bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed Postpartum Hemorrhage — A Rare Clinical Presentation of Thrombotic Thrombocytopenic Purpura‐Hemolytic Uremic Syndrome: A Case Report
Authors: Chen Yu‐Chieh , Chen Hung‐Sheng , Shen Ching‐Ju , Chang Huei‐Ming , Tsai Eing‐Mei
Published: July 2009

Thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) are rare and closely related disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Many risk factors have been reported including infection, cancer, pregnancy, a variety of drugs (e.g. anticancer drugs), and autoimmune diseases. The incidence of TTP‐HUS is higher in females than in males, especially during pregnancy and the immediate postpartum period. Review of the literature reveals that delayed postpartum hemorrhage is a rare clinical presentation of TTP‐HUS. We report a case of TTP‐HUS with recurrent delayed postpartum hemorrhage and dismal outcome.
Comparison of Two Heat‐pressed All‐ceramic Crown Systems
Authors: Tsai Ting‐Ting , Hung Chun‐Cheng , Chen Jeng‐Huey , Hou Guey‐Lin , Wang Jen‐Chyan , Tsai Ching‐Fang , Lai Pei‐Lin , Tsai Chi‐Cheng
Published: July 2009

There is increasing demand for all‐ceramic crowns to improve esthetics and avoid the intraoral use of metal. There are several ways to fabricate all‐ceramic prostheses. The heat‐press method is easily handled, creates less porosity than the conventional powder slurry method, produces consistent quality, and avoids firing shrinkage. Each of the popular brands of heat‐press ceramics has its own heat‐press furnace. The purposes of this study were to determine whether it was possible to use one heat‐press furnace to make different all‐ceramic prostheses, and to compare the fit and hardness of two commercial heat‐press all‐ceramic systems made using the staining technique. Ceramic ingots were analyzed by X‐ray diffraction analysis before heat press. Finesse® All‐Ceramic and OPC 3G® specimens were both heat‐pressed using a porcelain pressing furnace designed for Finesse®. Mesio‐occluso‐distal inlays were cemented to the metal die with temporary cement. Marginal accuracy was measured using a three‐dimensional coordinate measuring machine. Vickers hardness was measured using a microhardness tester. X‐ray diffraction analysis of the ceramic ingots showed that the main peak position for Finesse® was leucite (KAlSi2O6) and for OPC 3G® was lithium disilicate (Li2Si2O5). The marginal gap for Finesse® was statistically lower than that for OPC 3G® (62.5 ± 15.5 vs 99.4 ± 11.6 mm; p < 0.05). There was no statistically significant difference in hardness between Finesse® and OPC 3G® (613.8 ± 49.2 vs 660.0 ± 34.0 kgf/mm2; p > 0.05). The marginal gaps for Finesse® and OPC 3G® were clinically acceptable. Therefore, it is possible to use one heat‐press furnace to cast different all‐ceramic systems.
Aeromonas hydrophila Septicemia in Acute Hand Injury: A Case Report
Authors: Yang Chin‐Chiang , Sun I‐Feng , Liu Chia‐Ming , Lai Chung‐Sheng
Published: July 2009

Aeromonas hydrophila is an uncommon and frequently overlooked cause of skin and soft‐tissue infection. Rapid onset of cellulitis and bullae formation in the setting of soft‐tissue trauma in connection with exposure to fresh water should alert the clinician to the possibility of infection by this organism. We report a case of severe necrotizing fasciitis due to A. hydrophila infection involving the hand and arm, complicated by septicemia within 30 hours of injury. In addition to appropriate antibiotic therapy and general supportive care, treatment involves early surgical exploration for compartment decompression and aggressive debridement of all necrotic tissue followed by skin grafting for delayed wound closure. There was good functional outcome after more than 1 year of follow‐up. Early awareness of A. hydrophila infection, as well as of infection by Vibrio, is necessary in preventing crippling deformities of the hand in post‐traumatic wound infection with a history of exposure to fresh water.
Comparison of the Effect of Two Different Doses of 0.75% Glucose‐Free Ropivacaine for Spinal Anesthesia for Lower Limb and Lower Abdominal Surgery
Authors: Wong John On‐Nin , Tan Thomas Dou‐Moo , Leung Pak‐On , Tseng Kin‐Fui , Cheu Ning‐Wei , Tang Chao‐Shun
Published: July 2009

We compared the clinical efficacy and safety of two doses of ropivacaine for spinal anesthesia in Chinese patients undergoing lower limb and lower abdominal surgery. In this randomized, open‐label study, 40 patients were divided into two groups: group A received 3.5 mL (26.25 mg) of 0.75% glucose‐free ropivacaine, and group B received 4.5 mL (33.75 mg). Sensory and motor blocks were assessed during and after surgery through to complete recovery. Seven standard measurements were taken: time to onset of sensory blocks; maximum sensory cephalad spread; time to maximum sensory block; maximum number of blocked segments; duration of sensory block at L3; time to onset of complete motor block; and duration until complete motor block recovery. Vital signs and any adverse effects related to spinal anesthesia were also recorded. No significant differences were found between the two groups: time to onset of sensory block at L3 in group A vs B (2.1 ± 9.6 vs 1.7 ± 7.3 minutes), maximum cephalad spread [T4‐5 (C3‐T11) vs T4 (C3‐T8)], maximum number of blocked segments (18.0 ± 3.4 vs 19.8 ± 3.7), time to maximum sensory block (34.0 ± 22.9 vs 26.8 ± 17.9 minutes), duration of sensory block at L3 (251.2 ± 34.7 vs 277.3 ± 51.1 minutes), time to onset of complete motor block (13.4 ± 6.4 vs 10.3 ± 3.4 minutes), and time for complete recovery from motor block (264 ± 52.1 vs 292.5 ± 64.5 minutes). No significant differences in global hemodynamic changes were found during and after the operation. While shivering was more frequent in group B during the operation, the difference was not significant. Otherwise, there were no differences in adverse effects during and after surgery. We conclude that both doses of 0.75% glucose‐free ropivacaine, 26.25 mg (3.5 mL) and 33.75 mg (4.5 mL), have the same efficacy and safety in Chinese patients undergoing spinal anesthesia for lower limb and lower abdominal surgery.
Risk of Vocal Palsy After Thyroidectomy with Identification of the Recurrent Laryngeal Nerve
Authors: Chiang Feng‐Yu , Lee Ka‐Wo , Huang Yin‐Feng , Wang Ling‐Feng , Kuo Wen‐Rei
Published: July 2009

