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Cheng CT, Hsu CP, Ooyang CH, Chou CY, Lin NY, Lin JY, Ku YK, Lin HS, Kao SK, Chen HW, Wu YT, Liao CH. Evaluation of ensemble strategy on the development of multiple view ankle fracture detection algorithm. Br J Radiol 2023; 96:20220924. [PMID: 36930721 PMCID: PMC10161902 DOI: 10.1259/bjr.20220924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE To identify the feasibility and efficiency of deep convolutional neural networks (DCNNs) in the detection of ankle fractures and to explore ensemble strategies that applied multiple projections of radiographs.Ankle radiographs (AXRs) are the primary tool used to diagnose ankle fractures. Applying DCNN algorithms on AXRs can potentially improve the diagnostic accuracy and efficiency of detecting ankle fractures. METHODS A DCNN was trained using a trauma image registry, including 3102 AXRs. We separately trained the DCNN on anteroposterior (AP) and lateral (Lat) AXRs. Different ensemble methods, such as "sum-up," "severance-OR," and "severance-Both," were evaluated to incorporate the results of the model using different projections of view. RESULTS The AP/Lat model's individual sensitivity, specificity, positive-predictive value, accuracy, and F1 score were 79%/84%, 90%/86%, 88%/86%, 83%/85%, and 0.816/0.850, respectively. Furthermore, the area under the receiver operating characteristic curve (AUROC) of the AP/Lat model was 0.890/0.894 (95% CI: 0.826-0.954/0.831-0.953). The sum-up method generated balanced results by applying both models and obtained an AUROC of 0.917 (95% CI: 0.863-0.972) with 87% accuracy. The severance-OR method resulted in a better sensitivity of 90%, and the severance-Both method obtained a high specificity of 94%. CONCLUSION Ankle fracture in the AXR could be identified by the trained DCNN algorithm. The selection of ensemble methods can depend on the clinical situation which might help clinicians detect ankle fractures efficiently without interrupting the current clinical pathway. ADVANCES IN KNOWLEDGE This study demonstrated different ensemble strategies of AI algorithms on multiple view AXRs to optimize the performance in various clinical needs.
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Affiliation(s)
- Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou ; Chang Gung University, Taoyuan, Taiwan
| | - Chih-Po Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou ; Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiang Ooyang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou ; Chang Gung University, Taoyuan, Taiwan
| | - Chia-Yi Chou
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou ; Chang Gung University, Taoyuan, Taiwan
| | - Nai-Yu Lin
- Department of Surgery, Chang Gung Memorial Hospital, Linkou; Chang Gung University, Taoyuan, Taiwan
| | - Jia-Yen Lin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Kang Ku
- Department of Medical Imaging and Intervention, New Taipei Municipal TuCheng Hospital, Chang Gung Medical Foundation, New Taipei, Taiwan
| | - Hou-Shian Lin
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou ; Chang Gung University, Taoyuan, Taiwan
| | - Shao-Ku Kao
- Department of Electrical Engineering and Green Technology Research Center, School of Electrical and Computer Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Wu Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Yu-Tung Wu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou ; Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou ; Chang Gung University, Taoyuan, Taiwan
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Chen YJ, Seak CJ, Kang SC, Chen TH, Chen CC, Ng CJ, Lee CW, Su MY, Huang HC, Chen PC, Ooyang CH, Hsieh SY, Cheng HT. A new perspective of the risk of caustic substance ingestion: the outcomes of 468 patients in one North Taiwan medical center within 20 years. Clin Toxicol (Phila) 2020; 59:409-417. [PMID: 33078983 DOI: 10.1080/15563650.2020.1822998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Caustic substance ingestion is frequently life-threatening, and its pathological mechanisms of tissue damage are well documented. However, few studies have assessed the combined effects of pH and the ingested dose on patient outcomes. Additionally, the miscellaneous chemical properties are not immediately available for providing predictive insights to physicians. This study aimed to provide a new perspective of the risk assessment of caustic substance ingestion based on the pH and dose. METHODS The retrospective study analyzed adults treated for caustic substance ingestion at Chang Gung Memorial Hospital between January 1999 and December 2018. Uniformly strict inclusion/exclusion criteria and a double-checked process during chart review were adopted. All patients underwent urgent esophagogastroduodenoscopy (EGD) within 24 h. Caustic mucosal damage was graded using Zargar's modified endoscopic classification. The pH and ingested dose of caustic substances were clearly recorded. Statistical analyses were conducted using IBM SPSS, version 22. RESULTS Based on the 468 enrolled cases, the pH and dose were valuable predictors of the extent of gastrointestinal tract injury, commonly encountered complications, and long-term overall survival outcomes. Risks of mortality and perforation were dose-dependent for acids and pH-dependent for alkalis. The severe EGD findings (grade ≥ 2b) in this study were pH-dependent for both substances and additionally dose-dependent for acids. CONCLUSION Combining pH and dose, we proposed a new perspective for the risk assessment of caustic substance ingestion. Such findings may provide predictive insights for resolving clinical uncertainty before the availability of examination results. "Large doses of acids" and "high pH of alkalis" deserve special attention. This new perspective with a retrospective nature requires further validation.
