Body packing of illicit drugs is one of the means of drug trafficking. Asymptomatic suspects may be brought in by law-enforcement officers for body search of possible drug packing inside the body. Symptomatic body packers may present with gastrointestinal obstruction or toxicity of the leaking drugs inside the packets. Management strategies are largely determined by the modes of presentation. Asymptomatic persons must be persuaded with every effort for consent to the body cavity search as well as treatment for the safe passage of any packed drugs to avoid possible complications and medico-legal sequelae. Abdominal X-rays and computed tomography can be helpful in confirming the presence of drug packets and in identifying possible packet leakage. Gastrointestinal decontamination, whole bowel irrigation, use of specific antidote as well as operative intervention may be indicated. Emergency physicians must be conversant with the medical and legal aspects of the management of these body packers.
A study was carried out in a district hospital located close to the Hong Kong-Shenzhen border, in order to get a picture of the epidemiology of diseases and injuries sustained by Hong Kong residents in China. The emergency medical treatment provided and the degree of patient satisfaction were also analysed. The majority of the patients were adult males. Trauma constituted more than 50% of the attendance, with traffic accident and common assault being the leading causes. This group of Hong Kong residents preferred to be treated in Hong Kong hospitals because of perceived better quality of care. There was a high demand on the local ambulance service and this might have financial and resource implications.
Objective To obtain an idea on patient acceptance of a two-day medication supply policy in emergency departments, an opinion survey was carried out at the Accident & Emergency (A&E) department of North District Hospital. Methods Questionnaire were distributed to 200 ambulatory patients attending the A&E department on 4 April 2000, asking for their opinions on the reasonable duration of medication supply and its possible impact on emergency department misuse. The questionnaires were collected and the data analysed. Results A total of 78 questionnaires (39%) were returned. Forty-nine respondents (62.8%) accepted that dispensing two days of medications from emergency departments reasonable. Ten out of the 27 patients who disagreed on two-day supply (37.0%) considered that a three-day supply would be optimal. More than half of the respondents (52.6%) agreed with the hypothesis that a two-day supply policy would discourage misuse of emergency department service. Conclusion The great majority of patients attending A&E departments supported the prescription of two to three days supply of medication. This policy has important resource implication. However, its possible impact on misuse of emergency department service is controversial. (Hong Kong j.emerg.med. 2002;9:3–9)
A 55-year-old man was admitted in August 2014 as an emergency with sudden onset of vertigo, dizziness, and left-sided weakness. Initial Glasgow Coma Scale score was 15/15. Physical examination revealed left hemiparesis and an upgoing left plantar response. Both pupils were reactive with the left one slightly smaller than the right. Muscle power was grade 4 over 5 for the left upper and lower limbs. Urgent computed tomography (CT) examination of the brain revealed a hyperdense basilar artery, which was initially unnoticed (Fig 1). Subsequently, the patient's level of consciousness rapidly decreased and intubation was required. Urgent magnetic resonance angiography (MRA) identified loss of flow-related signals along the basilar artery (Fig 2). Diffusionweighted imaging (DWI) found restricted diffusion at the pons and bilateral cerebellar hemispheres (Fig 3). The brainstem appeared normal on the T2-weighted images and there was loss of flow void at the basilar artery (Fig 4). These neuroimaging findings were consistent with acute occlusion of the basilar artery, cytotoxic oedema at the brainstem and bilateral cerebellum. The patient died a week later despite intensive medical intervention.Acute basilar occlusion is a true neurological emergency. Early diagnosis and treatment are essential to prevent brainstem infarct and death. It is uncommon and accounts for 1% of all strokes. 1 Nonetheless, when present, a hyperdense basilar artery is evident on non-contrast CT images in approximately 65% of patients 2 and enables the diagnosis to be confirmed. Hyperdensity at the occluded basilar artery is due to an intraluminal blood clot and is analogous to the 'hyperdense middle cerebral artery sign' of acute thromboembolism of middle cerebral artery.A very high index of suspicion is required because CT findings can be subtle. Diagnosis requires careful scrutiny of the basilar artery and the posterior circulation. Hyperdense basilar artery may be the only sign before development of an established infarct. Pitfalls to diagnosis include vascular wall calcification secondary to atherosclerosis, partial volume averaging, haematocrit elevation, and vessel dilation. Meticulous evaluation of the CT images of thin collimation and narrowed window, careful comparison of the density of the basilar artery with other intracranial vessels and previous CT images, if available, will be helpful. A blood clot within the basilar artery will present as a hyperdense intraluminal filling defect. Vascular calcification may present as rim or curvilinear peripheral hyperdensity. In patients with hemo-concentration, there should be generalised increased attenuations of the intracerebral vasculature instead of focal abnormality.
We propose a modified convolutional neural network (CNN) tailor-made for computed tomography (CT) image disease recognition to assist doctors in disease diagnosis. First, we analyze the effects of varying the CNN activation function and pooling parameters, as well as the CNN's performance using one data set. Second, we address the activation error that occurs when the sample data size is increased by preprocessing images by an enhancement technique, adjusting the activation function and initialization weighting, training/testing the target, and adaptively extracting features. We found that our method alleviates overfitting with these techniques. The experimental results show that our proposed scheme improves the recognition rate and can better generalize findings.
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