bluuebunny/crossref_metadata_2025 huggingface dataset:
Developmental learning impairments in a rodent model of nodular heterotopia
Authors: Threlkeld Steven W. , Hill Courtney A. , Cleary Caitlin E. , Truong Dongnhu T. , Rosen Glenn D. , Fitch R. Holly
Published: July 2009

Developmental malformations of neocortex—including microgyria, ectopias, and periventricular nodular heterotopia (PNH)—have been associated with language learning impairments in humans. Studies also show that developmental language impairments are frequently associated with deficits in processing rapid acoustic stimuli, and rodent models have linked cortical developmental disruption (microgyria, ectopia) with rapid auditory processing deficits. We sought to extend this neurodevelopmental model to evaluate the effects of embryonic (E) day 15 exposure to the anti-mitotic teratogen methylazoxymethanol acetate (MAM) on auditory processing and maze learning in rats. Extensive cortical anomalies were confirmed in MAM-treated rats post mortem. These included evidence of laminar disruption, PNH, and hippocampal dysplasia. Juvenile auditory testing (P21–42) revealed comparable silent gap detection performance for MAM-treated and control subjects, indicating normal hearing and basic auditory temporal processing in MAM subjects. Juvenile testing on a more complex two-tone oddball task, however, revealed a significant impairment in MAM-treated as compared to control subjects. Post hoc analysis also revealed a significant effect of PNH severity for MAM subjects, with more severe disruption associated with greater processing impairments. In adulthood (P60–100), only MAM subjects with the most severe PNH condition showed deficits in oddball two-tone processing as compared to controls. However, when presented with a more complex and novel FM sweep detection task, all MAM subjects showed significant processing deficits as compared to controls. Moreover, post hoc analysis revealed a significant effect of PNH severity on FM sweep processing. Water Maze testing results also showed a significant impairment for spatial but not non-spatial learning in MAM rats as compared to controls. Results lend further support to the notions that: (1) generalized cortical developmental disruption (stemming from injury, genetic or teratogenic insults) leads to auditory processing deficits, which in turn have been suggested to play a causal role in language impairment; (2) severity of cortical disruption is related to the severity of processing impairments; (3) juvenile auditory processing deficits appear to ameliorate with maturation, but can still be elicited in adulthood using increasingly complex acoustic stimuli; and (4) malformations induced with MAM are also associated with generalized spatial learning deficits. These cumulative findings contribute to our understanding of the behavioral consequences of cortical developmental pathology, which may in turn elucidate mechanisms contributing to developmental language learning impairment in humans.
Electrical low‐frequency stimulation induces long‐term depression of sensory and affective components of pain in healthy man
Authors: Rottmann Silke , Jung Kerstin , Ellrich Jens
Published: July 2009

Electrical low‐frequency stimulation (LFS) of nociceptive skin afferents reliably induces long‐term depression (LTD) of pain. Recent experiments have assessed the effects of LTD on pain perception by using a simple one‐dimensional rating scale. The psychophysical study investigated the impact of noxious LFS on the sensory and affective aspects of pain perception by multidimensional rating scales.

In 20 healthy volunteers, nociceptive fibers of the left hand dorsum were electrically stimulated by a concentric electrode. Test stimulation series (15 stimuli each, 0.125Hz) were performed before (Pre) and after (Post) a conditioning LFS (1Hz, 20min) or no stimulation period (Control). Pain ratings concerning test stimulation and LFS were obtained by multidimensional assessment including Verbal rating scale of perceived stimulus intensity (VRS‐I) and unpleasantness (VRS‐U) and pain perception scale with sensory (SES‐S) and affective items (SES‐A).

After the conditioning LFS, VRS‐I, VRS‐U, SES‐S, and SES‐A decreased as compared to Pre series and Control. During conditioning LFS, ratings decreased. Factor analysis of SES‐S revealed sole reduction of superficial sharp pain perception after conditioning LFS in contrast to Control experiment. Perception of deep rhythmic pain decreased over time. Deep constant pain and superficial heat pain were not affected.

Electrical test stimulation via concentric electrode evokes sensory as well as affective pain perception. Both components decrease during noxious, conditioning LFS and remain depressed for at least one hour. Reduction of sharp pain points to Aδ fiber mediated LTD. These results stress the analgesic potency of LTD and its possible impact on future therapy in chronic pain.
Efficacy of Medium‐chain Triglycerides Compared with Long‐chain Triglycerides in Total Parenteral Nutrition in Patients with Digestive Tract Cancer Undergoing Surgery
Authors: Chen Fang‐Ming , Wang Jaw‐Yuan , Huang Tsung‐Jen , Hsieh Jan‐Sing , Sun Li‐Chu , Juang Rue‐Fen
Published: July 2009

The objectives of this prospective, randomized study were to evaluate the efficacy and tolerability of the short‐term use of medium‐chain triglyceride/long‐chain triglyceride (MCT/LCT) fat emulsions, and to compare the hematologic and biochemical effects of MCT/LCT fat emulsions with LCT fat emulsions in gastrointestinal (GI) tract cancer patients following surgery. Thirty patients with GI tract cancer requiring total parenteral nutrition (TPN) were equally randomized to receive MCT/LCT or LCT emulsions for 7 days. After 7 days, no sign of complications directly related to administration of fat emulsions was observed and there were no marked differences in anthropometry, length of hospital stay, and surgical complication rates between the two groups. However, MCT/LCT significantly improved plasma prealbumin concentration (p = 0.005). Changes in complements C3 and C4, total lymphocyte count, and immunoglobulins after TPN were not significantly different between the groups. Serum triglyceride and cholesterol levels remained constant. The serum insulin level in the MCT/LCT group was higher than in the LCT group (p = 0.048). Our data revealed that MCT/LCT fat emulsions significantly enhanced nutritional status in patients with GI tract cancer, indicated by higher prealbumin levels, which might be partially due to the higher circulating insulin levels in the MCT/LCT group.
Association between Cigarette Smoking and Hypoxanthine Guanine Phosphoribosyltransferase Activity
Authors: Chang Shun‐Jen , Chen Shiu‐Min , Chiang Shang‐Lun , Chang Kee‐Lung , Ko Ying‐Chin
Published: July 2009

