bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of p53, DCC, and HER‐2/neu in Mucinous Carcinoma of the Breast
Authors: Hsu Yung‐Hsiang , Shaw Cheng‐Kuang
Published: July 2009

We investigated the clinicopathologic and oncoprotein expression characteristics of 11 pure mucinous and 76 non‐mucinous infiltrating ductal carcinomas in the human female breast. We compared patient age, tumor size, axillary lymph node status, and the expression of estrogen receptor (ER), progesterone receptor (PR), deleted‐in‐colon cancer (DCC), HER‐2/neu, and p53. Mucinous carcinoma with axillary lymph node metastasis occurs less frequently than non‐mucinous carcinoma (0% vs 63.1%; p = 0.0018). Compared with the non‐mucinous type, mucinous carcinoma specimens have more DCC expression (100% vs 48.7%; p = 0.0027) and more ER expression (90.9% vs 26.9%; p = 0.0023), but less HER‐2/neu overexpression (0% vs 38.1%; p = 0.0302). We confirmed that mucinous carcinoma samples from the breast reveal distinct clinicopathologic and oncoprotein expression features compared with non‐mucinous carcinoma and, therefore, it seems reasonable to suggest different biologic characteristics and manifestations.
Performance of Thallium‐201 Electrocardiography‐gated Myocardial Perfusion Single Photon Emission Computed Tomography to Assess Left Ventricular Function
Authors: Hung Guang‐Uei , Yang Kuang‐Tao , Hsia Chien‐Hsun , Yang Po‐Ta
Published: July 2009

This study evaluated the performance of gated single photon emission computed tomography (SPECT) with thallium‐201 (201Tl) in assessing left ventricular ejection fraction (LVEF), end‐diastolic volume (EDV), and end‐systolic volume (ESV) in Taiwanese by determining repeatability and correlation with two‐dimensional (2D) echocardiography. A total of 18 patients underwent two sequential gated SPECT acquisitions within 30 minutes in the resting state to assess repeatability. Another 28 patients who underwent gated SPECT and 2D echocardiography within 7 days were included for comparison. The two sequential measurements were well correlated with respect to LVEF, EDV, and ESV (r = 0.97, 0.95, and 0.97, respectively, all p < 0.0001). Bland‐Altman analysis revealed that two standard deviations of the absolute difference between the two sequential measurements for LVEF, EDV, and ESV were 6.4%, 16.8 mL, and 8.6 mL, respectively. For LVEF, EDV, and ESV, correlations between redistribution 201Tl‐gated SPECT and echocardiography were also excellent (all r = 0.83, p < 0.0001). LVEF was similar with 201Tl‐gated SPECT and echocardiography, but EDV and ESV were significantly higher with echocardiography (p < 0.05). Our study revealed that 201Tl‐gated SPECT has high repeatability and excellent correlation with echocardiography for the assessment of LVEF and volumes in Taiwanese. These results support the clinical application of gated SPECT in routine 201Tl myocardial perfusion imaging in Taiwanese.
Rare Extra‐articular Manifestation of Rheumatoid Arthritis: Scleromalacia Perforans
Authors: Wu Chen‐Ching , Yen Jeng‐Hsen , Tsai Wen‐Chan , Liu Hong‐Wen , Yu Hui‐Chun
Published: July 2009

Rheumatoid arthritis is a systemic disease with manifestations in many organs. In most cases, involvement of the locomotor system dominates the clinical picture. However, extra‐articular manifestations can be detected in almost any organ system with varied incidence in different series. Ophthalmic presentations include Sjogren's syndrome, episcleritis, and scleritis. The most severe form of scleritis, scleromalacia perforans, is a very rare ophthalmic manifestation. We present the case of a 60‐year‐old man who had had rheumatoid arthritis for more than 10 years. He had scleromalacia perforans but no other extra‐articular manifestations.
Effect of Glycemic Control on Electrophysiologic Changes of Diabetic Neuropathy in Type 2 Diabetic Patients
Authors: Huang Chun‐Chiang , Lee Chia‐Ling , Huang Mao‐Hsiung , Chen Tien‐Wen , Weng Ming‐Cheng , Tseng Hsiang‐Chieh
Published: July 2009

Diabetic neuropathy is a common complication of diabetes mellitus. Effective blood glucose control retards changes in nerve conduction velocity in type 1 diabetes. This study examined the relationship between glycemic control and electrophysiologic changes in diabetic neuropathy in 57 type 2 diabetic patients. Nerve conduction in the peroneal motor nerve, tibial motor nerve, and sural nerve were measured at study entry and at follow‐up 24 ± 3.12 months later. Changes in individual nerves are expressed as a percentage change (PC) and overall electrophysiologic changes are expressed as the sum of individual PCs. The PCs for peroneal motor nerve velocity, tibial motor nerve velocity, and sural nerve velocity were all lower in patients with a mean HbA1c of 8.5% or less compared with those in patients with a mean HbA1c of more than 8.5%, and SPCV (sum of PC in velocity) was significantly inversely correlated with mean HbA1c. However, there was no significant difference in SPCV in subjects with or without hypertension, hypertriglyceridemia, or low high‐density lipoprotein cholesterol concentration. In conclusion, hyperglycemia is the most important etiology for electrophysiologic progression in type 2 diabetic patients. Furthermore, a mean HbA1c of more than 8.5% will result in significant deterioration in electrophysiology.
Anterior Subtalar Dislocation: A Case Report
Authors: Chuo Chin‐Yi , Lu Cheng‐Chang , Liu Ping‐Cheng , Shen Wun‐Jer
Published: July 2009