The purpose of this study was to assess the risk of vocal palsy after thyroidectomy with identification of recurrent laryngeal nerve (RLN) during surgery. In all, 521 patients treated by the same surgeon were enrolled in this study. Temporary and permanent vocal palsy rates were analyzed for patient groups classified according to surgery for primary benign thyroid disease, thyroid cancer, Graves' disease, and reoperation. Measurement of the vocal palsy rate was based on the number of nerves at risk. Twentysix intentionally sacrificed RLNs were excluded from analysis. Forty patients developed postoperative unilateral vocal palsy. Complete recovery of vocal palsy was documented for 35 of the 37 patients (94.6%) whose RLN integrity had been ensured intraoperatively. Recovery from temporary vocal palsy ranged from 3 days to 4 months (mean, 30.7 days). The overall incidences of temporary and permanent vocal palsy were 5.1% and 0.9%, respectively. The rates of temporary/permanent vocal palsy in groups classified according to underlying disease were 4.0%/0.2% for benign thyroid disease, 2.0%/0.7% for thyroid cancer, 12.0%/1.1% for Graves' disease, and 10.8%/8.1% for reoperation. Surgery for thyroid cancer, Graves' disease, and recurrent goiter were associated with significantly higher vocal palsy rates. Most patients without documented nerve damage during the operation recovered from postoperative vocal palsy. Total lobectomy with routine RLN identification is recommended as a basic procedure in thyroid surgery.
Total Intravenous Anesthesia for Repair of Congenital Diaphragmatic Hernia: A Case Report
Authors: Hsu Hung‐Te , Chang Yin‐Lung , Yu Kwong‐Leung , Cheng Kuang‐I , Tang Chao‐Shun , Lin Jao‐Yu , Tseng Hsing‐I
Published: July 2009

Congenital diaphragmatic hernia is a cardiopulmonary anomaly that causes severe respiratory disorder. Traditionally, inhalational anesthetics with mechanical hyperventilation, opioids, and muscle relaxants are used in anesthesia for repair surgery. In this case, we used total intravenous anesthesia combined with high‐frequency oscillatory ventilation and inhaled nitric oxide for surgical repair of the diaphragm. After surgery, the patient recovered well and was discharged from hospital 1 month later.
Predicting the Grade of Disability 1 Year After Stroke Following Rehabilitation
Authors: Lin Jau‐Hong , Tsai Athena Yi‐Jung , Lo Sing‐Kai , Chang Jyh‐Jong , Huang Mao‐Hsiung
Published: July 2009

The purpose of this study was to identify predictors of grades of disability at least 1 year after stroke rehabilitation therapy. We recruited stroke patients from the inpatient rehabilitation department of a university hospital. The degree of disability was graded using the disability evaluation at least 1 year after stroke onset. Functional ability was evaluated using the Functional Independence Measure instrument on admission, on discharge from the inpatient rehabilitation program, and at the 6‐month follow‐up visit after discharge. Major sociodemographic, medical, and rehabilitative factors were also collected during the hospitalization period. Of the 109 patients surveyed, 64 (58.7%) had severe or very severe grades of disability. The correlates of severe or very severe disability in logistic regression analyses were bilaterally affected (odds ratio, OR, 10.8), impaired orientation (OR, 3.6), and poorer functional ability at discharge (OR, 7.6). Based on the significant predictors identified, the logistic regression model correctly classified severe or very severe disability in 68.0% of subjects. The higher frequency of severe or very severe disability in this study may have been due to the relatively more severely affected stroke patient population in the inpatient rehabilitation service and the use of unique disability evaluation criteria. These results may provide information useful in planning continuous rehabilitation care and setting relevant socio‐welfare policies for stroke victims.
Allopurinol‐induced Severe Hypersensitivity with Acute Renal Failure
Authors: Chen I‐Hung , Kuo Mei‐Chuan , Hwang Shang‐Jyh , Chang Jer‐Ming , Chen Hung‐Chun
Published: July 2009

A 62‐year‐old male was sent to the emergency room due to a high fever and generalized skin rash after taking allopurinol for 9 days. Physical examination was normal except for the generalized skin rash presenting with erythematous macules. Complete blood count showed leukocytosis with eosinophilia. Blood biochemistry showed impaired renal and hepatic function. Pathologic examination concluded that the skin rash was erythema multiforme. These findings met the diagnostic criteria for allopurinol‐induced hypersensitivity syndrome (AHS). Our patient not only had the most common skin lesion but soon developed acute renal failure that required intermittent hemodialysis, despite rapid discontinuation of allopurinol and adequate hydration and steroid therapy. No other causes of acute renal failure were found. Renal impairment was the worst part of the patient's condition and he never completely recovered. AHS should be considered in the differential diagnosis of acute renal and hepatic failure in patients with evidence of allergy and recent use of allopurinol.
Unilateral Stereotactic Posteroventral Globus Pallidus Internus Pallidotomy for Parkinson's Disease: Surgical Techniques and 2‐Year Follow‐Up
Authors: Yen Chun‐Po , Wu Shiao‐Jing , Su Yu‐Feng , Kwan Aij‐Lie , Howng Sheng‐Long , Shih Pang‐Ying
Published: July 2009