The aim of this study was to investigate the association between smoking behavior and hypoxanthine guanine phosphoribosyltransferase (HGPRT) activity. A cross‐sectional study was performed of 82 men, including 38 non‐smokers and 44 smokers. Inosine monophosphate (IMP), the product of HGPRT (used as the index of activity), was measured in peripheral blood mononuclear cells using high‐performance liquid chromatography. The factors potentially associated with HGPRT activity included age, glutamyl oxaloacetic transaminase, glutamyl pyruvic transaminase, cholesterol, uric acid, triglycerides, creatinine, body mass index, gout, systolic blood pressure, diastolic blood pressure, alcohol consumption, and cigarette smoking. Mean HGPRT activity was 7.05 ± 3.44 nmol/106 viable cells/hour for all participants, and was significantly lower for smokers than for non‐smokers (6.24 ± 3.40 vs 7.98 ± 3.28 nmol/106 viable cells/hour; p = 0.02). In addition, as the number of smoked cigarettes increased, the HGPRT activity decreased (p < 0.05). The age at onset of cigarette smoking showed a positive correlation with HGPRT activity after adjusting for smoking duration, serum uric acid, and cigarettes smoked per year using a multiple regression model (p < 0.001). We concluded that the greater the number of cigarettes smoked, the lower the HGPRT activity, and that HGPRT activity was higher in smokers who had started smoking later.
Ruptured Aneurysm of the Sinus of Valsalva into the Right Atrium without Ventricular Septal Defect: A Case Report and Literature Review
Authors: Lee Shuo‐Tsan , Lin Tsung‐Hsien , Su Ho‐Ming , Voon Wen‐Chol , Lai Wen‐Ter , Sheu Sheng‐Hsiung , Chiu Chaw‐Chi , Lin Young‐Tso
Published: July 2009

Aneurysm of the sinus of Valsalva (ASV), frequently associated with ventricular septal defect (VSD), is a rare cardiac disease that may be acquired or congenital. Rupture of an ASV, rare in the noncoronary cusp, usually produces serious hemodynamic change and carries poor prognosis if not treated surgically. We present the case of a 55‐year‐old female who came to us complaining of exertional dyspnea. Transthoracic echocardiography and aortography showed a noncoronary cusp ASV with rupture into the right atrium but without VSD. Because of high left to right shunt flow, she underwent successful surgical intervention with aneurysm repair approached from both the aorta and right atrium with a knitted Dacron patch. This was a rare case of noncoronary cusp involvement in ASV that ruptured into the right atrium without VSD.
Successful Treatment of Cerebral Venous Thrombosis Associated with Bilateral Internal Jugular Vein Stenosis Using Direct Thrombolysis and Stenting: A Case Report
Authors: Huang Poyin , Yang Yuan‐Han , Chen Chun‐Hung , Lin Ruey‐Tay , Lin Wei‐Chen
Published: July 2009

Cerebral venous thrombosis (CVT) is not uncommon, but CVT associated with bilateral internal jugular vein stenosis (BIJVS) is rare. Bilateral internal jugular vein stenting is also a rare procedure. We report on a patient with CVT associated with BIJVS, who was treated successfully using direct thrombolysis and bilateral internal jugular vein stenting.
Experimental Ocular Toxocariasis in Mice Infected with Long‐term‐maintained Embryonated Eggs ofToxocara canis
Authors: Fan Chia‐Kwung , Lin Yun‐Ho , Hung Chien‐Ching , Su Kua‐Eyre
Published: July 2009

Ocular injury to ICR mice from embryonated eggs ofToxocara canis, which had been maintained in 2% formalin for 14 months at 4°C, was evaluated by microscopic and pathologic assessments at 1, 2, 3, 5, 7, 28, 56, 84, 112, 140, 168, 196, 294 and 469 days post infection (DPI). On each date, three infected mice and two age‐matched uninfected control mice were sacrificed; left eyeballs from infected mice were examined for larvae under a dissecting microscope while all right eyeballs were embedded in paraffin for histologic study. No larvae were observed in the left eyeball of any of the 42 infected mice, while pathologic changes were observed in right eyeballs. Pathologically, the predominant changes were retinal detachment, iridocyclitis, and pars planitis, followed by optic nerve papillitis and superficial infarcts, as observed in one of three infected mice per group at 56, 140, and 168 DPI, respectively. No infiltrating cells surrounding the larvae in the retina were observed in the infected mice. This is the first report that larvae hatched fromT. canisembryonated eggs maintained for a long time can cause murine ocular toxocariasis. These results further extend our knowledge of the pathogenicity ofT. canisembryonated eggs.
Intra‐articular Ganglion Cyst from Medial Collateral Ligament of the Knee Joint: A Case Report and Review of the Literature
Authors: Lin Kai‐Cheng , Teng Hsiu‐Peng , Chen Chi‐Hui , Hsu Chien‐Jen
Published: July 2009

