bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydatid Cyst of the Liver: A Case Report and Literature Review
Authors: Yuan Wei‐Hsin , Lee Rheun‐Chuan , Chou Yi‐Hong , Chiang Jen‐Huey , Chen Yuh‐Kuen , Hsu Hui‐Chen
Published: July 2009

Taiwan is nearly free from hydatid disease. We report a case of hydatid cyst of the liver in a 37‐year‐old man who originally lived in India and had migrated to Taiwan 2 years earlier. He presented with right upper quadrant pain and intermittent low‐grade fever. Both sonography and computed tomography (CT) demonstrated a cystic lesion with vesicles at its periphery in segments 6 and 7 of the liver. A hydatid cyst was diagnosed. The patient underwent radical excision of the cyst with total removal without opening the wall. He also received pre‐ and postoperative oral mebendazole. Pathology showed a hydatid cyst consisting of three layers: the inner single nucleated geminal layer, the middle acellular laminated layer, and the outer pericyst originating from inflammatory and hepatic cells. This case highlights that accurate preoperative diagnosis of hydatid disease can be made from personal history, typical sonography and CT study in non‐endemic areas.
Huge Spinal Extradural Meningeal Cyst in the Thoracolumbar Spine: A Case Report of a Rare Cause of Low Back Pain
Authors: Liu Su‐Hao , Ho Jih‐Tsun , Yip Chi‐Man , Liao Wei‐Chuan , Hsu Shu‐Shong , Lai Ping‐Hong , Tseng Hui‐Hwa
Published: July 2009

Symptomatic intraspinal extradural meningeal cysts are rare. We present the case of a 17‐year‐old female with low back pain, progressive numbness, and radiation pain to the flank and lower limbs. Magnetic resonance imaging and computed tomographic myelography revealed a huge intraspinal extradural meningeal cyst extending from T12 to L3 with cord and dural sac compression. The patient underwent surgery to open the cyst and close the connecting dural defect. Pathologic examination of the cyst disclosed non‐specific fibrous connective tissue without an inner arachnoid single‐cell lining. She achieved complete recovery after the operation. There was no recurrence of the cyst at a 2‐year follow‐up.
Determination of the Minimum Effective Dosages of Praziquantel, Albendazole, and Mebendazole Against Clonorchis Sinensis Infection in Rats
Authors: Fan Ping‐Chin , Wu Chin‐Cheng , Huang Ping , Yen Chih‐Wei
Published: July 2009

In order to determine the minimum effective dosages of praziquantel, albendazole, and mebendazole against Clonorchis sinensis infection in Sprague‐Dawley rats, each rat was infected with 30 metacercariae and treated with one of three drugs. The rats were killed and examined 25 days after praziquantel treatment or 11 days after albendazole or mebendazole treatment. The minimum effective dosages were a single dose of praziquantel 375 mg/kg, albendazole 150 mg/kg, and mebendazole 150 mg/kg. Trials are required to determine whether these dosages are useful in the treatment of human clonorchiasis.
HCV Infection Complicated with Nephrotic Syndrome, Immune Complex Crescentic Glomerulonephritis and Acute Renal Failure: A Case Report
Authors: Chen Yi‐Chun , Kuo Mei‐Chuan , Chen Hung‐Chun , Lai Yung‐Hsiung , Hwang Shang‐Jyh
Published: July 2009

There is ample evidence suggesting that hepatitis C virus (HCV)‐associated autoimmunity plays a role in a broad spectrum of autoimmune diseases, which are usually overlooked. We report on a case of nephrotic syndrome, palpable purpura, cryoglobulinemia, hypocomplementemia, and acute renal failure complicated by immune complex glomerulonephritis (GN). The patient is a 64‐year‐old man with HCV infection, who was initially considered to present only an HCV‐associated cryoglobulinemic GN. However, renal biopsy revealed a “full house” immune complex crescentic GN, which led to our subsequent investigation. The attending clinicians faced what is a common dilemma, where an HCV‐associated autoimmune disease inevitably switches to a lupus‐like GN. Hence, we also discuss treatment.
Basal Cell Carcinoma of the Nipple‐areola Complex: A Case Report
Authors: Huang Ching‐Wen , Pan Ching‐Kuen , Juan Chung‐Chou , Ker Chen‐Guo , Shih Teng‐Fu , Tsai Cheng‐Chien
Published: July 2009

Basal cell carcinoma (BCC) of the nipple‐areola complex is very rare. Only 24 cases were reported in the literature and 17 (70.8%) of these cases arose in men. Most of the cases were treated with simple excision. We report on a case of BCC of the nipple‐areola complex in a 46‐year‐old woman, treated with partial mastectomy. Metastasis to the axillary lymph nodes had been noted in 3 (12.5%) of the 24 reported cases of BCC of the nipple‐areola complex. Thus, we applied the concept of the sentinel lymph node to detect possible metastases of axillary lymph nodes, letting us avoid the unnecessary axillary lymph node dissection and possible future morbidity.
Value of Nodal Drainage Patterns and Tumor Location from Lymphoscintigraphic Mapping in Detecting Axillary Sentinel Lymph Node Status in Breast Cancer: Experience at Kaohsiung Medical University Hospital
Authors: Chen Yu‐Wen , Lai Yung‐Chang , Hsu Chien‐Chin , Chuang Ya‐Wen , Hou Ming‐Feng
Published: July 2009