With the advent of levodopa (L‐dopa) and the recognition of its striking effect on Parkinson's disease (PD), virtually all surgical procedures for PD ceased from the mid 1960s. However, there has been a resurgence of pallidotomy and other stereotactic procedures in the last two decades as physicians realized that most PD patients eventually face medical failure after long‐term treatment with L‐dopa. Nine PD patients, three men and six women, with an average age of 62 years and disease duration of 13 years underwent unilateral globus pallidus internus (GPi) pallidotomy contralateral to the side with marked akinetic symptoms and drug‐induced dyskinesia. All patients were evaluated using the Unified Parkinson's disease Rating Scale (UPDRS) after drug withdrawal and while taking their optimal medical regimen, preoperatively and 6, 12, and 24 months after surgery. There was significant improvement in activities of daily living and motor subscores as well as total UPDRS score in the “off” state at the 2‐year follow‐up, which mainly resulted from improvement in contralateral bradykinesia and rigidity. Significant improvements in contralateral akinetic symptoms and drug‐induced dyskinesia were also observed in the “on” state and were sustained for at least 2 years. Ipsilateral and axial symptoms were not altered by unilateral GPi pallidotomy. The complications of surgery were generally well tolerated. One patient had a small postoperative asymptomatic hemorrhage identified by routine follow‐up magnetic resonance imaging. Another two patients developed temporary sexual disinhibition and auditory hallucination, respectively, which resolved spontaneously 2 weeks after surgery. The effect of pallidotomy for alleviation of akinetic parkinsonism is modest but significant, and continues to be effective for at least 2 years. Further analytical studies, especially the correlation of clinical effects and lesion locations, are important not only to provide direct feedback for surgeons to examine the technical accuracy and but also to facilitate understanding of the pathophysiology of PD.
The History of Schistosomiasis Japonica in Taiwan
Authors: Fan Ping‐Chin
Published: July 2009

Studies of schistosomiasis japonica in Taiwan indicate that the Formosan strain of Schistosoma japonicum is zoophilic in nature. After the discovery of the adult worm of S. japonicum in 1914, a considerable number of epidemiologic studies and experimental infection studies were conducted. This paper is a review of the history of schistosomiasis japonica in Taiwan from before World War II to 2003.
Intravitreal Triamcinolone Acetonide for Patients with Macular Edema due to Branch Retinal Vein Occlusion
Authors: Cheng Kai‐Chun , Wu Wen‐Chuan
Published: July 2009

We designed a case series study to evaluate the outcome of intravitreal triamcinolone acetonide for the treatment of macular edema due to branch retinal vein occlusion (BRVO). The prospective comparative nonrandomized clinical interventional study included 27 patients (27 eyes) with macular edema due to BRVO. The study group consisted of 16 patients who had accepted an intravitreal injection (IVI) of 4 mg triamcinolone acetonide. The control group included 11 patients without IVI of triamcinolone acetonide. The mean follow‐up was 103.00 36.24 days in the study group and 94.55 36.31 days in the control group. In the study group, visual acuity measurements improved significantly (p 0.001) from 0.77 0.43 logarithm of minimal angle of resolution (logMAR) preoperatively to a best postoperative visual acuity of 0.44 0.43 logMAR. Fourteen eyes (87.5%) gained improvement in visual acuity, with 10 eyes (62.5%) showing an increase in visual acuity of at least two Snellen lines. All 16 patients showed significant macular edema resolution in optical coherence tomography examination (p 0.001) and perivascular leakage decrease in fluorescein angiography post‐IVI. In the control group, baseline best‐corrected visual acuity and best‐corrected visual acuity during the follow‐up did not vary significantly (p 0.294). In conclusion, IVI of triamcinolone acetonide can lead to an increase in visual acuity and a resolution of macular edema in patients with BRVO.
Clinical Characteristics of Patients with Sporadic Colorectal Cancer and Primary Cancers of Other Organs
Authors: Kan Jung‐Yu , Hsieh Jan‐Sing , Pan Yong‐Sang , Wang Wen‐Ming , Chen Fang‐Ming , Jan Chang‐Ming , Huang Yu‐Sheng , Huang Tsung‐Jen , Wang Jaw‐Yuan
Published: July 2009