A 57‐year‐old male complained of a painful sensation on the medial joint line of the right knee for about 5 years. A palpable soft mass measuring about 5.5 × 4.0 × 2.0 cm was found on the medial joint line. Plain roentgenography showed bulging soft tissue over the medial aspect of the right knee. Sonography revealed a hypoechoic intra‐articular soft tissue mass. Magnetic resonance imaging revealed a multilobulated homogeneous cystic lesion originating from the medial collateral ligament, with hypointensity on T1‐weighted images and hyperintensity on T2‐weighted images. We performed an arthroscopic examination before surgical excision of the tumor to rule out a parameniscal cyst, and no meniscal tear was found. Microscopic examination proved that the excised tumor was a ganglion cyst. The patient was free of his previous symptoms and had no recurrence at 2‐year follow‐up.
Posterior Reversible Encephalopathy Syndrome: Magnetic Resonance Imaging and Diffusion‐Weighted Imaging in 12 Cases
Authors: Chou Mei‐Chun , Lai Ping‐Hong , Yeh Lee‐Ren , Yuan Mei‐Kang , Liang Huei‐Lung , Chen Clement , Pan Huay‐Ben , Yang Chien‐Fang , Li Jieh‐Yuan , Lo Yuk‐Keung
Published: July 2009

Posterior reversible encephalopathy syndrome (PRES) is a potentially devastating neurologic syndrome, but timely treatment may lead to complete reversal of the disease course. We reviewed 12 cases of PRES and describe the clinical history and imaging findings, including conventional magnetic resonance imaging (MRI), diffusion‐weighted imaging (DWI), and calculated apparent diffusion coefficient (ADC) maps, used to establish the diagnosis of PRES. Three male and nine female patients aged between 11 and 70 years (mean, 37 years) with clinical and imaging findings consistent with PRES were enrolled in the study. All patients had undergone conventional MRI and 10 had undergone additional DWI studies. Ten patients had follow‐up MRI studies. DWI was performed using a 1.5T system with a single‐shot spin‐echo echo‐planar pulse sequence. Initial and follow‐up neuroimaging and clinical history were reviewed. Lesions were almost always present over the posterior circulation, mainly the parieto‐occipital region, affecting primarily the white matter. The anterior circulation region, brainstem, cerebellum, deep cerebral white matter, and thalamus were also involved in five cases. Conventional MRI revealed hyperintensity on T2‐ weighted and fluid‐attenuated inversion recovery images. DWI showed isointensity and increased signal intensity on ADC values in all cases, indicating vasogenic edema. Clinical and MRI follow‐up showed that the symptoms and radiologic abnormalities could be reversed after appropriate treatment of the causes of PRES in most patients (9 of 10). In one patient, the ADC value was lower on follow‐up images, indicating cytotoxic edema with ischemic infarct. DWI was a useful complement to MRI in the diagnosis of PRES.
Coronary Artery Aneurysms in a Young Patient with Acute Myocardial Infarction: A Case Report
Authors: Su Ho‐Ming , Voon Wen‐Chol , Lin Tsung‐Hsien , Lai Wen‐Ter , Sheu Sheng‐Hsiung , Hsieh Chong‐Chao , Chiu Chaw‐Chi
Published: July 2009

Coronary artery aneurysms are not uncommon. They are usually arteriosclerotic in origin, and may be congenital or secondary to injury, dissection, infection, inflammation, or Kawasaki disease (KD). Herein, we report a case involving a 25‐year‐old male smoker with acute myocardial infarction (AMI). Coronary angiography showed triple‐vessel disease, coronary artery aneurysms, and diffuse ectasia. Coronary artery bypass grafting was performed without complications. Based on his history, serologic examinations, and angiographic findings, we suspected that his coronary artery aneurysms and ectasia were the adult sequelae of KD. This case is a good reminder that KD victims may suffer from young‐onset AMI.
Sialolipoma of the Floor of the Mouth: A Case Report
Authors: Lin Yu‐Ju , Lin Li‐Min , Chen Yuk‐Kwan , Hsue Shui‐Sang , Wang Wen‐Chen , Lin Cheng‐Chung , Shen Yee‐Hsiung
Published: July 2009

Intra‐oral lipoma is a well‐known entity, but lipomatous tumors including salivary gland tissue containing clustered or peripherally located ducts and acinar cells are uncommon. They are a newly recognized entity of salivary gland lipoma, designated sialolipoma. We describe a case of sialolipoma arising in the floor of the mouth presenting with apparently normal salivary gland tissue, as demonstrated by both histologic and immunohistochemical findings, in a 67‐year‐old female. Complete surgical removal of the tumor with preservation of the sublingual gland was implemented after a careful examination confirming that the lesion did not originate from the sublingual gland.
Differentiation Among Metastatic Brain Tumors, Radiation Necroses, and Brain Abscesses Using Proton Magnetic Resonance Spectroscopy
Authors: Hwang Yan‐Fen , Hwang Shiuh‐Lin , Kwan Aij‐Lie , Howng Shen‐Long , Huang Tzuu‐Yuan
Published: July 2009

Magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) were evaluated for differentiating metastatic brain tumors, radiation necroses, and brain abscesses. Twelve histologically verified lesions in 12 patients were studied using preoperative MRI and proton MRS. The signal intensities of four major metabolites, N‐acetyl aspartate (NAA), choline‐containing compounds (Cho), creatine and phosphocreatine (Cr), and lactate (Lac), were observed over the region of interest. Metastatic brain tumors showed a decrease in NAA/Cr and an increase in Cho/Cr ratios. Radiation necroses showed a decrease in NAA/Cr and no change in Cho/Cr ratios. Brain abscesses showed an increase in Lac/Cr ratio. Correlation with histopathologic findings showed that a high Cho signal was suggestive of a metastatic brain tumor. Lac signals were observed in brain abscesses, presumably reflecting the anerobic glycolysis of living cells. Although more cases and studies are necessary, metabolic information provided by proton MRS combined with MRI is useful for differentiating among metastatic brain tumors, radiation necroses, and brain abscesses.
Investigation of Management Models in Elite Athlete Injuries
Authors: Chen Shen‐Kai , Cheng Yun‐Min , Huang Peng‐Ju , Chou Pei‐Hsi , Lin Yen‐Chung , Hong Yu‐Jue
Published: July 2009