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Affiliation(s)
- Yu-Jhou Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ching Kang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Hsing Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Cheng Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Image and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chip-Jin Ng
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Yao Su
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.,Board of Directors and Supervisors, Taiwan Association for the Study of Small intestinal Disease (TASSID), Taoyuan, Taiwan
| | - Hsin-Chih Huang
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Pin-Cheng Chen
- Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chun-Hsiang Ooyang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hao-Tsai Cheng
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
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Chen YJ, Seak CJ, Chen CC, Chen TH, Kang SC, Ng CJ, Lee CW, Su MY, Huang HC, Ooyang CH, Hsieh SY, Cheng HT. The Association Between Caustic Ingestion and Psychiatric Comorbidity Based on 396 Adults Within 20 Years. Risk Manag Healthc Policy 2020; 13:1815-1824. [PMID: 33061714 PMCID: PMC7533265 DOI: 10.2147/rmhp.s272527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/04/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose High prevalence of psychiatric comorbidities (PCs) has been widely documented in caustic substance ingestion cases. However, their effect on the clinical features and prognostic outcomes remains unclear due to the paucity of discussion. We report on detailed clinical courses with long-term multifaceted outcomes and review the association between caustic ingestion and each specific PC. Patients and Methods The retrospective chart review included 396 adults (median follow-up, 16.6 months) with and 377 without (control group) PCs treated between 1999 and 2018 at Chang Gung Memorial Hospital. All PCs were diagnosed/confirmed by psychiatrists through face-to-face interviews. Results The PCs predicted serious esophagogastroduodenoscopy grading, higher rates of admission/surgery/intensive care unit stay, increments of systemic/gastrointestinal complications, and poorer 5-year overall survival rates. The poor survival among patients with PCs was highly consistent with their baseline characteristics. Significantly advanced age, more non-PCs, alcoholism, illicit drug abuse, and baseline unhealthy status resulted in statistically higher risks of severe complications and limited recovery. Conclusion PCs changed clinical patterns and had critical roles in the survival outcomes of caustic injury victims. Clinical awareness achieves benefit by limiting injuries in mild cases or allowing emergent interventions in severe cases. Future studies based on worldwide populations are essential for realizing geographic differences.
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Affiliation(s)
- Yu-Jhou Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chen-June Seak
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chien-Cheng Chen
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Medical Image and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Tsung-Hsing Chen
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shih-Ching Kang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chip-Jin Ng
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chao-Wei Lee
- Division of General Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Ming-Yao Su
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan.,Board of Directors and Supervisors, Taiwan Association for the Study of Small Intestinal Disease (TASSID), Taoyuan 33305, Taiwan
| | - Hsin-Chih Huang
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
| | - Chun-Hsiang Ooyang
- Division of Trauma and Emergent Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hao-Tsai Cheng
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.,College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,College of Medicine, Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan 33302, Taiwan.,Department of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan
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Liao CH, Wu YT, Cheng CT, Ooyang CH, Kang SC, Fu CY, Hsu YP, Hsieh CH, Chen CC. An Image-Based Mobile Health App for Postdrainage Monitoring: Usability Study. J Med Internet Res 2020; 22:e17686. [PMID: 32857060 PMCID: PMC7486677 DOI: 10.2196/17686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 01/16/2023] Open
Abstract