Sentinel lymph node (SLN) biopsy is an alternative to axillary node dissection for staging breast cancer treatment. In this article, we investigated nodal drainage patterns and tumor location using lymphoscintigraphy to predict the axillary sentinel lymph node status. We enrolled 88 patients with clinically suspicious or biopsy‐proven breast cancer from March 2001 to October 2002. The average age of subjects was 48 ± 4 years and the clinical stage was T1‐2N0Mx. Tc‐99m sulfur colloid was used in a hybrid combination of subdermal and perilesional injections around the selected corners of the tumor or biopsy site. Sentinel lymphoscintigraphy was performed 16‐20 hours before surgery. Sentinel nodes were marked on the skin. An intraoperative gamma probe was used to confirm the sentinel lymph node location before biopsy. Most primary tumors were in the outer upper quadrant (52.3%), followed by the inner upper quadrant (17.0%), outer inferior quadrant (12.5%), central areolar area (11.4%), and inner inferior quadrant (6.8%). The nodal drainage patterns on 2‐hour lymphoscintigraphy were as follows: axillary alone (76.1%), internal mammary nodes alone (1.1%), both axillary and internal mammary nodes (11.4%), and no drainage (11.4%). Internal mammary lymphatic drainage is related to tumor location in the inner quadrants of the breast. About 11.4% of all patients had poorly identified SLNs on lymphoscintigraphy within a 2‐hour period, but there was improvement in the overall detection rate up to 95% by intraoperative gamma probe the next day. Preoperative lymphoscintigraphic mapping has value in providing individual lymphatic drainage patterns and tumor location that are important in the interpretation of the results of SLN biopsy during surgery.
Effects of Laser In Situ Keratomileusis on the Corneal Endothelium
Authors: Chiang Chun‐Chi , Lin Jane‐Ming , Bair Pei‐Jane , Chen Wen‐Lu , Tsai Yi‐Yu , Tseng Sung‐Huei
Published: July 2009

The purpose of this study was to assess the effects of laser in situ keratomileusis (LASIK) on the corneal endothelium. In a prospective study, the corneal endothelium of 87 eyes (45 patients) was examined before and 1 month after LASIK. Patients were divided into two groups: people who wear contact lenses (48 eyes) and people who had never worn contact lenses (39 eyes). The corneal endothelium was analyzed for cell density, percentage of hexagonal cells, and coefficient of variation (CV) of cell size. The mean cell density and percentage of hexagonal cells was significantly higher 1 month after LASIK for all 87 eyes. However, the mean CV of cell size was not significantly different. In contact lens wearers, there was a significant increase in mean cell density and percentage of hexagonal cells, but there was no significant change in mean CV of cell size after LASIK. Among patients who had never worn contact lenses, no significant changes were noted in mean cell density, percentage of hexagonal cells, or mean CV of cell size. In this study, LASIK caused no damage to the corneal endothelium. Postoperative improvements in the mean cell density and percentage of hexagonal cells in patients who were contact lens wearers may be related to the discontinuance of contact lens use after LASIK.
Abdominopelvic Perivascular Epithelioid Cell Tumor with Overt Malignancy: A Case Report
Authors: Chen I‐Yu , Yang Sheau‐Fang , Chai Chee‐Yin , Chen Fang‐Ming
Published: July 2009

Perivascular epithelioid cell tumor (PEComa) is a group of rare tumors composed of epithelioid cells with characteristic perivascular distribution and co‐expression of the melanogenic marker HMB‐45 and muscular markers. There are no documented parameters referring to the biologic behavior of PEComa. We report an abdominopelvic PEComa with overt malignancy in a 16‐year‐old girl. Histologically, the tumor showed the typical morphophenotypic characteristics of PEComa. Though the cytologic appearance of the tumor cells was relatively bland, the extensive necrosis, presence of lymph node metastases, and surrounding tissue invasion were all indicative of malignancy. Relapse of the tumor with multiple lymphadenopathy shortly after debulking surgery for the primary lesion, and postoperative adjuvant chemotherapy, further denoted its aggressive behavior.
Rapid Resolution of Infantile Acute Subdural Hematoma: A Case Report
Authors: Huang Shu‐Hung , Lin Ching‐Kuo , Loh Joon‐Khim , Lee Hui‐Mi , Kwan Aij‐Lie , Howng Shen‐Long
Published: July 2009

Subdural hematomas in infants are uncommon but usually result from non‐accidental trauma or from trauma associated with motor vehicle accidents. This report describes the case of an infant with a traumatic acute subdural hematoma that resolved within 65 hours. A 23‐month‐old boy fell from a height of approximately 10 m. Brain computed tomography disclosed a left subdural hematoma with midline shift. The associated clots resolved spontaneously within 65 hours of the injury. Although they may mimic more clinically significant subdural hematomas, such collections of clots are likely to be located at least partly within the subarachnoid space. Their recognition may influence decisions regarding both surgical evacuation and the likelihood of non‐accidental injury. Clinical and radiographic features distinguishing these “disappearing subdural hematomas” from more typical subdural hematomas are discussed.
Embolization of Arteriovenous Fistula After Radiosurgery for Multiple Cerebral Arteriovenous Malformations
Authors: Luo Chao‐Bao , Guo Wan‐Yuo , Teng Michael MH , Chang Feng‐Chi , Pan David H.
Published: July 2009