This cross‐sectional study investigated management models among elite athletes participating in sports including baseball, basketball, soccer, volleyball, tennis, softball, football, handball, track and field, swimming, judo, tae‐kwon‐do, gymnastics, archery, and weight lifting at the Tsoying National Sport Training Center. Data were collected by questionnaire. Of the 393 athletes investigated, 56% were male and 44% were female, with an average age of 20.9 years and average length of athletic experience of 9.8 years. At the time of the survey, 74.8% had sporting injuries and were being treated with Chinese and/or Western medicine. Among injured athletes, 14.5% chose Western treatment, 8.1% chose Chinese medicine, and 75.4% received combined treatment. There were various reasons for choosing the management model. Most athletes had ordinary self‐recognition of sports injury prevention. Their qualified ability for sports injury prevention was 70%. This ability was significantly correlated with age, education, and sports experience. Within Taiwan's current medical and social environment, elite athletes prefer a combination of Eastern and Western treatments for sports injuries. Each of the medical approaches are widely accepted by elite athletes and their coaches. Doctors trained in Western medicine should learn these alternative treatment methods and apply them effectively in athletes, so that a better medical network can be established.
Right Ventricle‐dependent Coronary Circulation in Pulmonary Atresia with Intact Ventricular Septum: A Case Report
Authors: Lee Meng‐Hsun , Wu Jiunn‐Ren , Dai Zeng‐Kong , Hsu Jong‐Hau , Chou Chau‐Chi , Chen Huai‐Min
Published: July 2009

Pulmonary atresia with intact ventricular septum (PAIVS) is a morphologically heterogeneous lesion and accounts for 1‐3% of critically ill infants with congenital heart disease. Numerous surgical approaches have been attempted with varying degrees of success, but the mortality rate is still high in most series. The optimal surgical procedure depends on the size and morphology of the tricuspid valve and right ventricle and the presence or absence of right ventricle‐dependent coronary circulation. Therefore, it is pivotal to define the precise morphologic and hemodynamic characteristics, especially coronary artery anatomy. In this report, we describe a full‐term female neonate with cyanosis soon after birth. Two‐dimensional and color Doppler echocardiography corroborated the diagnosis of PAIVS and showed a small right ventricle. Cardiac catheterization indicated PAIVS and further revealed right ventricle‐dependent coronary circulation. A systemic‐to‐pulmonary artery shunt was constructed with a positive immediate result.
Encapsulated Columnar‐cell Carcinoma of the Thyroid: A Case Report
Authors: Huang Wan‐Ting , Yang Sheau‐Fang , Wang Sheng‐Lan , Chai Chee‐Yin , Chan Hon‐Man
Published: July 2009

Columnar‐cell carcinoma is a rare form of papillary thyroid carcinoma. It is a biologically aggressive variant, according to the World Health Organization classification, due to its rapid growth, high local recurrence rate, and frequent lung, brain, and bone metastases. However, recent reports indicate encapsulated tumors confined to the thyroid gland are associated with a more favorable prognosis. We report a case of encapsulated columnar‐cell carcinoma occurring in the right lobe of the thyroid in a 25‐year‐old female and discuss the histopathologic features, differential diagnosis, and prognostic factors.
Transthoracic or Transhiatal Resection for Middle‐ and Lower‐Third Esophageal Carcinoma?
Authors: Chou Shah‐Hwa , Kao Eing‐Long , Huang Meei‐Feng , Chuang Hung‐Yi , Wang Wen‐Ming , Wu Deng‐Chyang
Published: July 2009

Transthoracic esophagectomy (TTE) and transhiatal esophagectomy (THE) are two common methods of resection for esophageal cancer. Although many studies have been performed in Western countries, there are still controversies over which method is the better procedure. In this study, postoperative improvement in dysphagia and the degree of postoperative pain were compared. The cases of 50 patients undergoing TTE and 23 undergoing THE for esophageal cancer between March 1997 and October 2002 were retrospectively reviewed. The location of the lesion, clinical stage (TNM), operative time, operative blood loss, hospital stay, complications, number of lymph nodes dissected, and survival duration were recorded. Pre‐ and postoperative dysphagia scores and postoperative pain perception (using a visual analog scale) were analyzed. Preoperative clinical stage and lesion site were not significantly different in the TTE and THE groups. The operative time was longer and the number of lymph nodes removed was larger in the TTE group. However, there were no differences in operative blood loss, hospital stay, complications, survival duration, and improvement in dysphagia. Pain perception in the THE group was significantly better than that in the TTE group. THE is a safe and rapid procedure, with recovery and survival periods similar to those for TTE. Both patient groups enjoyed the same ability to eat. Therefore, THE is an acceptable alternative to TTE for patients with middle‐ and lower‐third esophageal cancer. Moreover, THE caused much less postoperative pain than TTE, which made patients more comfortable.
Connecting Rigidities of Various Precision Attachments Compared with the Conical Crown Retained Telescope
Authors: Wang Chau‐Hsiang , Lee Huey‐Er , Du Je‐Kang , Igarashi Yoshimasa
Published: July 2009