Background The application of mobile health (mHealth) platforms to monitor recovery in the postdischarge period has increased in recent years. Despite widespread enthusiasm for mHealth, few studies have evaluated the usability and user experience of mHealth in patients with surgical drainage. Objective Our objectives were to (1) develop an image-based smartphone app, SurgCare, for postdrainage monitoring and (2) determine the feasibility and clinical value of the use of SurgCare by patients with drainage. Methods We enrolled 80 patients with biliary or peritoneal drainage in this study. A total of 50 patients were assigned to the SurgCare group, who recorded drainage monitoring data with the smartphone app; and 30 patients who manually recorded the data were assigned to the conventional group. The patients continued to record data until drain removal. The primary aim was to validate feasibility for the user, which was defined as the proportion of patients using each element of the system. Moreover, the secondary aim was to evaluate the association of compliance with SurgCare and the occurrence of unexpected events. Results The average submission duration was 14.98 days, and the overall daily submission rate was 84.2%. The average system usability scale was 83.7 (SD 3.5). This system met the definition of “definitely feasible” in 34 patients, “possibly feasible” in 10 patients, and “not feasible” in 3 patients. We found that the occurrence rates of complications in the SurgCare group and the conventional group were 6% and 26%, respectively, with statistically significant differences P=.03. The rate of unexpected hospital return was lower in the SurgCare group (6%) than in the conventional groups (26%) (P=.03). Conclusions Patients can learn to use a smartphone app for postdischarge drainage monitoring with high levels of user satisfaction. We also identified a high degree of compliance with app-based drainage-recording design features, which is an aspect of mHealth that can improve surgical care.
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Affiliation(s)
- Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Yu-Tung Wu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chun-Hsiang Ooyang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Shih-Ching Kang
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Yu-Pao Hsu
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Chang Gang University, Taoyaun, Taiwan
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Liao CH, Ooyang CH, Chen CC, Liao CA, Cheng CT, Hsieh MJ, Hsieh CH, Tsai CY, Yeh TS, Yeh CN, Fu CY. Video Coaching Improving Contemporary Technical and Nontechnical Ability in Laparoscopic Education. J Surg Educ 2020; 77:652-660. [PMID: 31859226 DOI: 10.1016/j.jsurg.2019.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/16/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE A video coaching (VC) system has been developed in surgical education. This study compares the educational effect on technical and nontechnical skills of the VC method for teaching laparoscopic surgery. DESIGN We conducted a prospectively randomized study of an education program to teach laparoscopic procedures. SETTING The study was performed at the Chang Gung Memorial Hospital, a university hospital in Taiwan. PARTICIPANTS We enrolled sixteen first- or second-year surgical residents.The participants were randomized into VC and conventional teaching (CT) groups, and their surgical skills were judged by the Global Operation Assessment of Laparoscopic Skills (GOALS) and the Objective Structured Assessment of Technical Skills (OSATS). Nontechnical skills were evaluated by the Non-Technical Skills for Surgeons (NOTSS) assessment and self-efficacy questionnaires (SEQs). After the program, posttraining scores were compared to assess improvements. RESULTS The 16 enrolled participants finished the entire course and completed all the videos during the study period. Comparing the VC and CT groups, we found that the pretraining GOALS, OSATS, NOTSS and SEQ scores were similar between both groups. However, after training, the OSATS score gain was higher in the VC groupthan in the CT group (9.25 ± 2.05 vs. 6.50 ± 1.51, p=0.009). Regarding nontechnical skills, the NOTSS score improved more in the VC group than in the CT group (5.50 ± 0.93 vs. 4.25 ± 0.89, p=0.015). The SEQ score was also higher in the VC group (32.13 ± 2.10) than in the CT group (29.50 ± 1.77), with a significant difference (p=0.018). CONCLUSION VC can help surgeons build their expertise using a more accessible method. Additionally, VC can shorten the learning curve and improve self-efficacy, thereby contributing to surgeons' education.