Anterior subtalar dislocations are extremely rare. To our knowledge, six cases have been reported in detail in the literature, but for only two of these was an anteroposterior view radiograph used to confirm the diagnosis. We report a case of anterior subtalar dislocation in which the posterior tibialis tendon was incarcerated in the talonavicular joint and that required an open reduction. We discuss the diagnosis, mechanism, and treatment.
Expression of Glucose Transporter‐1 in Taiwanese Patients with Breast Carcinoma—A Preliminary Report
Authors: Kuo Shou‐Jen , Wu Yao‐Chung , Chen Chun‐Ping , Tseng Hsin‐Shun , Chen Dar‐Ren
Published: July 2009

Malignant cells show increased glucose uptake in vitro and in vivo. High expression of the glucose transporter‐1 gene (GLUT1) has been found in many human tumor tissues. The aim of this study was to investigate the correlation between GLUT1 expression in breast carcinomas of Taiwanese patients and clinical prognostic parameters. Twenty‐eight (71.8%) of the 39 breast carcinomas analyzed showed positive GLUT1 expression with different intensities: 1+, 19 cases (48.7%); 2+, 6 cases (15.4%), 3+, 3 cases (7.7%). No significant correlation was seen between GLUT1 expression and clinical prognostic parameters such as tumor size (p = 0.085), age (p = 0.4528), axillary lymph node metastasis (p = 0.9562), nuclear grade (p = 0.6895), estrogen receptor‐positive (p = 1.0000), and progesterone receptor‐positive (p = 0.9689).
Positive Association Between STAT3 and Ki‐67 in Cervical Intraepithelial Neoplasia
Authors: Yang Sheau‐Fang , Yuan Shyng‐Shiou F. , Yeh Yao‐Tsung , Hung Sz‐Chi , Wu Ming‐Tsang , Su Jinu‐Huang , Chai Chee‐Yin
Published: July 2009

Signal transducer and activator of transcription 3 (STAT3) has been regarded as an oncogene in many types of cancers. However, its role in cervical carcinogenesis is not well determined. The purpose of this study was to evaluate the expression patterns of STAT3 in cervical intraepithelial neoplasia (CIN), normal cervix (NC), and squamous cell carcinoma (SCC) to explore its possible role in cervical carcinogenesis. Paraffin‐embedded sections from 83 patients including 20 CIN 1, 10 CIN 2, 26 CIN 3, and 27 comparative cases of 10 NC and 17 stage Ib SCC were collected in this study. Immunohistochemistry was performed to analyze the expression patterns of STAT3, and the results obtained were categorized by a semiquantitative method and were further correlated with the CIN histopathologic grade and the proliferation marker, Ki‐67, using the c2 test. Our results showed that nuclear STAT3 expression was predominantly in the squamous epithelial cells, and that high‐grade CIN and stage Ib SCC lesions had a higher nuclear STAT3 expression when compared with NC and CIN 1. Furthermore, the nuclear STAT3 expression in CIN was significantly correlated with Ki‐67 expression (p= 0.025), but not CIN lesion grade. In summary, our results indicate that an altered STAT3 expression in CIN is correlated with cell proliferation but may not have a direct contribution to cervical carcinogenesis.
Morbidity After Total Thyroidectomy for Benign Thyroid Disease: Comparison of Graves' Disease and Non‐Graves' Disease
Authors: Chiang Feng‐Yu , Lin Jen‐Chih , Wu Che‐Wei , Lee Ka‐Wo , Lu Shang‐Pin , Kuo Wen‐Rei , Wang Ling‐Feng
Published: July 2009

The purpose of this study was to review the safety of total thyroidectomies for benign thyroid disease, with special emphasis on the comparison between Graves' disease and non‐Graves' disease. In this study, 107 patients who underwent total thyroidectomies for clinically benign thyroid disease performed by the same surgeon between January 1987 and December 2004 were enrolled; 48 had Graves' disease and 59 had non‐Graves' disease. The rates of temporary vs. permanent hypoparathyroidism, hematoma requiring surgical intervention, and temporary vs. permanent recurrent laryngeal nerve palsy (RLNP) after total thyroidectomy for benign thyroid disease were 34.6% vs. 3.7%, 6.5%, and 6.5% vs. 1.85%, respectively. The rates of permanent hypoparathyroidism and temporary RLNP in the Graves' disease group were significantly different when compared with the non‐Graves' disease group (8.3% vs. 0% and 11.5% vs. 2.5%, respectively). However, comparing the rates of temporary hypoparathyroidism, permanent RLNP, and postoperative hematoma, there was no statistically significant difference. Compared with total lobectomy, the rates of postoperative hematoma increased significantly for total thyroidectomy (6.5% vs. 0.48%). Total thyroidectomy for non‐Graves' benign thyroid disease may be performed with minimal morbidity as has been advocated by many authors. For patients with Graves' disease in this study, however, the complication rates of permanent hypoparathyroidism and temporary RLNP were significantly increased. Therefore, we suggest that total thyroidectomy for Graves' disease should be performed by an experienced surgeon.
Safety of Performing Percutaneous Dilational Tracheostomy in Patients with Preexisting Barotrauma
Authors: Sheu Chau‐Chyun , Tsai Jong‐Rung , Cheng Meng‐Hsuan , Chong Inn‐Wen , Huang Ming‐Shyan , Hwang Jhi‐Jhu
Published: July 2009