Cerebral arteriovenous malformation (CAVM) associated with arteriovenous fistula (AVF) is rare. It may be difficult to identify hemodynamic details of mixed CAVM and AVF, even when using x‐ray cerebral angiography (digital subtraction angiography). We report on a 37‐year‐old male patient with headache that led to an initial diagnosis of deep frontotemporal CAVM. The first DSA revealed engorged, tortuous, and high‐flow venous drainage in addition to clusters of vasculature niduses. The patient was initially treated using !‐knife radiosurgery (GKRS), which resulted in partial nidus obliteration, documented by a series of follow‐up magnetic resonance imaging (MRI). However, the high‐flow venous drainage remained, seen on MRI as engorged venous pouches. Clinically, the patient was bothered by persistent headache and bruits after GKRS. Follow‐up DSA 3 years after GKRS confirmed a small remnant CAVM nidus and a nearby AVF, separated from and lateral to the original CAVM nidus in the ipsilateral deep temporal lobe. When the initial DSA was reviewed, it revealed that the AVF was difficult to define because of superimposition of the nidus and engorged drainage vessels. Embolization of the AVF using electrodetachable coils resulted in total occlusion of the AVF. The patient's symptoms resolved immediately after embolization. This case suggests that superselective angiography using a microcatheter may be necessary for the initial diagnosis of CAVM associated with AVF with high‐flow and engorged venous drainage. For CAVM patients with persistent symptoms after radiosurgery and engorged venous drainage when CAVM is expected to be cured, a microcatheter and superselective endovascular approach may offer diagnosis. Immediate embolization for associated AVF in the same angiographic session may thereby improve neurologic deficits and reduce hemorrhagic risk during the latency after GKRS.
Giant Rhinolith: A Case Report
Authors: Hsiao Ji‐Chang , Tai Chih‐Feng , Lee Ka‐Wo , Ho Kuen‐Yao , Kou Wen‐Rei , Wang Ling‐Feng
Published: July 2009

A rhinolith is a stone that forms in the nose. It occurs as a result of the solidification of mucus and nasal debris by mineral salts, calcium, magnesium phosphate and carbonate. It can be seen on radiographs as a radiopaque object in the nasal fossa and may be confused with several pathologic entities that will call for more invasive surgical procedures. We present the first case of a giant rhinolith, possibly arising from aspergillosis, and discuss its clinical and radiologic features.
Pig as a Favorable Animal for Taenia Saginata Asiatica Infection
Authors: Fan Ping‐Chin , Chung Win‐Cheng , Lin Chung‐Yung , Wu Chin‐Cheng
Published: July 2009

The epidemiology of Taenia saginata in some parts of Asia is confusing, in that beef does not appear to be the source of infection. In some areas, beef is either not available or not eaten raw, whereas pork at times is eaten uncooked. In light of this situation, we have exposed pigs and other animals to infection with strains of T. saginata to establish their ability to serve as intermediate hosts. Eggs of Taiwan Taenia, Korea Taenia, Indonesia Taenia, Thailand Taenia, Philippines Taenia, Ethiopia Taenia, and Madagascar Taenia were fed to 83 pigs of three strains: 43 Small‐Ear Miniature (SEM), 34 Landrace Small‐Ear Miniature (L‐SEM), and 6 Duroc‐Yorkshire‐Landrace (DYL). We also fed the eggs to 10 Holstein calves, 17 Sannean goats, and 4 monkeys (Macaca cyclopis). We succeeded in infecting SEM (infection rate 88%, cysticercus recovery rate 19.1%), L‐SEM (83%, 1.1%), and DYL (100%, 0.3%) pigs with Taiwan Taenia; SEM (100%, 1.7%), L‐SEM (100%, 5.6%), and DYL (100%, 0.06%) pigs with Korea Taenia; SEM (100%, 22%) and L‐SEM (100%, 1.6%) pigs with Indonesia Taenia; SEM (75%, 0.06%) pigs with Thailand Taenia SEM (100%, 11%) pigs with Philippines Taenia; SEM (80%, 0.005%) pigs with Ethiopia Taenia; SEM (100%, 0.2%) pigs with Madagascar Taenia. Holstein calves became infected with Taenia from Taiwan (100%, 1.1%), Korea (100%, 0.03%), Thailand (100%, 0.2%), and the Philippines (100%, 6%); however, the cysticerci of Taenia from Korea, Thailand, and the Philippines were degenerated and/or calcified. Sannean goats became infected with Taenia from Taiwan (33%, 0.01%) and Korea (50%, 0.02%), while monkeys became infected with Taenia from Taiwan (50%, 0.01%). However, the cysticerci were degenerated and/or calcified. Therefore, these strains of pig seem to be favorable animal models for experimental studies of T. saginata‐like tapeworms, with the SEM pig the most favorable.
Intestinal Obstruction During Pregnancy
Authors: Chang Yu‐Tang , Huang Yu‐Sheng , Chan Hon‐Man , Huang Che‐Jen , Hsieh Jan‐Sing , Huang Tsung‐Jen
Published: July 2009

Intestinal obstruction is a rare cause of acute abdominal pain during pregnancy. We reviewed and analyzed the medical records of four pregnant women with intestinal obstruction, treated at the Department of Surgery in the Kaohsiung Medical University Hospital during a period of 19 years, between June 1984 and December 2002. Their ages ranged from 22 to 35 years (mean, 28 yrs). Three cases had had prior lower abdominal surgery. Adhesion was the unique finding in all four patients during the operation. Enterolysis was needed to release the intestinal obstruction in three of the patients; the fourth required resection and anastomosis of the ileum as a result of volvulus. Premature labor was prevented with tocolysis in two patients. The results of this study lead us to emphasize the importance of close observation and early surgery to avoid intestinal strangulation if a pregnant woman who develops intestinal obstruction has an old surgical scar on her abdomen. Premature labor may be avoided with tocolysis.
Jejunal Tuberculosis: Incidental Finding on an FDG‐PET Scan
Authors: Wang Hsin‐Yi , Lin Wan‐Yu
Published: July 2009

A 32‐year‐old male had suffered from persistent dull epigastric pain, constipation, postprandial vomiting, and body‐weight loss for 2 months. An abdominal computed tomography (CT) scan showed thickening of the proximal jejunal wall. He was also referred to our center for an fluoro‐2‐deoxy‐D‐glucose‐positron emission tomography (FDG‐PET) scan because his tumor marker CA19‐9 was above 800 ng/mL and malignancy was suspected. The PET scan showed an FDG‐avid lesion over the upper left abdomen. Endoscopy of the small intestine revealed focal thickening of the mucosal fold and skip ulcer lesions in the jejunum. Culture from the biopsy tissue proved the diagnosis of Mycobacterium tuberculosis infection. No evidence of pulmonary tuberculosis was detected during further evaluation.
Pneumorrhachis Following Lumbar Puncture: A Case Report
Authors: Lin Lung‐Chang , Liao Yu‐Mei , Yang Rei‐Cheng
Published: July 2009