Most cancer patients often neglect the possibility of secondary cancer. Colorectal cancer (CRC) is the third leading cause of cancer death in Taiwan. It is important to be aware of the clinical characteristics of double cancer in CRC patients for early diagnosis and treatment. We retrospectively analyzed 1,031 CRC patients who underwent surgical treatment at the Department of Surgery of Kaohsiung Medical University Hospital between January 1998 and December 2004. Among these patients, CRC was accompanied by cancer of other organs in 17 patients (1.65%), either synchronously or metachronously. Therefore, we describe our experience regarding the location of CRC, the clinical symptoms and signs of these patients, the TNM stage, histology, phase, association with other malignancies, interval between cancers and clinical outcomes. Of the 17 patients in whom CRC was accompanied by primary cancer of other organs, there were four synchronous and 13 metachronous multiple cancer patients. Our patient group comprised six men and 11 women with ages ranging from 47 to 88 years (median age, 66 years). The most common location of CRC was the sigmoid colon. Six gastric cancers (35.2%) and six breast cancers (35.2%) were associated with primary CRC. The remaining six second primary cancers were one lung cancer, one thyroid cancer, one cervical cancer, one ovarian cancer, one skin cancer, and one urinary bladder cancer. Of the 13 metachronous multiple cancer patients, eight patients developed subsequent CRC after primary cancers of other organs, whereas two patients developed a subsequent second primary cancer after CRC. The intervals between the development of metachronous multiple cancers ranged from 2 to 19 years. In this retrospective analysis, breast and gastric cancer patients were at increased risk of developing subsequent secondary CRC. Careful attention should always be paid to the possibility of secondary CRC in treating these cancer patients. Cancer patients with hematochezia or gastrointestinal symptoms/signs should be evaluated for the possibility of second primary CRC during their regular follow‐up.
Psychopathology of Aboriginal and Non‐Aboriginal Adolescents Living in the Mountainous Region of Southern Taiwan
Authors: Yen Cheng‐Fang , Hsu Chia‐Chuang , Liu Shu‐Chun , Huang Chi‐Fen , Yang Mei‐Sang
Published: July 2009

The aim of this study was to examine the hypothesis that Taiwanese aboriginal adolescents feature more severe psychopathology than non‐aboriginal adolescents who live in the same mountainous region of southern Taiwan, and to test the hypothesis by controlling other individual and environmental factors. In this study, a total of 251 aboriginal and 79 non‐aboriginal Taiwanese adolescents were enrolled. Their psychopathology was measured by the Symptom Checklist‐90‐Revised Scale; demographic and family characteristics, and their affinity with their peer group and with their school were also assessed. The results of the multiple regression analysis revealed that aboriginal adolescents feature more severe psychopathology than non‐aboriginal adolescents, and indicated that females and adolescents perceiving higher levels of family conflict and lower family support were more likely to experience more severe psychopathology than those perceiving the contrary. Those who devise strategies to improve the mental health of adolescents living in impoverished regions must take into consideration their ethnicity, gender, and family context when devising such treatment strategies.
Freiberg's Infraction — Treatment with Metatarsal Neck Dorsal Closing Wedge Osteotomy: Report of Two Cases
Authors: Lin Sung‐Yen , Cheng Yuh‐Min , Huang Peng‐Ju
Published: July 2009

Freiberg's infraction is a disease of avascular necrosis that most commonly involves the head of the second or third metatarsal. Several mechanisms have been proposed for its pathogenesis, but stress overloading is the most widely accepted etiology. Nonoperative treatment is thought to be effective in the early stages but not in the late stages of the disease. The methods of operative treatment for symptomatic Freiberg's infraction remain controversial. We report two cases of late stage Freiberg's infraction treated by metatarsal neck dorsal closing wedge osteotomy with good results, and we infer that this operation may be recommended for patients with symptomatic Freiberg's infraction in whom conservative treatments have little effect.
Conversion Disorder in Stroke: A Case Report
Authors: Chou Hsien‐Yeh , Huang Mao‐Hsiung , Weng Ming‐Cheng , Chen Tien‐Wen
Published: July 2009

Conversion disorder is caused by previous severe stress, emotional conflict, or an associated psychiatric disorder, and usually presents with one or more neurologic symptoms. Clinically, it is challenging to diagnose diseases such as transient ischemia attack, stroke, brain tumor, spinal cord injury, and neuropathy. In this case report, we present a male stroke patient who had a typical conversion disorder.
Multivariate Analysis of Prognostic Determinants for Colorectal Cancer Patients with High Preoperative Serum CEA Levels: Prognostic Value of Postoperative Serum CEA Levels
Authors: Ma Cheng‐Jen , Hsieh Jan‐Sing , Wang Wen‐Ming , Su Yu‐Chung , Huang Che‐Jen , Huang Tsung‐Jen , Wang Jaw‐Yuan
Published: July 2009

High preoperative serum carcinoembryonic antigen (CEA) levels have been well investigated and found to be associated with poor prognosis in patients with colorectal cancer (CRC). However, it has been observed that the outcome varies after curative resection, along with postoperative serum CEA levels; some patients continue to have high postoperative serum CEA levels while postoperative CEA levels return to normal in others. The purpose of this study was to determine the prognostic significance of postoperative serum CEA levels in CRC patients with high preoperative serum CEA levels. Between January 2002 and December 2004, 423 CRC patients underwent operation in our hospital; 181 (42.8%) had high preoperative serum CEA levels and were enrolled in this study. Among the 181 patients, 165 patients had curative resection; the remaining 16 had stage IV disease, so they underwent palliative surgery and were subsequently excluded from analysis. Pre‐ and postoperative serum CEA levels were measured and analyzed. All patients had curative resection and were divided into two groups according to postoperative serum CEA levels: one group comprised patients with postoperative serum CEA ≥ 5ng/mL (n = 80) and the other group comprised patients with postoperative serum CEA levels < 5ng/mL (n = 85). Postoperative serum CEA levels were significantly related to location of primary tumors (p = 0.042), lymph node metastases (p = 0.009), TNM stage (p = 0.001), and postoperative relapse (p = 0.004). The results of multivariate analysis showed that both lymph node metastases and high postoperative serum CEA levels (≥ 5ng/mL) were independent prognostic factors for CRC patients after curative resection. Postoperative serum CEA levels can be a single independent prognostic determinant in CRC patients with high preoperative serum CEA levels. Intensive follow‐up and adjuvant therapy may be necessary in CRC patients who continue to have high postoperative serum CEA levels even after curative resection.
Primary Appendiceal Malignancy: A Clinicopathologic Study
Authors: Chen Hwa‐Tzong , Lee Yeu‐Tsu M. , Wu Yung‐Kang , Yin Wun‐Yaw , Lee Ming‐Che , Chou Andy Shaw‐Bin , Hsu Yung‐Hsiang
Published: July 2009