The purpose of this investigation was to observe the connecting rigidity of various precision attachments and to compare their connecting rigidities with the conical crown retained telescope (CCT). The connecting rigidity of a retainer was assessed using the flexibility test to measure the mesial and distal end displacements. Four precision attachments were analyzed: the dovetail slide attachment beyeler, cylindrical slide attachment, Spang Stabilex and Mini SG. The CCT was used as the control. Although there were many statistically significant differences between the displacements with the various attachments, displacements when vertically loaded were very small: all mesial end displacements were within 3 μm and distal end displacements were 21.4 μm. The largest of the mesial end displacements when horizontally loaded was as large as 44.5 μm (dovetail slide beyeler), while the others were all below 16.5 μm. The same phenomena occurred with the distal end displacements when horizontally loaded: the largest was seen with the dovetail slide beyeler, followed sequentially by the Spang Stabilex, CCT, cylindrical slide, and the Mini SG. The distal displacement with the dovetail slide beyeler was as large as 75.2 μm; those with the others were all below 31.2 μm, with numerous statistically significant differences between the displacements with the various attachments. Thus, connecting rigidities of rigid precision attachments are very similar to CCT, and only the dovetail slide beyeler attachment is too weak to resist horizontal displacement force.
Dengue Virus‐Associated Hemophagocytic Syndrome and Dyserythropoiesis: A Case Report
Authors: Lu Po‐Liang , Hsiao Hui‐Hwa , Tsai Jih‐Jin , Chen Tun‐Chieh , Chen Tyen‐Po , Lin Sheng‐Fung , Feng Ming‐Chu
Published: July 2009

A 33‐year‐old man had dengue hemorrhagic fever with initial presentation of fever, leukocytosis, and thrombocytopenia. The cause of the subsequent rapid decline in red cell counts without evidence of intravascular hemolysis or massive bleeding was confirmed as hemophagocytosis and dyserythropoiesis by bone marrow study. The patient recovered with supportive care and the bone marrow pattern was normal on repeated bone marrow study. To our knowledge, this is the first reported case of dengue virus‐associated hemophagocytosis and dyserythropoiesis in Taiwan. Clinicians should consider that the occurrence of hemophagocytosis and dyserythropoiesis could be due to dengue virus infection. That this dengue virus infection was confirmed by a positive serology result at the convalescent stage but not at the acute symptomatic stage underlines the need for a second dengue serology study, as dengue infection can be missed due to an initial negative serology result.
Unusual Gas Pattern in Emphysematous Cystitis: A Case Report
Authors: Juan Yung‐Shun , Shen Jung‐Tsung , Wang Chii‐Jye , Chuang Shu‐Mien , Jang Mei‐Yu , Wu Wen‐Jeng , Huang Chun‐Hsiung
Published: July 2009

We present a case of emphysematous cystitis in a 43‐year‐old female. The gas pattern was unusual because there was only gas accumulation in the urinary bladder without bladder wall thickening or intramural gas formation. The differential diagnosis included postoperative states, enterovesical fistula, and iatrogenic instrumentation. The prognosis of emphysematous cystitis is good after early diagnosis and prompt treatment with appropriate antibiotics, blood glucose control, and adequate urinary drainage. The patient was discharged on hospital day 5 with one additional week of oral antibiotic therapy. She was quite well at the time of writing and her diabetes was controlled with an oral hypoglycemic agent.
Morphometric Analysis of the Mandible in Subjects with Class III Malocclusion
Authors: Pan Jin‐Yun , Chou Szu‐Ting , Chang Hong‐Po , Liu Pao‐Hsin
Published: July 2009

This study evaluated the deformations that contribute to Class III mandibular configuration, employing geometric morphometric analysis. Lateral cephalograms of male and female groups of 100 young adults and 70 children with Class III malocclusion were compared to those of counterparts with normal occlusion. The sample included an equal number of both genders. The cephalographs were traced, and 12 homologous landmarks were identified and digitized. Average mandibular geometries were generated by means of Procrustes analysis. Thin‐plate spline analysis was then applied to mandibular configurations to determine local form differences in male and female groups of adults and children with normal occlusion and Class III malocclusion. The mandibular morphology was significantly different between these two groups of male and female adults, and children (p< 0.0001). This spline analysis revealed an anteroposterior elongation of the mandible along the condylion‐gnathion axis, showing an extension in the regions of the mandibular condyle and ramus, and of the anteroinferior portion of the mandibular symphysis in Class III groups. More extension was evident in Class III adults. The deformations in subjects with Class III malocclusion may represent a developmental elongation of the mandible anteroposteriorly, which leads to the appearance of a prognathic mandibular profile.
Diphyllobothriasis Latum: the First Child Case Report in Taiwan
Authors: Chou Hsiao‐Feng , Yen Chuan‐Min , Liang Wen‐Chen , Jong Yuh‐Jyh
Published: July 2009

Diphyllobothriasis latum is an intestinal parasitosis caused by the ingestion of mostly raw freshwater fish containing plerocercoids of Diphyllobothrium latum. We report an 8‐year‐old boy who came to our hospital with the complaint of a tapeworm hanging from the anus after defecation. The other symptom was mild abdominal cramping for a period of 1 year. The laboratory examination did not reveal anemia or vitamin B12 deficiency. Examination of gravid proglottids with rosette‐like central uterus and typically operculated eggs of D. latum confirmed the diagnosis. The morphologic characters of proglottids and eggs size are compatible with D. latum. The patient had a history of eating uncooked fish for 1 year. Salmonids may be the infection source. He was treated with two doses of praziquantel and passed about 183 cm in length of all proglottids. There is a high prevalence of diphyllobothriasis latum in the northern temperate areas, but it is very rare in children. This patient is the first child case reported in Taiwan.
A Rare Case of Combined Small‐Cell Lung Cancer with Unusual Soft Tissue Metastasis
Authors: Hsiao Hui‐Hua , Tsai Hui‐Jen , Liu Yi‐Chang , Tseng Shi‐Bin , Lin Sheng‐Fung , Tseng Yi‐Ting , Chai Chee‐Yin
Published: July 2009