We report a rare case of pneumorrhachis following lumbar puncture. A 4‐year‐old boy was admitted to our hospital with seizures following a head injury and upper respiratory infection. Lumbar puncture was performed to rule out central nervous system infection. In response to leg pain and weakness a few hours after the procedure, lumbar spine computed tomography (CT) revealed pneumorrhachis at the level of L5‐ S1. In a follow‐up CT scan 3 days later, the pneumorrhachis resolved spontaneously. Pneumorrhachis following diagnostic lumbar puncture is an extremely rare condition. We discuss pneumorrhachis and review cases in the literature.
Effects of Antiglaucoma Drugs on Calcium Mobility in Cultured Corneal Endothelial Cells
Authors: Wu Kwou‐Yeung , Hong Show‐Jen , Wang Hwei‐Zu
Published: July 2009

The aim of this study was to estimate the effects of various antiglaucoma drugs including betaxolol, timolol, levobunolol, brimonidine, carteolol, dipivefrin, dorzolamide, brinzolamide, latanoprost, unoprostone, and pilocarpine on intracellular free Ca2+ ([Ca2+]i) mobility in cultured bovine corneal endothelial cells. Various antiglaucoma drugs were diluted from original concentrations to 1/100, 1/1,000, and 1/10,000. The [Ca2+]i mobility was studied by spectrofluorophotometry after loading with the ester of fura‐2 (fura‐2/AM). It was found that timolol (58 μM and 5.8 μM), levobunolol (171 μM, 17.1 μM, and 1.71 μM), betaxolol (162 μM, 16.2 μM, and 1.62 μM), carteolol (680 μM and 68 μM), dipivefrin (28 μM and 2.8 μM), dorzolamide (616 μM and 61.6 μM), brinzolamide (260 μM), latanoprost (1.1 μM), unoprostone (28.2 μM, 2.82 μM, and 0.282 μM), and pilocarpine (408 μM and 40.8 μM) induced a significant increase in [Ca2+]i. Nevertheless, only brimonidine (68 μM and 6.8 μM) decreased [Ca2+]i concentration significantly. Benzalkonium chloride preservative did not affect [Ca2+]i after addition of 0.001, 0.0001 and 0.00001 mg/mL to cells. These results indicate that all antiglaucoma drugs may affect the physiologic function of corneal endothelial cells through change of [Ca2+]i.mobility.
Wisconsin Card Sorting Test Performance after Putaminal Hemorrhagic Stroke
Authors: Su Chwen‐Yng , Wuang Yee‐Pay , Chang Jui‐Kun , Guo Nai‐Wen , Kwan Aij‐Lie
Published: July 2009

The purpose of this study was to compare the performance differences in the Wisconsin Card Sorting Test (WCST) between 55 patients with putaminal hemorrhage (PH) 3 months after stroke and 69 age‐matched normal controls. Impairment on WCST was defined as performance greater than 1.64 standard deviation below the control mean. A multivariate analysis of covariance (MANCOVA) controlling for education yielded a significant main effect for group but not for education and interaction of group × education. Univariate analyses revealed significant between‐group differences in five WCST measures, including perseverative errors (PE), perseverative responses (PR), conceptual‐level responses (CLR), number of categories completed (NCC), and trials to complete the first category (TCC). For patients with PH, z‐scores for two WCST indices were within the impaired range: TCC and PR. A high percentage of patients (40‐47%) scored in the designated impaired range on NCC, PR, PE, and TCC. The WCST variables discriminated patients from controls with an overall accurate classification rate of 91.9%. Of these, the variables that contributed most to the differentiation between patients and normal controls were PE, CLR, and total number correct (TNC) (a standardized canonical discriminant function coefficient > 0.40). Finally, no significant hemispheric laterality effects emerged on any of the WCST variables. The results of this study provide further evidence of impaired mental set shifting in stroke patients with PH. The implications for rehabilitation professionals are discussed, and recommendations for further research are made.
Spontaneous Pneumothorax as a Complication of Septic Pulmonary Embolism in an Intravenous Drug User: A Case Report
Authors: Sheu Chau‐Chyun , Hwang Jhi‐Jhu , Tsai Jong‐Rung , Wang Tung‐Heng , Chong Inn‐Wen , Huang Ming‐Shyan
Published: July 2009

Infective endocarditis has been the major cause of morbidity and mortality among intravenous drug users (IDUs) with infections, mostly involving the tricuspid valve and presenting multiple septic pulmonary embolisms. Numerous pulmonary complications of septic pulmonary embolism have been described, but only a few have reported spontaneous pneumothorax. Our patient, a 23‐year‐old heroin addict, was hospitalized for tricuspid endocarditis and septic pulmonary embolism. Acute onset of respiratory distress occurred on his seventh hospital day and rapidly resulted in hypoxemia. Immediate bedside chest radiograph demonstrated left pneumothorax. It was thought to be a spontaneous pneumothorax, because he had not undergone any invasive procedure before the occurrence of pneumothorax. His clinical condition improved after the insertion of an intercostal chest tube. He later underwent surgery to replace the tricuspid valve as a result of the large size of the vegetation and poor control of infection. He ultimately survived. Pneumothorax is a possible lethal complication of septic pulmonary embolism in IDUs with right‐sided endocarditis and should be considered in such patients when respiratory distress occurs acutely during their hospitalization.
Transpositional Adipofascial Flaps for Complicated Acute Finger Injuries
Authors: Poon Kein Boon , Chien Song‐Hsiung , Lin Gau‐Tyan , Fu Yin‐Chih
Published: July 2009