Primary appendiceal cancer is a rare neoplasm. We analyzed the clinicopathologic characteristics and clinical outcomes of patients with primary appendiceal cancer treated at Buddhist Tzu Chi General Hospital in Eastern Taiwan. We reviewed the medical records of patients who had appendectomy at our hospital over a 10‐year period and studied those who had histologically proven malignant appendiceal neoplasms. We treated eight such patients: seven males and one female. Their median age was 66 years (range, 59–78 years). There were three mucinous adenocarcinomas, two colonic type adenocarcinomas, and three adenocarcinoids. No patient was diagnosed correctly before surgery, and five (62.5%) had a preoperative diagnosis of acute appendicitis. Operative procedures included right hemicolectomy or partial colectomy in four, debulking and right hemicolectomy in three, and appendectomy only in one. With a mean follow‐up of 64 months (range, 3–132), patients with adenocarcinoid lesions had better prognosis than those with adenocarcinomas. The important prognostic factors of primary appendiceal cancer included histologic subtypes and the extent of dissemination. In our series, palliative resection for disseminated lesions with or without additional chemotherapy resulted in long‐term survival.
Traumatic Tricuspid Insufficiency with Chordae Tendinae Rupture: A Case Report and Literature Review
Authors: Lin Shin‐Jing , Chen Chao‐Wen , Chou Chun‐Jen , Liu Kuan‐Ting , Su Ho‐Ming , Lin Tsung‐Hsien , Voon Wen‐Chol , Lai Wen‐Ter , Sheu Sheng‐Hsiung
Published: July 2009

With the increase in the number of automobile accidents, traumatic tricuspid insufficiency, a rare complication of non‐penetrating blunt chest injury, has become an important problem. This kind of injury has been found more frequently during the last decade, partly because of better diagnostic procedures and a better understanding of the pathology. Here, we report a 22‐year‐old male patient who suffered chest trauma from an automobile accident. Echocardiography demonstrated tricuspid chordae tendinae rupture with remarkable tricuspid regurgitation. We discuss this case in comparison with the previous literature. This case reminds us that physicians in the emergency department should be aware of this potential complication following non‐penetrating chest trauma.
Changes in Gingival Crevicular Fluid Interleukin‐4 and Interferon‐gamma in Patients with Chronic Periodontitis Before and After Periodontal Initial Therapy
Authors: Tsai Chi‐Cheng , Ku Chia‐Hsin , Ho Ya‐Ping , Ho Kun‐Yen , Wu Yi‐Min , Hung Chun‐Cheng
Published: July 2009

Cytokines are pivotal to the immune response of chronic periodontitis. The present study investigated the changes of gingival crevicular fluid (GCF) interleukin‐4 (IL‐4) and interferon‐gamma (IFN‐γ) in patients with chronic periodontitis before and after initial nonsurgical periodontal therapy (NSPT). GCF was collected from 17 patients by means of Periopaper® at baseline and 1 month after NSPT. IL‐4 and IFN‐γ were measured by enzyme‐linked immunoabsorbent assay. NSPT resulted in decreased total amount of IFN‐γ, increased concentration of IL‐4, and increased ratio of IL‐4 to IFN‐γ levels. We suggest that a low ratio of IL‐4 to IFN‐γ levels might be involved in the destruction (diseased sites) of periodontal tissue, whereas an increased ratio of IL‐4 to IFN‐γ levels could be related to the improvement of clinical periodontal health.
Predictive Risk Factors for Upper Gastrointestinal Bleeding with Simultaneous Myocardial Injury
Authors: Wu I‐Chen , Yu Fang‐Jung , Chou Jun‐Jen , Lin Tzeng‐Jih , Chen Han‐Wen , Lee Chee‐Siong , Wu Deng‐Chyang
Published: July 2009

The aims of this study were to: (1) evaluate the epidemiology of simultaneous upper gastrointestinal bleeding (UGIB) and myocardial injury using parameters including troponin I (TnI); and (2) investigate the predictive risk factors of this syndrome. One hundred and fifty‐five patients (101 men, 54 women; mean age, 64.7 ± 10.4 years; range, 38–94 years) at the emergency department (ED) with the major diagnosis of UGIB were included. They underwent serial electrocardiography (ECG) and cardiac enzyme follow‐up. Emergent gastroendoscopy was performed within 24 hours in most patients except for those who refused or were contraindicated. Mild myocardial injury was defined as the presence of any of the following: typical ST‐T change on ECG, elevated creatine kinase‐MB (CK‐MB) > 12U/L, or TnI > 0.2ng/dL. Moderate myocardial injury was defined as the presence of any two of the previously mentioned conditions. In total, 51 (32.9%) and 12 (7.74%) patients developed mild and moderate myocardial injuries, respectively. Myocardial injury was more common among patients with variceal bleeding (20/25 = 80.0%) than those with ulcer bleeding (23/112 = 20.5%). It could partially be attributed to a higher baseline TnI level in cirrhotic patients. After adjusting for significant risk factors revealed by the univariate analysis, UGIB patients with a history of liver cirrhosis and more than three cardiac risk factors comprised a high‐risk group for simultaneously developing myocardial injury. Other factors including age, gender, the color of nasogastric tube irrigation fluid, history of nonsteroidal anti‐inflammatory drug use, vasopressin or terlipressin administration, vital signs, and creatinine recorded at the ED were not significant predictors. Those who developed myocardial injury had a longer hospital stay (mean duration, 8.73 ± 6.94 vs. 6.34 ± 2.66 days; p = 0.03) and required transfusion of more units of packed erythrocytes.
Orbital Metastasis from Urothelial Carcinoma of the Urinary Bladder
Authors: Lin Han‐Ching , Chang Chang‐Hsien , Li Wei‐Ming , Hsiao Hsi‐Lin , Chang Tu‐Hao , Wu Wen‐Jeng , Huang Chun‐Hsiung
Published: July 2009