Combined small‐cell lung carcinoma (SCLC) is a rare tumor. We report a case of combined SCLC of the lung, including adenocarcinoma and spindle‐shaped cell tumor, with an unusual initial presentation. The patient suffered from a right shoulder mass, subsequently undergoing biopsy. A lung nodule was noted later after complete examination. The diagnosis turned out to be combined cell carcinoma with three different components (small‐cell carcinoma, adenocarcinoma, and spindle‐shaped cell tumor) after examination upon total removal of the lung nodule by lobectomy. In addition to the rarity of the three components in such a tumor, soft tissue metastasis also made it an unusual case.
Gitelman Syndrome: Report of Three Cases and Literature Review
Authors: Lee Ya‐Ting , Wang I‐Fan , Lin Tsung‐Hsien , Huang Chia‐Tsuan
Published: July 2009

Gitelman syndrome (GS) is a rare autosomal recessive, inherited renal tubular disorder. Herein, we report three cases of GS, one sporadic case and two siblings. They have typical laboratory findings, including hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. All of them were treated with oral potassium and magnesium supplements. They received regular pediatric clinic follow‐up to check electrolytes and monitor development. These three cases reminded us that doctors should be alert to unexplained hypokalemia, which is usually the initial presentation of GS.
Mechanisms of Cough Syncope as Evaluated by Valsalva Maneuver
Authors: Chao A‐Ching , Lin Ruey‐Tay , Liu Ching‐Kuan , Wang Pao‐Yu , Hsu Hung‐Yi
Published: July 2009

Successful treatment of cough syncope depends on the correction of various pathogenetic mechanisms among different patients. The valsalva maneuver (VM), which elicits hemodynamic responses mimicking coughs, has potential for investigating the individual pathogenesis of cough syncope. Eighteen consecutive patients suffering from cough‐induced syncope were examined. All patients were asked to cough and to perform VM several times under continuous cerebral blood‐flow velocity and blood pressure (BP) monitoring by transcranial Doppler and finger plethysmography. Eight patients demonstrated abnormal VM characterized by the absent BP overshoot following the relief of straining. Patients demonstrating abnormal VM had delayed BP recovery after cough (median, 16.4; range, 8.7–25.6 seconds) compared to those demonstrating normal VM (2.6, 1.3–3.8 seconds, p < 0.001). Seven of the 10 patients exhibiting normal BP overshoot during VM had stenotic arterial lesions in the cerebral or coronary circulation, whereas only one of the eight patients demonstrating absent BP overshoot had coronary artery disease (70% vs. 12.5%, p = 0.025). Other clinical profiles, body mass index, frequency of obstructive pulmonary disease and valsalva ratio did not differ between patients featuring normal and absent BP overshoot. In conclusion, the pathogenesis of cough syncope could be different between patients with normal and abnormal VM responses. Patients who had no BP overshoot during VM sustained prolonged hypotension after cough. The VM helps in discriminating among pathogenic mechanisms and guiding investigation and treatment for cough syncope patients.
Red Umbilicus as a Clinical Manifestation in a 19‐Month‐Old Girl with Typhoid Colonic Perforation
Authors: Chang Yu‐Tang , Lin Jan‐You
Published: July 2009

Redness of the umbilicus is usually considered to be a reliable sign of underlying gangrenous bowel or peritonitis in tiny infants but seldom among non‐neonatal patients. We report a 19‐month‐old girl with final diagnosis of typhoid colonic perforation who initially presented with abdominal distention and umbilical erythema on arrival at our emergency department. The redness of umbilicus diminished gradually after laparotomy. Thin abdominal wall, severe intra‐abdominal soiling, and polymicrobial infection accounted for the inflammatory process spreading to the skin of the umbilicus. Because of its rarity beyond the neonatal period, prompt diagnosis depends on maintaining a high index of suspicion when the abdomen is distended and suddenly tender to palpation.
Organophosphate Poisoning: 10 Years of Experience in Southern Taiwan
Authors: Tsai Jong‐Rung , Sheu Chau‐Chyun , Cheng Meng‐Hsuan , Hung Jen‐Yu , Wang Chuan‐Sheng , Chong Inn‐Wen , Huang Ming‐Shyang , Hwang Jhi‐Jhu
Published: July 2009

Poisoning due to organophosphate pesticides is an important cause of morbidity and mortality worldwide. Although standard treatments involving the administration of atropine and oximes have been used, there remain many controversial areas concerning organophosphate poisoning (OPP). Herein, we present our 10 years of experience in assessing the severity of OPP in southern Taiwan. A retrospective study was performed on patients admitted with OPP. A total of 75 patients (50 males and 25 females) were studied between January 1996 and December 2005. Diagnosis was based on a clinical assessment and serum acetylcholinesterase (AChE) level at the time of hospital admission. The severity of OPP was assessed using the grading system of Bardin et al. The duration and dosage of atropine and palidroxime were recorded. All the biochemical data were analyzed. Sixty‐one of the patients had attempted suicide and 14 patients had accidental exposure. The overall mortality rate was 8%. Muscarinic effects were observed in 66 (88%) of the OPP patients and the most frequent symptom was bronchial hypersecretion (52%). Among these three different severity groups, prolonged length of stay, higher infection rates, and higher mortality were found in the life‐ threatened group. The initial serum C‐reactive protein (CRP) level was strongly correlated to the severity grading of the OPP. Nearly half of the patients were admitted to the intensive care unit (ICU) and, of this, 21 patients developed respiratory failure within 72 hours. Low serum AChE levels support the diagnosis of OPP, but no significant association was found between the severity of OPP and serum AChE levels. The grading system of Bardin et al is very helpful for physicians to facilitate the recognition of seriously poisoned subjects, and to permit their early admission to an ICU. Initial serum CRP, an acute phase reactant, had significant value in assessing the severity of the OPP. Although the management of acute OPP is supportive and the recovery rate is high, anti‐cholinergic therapy should be used as soon as possible to counteract muscarinic effects. Physicians must be aware of the potential dangers of respiratory failure, which could occur within 72 hours of OPP.
Rupture of Renal Pelvis in an Adult with Congenital Ureteropelvic Junction Obstruction After Blunt Abdominal Trauma
Authors: Li Wei‐Ming , Liu Chia‐Chu , Wu Wen‐Jeng , Chou Yii‐Her , Huang Chun‐Hsiung , Li Ching‐Chia
Published: July 2009