Seven patients who presented with complicated acute finger injuries were treated successfully with local transpositional adipofascial flaps. This is a one‐stage procedure with advantages of simplicity and rapidity. This flap is thin with good pliability and provides a very versatile and reliable covering for soft‐tissue defects of the fingers. Full‐thickness skin grafts were applied to the raw surface of the adipofascial flaps in all patients. All cases had excellent wound healing and restored full range of motion. This procedure facilitates early wound healing and early range of motion for finger joints; it also reduces wound pain, minimizes scar formation, and eliminates the need for second‐stage surgery.
A Comparative Study of Three Fecal Occult Blood Tests in Upper Gastrointestinal Bleeding
Authors: Chiang Chien‐Hua , Jeng Jen‐Eing , Wang Wen‐Ming , Jheng Bing‐Hong , Hsu Wan‐Ting , Chen Bai‐Hsiun
Published: July 2009

The purpose of this study was to evaluate the performance characteristics of three fecal occult blood tests (FOBTs): the chemical o‐toluidine test, the immunochemical OC‐Hemodia test, and the immunochromatographic Quick Chaser Occult Blood (QCOB) test, which detect human hemoglobin and transferrin simultaneously in cases of upper gastrointestinal (GI) bleeding. Included were 48 FOBT specimens in 48 consecutive admission cases of upper GI bleeding (endoscopy confirmed). We excluded those fecal specimens with an obvious tarry and bloody appearance. The QCOB test revealed the highest positive rates of 33/48 (68.8%), and significantly higher positive rates than that of the OC‐Hemodia test and o‐toluidine test (p< 0.025 and < 0.01, respectively). In the patient group with upper GI bleeding due to gastric and duodenal ulcers, the QCOB test had higher positive rates (68.6%) than did the o‐toluidine test (34.3%) (p< 0.01). There was no fecal specimen that was positive for the o‐toluidine test or OC‐Hemodia test and was negative for the QCOB test. Our results reveal that the QCOB test has significantly higher positive rates of fecal occult blood than either the OC‐Hemodia test or o‐toluidine test. The QCOB test is better than the other two tests for detecting occult blood in patients with upper GI bleeding.
Stratus Optical Coherence Tomography for Evaluating Optic Disc Pits Associated with Maculopathy Before and After Vitrectomy: Two Case Reports
Authors: Chiu Yu‐Te , Chen Hsin‐Yi , Tsai Yi‐Yu , Lin Jane‐Ming , Chiang Chun‐Chi
Published: July 2009

Optic disc pit (ODP) can be either congenital or acquired. Congenital ODP is typically unilateral, and the visual acuity and visual field are normal unless associated with macular serous detachment, which occurs in about 25‐75% of cases. Acquired ODP is known as an important risk factor for progressive visual field loss in glaucoma. The fundus finding of congenital ODP includes oval depression involving the optic disc, with or without macular serous detachment. We used third‐generation Stratus optical coherence tomography (Straus OCT) to investigate the possible pathogenesis of ODP associated with maculopathy and to monitor the anatomic changes before and after treatment.
The Benefit of Arthroscopy for Symptomatic Total Knee Arthroplasty
Authors: Teng Hsiu‐Peng , Chou Yi‐Jiun , Lin Li‐Chun , Wong Chi‐Yin
Published: July 2009

Thirty‐one knees with symptomatic total knee arthroplasty were diagnosed and treated arthroscopically. There were 18 knees with soft tissue impingement and 13 knees without. There were 16 knees with painful arthroplasty and range of motion (ROM) greater than 90°. Hypertrophied synovitis with or without impingement was more easily found by arthroscopy in this group than in the other 15 knees with the chief complaint of limited ROM, where more remarkable fibrotic tissue with intra‐articular adhesion was found. Overall, the average improvement in ROM was 43.1° immediately after arthroscopy, and 20° at the final follow‐up. Symptoms improved in 90.3% of patients, and 58.1% were satisfied with the outcome of their surgery. Arthroscopy is helpful for intra‐articular diagnosis, obtaining a specimen for histopathologic analysis, culture for subclinical infection, and better improvement in ROM. In our experience, arthros‐copy for symptomatic knee arthroplasty is reliable, safe and effective.
Cognitive Biases for Emotional Faces in High‐ and Low‐Trait Depressive Participants
Authors: Hsieh Yi‐Hsing , Ko Huei‐Chen
Published: July 2009

This study examined the association between trait depression and information‐processing biases. Thirty participants were divided into high‐ and low‐trait depressive groups based on the median of their depressive subscale scores according to the Basic Personality Inventory. Information‐processing biases were measured using a deployment‐of‐attention task (DOAT) and a recognition memory task (RMT). For the DOAT, participants saw one emotional face paired with a neutral face of the same person, and then were forced to choose on which face the color patch had first occurred. The percentage of participants' choices favoring the happy, angry, or sad faces represented the selective attentional bias score for each emotion, respectively. For the RMT, participants rated different types of emotional faces and subsequently discriminated old faces from new faces. The memory strength for each type of face was calculated from hit and false‐positive rates, based on the signal detection theory. Compared with the low‐trait depressive group, the high‐trait depressive group showed a negative cognitive style. This was an enhanced recognition memory for sad faces and a weakened inhibition of attending to sad faces, suggesting that those with high depressive trait may be vulnerable to interpersonal withdrawal.
Concerns and Recommendations of Internal Medicine Residents in HIV Patient Care in the Second Decade of the AIDS Epidemic in Taiwan
Authors: Hsiung Ping‐Chuan , Tsai Yun‐Fang
Published: July 2009