Radical cystectomy with ileal conduit diversion remains the standard treatment for invasive bladder cancer. We report a patient with urothelial carcinoma of the urinary bladder and found metastasis to the orbit post radical cystectomy and ileal conduit diversion presenting as blurred vision and diagnosed by open biopsy. The orbit is an infrequent site of metastasis from bladder cancer cells. To the best of our knowledge, there are fewer than 10 case reports of orbital metastasis from urothelial carcinoma reported in the English medical literature.
Mucoepidermoid Carcinoma on the Vermilion Border of the Upper Lip: A Case Report and Literature Review
Authors: Chan Leong‐Perng , Chiang Feng‐Yu , Lee Ka‐Wo , Kuo Wen‐Rei
Published: July 2009

Mucoepidermoid carcinoma occurring in the upper lip is extremely rare. A review of the English literature on mucoepidermoid carcinoma found only four reported cases in the lower lip, and none on the vermilion border of the upper lip. We present a 57‐year‐old patient who had an asymptomatic lesion on the middle upper lip for 30 years. It had grown progressively and had ulcerated over 1 month ago; the tumor was treated by M‐excision. After 17 months of post‐therapy, the patient had no local recurrence or distant metastasis. Mucoepidermoid carcinoma is a rare malignancy on the vermilion border of the upper lip with no reported cases to date. The origins of this tumor are not completely understood. Complete resection of the mucoepidermoid carcinoma usually achieves a successful outcome. Although very rare, mucoepidermoid carcinoma should be taken into consideration in the differential diagnosis of any upper lip mass.
Hindfoot Arthrodesis for Neuropathic Deformity
Authors: Huang Peng‐Ju , Fu Yin‐Chih , Lu Cheng‐Chang , Wu Wen‐Lan , Cheng Yuh‐Min
Published: July 2009

Acquired neurologic disorders of the foot lead to arthrosis, deformities, instabilities, and functional disabilities. Hindfoot arthrodesis is the current option available for irreducible or nonbraceable deformities of neuropathic feet. However, the role of ankle arthrodesis in these patients has been questioned because of high nonunion and complication rates. From 1990 to 2001, 17 cases of acquired neuropathic foot deformities were treated by four tibiotalocalcaneal (TTC) arthrodeses and 13 ankle arthrodeses. TTC arthrodesis was performed on cases with combined ankle and subtalar arthritis or cases whose deformities or instabilities could not be corrected by ankle fusion alone. There was no nonunion of TTC arthrodesis and seven ununited ankle arthrodeses were salvaged by two TTC‐attempted arthrodeses and five revision ankle‐attempted arthrodeses. Eventually in these cases, there was one nonunion in TTC arthrodesis and one nonunion in revision ankle arthrodesis. The final fusion rate was 88% (15 of 17 cases) with average union time of 6.9 months (range, 2.5–18 months). The American Orthopaedic Foot and Ankle Society ankle hind‐foot functional scores were evaluated: one was excellent (5.8%), seven were good (41%), eight were fair (53.3%), and one was poor (5.8%) in terms of total functional outcome. We conclude that TTC arthrodesis is indicated for cases with ankle and subtalar involvement and ankle arthrodesis is an alternative for cases with intact subtalar joint. We recommend revision ankle arthrodesis if the ankle fails to fuse and the bone stock of the talus is adequate. TTC arthrodesis is reserved for ankles with poor bone stock of the talus with fragmentation.
Volvulus in Pregnancy: A Diagnostic Dilemma
Authors: Ou Kae‐Yng , Lee Yi‐Ming , Shen Ching‐Ru , Chen Hung‐Shen , Tsai Eing‐Mei
Published: July 2009

In this case report, we describe a pregnant female patient at 27 weeks' gestation with a rare complication of volvulus. Her initial symptom was acute cramping pain of the lower right abdomen. Surgical intervention was performed under the impression of peritonitis. Pathologic diagnosis revealed volvulus of the mid ileum. The remainder of her pregnancy was uneventful. The physiologic changes of pregnancy may predispose the parturient to bowel obstruction due to compression of the gravid uterus against the intestine. If volvulus is suspected, then emergent surgery should be performed. Delays in treatment may result in septic shock and even death. We present this case to remind obstetricians of such rare causes of acute abdomen during pregnancy.
Implementation of an OSCE at Kaohsiung Medical University
Authors: Huang Yu‐Sheng , Liu Min , Huang Chun‐Hsiung , Liu Keh‐Min
Published: July 2009

The Objective Structured Clinical Examination (OSCE), a tool to objectively and fairly assess medical students' clinical competences, has become widely used in medical education worldwide. However, most medical schools in Taiwan have just begun to adopt this assessment method. In 2003, Kaohsiung Medical University (KMU) established the first standardized patient (SP) program in Taiwan and applied SPs with an OSCE. This study reports the process of the implementation of an OSCE at KMU, which includes collecting information, visiting leading clinical skills centers, consulting medical educators from other countries, holding international conferences, establishing an OSCE committee, writing cases, training SPs, administrating the OSCE, and receiving feedback from medical students. Most students were satisfied with the assessment and appreciated the learning experience. Based on the experience in 2003, the OSCE committee decided to incorporate the OSCE into the medical curriculum as a measure to assess medical students' clinical competences. In addition to assessing medical students' clinical competence, the OSCE can also be applied to other professional health education, such as dentistry, nursing, and pharmacy. We are currently sharing our experience with other colleges at KMU.
Endothelin‐1 Antisense Oligonucleotide Suppresses the Proliferation of Glomerular Mesangial Cells Stimulated with Angiotensin‐II
Authors: Lee Jia‐Jung , Shin Shyi‐Jang , Chiu Yi‐Wen , Chen Hung‐Chun
Published: July 2009