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Affiliation(s)
- Chien-Hung Liao
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiang Ooyang
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- Department of Physical medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taoyuan Taiwan
| | - Chien-An Liao
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tung Cheng
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Department of Cardiovascular and thoracic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Hsun Hsieh
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Traumatology and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Liao CH, Hsieh FJ, Chen CC, Cheng CT, Ooyang CH, Hsieh CH, Yang SJ, Fu CY. The Prognosis of Blunt Bowel and Mesenteric Injury-the Pitfall in the Contemporary Image Survey. J Clin Med 2019; 8:jcm8091300. [PMID: 31450573 PMCID: PMC6780049 DOI: 10.3390/jcm8091300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/01/2019] [Accepted: 08/22/2019] [Indexed: 11/28/2022] Open
Abstract
Delayed diagnosis and intervention of blunt bowel and mesenteric injury (BBMI) is a hazard because of poor prognosis. Computed tomography (CT) is the standard imaging tool to evaluate blunt abdominal trauma (BAT). However, a high missed diagnosis rate for BMMI was reported. In this study, we would like to evaluate the presentation of CT in BBMI. Moreover, we want to evaluate the impact of deferred surgical intervention of BBMI on final prognosis. We performed a retrospective study from 2013–2017, including patients with BAT and BBMI who underwent surgical intervention. We evaluated clinical characteristics, CT images, and surgical timing, as well as analyzed the prognosis of BBMI. There were 6164 BAT patients and 188 BMI patients included. The most common characteristics of CT were free fluid (71.3%), free air (43.6%), and mesenteric infiltration (23.4%). There were no single characteristics of a CT image that can predict BBMI significantly. However, under close monitoring, we find that deferred intervention did not prolong the hospital and intensive care unit stays and did not worsen the prognosis and mortality.
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Affiliation(s)
- Chien-Hung Liao
- Department of Trauma and emergency surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan
| | - Feng-Jen Hsieh
- Department of Trauma and emergency surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and emergency surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan
| | - Chun-Hsiang Ooyang
- Department of Trauma and emergency surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and emergency surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan
| | - Shang-Ju Yang
- Department of Trauma and emergency surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and emergency surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fuhsing St., Taoyuan 333, Taiwan.
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Yang SJ, Ooyang CH, Wang SY, Liu YY, Kuo IM, Liao CH, Wu TJ. Adenosquamous carcinoma of the ampulla of Vater - a rare disease at unusual location. World J Surg Oncol 2013; 11:124. [PMID: 23721111 PMCID: PMC3694520 DOI: 10.1186/1477-7819-11-124] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 05/17/2013] [Indexed: 11/10/2022] Open
Abstract
Adenosquamous carcinoma is defined as a tumor in which both glandular and squamous elements are histologically malignant. Although some published studies have analyzed and discussed adenosquamous carcinomas, hybrid malignancy of the ampulla of Vater has rarely been discussed thus far in the literature. In this study, we report the case of a 64-year-old man who presented with jaundice and intermittent abdominal dull pain that persisted for several weeks. The patient was diagnosed with adenosquamous carcinoma of the ampulla of Vater and underwent pancreaticoduodenectomy. The final diagnosis was adenosquamous carcinoma of the ampulla of Vater, T3N1M0, stage IIB. Although R0 resection was performed, he had multiple liver metastases 2 months after the operation; he died 4 months later. Upon reviewing the medical records of our institute, we identified 4 patients who were diagnosed with adenosquamous carcinoma of the ampulla of Vater in the past 2 decades. We also identified only five reported cases of this lesion in the English literature. Adenosquamous carcinoma of the ampulla of Vater is a rare disease with a dismal prognosis. Surgical intervention does not appear to prolong patient survival. Early recurrence and distal metastasis may be encountered after surgery.
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Affiliation(s)
- Shang-Ju Yang
- Department of Traumatology and Emergency Surgery, Chang-Gung memorial hospital, Linkou Fu-Shin Street, Taoyuan 333, Taiwan
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Liao CH, Liu YY, Chen CC, Wang SY, Ooyang CH, Kuo IM, Yeh TS. Single-Incision Laparoscopic-Assisted Surgery for Small Bowel Obstruction. J Laparoendosc Adv Surg Tech A 2012; 22:957-61. [DOI: 10.1089/lap.2012.0193] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chien-Hung Liao
- Department of Traumatology and Emergency Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yin Liu
- Department of General Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Department of Traumatology and Emergency Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiang Ooyang
- Department of Traumatology and Emergency Surgery, Chang Gung University, Taoyuan, Taiwan
| | - I-Ming Kuo
- Department of Traumatology and Emergency Surgery, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung University, Taoyuan, Taiwan
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Kuo IM, Liao CH, Hsin MC, Kang SC, Wang SY, Ooyang CH, Fang JF. Blunt diaphragmatic rupture - a rare but challenging entity in thoracoabdominal trauma. Am J Emerg Med 2012; 30:919-24. [DOI: 10.1016/j.ajem.2011.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/24/2011] [Accepted: 03/25/2011] [Indexed: 12/23/2022] Open
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