Internal medicine residents are usually on the front line of caring for HIV‐infected patients. In the second decade of the AIDS epidemic in Taiwan, a qualitative study was conducted to recognize the concerns of internal medicine residents in caring for HIV/AIDS patients and to identify possible strategies to promote HIV patient care that have not been addressed in previous research. Individual in‐depth interviews were conducted with 47 internal medicine residents at a university hospital in Taiwan. Seven factors (stereotypes of AIDS; fear of transmission; concerns of families, friends, and colleagues; lack of clinical expertise; lack of collegial support; lack of a sense of accomplishment; and lack of worker's compensation if infected) were found to be the chief concerns of participants in providing HIV/AIDS care. Four strategies (education, clinical experience, safe working environment, and employee benefits) were voiced as those that could promote health care professionals' well‐being and willingness to provide HIV/AIDS care. The results of this study are explained in light of the historical, social, and medical contexts in Taiwan.
Duodenal Obstruction after Elective Abdominal Aortic Aneurysm Repair: A Case Report
Authors: Lin Chun‐Yao , Lin Bor‐Yen , Kang Pei‐Luen
Published: July 2009

Gastrointestinal tract complications after abdominal aortic aneurysm (AAA) repair are well known. The reported frequency ranges from 6.6% to 21%. However, the incidence of duodenal obstruction following AAA has probably been underestimated. This report concerns a 78‐year‐old male who was admitted for elective repair of an infrarenal AAA. On the ninth postoperative day, the patient presented with large quantities of bile‐stained vomitus despite passing flatus per rectum. Metoclopramide and ranitidine were given under the initial impression of paralytic ileus. However, the upper gastrointestinal obstruction persisted, and on day 12, computerized tomography (CT) revealed marked distension of the gastric tube and duodenum, down to the level of the third portion, with abrupt change of caliber at the point of the superior mesenteric artery (SMA). SMA syndrome was diagnosed. After nasogastric tube aspiration, parenteral nutrition, and 11 days of conservative treatment, abdominal CT and upper gastrointestinal series showed no apparent duodenal obstruction. The patient was discharged on the 29th postoperative day; follow‐up abdominal CT 4 months later was unremarkable.
Comparison of Nucleotide Sequence of P2C Region in Diabetogenic and Non‐Diabetogenic Coxsackie Virus B5 Isolates
Authors: Chou Cheng‐Chong , Lin Kuei‐Hsiang , Ke Guan‐Ming , Tung Yi‐Ching , Cheng Jeng‐Yin , Chen Bai‐Hsiun , Chao Mei‐Chyn
Published: July 2009

Enteroviruses are environmental triggers in the pathogenesis of type 1 diabetes mellitus (DM). A sequence of six identical amino acids (PEVKEK) is shared by the 2C protein of Coxsackie virus B and the glutamic acid decarboxylase (GAD) molecules. Between 1995 and 2002, we investigated 22 Coxsackie virus B5 (CVB5) isolates from southern Taiwan. Four of these isolates were obtained from four new‐onset type 1 DM patients with diabetic ketoacidosis. We compared a 300 nucleotide sequence in the 2C protein gene (p2C) in 24 CVB5 isolates (4 diabetogenic, 18 non‐diabetogenic and 2 prototype). We found 0.3‐10% nucleotide differences. In the four isolates from type 1 DM patients, there was only 2.4‐3.4% nucleotide difference, and there was only 1.7‐7.1% nucleotide difference between type 1 DM isolates and non‐diabetogenic isolates. Comparison of the nucleotide sequence between prototype virus and 22 CVB5 isolates revealed 18.4‐24.1% difference. Twenty‐one CVB5 isolates from type 1 DM and non‐type 1 DM patients contained the PEVKEK sequence, as shown by the p2C nucleotide sequence. Our data showed that the viral p2C sequence with homology with GAD is highly conserved in CVB5 isolates. There was no difference between diabetogenic and non‐diabetogenic CVB5 isolates. All four type 1 DM patients had at least one of the genetic susceptibility alleles HLA‐DR, DQA1, DQB1. Other genetic and autoimmune factors such as HLA genetic susceptibility and GAD may also play important roles in the pathogenesis in type 1 DM.
Intramedullary Pinning with Tension‐Band Wiring for Surgical Neck Fractures Of the Proximal Humerus in Elderly Patients
Authors: Lu Cheng‐Chang , Chang Ming‐Wei , Lin Gau‐Tyan
Published: July 2009

Most proximal humeral fractures in the elderly population are related to osteoporosis. Several methods have been proposed to treat surgical neck fractures of the proximal humerus in elderly people. This study investigates a new method of intramedullary pinning with tension‐band wiring. From June 1998 to March 2001, 10 female patients with a mean age of 73.0 years and displaced two‐ or three‐part surgical neck fractures of the proximal humerus were studied. Two intramedullary pins were used with tension‐band wiring via a deltopectoral approach with minimum dissection. The mean follow‐up was 20.6 months. Final outcome was evaluated using the constant score, visual analog scale (VAS) score, questionnaire, and an outcome assessment form. The outcome was excellent in four patients, good in five, and fair in one. The mean Constant score was 80.8 and the VAS score was 83.0. There was no nonunion, avascular necrosis, deep infection, or pin migration. No patient needed further revision open reduction with internal fixation or prosthesis replacement. We therefore concluded that intramedullary pinning with tension‐band wiring is a safe, reliable method, with few complications, for treating surgical neck fractures of the proximal humerus in elderly patients.
Macular Hole in Behcet's Disease
Authors: Sheu Shwu‐Jiuan , Yang Cheng‐An
Published: July 2009