Isolated injury to the renal pelvis following blunt abdominal trauma is very rare. However, a pre‐existing renal abnormality will increase the risk of rupture. We present a 24‐year‐old man with rupture of the left renal pelvis following blunt abdominal trauma. He had pre‐existing left ureteropelvic junction (UPJ) obstruction. Delayed computed tomography scan with excretory phase revealed contrast medium extravasation from the left UPJ, and left renal pelvis rupture was diagnosed. He was managed successfully with ureteral double‐J stenting for 2 months.
Taste Disturbance After Palatopharyngeal Surgery for Obstructive Sleep Apnea
Authors: Hsiao Han‐Ren , Li Hsueh‐Yu
Published: July 2009

Taste disorder is a rare complication of uvulopalatopharyngoplasty, and may have a significant impact on quality of life. Herein, we report a case of obstructive sleep apnea syndrome in a 51‐ year‐old man who experienced taste disturbance after palatopharyngeal surgery using electrocautery for developing a uvulopalatal flap. Gustatory function test using three‐drop‐method with solutions of highest concentration was implemented to assess the deficiency of four basic tastes. The results showed deficit of sweet taste associated with phantom of bitter taste. The patient reported constant spontaneous bitter taste and dysgeusia in sweet taste with poor quality of life at the 2‐year follow‐up. We suggest that patients are informed of the potential for taste impairment from palatopharyngeal surgery, as well as reducing the use of electrocautery in developing uvulopalatal flap to reduce damage to taste function.
Myocardial Infarction Due to Giant Cell Arteritis: A Case Report and Literature Review
Authors: Lin Long‐Wei , Wang Shoei‐Shen , Shun Chia‐Tung
Published: July 2009

Giant cell arteritis occurs mainly in the cranial arteries, especially in the temporal area, and rarely in the coronary arteries. Here, we present a case of coronary artery giant cell arteritis in a 51‐year‐old woman who complained of atypical chest pain. Radionuclide angiography showed dilated left ventricle with global hypokinesia. Despite medical treatment, she suffered progressive heart failure and finally was given a heart transplant. The pathologic examination revealed myocardial infarction due to coronary giant cell arteritis. Unusual giant cell arteritis should be considered in the differential diagnoses of myocardial infarction.
PON1 Activity is Inversely Related to LDL ApoB Carbonyl Content in Patients with Coronary Artery Disease
Authors: Sharma Ritu , Singh Balwant , Mahajan Mridula
Published: July 2009

The objective of this study was to investigate apolipoprotein B (apoB) carbonyl content as a parameter for studying low‐density lipoprotein (LDL) oxidation in coronary artery disease (CAD) risk assessment and to explore the relationship between apoB carbonyl content (an index of protein oxidation) and paraoxonase 1 (PON1) activity in CAD patients and controls. A total of 200 patients suffering from CAD and 150 normal individuals were included in the present study. CAD patients were classified into two groups on the basis of associated risk factors (diabetes mellitus, hypertension): group 1 (n = 120; CAD patients with associated risk factors) and group 2 (n = 80; CAD patients with no associated risk factors). All subjects were assayed for apoB carbonyl content, LDL‐malondialdehyde (LDL‐MDA), PON1 activity, and lipid and apolipoprotein levels. ApoB carbonyl content was significantly (p < 0.01) raised in CAD patients (with or without associated risk factors) as compared to controls. Patients also had relatively raised LDL‐MDA levels. Serum PON1 activity was significantly low (p < 0.01) in CAD patients. A significantly (p < 0.01) negative coefficient of correlation was observed between apoB carbonyl content and PON1 activity in both patients and controls. CAD patients with associated risk factors had highly raised (p < 0.01) apoB carbonyl content and considerably depressed PON1 activity compared to those with no associated risk factors. LDL‐MDA levels did not differ significantly (p > 0.05) between the two groups. CAD patients in group 1 also had significantly raised apoB levels and low HDL‐cholesterol and apoA1 levels as compared to patients in group 2, while the other lipid variables did not show any significant difference. A significantly negative coefficient of correlation was observed between apoB carbonyl content and PON1 activity in both patients and controls. This is a new piece of information that needs to be further explored. Quantification of apoB carbonyl content may act as a suitable parameter for studying LDL oxidation in the evaluation of CAD risk, especially when confounding risk factors are present.
Clinical Presentation of Acute Scrotum in Young Males
Authors: Liu Chia‐Chu , Huang Shu‐Pin , Chou Yii‐Her , Li Ching‐Chia , Wu Ming‐Tsang , Huang Chun‐Hsiung , Wu Wen‐Jeng
Published: July 2009

