emergency tracheostomy. The 30-day mortality was 38.6%. Uncontrolled HNC (adjusted odds ratio [OR], 4.13; 95% confidence interval, 1.14–14.92) and Acute Physiology and Chronic Health Evaluation II score (adjusted OR 1.13; 95% confidence interval, 1.04–1.22) were found as the risk factors for 30-day mortality in multivariate analysis. Conclusions:Although critically ill patients with HNC usually had advanced cancers and carried a high rate of cancer-related life-threatening airway complications, their 30-day mortality was favorable and only independently associated with cancer status and Acute Physiology and Chronic Health Evaluation II score.

Spontaneous hemothorax caused by metastasis of a rib tumour

A 62-year-old man with a history of hepatocellular carcinoma presented to the emergency department with sudden onset of chest pain on his right side, dyspnea and syncope. A chest computed tomography scan with contrast showed active extravasation of the contrast medium from a rib tumour, forming a

Osteopoikilosis in the pelvic region

A 28-year-old man presented with epigastric pain after alcohol intake. His physical examination was unremarkable. Abdominal radiography showed small, round, sclerotic opacities distributed symmetrically along the sacroiliac joints, pubic symphysis, acetabulum of the pelvis and the femoral heads ([

The Case | Generalized petechiae and acute renal failure

A 31-year-old woman presented with fever, chills, and abdominal pain for 1 day. On examination, she was found to have a temperature of 35.3 1C, pulse rate of 109 beats per minute, and blood pressure of 123/95 mm Hg. Generalized petechiae (Figure 1) were noted over the trunk and extremities. The abdomen was soft without rebound tenderness. Pertinent laboratory data were as follows: blood urea nitrogen 14 mg per 100 ml, creatinine 2.1 mg per 100 ml, sodium 134.2 mEq l , potassium 2.54 mEq l , aspartate aminotransferase 49 IU l , alanine aminotransferase 3 IU l , and total bilirubin 0.75 mg per 100 ml. The patient had a profound metabolic acidosis with pH of 7.190, bicarbonate of 13 mmol l , and lactate of 9.7 mmol l . White blood cell count was 7900 ml 1 (with 20% band form), hemoglobin 15 g ml , and platelet count was 18 000 ml . There was a marked coagulopathy with prothrombin time 480 s and activated partial thromboplastin time 4200 s, fibrinogen level of 92.1 mg per 100 ml (normal 200–400), fibrin degradation product levels of 532.9 mg ml 1 (normally o5), and D-Dimer level of 85131.6 ngFEU ml 1 (normally o500). Abdominal computed tomography (CT) (Figure 2) was performed to look for a focus of infection.