Behcet's disease is an inflammatory disorder of unknown cause, characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Ocular involvement occurs in 60‐80% of patients with Behcet's disease and presents as panuveitis in most cases. Posterior segment involvement may lead to irreversible alterations and significant vision loss. The development of a partial or full‐thickness macular hole, though rarely reported, may cause serious vision loss. In this report, we present two cases of macular hole in the worse eye of bilateral cases of Behcet's disease, and discuss the possible mechanisms and management in such cases.
Laparoscopic Bladder Diverticulectomy for Large Bladder Diverticulum: A Case Report
Authors: Juan Yung‐Shun , Jang Mei‐Yu , Wang Chii‐Jye , Li Ching‐Chia , Shen Jung‐Tsung , Wu Wen‐Jeng , Huang Chun‐Hsiung
Published: July 2009

Bladder diverticula are herniations of the bladder mucosa through the bladder wall musculature. Acquired bladder diverticula are the result of outlet obstruction, mostly benign prostate enlargement, infections, or urethral stricture. Traditionally, bladder diverticulum was excised by the open method. However, the laparoscopic technique has been widely used to treat many urologic diseases, including bladder diverticulum. Laparoscopic diverticulectomy can be performed transperitoneally or extraperitoneally. We report our initial experience with laparoscopic transperitoneal diverticulectomy for a large bladder diverticulum caused by bladder outlet obstruction. The patient had satisfactory micturition and was discharged on the eighth postoperative day.
Terlipressin‐Related Acute Myocardial Infarction: A Case Report and Literature Review
Authors: Lee Min‐Yi , Chu Chin‐Sheng , Lee Kun‐Tai , Lee Hsiang‐Chun , Su Ho‐Ming , Cheng Kai‐Hung , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: July 2009

Acute ST‐segment elevation myocardial infarction after the administration of terlipressin in patients with hemorrhagic esophageal varices is a rare but life‐threatening complication. We report the case of a 73‐year‐old female patient with esophageal variceal bleeding complicated with acute ST‐segment elevation myocardial infarction after intravenous injection of terlipressin. We discuss the underlying mechanisms of terlipressin‐related acute myocardial infarction and review the literature.
Spontaneous Dissecting Aneurysm of the Renal Artery: A Case Report
Authors: Su Chin‐Ming , Wu Wen‐Jen , Lee Yung‐Chin , Ke Hung‐Lung , Chou Yii‐Her , Huang Chun‐Hsiung
Published: July 2009

Primary dissecting aneurysms of the renal artery are exceedingly rare. The triad of flank pain, hematuria, and hypertension of acute onset in the absence of urinary obstruction should suggest this rare condition. We report a case of spontaneous dissecting aneurysm of the renal artery treated using conservative medical treatment. The diagnosis, therapeutic management, and outcome are discussed.
Mosquito Surveys Carried out On Green Island, Orchid Island, and Penghu Island, Taiwan, in 2003
Authors: Teng Hwa‐Jen , Huang Guo‐Chin , Chen Yung‐Chen , Hsia Wei‐Tai , Lu Liang‐Chen , Tsai Wen‐Tang , Chung Mei‐Ju
Published: July 2009

Field surveys of mosquitoes were carried out on Green, Orchid, and Penghu Islands in 2003 to ascertain the status of mosquito vectors. Eighteen species of mosquitoes were collected, including three species of Anopheles, four species of Aedes, eight species of Culex, two species of Armigeres, and one species of Malaya. Seventeen previously recorded species were not collected in this study but 11 species collected had not previously been recorded. Ten newly recorded species, An. maculatus, An. takasagoensis, Ae. alcasidi, Ae. lineatopennis, Ae. vexans vexans, Ar. omissus, Cx. vishnui, Cx. halifaxii, Cx. hayashii, and Cx. neomimulus, were collected on Green Island and one previously unrecorded species, Ar. subalbatus, was collected on Orchid Island. Potential vectors An. maculatus and An. sinensis, malaria vectors in Korea and Mainland China, Ae. albopictus, a vector of dengue in Taiwan and West Nile virus in the USA, Cx. vishnui and Cx. tritaeniorhynchus, Japanese encephalitis vectors in Taiwan, Ae. vexans vexans, an eastern equine encephalitis vector in the USA, and Cx. quinquefasciatus, a vector of filariasis in Taiwan and West Nile virus in the USA, were among the mosquito species collected.
Ultrasonographic Findings in Hemiplegic Knees of Stroke Patients
Authors: Yang Chao‐Pin , Lee Chia‐Ling , Chen Tien‐Wen , Lee Su , Weng Ming‐Cheng , Huang Mao‐Hsiung
Published: July 2009

Clinical and radiologic asymmetric arthritic differences between paralyzed and nonparalyzed limbs of stroke patients have been reported. Arthritic pathology aggravates motor dysfunction and compromises rehabilitation. Musculoskeletal ultrasonography plays an important role in showing soft tissue and the articular cartilage of the knee. Fifty‐nine patients with either ischemic or hemorrhagic stroke‐induced right or left hemiplegia were recruited to evaluate soft‐tissue and intra‐articular cartilage changes in hemiplegic knees of stroke patients using ultrasonography. An additional 15 subjects (30 knees) without knee disease or a history of knee trauma or surgery were used as controls. There were significant differences in suprapatellar effusion and patellar tendinitis between hemiplegic and nonhemiplegic knees. Suprapatellar effusion and pes anserinus tendinitis were correlated with Brunnstrom stage. The length of time since stroke onset was not significantly correlated with positive ultrasonographic findings in hemiplegic knees. In conclusion, ultrasonography is useful for detecting periarticular soft‐tissue changes and intra‐articular lesions in hemiplegic knees of stroke patients.
Expression of Hsp72 in Lymphocytes in Patients with Febrile Convulsion
Authors: Lin Lung‐Chang , Chen Hsiang‐Wen , Yang Rei‐Cheng
Published: July 2009