Antisense oligonucleotide (AON) has been applied to modern molecular pharmacology. We have previously demonstrated that angiotensin‐II (Ang‐II) is an active stimulator of endothelin‐1 (ET‐1) production in glomerular mesangial cells. This study was designed to investigate the specific effect of ET‐1 AON on inducing proliferation of cultured rat mesangial cells stimulated with Ang‐II. ET‐1 was measured by radioimmunoassays. The results were: (1) Ang‐II enhanced ET‐1 production of mesangial cells; (2) ET‐1 production of mesangial cells was significantly suppressed by ET‐1 AON, and this production was not affected by either ET‐1 sense or scramble oligonucleotide in different concentrations; (3) Ang‐II increased [3H]‐thymidine uptake of mesangial cells, which was suppressed to 25% by ET‐1 AON but not by ET‐1 sense or scramble oligonucleotide. Our results indicate that ET‐1 AON effectively suppresses the ET‐1 production and the Ang‐II‐stimulated proliferation of mesangial cells, and therefore may offer treatment for proliferative glomerulonephritis.
Prognostic Factors of Organophosphate Poisoning Between the Death and Survival Groups
Authors: Lin Tzeng‐Jih , Jiang Donald‐D , Chan Hon‐Man , Hung Dong‐Zong , Li Hong‐Ping
Published: July 2009

In this prospective case series study, we consider the different factors between death and survival groups of organophosphate poisoning. Patients in tertiary‐care medical center who had been exposed to organophosphate were included in the study. Pralidoxime (PAM) was discontinued after atropine had controlled the clinical situation. We recorded the demographic data, amount of organophosphate consumption, duration of coma, duration of ventilator use, duration of hospitalization, findings of chest X‐ray, white blood cell count, acetylcholinesterase concentration, plasma cholinesterase concentration, total atropine amount, duration of atropine use, total PAM amount, duration of PAM use, urine organophosphate peak concentration, duration of urine organophosphate and mortality rate. Urine was collected every 8 hours and was analyzed by gas chromatography equipped with a flame photometric detector and gas chromatography with mass spectrometer detector for organophosphate determination. The urine organophosphate peak concentration was recorded. Wilcoxon rank sum test was used to compare the factors between death and survival groups. Fisher's exact test was used to compare the different findings of chest X‐ray between the death and survival groups. Evidently, the death group had a higher amount of organophosphate consumption, duration of coma, and higher white blood cell count than those in the survival group. Also, the death group had lower duration of hospitalization, and decreased concentrations of acetylcholinesterase and plasma cholinesterase. Total PAM amount use and duration of PAM use were lower. However, the duration of ventilator use, findings of chest X‐ray, total atropine amount, duration of atropine, urine organophosphate peak concentration and duration of urine organophosphate were similar in both groups. The mortality rate of our 50 cases was 20%. As stated earlier, the cases of the death group had insufficient PAM therapy. The maximum duration of PAM use was shorter than the maximum duration of urine organophosphate, although the medians of duration of PAM use were more than the medians of duration of urine organophosphate in both the survival and death groups. Prolonged coma duration, lower level of acetylcholinesterase and lower level of plasma cholinesterase were related to the poor prognosis of the patients.
Orbital Metastasis of Prostate Cancer: A Case Report
Authors: Uluocak Nihat , Suha Parlaktas Bekir , Ersay Deniz Fatih , Erdemir Fikret , Dogan Koseoglu Resit , Gedar Melike Ozgun
Published: July 2009

We report a case with metastatic orbital cancer secondary to prostatic adenocarcinoma. After initiation of total androgen blockade, the visual complaints, pain and periorbital swelling regressed dramatically within 2 months of treatment. However, the disease subsequently progressed and the patient died 12 months after diagnosis.
Comparison of Vitrectomy Alone and Combined Vitrectomy, Phacoemulsification and Intraocular Lens Implantation for Proliferative Diabetic Retinopathy
Authors: Tseng Han‐Yi , Wu Wen‐Chuan , Hsu Sheng‐Yao
Published: July 2009

There have been concerns that there may be an increased incidence of iris neovascularization (NV) following lens removal in patients with proliferative diabetic retinopathy (PDR). In this study, we retrospectively compared vitrectomy alone and vitrectomy combined with phacoemulsification (phacovitrectomy) and intraocular lens implantation regarding both complications and results. Fifty‐three eyes for vitrectomy group and 31 eyes for phacovitrectomy group were included. Postoperative iris and angle NV were found in eight (15.1%) eyes in the first group and no (0%) eyes in the second. The incidence was significantly lower (p < 0.05) in the phacovitrectomy group. The final vision gain of one or more lines was found in 17 (32.1%) and 21 (67.7%) eyes, respectively. There was significantly better vision improvement in the phacovitrectomy group. We consider the combined procedure to be useful as an alternative surgical treatment for patients with PDR and cataract formation.
Giant Spermatocele Mimicking Hydrocele: A Case Report
Authors: Yeh Hsin‐Chih , Wang Chii‐Jye , Liu Chia‐Chu , Wu Wen‐Jeng , Chou Yii‐Her , Huang Chun‐Hsiung
Published: July 2009