The purpose of this study was to assess the clinical presentation and ultrasonographic findings of acute scrotum in young males. A total of 87 patients (≤ 25 years old) with presentation of acute scrotum were retrospectively analyzed in Kaohsiung Medical University Hospital. The patients were divided into three groups according to their final diagnosis: 41 patients with testicular torsion (TT), eight patients with torsion of the testicular appendage (TTA), and 38 patients with epididymo‐orchitis (EO). The mean ages of the TT group (14.0 ± 5.7 years) and EO group (16.6 ± 7.6 years) were higher than that of the TTA group (10.0 ± 3.5 years) (p = 0.02). White blood cell count (> 10,000 cells/mL) was not found to be statistically different among groups. Pyuria was found in 10 (26%) patients with EO. Color Doppler ultrasound has high sensitivity (87.9%) and specificity (93.3%) rates to differentiate TT from other causes of acute scrotum. In cases with a lower risk of TT, we suggest that a technically adequate color Doppler ultrasound may be arranged to help differentiate diagnoses and prevent needless surgery. The importance of emergent management for acute scrotum should also be impressed upon the public through education to avoid delayed presentation to medical facilities.
Dynamic Magnetic Resonance Imaging Used in Evaluation of Female Pelvic Prolapse: Experience from Nine Cases
Authors: Chi Tony Wing‐Cheong , Chen Shin‐Hong
Published: July 2009

Prolapse of pelvic organs in a female can be simple or complex. To make a definite diagnosis of pelvic prolapse preoperatively, dynamic magnetic resonance (MR) is an alternative to conventional fluoroscopic or sonographic examination, with the advantage of providing greater details, and thus helping the surgeon to have a good preoperative plan. Nine women suffering from pelvic prolapse with or without urinary stress incontinence underwent dynamic MR imaging examination (1.0T Magnex100/HP, Shimadzu, Kyoto, Japan) before surgery. All patients were examined in the supine position. A single‐shot ultra‐high speed scan (FE/8/3.02–20°, 128, 100%‐ 100% 1 NEX 1 slice 10 mm L 1.0 second) was used to obtain midline sagittal images, with the patients at rest and during pelvic strain. MR images were then obtained every 4 seconds. Each examination was analyzed, based on specific measurements, to determine the presence and extent of prolapse of pelvic organs. The pubococcygeal, levator hiatus width and muscular pelvic floor relaxation lines, and the angle of the levator plate were identified. Based on these measurements, multicompartment involvement in the pelvic prolapse was confirmed in five patients (5/9). Four patients (4/9) had single compartment involvement. Seven patients underwent surgery. All patients reported significant improvement in their symptoms and signs after surgical intervention. Two patients had an almost complete recovery. MR demonstrated simple or complex organ descent in all pelvic compartments, and may become a standard preoperative examination for pelvic floor abnormalities. The MR images facilitated comprehensive planning by the surgeon; thus, they can increase the success rate and help to accurately predict the outcome of the surgical intervention. The surgeons also expressed high postsurgical satisfaction with the information provided by dynamic MR.
Large Vesicula Seminalis Cyst: A Very Rare Cause of Constipation and Male Infertility
Authors: Ates Yuksel , Kilciler Guldem , Bedir Selahattin , Aslan Murat , Kilciler Mete , Tuzun Ahmet , Yagci Gokhan , Bagci Sait
Published: July 2009

We report a 35‐year‐old male patient with chronic constipation and infertility for 4 years. Spermiogram revealed severe oligospermia. An external mass compressing the rectum was found during rectal examination and flexible rectosigmoidoscopy. Abdominal computed tomography showed a presacral cystic mass which displaced the bladder anteriorly. The cyst was completely removed with open surgery. Histopathologic analysis revealed a cystic lesion covered with squamous epithelium including polymorphonuclear leukocytes, macrophages and sperm cells. After the operation, the patient's symptoms were relieved. We considered that the constipation was caused by external compression by the vesicula seminalis cyst. In cases of constipation with infertility, vesicula seminalis cyst should be kept in mind.
Use of Caveolin‐1, Thyroid Transcription Factor‐1, and Cytokeratins 7 and 20 in Discriminating Between Primary and Secondary Pulmonary Adenocarcinoma from Breast or Colonic Origin
Authors: Tsao Shu‐Chuan , Su Yue‐Chiu , Wang Sheng‐Lan , Chai Chee‐Yin
Published: July 2009

The objectives of this study were firstly to compare the immunostaining patterns of antibodies against caveolin‐1, thyroid transcription factor‐1 (TTF‐1), cytokeratin 7 (CK7) and cytokeratin 20 (CK20) in primary and secondary pulmonary adenocarcinomas of breast or colonic origin, and secondly, to investigate their use alone and in combination, in distinguishing between primary and secondary lung adenocarcinomas from breast or colonic origin. Of the 49 lung adenocarcinoma specimens that were enrolled in this study, 30 were primary pulmonary adenocarcinomas, and 19 (9, breast origin; 10, colonic origin) were metastatic pulmonary carcinomas. Immunohistochemical staining was used to detect the expression of caveolin‐1, TTF‐1, CK7, and CK20. Primary pulmonary adenocarcinoma most often had the CK7‐positive/CK20‐negative immunohistochemical phenotype and was either TTF‐1 positive or caveolin‐1 negative. Secondary pulmonary adenocarcinoma of breast origin most often had the CK7‐positive/CK20‐negative immunohisto‐chemical phenotype and was either TTF‐1 negative or caveolin‐1 positive, while secondary pulmonary adenocarcinoma of colonic origin most often had the CK20‐positive/CK7‐negative immunohistochemical phenotype and was either TTF‐1 negative or caveolin‐1 positive. The results suggest that caveolin‐1, TTF‐1, or CK7/CK20 alone did not distinguish reliably between primary and secondary pulmonary adenocarcinomas originating from breast or colon. The use of a panel of antibodies that includes TTF‐1, caveolin‐1, and CK7/CK20 may have higher sensitivity in discriminating between primary adenocarcinomas and metastatic lung adenocarcinomas from breast or colonic origin.