The pathophysiology of febrile convulsion, the most common childhood neurologic disease, remains unclear. In this study, we investigated what role a heat shock protein plays in this disease. We enrolled eight boys and two girls with febrile convulsion and 10 age‐matched healthy controls. We did a biosynthetic evaluation of both groups by separating lymphocytes and measuring the expression of heat shock protein 72 before and after heat shock treatment. Before the treatment, both groups were found to have small amounts of constitutive heat shock protein 72. Afterwards, its expression increased in both groups, and no statistical difference was found between the increases in the two groups. In addition, there was no obvious difference in the susceptibility to produce heat shock proteins. However, the febrile convulsion group was found to have a significant decrease in phosphorylation of heat shock protein 72. These results suggest the possible involvement of post‐translational modification of heat shock proteins, most likely phosphorylation, in the pathogenesis of febrile convulsion.
Primary Mesenteric Lipoma Causing Closed Loop Bowel Obstruction: A Case Report
Authors: Wong Heong‐Ieng , Chen Chiao‐Yun , Liu Gin‐Chung
Published: July 2009

Primary mesenteric lipoma is rare, with fewer than 50 cases described in English‐language literature, and those causing bowel obstructions are even more uncommon. The long stalk of the lipoma that caused secondary volvulus and rapid ischemic change in our patient is worth reporting because of its rarity and distinctive picture in emergency abdominal computed tomography.
Intraocular Pressure Change after Laser In Situ Keratomileusis (LASIK)
Authors: Hsu Sheng‐Yao , Tsai Rong‐Kung , Hsu Yung‐Chung , Lin Chang‐Ping
Published: July 2009

To analyze the relationship between change in intraocular pressure (IOP) after laser in situ keratomileusis (LASIK), and preoperative central‐corneal thickness (CCT), and central‐corneal ablation depth (CCAD), a prospective study was conducted of 30 patients (60 eyes) with myopia or myopic astigmatism who underwent LASIK and who were followed up for a mean of 6 months. The parameters evaluated included IOP 1 week preoperatively and 3 months postoperatively, pre‐ and postoperative CCT, and CCAD; in addition, the anterior ocular segment and the fundus were examined, as was the apparent and cycloplegic refraction. There were 11 male patients and 19 female patients (mean age, 28.3 years) involved in the study. Mean IOP readings were 14.9 mmHg 1 week preoperatively, and 8.3 mmHg 3 months postoperatively; thus, the mean decrease in IOP after LASIK was 6.6 mmHg. Mean values for preoperative CCT, postoperative CCT, and CCAD were 537.2 ± 34.7 μm, 434.0 ± 32.5 μm, and 101.6 ± 23.90 μm, respectively. IOP correlated with CCT both pre‐ and postoperatively. The mean change in IOP after LASIK for myopia and myopic astigmatism was statistically significant, but did not correlate with CCAD or age. We postulate that CCAD is not a significant predictor of IOP after LASIK.
Cranial‐Base Morphology in Children with Class III Malocclusion
Authors: Chang Hong‐Po , Chou Tsau‐Mau , Hsieh Shu‐Hui , Tseng Yu‐Chuan
Published: July 2009

The association between cranial‐base morphology and Class III malocclusion is not fully understood. The purpose of this study was to investigate the morphologic characteristics of the cranial base in children with Class III malocclusion. Lateral cephalograms from 100 children with Class III malocclusion were compared with those from 100 subjects with normal occlusion. Ten landmarks on the cranial base were identified and digitized. Cephalometric assessment using seven angular and 18 linear measurements was performed by univariate and multivariate analyses. The results revealed that the greatest between‐group differences occurred in the posterior cranial‐base region. It was concluded that shortening and angular bending of the cranial base, and a diminished angle between the cranial base and mandibular ramus, may lead to Class III malocclusion associated with Class III facial morphology. The association between cranialbase morphology and other types of malocclusion needs clarification. Further study of regional changes in the cranial base, with geometric morphometric analysis, is warranted.
Unusual Solitary Fibrous Tumors in the Central Nervous System: A Report of Two Cases
Authors: Hu Shih‐Wen , Tsai Kun‐Bow , Yang Sheau‐Fang , Chai Chee‐Yin , Lee Kung‐Shing
Published: July 2009

Solitary fibrous tumors (SFTs) are uncommon, and most are found in the pleura. Extrapleural SFTs are rare and have been found in the lung, pericardium, mediastinum, soft tissue of any site, and upper respiratory tract. SFTs of the central nervous system (CNS) are very rare. The biologic features are unknown and remain poorly understood from a clinical standpoint. Most neurosurgeons do not believe that SFTs can present as primary CNS neoplasms. Most SFTs are clinically benign and indolent, and recurrences after surgical excision are scarce. Because malignant transformation or metastasis has been reported, all SFTs should be treated as having malignant potential. Long‐term follow‐up is recommended. We report two cases, so that surgeons may recognize that this is an entity different from other spindle‐cell CNS tumors.
Rhabdomyomatous Mesenchymal Hamartoma: A Plaque‐Type Variant in an Adult
Authors: Chang Chih‐Po , Chen Gwo‐Shing
Published: July 2009

We present the case of a 40‐year‐old woman who had a flesh‐colored asymptomatic plaque‐like lesion above her chin since she was 30 years old. She was generally healthy and physical examination revealed no congenital abnormalities. Histopathology revealed a normal epidermal surface, mature striated muscle fibers arranged randomly within the dermis, and subcutaneous tissue associated with normal‐appearing mesenchymal elements such as adipose tissue, collagen, blood vessels, and mature hair follicles. This fits the diagnosis of rhabdomyomatous mesenchymal hamartoma. Our case was different from previously reported cases with regards to the age of onset and clinical presentation. We report this rare adult case and discuss its differential diagnosis.