Spermatoceles are usually asymptomatic and often found incidentally during physical examination. We report a case of giant spermatocele that mimicked a hydrocele. A 55‐year‐old man suffered from right scrotal enlargement for several years. As the heavy sensation and scrotal soreness worsened in recent months, he came to our outpatient clinic for help. Hydrocele was suspected due to transilluminating appearance of the scrotal content. Surgical exploration was arranged and a giant spermatocele was found. Total excision of the spermatocele was performed and the patient recovered well. The specimen was sent for pathology and spermatocele with spermatozoa was noted.
Late Miocene magmatic activity in the Attic-Cycladic Belt of the Aegean (Lavrion, SE Attica, Greece): implications for the geodynamic evolution and timing of ore deposition
Authors: LIATI ANTHI , SKARPELIS NIKOS , PE-PIPER GEORGIA
Published: July 2009

Numerous post-metamorphic Miocene granitoids occur in the area of Lavrion, SE Attica, at the western end of the Attic-Cycladic Belt of the Aegean. U–Pb ion microprobe-dating (SHRIMP) of zircon from a granitoid sill in the hanging-wall of a regional detachment fault reveals two distinct ages: (1) 11.93 ± 0.41 Ma, obtained from inherited zircon cores with metamorphic characteristics (homogeneous cathodoluminescence, low Th/U ratios) and granulite-type (round/resorbed) morphology. This age is interpreted as the time of a likely granulite-facies metamorphism of the precursor rock. (2) 8.34 ± 0.20 Ma, obtained by oscillatory zoned zircon domains with cathodoluminescence and Th/U characteristics typical for magmatic origin. This age is interpreted as the crystallization time of the granitoid sills. Although a granulite-facies metamorphic event has not been recognized so far for rocks of the Attic-Cycladic Belt, it seems to be the most plausible hypothesis to explain both the zircon systematics and age results. This hypothesis is consistent with an extensional regime predominating in the Aegean from Late Miocene times onwards. A possible granulite-facies metamorphism can be related to magmatic underplating at the initial stages of extension, setting an upper age ofc.12 Ma for the operation of the detachment fault. The 8.34 ± 0.20 Ma zircon crystallization age is, statistically, marginally different to a previous K–Ar feldspar date of hornblende-bearing dykes (9.4 ± 0.3 Ma) and identical to a 8.27 ± 0.11 Ma K–Ar biotite date of the main granitoid stock in the area, thus being generally consistent with prior age constraints from the region. Operation of the detachment fault in the Lavrion area is therefore bracketed betweenc.11.9 Ma and at least 8.3 Ma. This time range is in line with the time of operation of detachment faults suggested previously for the Cycladic islands. Carbonate-hosted replacement-type massive sulphide Pb–Zn–Ag ores are spatially associated with the detachment fault and related extensional structures in the Basal Unit. Therefore, these Pb–Zn–Ag ores probably also formed within the above time span ofc.11.9 to at least 8.3 Ma. U–Pb ion microprobe (SHRIMP) dating of zircon from an orthogneiss within the metaclastic subunit of the Basal Unit in Lavrion yielded a protolith age of 240 ±4 Ma, consistent with ages of Triassic volcanism elsewhere in Greece.
Courts Without Borders: Domestic Sources of U.S. Extraterritoriality in the Regulatory Sphere
Authors: Putnam Tonya L.
Published: July 2009

Regulating private transactions across international boundaries has long posed a challenge to states. Extraterritoriality—the direct regulation of persons and conduct outside a state's borders—is an increasingly common mechanism by which strong states attempt to manage problems associated with transnational activities. This article seeks to account for variation across issues in the willingness of U.S. courts to regulate extraterritorially by focusing on the potential for external conduct to undermine domestic legal rules. It suggests further how attention to domestic-level regulatory processes, with particular focus on the role of private actors, can shed new light on transnational rulemaking and enforcement.
Large Selmer groups over number fields
Authors: BARTEL ALEX
Published: July 2009

Letpbe a prime number andMa quadratic number field,M≠ ℚ() ifp≡ 1 mod 4. We will prove that for any positive integerdthere exists a Galois extensionF/ℚ with Galois groupD2pand an elliptic curveE/ℚ such thatFcontainsMand thep-Selmer group ofE/Fhas size at leastpd.
Statistical analysis of earthward flow bursts in the inner plasma sheet during substorms
Authors: Ma Y. D. , Cao J. B. , Nakamura R. , Zhang T. L. , Reme H. , Dandouras I. , Lucek E. , Dunlop M.
Published: July 2009

In this article, we study the velocity distribution, density, duration, and energy transport of earthward flow bursts in the inner plasma sheet (IPS) during three substorm phases using the data of Cluster in 2001 and 2002. The mean peak velocity of earthward flow bursts in recovery phases (390 km/s) is smaller than those in growth and expansion phases (490 and 520 km/s). The super earthward flow bursts (V > 1000 km/s) appear more frequently in the expansion phase. The average ion density of earthward flow bursts in the recovery phase is 0.14 cm−3, much smaller than those in growth and expansion phases (0.28 and 0.21 cm−3), indicating that lobe reconnections most likely occur in the recovery phase. The average durations of earthward flow bursts in recovery phase are 48 s, smaller than those in growth and expansion phases (99 and 103 s), suggesting that the reconnections occurring in recovery phase are rather short‐lived. The earthward flow bursts in the expansion phase have largest capability of the transport of energy, about 7 times that in the recovery phase. Thus the earthward flow bursts in the expansion phase can produce largest impact effects to the inner magnetosphere.