Since its introduction in 1985 by Ciaglia et al, percutaneous dilational tracheostomy (PDT) has gradually become the procedure of choice in establishing a long‐term airway in many intensive care units (ICU). However, the safety of performing PDT in patients with barotrauma is still unknown and has never been reported. We present the case of a 35‐year‐old man with AIDS, who was admitted to our medical ICU for pneumonia and acute respiratory distress syndrome. He developed subcutaneous emphysema and pneumomediastinum as complications of mechanical ventilation. After stabilization of the barotrauma, he underwent PDT with the standard Ciaglia Blue Rhino technique. However, rapid and extensive progression of preexisting barotrauma occurred shortly after PDT. This severe complication was nearly fatal. The prolonged procedure during which the susceptible lung was exposed to longer duration of high airway pressure was thought to be the mechanism of rapid deterioration of the preexisting barotrauma. With aggressive supportive care, the patient survived. To prevent further deterioration of preexisting barotrauma during and after PDT in future cases, we propose some principles that should be strictly followed. Under administration of these principles, we safely performed PDT in another case with preexisting barotrauma 1 month later.
Adrenal Leiomyoma Treated by Hand‐Assisted Laparoscopic Adrenalectomy: A Case Report
Authors: Chang Tu‐Hao , Lee Yung‐Chin , Liu Chia‐Chu , Huang Chun‐Hsiung , Wu Wen‐Jeng
Published: July 2009

A left adrenal incidentaloma was found by abdominal ultrasound and computed tomography (CT) in a 53‐year‐old woman who had a history of non‐insulin dependent diabetes mellitus. Abdominal CT showed a well‐circumscribed adrenal mass (5.5 × 4.5 × 3.5 cm) with low density (32 HU) on precontrast scan and heterogeneous enhancement on postcontrast scan. Laboratory examinations revealed a nonfunctional adrenal tumor. As the malignant potential of the tumor could not be ruled out, the patient underwent hand‐assisted laparoscopic adrenalectomy. Postoperative recovery was uneventful, and pathologic examination revealed leiomyoma.
Effect on Spasticity After Performance of Dynamic‐Repeated‐Passive Ankle Joint Motion Exercise in Chronic Stroke Patients
Authors: Wu Chin‐Li , Huang Mao‐Hsiung , Lee Chia‐Ling , Liu Chin‐Wei , Lin Li‐Jung , Chen Chia‐Hsin
Published: July 2009

Spasticity associated with abnormal muscle tone is a common motor disorder following stroke, and the spastic ankle may affect ambulatory function. The purpose of this study was to investigate the short‐term effect of dynamic‐repeated‐passive ankle movements with weight loading on ambulatory function and spastic hypertonia of chronic stroke patients. In this study, 12 chronic stroke patients with ankle spasticity and inefficient ambulatory ability were enrolled. Stretching of the plantar‐flexors of the ankle in the standing position for 15 minutes was performed passively by a constant‐speed and electrically powered device. The following evaluations were done before and immediately after the dynamic‐repeated‐passive ankle movements. Spastic hypertonia was assessed by the Modified Ashworth Scale (MAS; range, 0–4), Achilles tendon reflexes test (DTR; range, 0–4), and ankle clonus (range, 0–5). Improvement in ambulatory ability was determined by the timed up‐and‐go test (TUG), the 10‐minute walking test, and cadence (steps/minute). In addition, subjective experience of the influence of ankle spasticity on ambulation was scored by visual analog scale (VAS). Subjective satisfaction with the therapeutic effect of spasticity reduction was evaluated by a five‐point questionnaire (1 = very poor, 2 = poor, 3 = acceptable, 4 = good, 5 = very good). By comparison of the results before and after intervention, these 12 chronic stroke patients presented significant reduction in MAS and VAS for ankle spasticity, the time for TUG and 10‐minute walking speed (p < 0.01). The cadence also increased significantly (p < 0.05). In addition, subjective satisfaction with the short‐term therapeutic effect was mainly good (ranging from acceptable to very good). In conclusion, 15 minutes of dynamic‐repeated‐passive ankle joint motion exercise with weight loading in the standing position by this simple constant‐speed machine is effective in reducing ankle spasticity and improving ambulatory ability.
Tube Thoracostomy‐Related Necrotizing Fasciitis: A Case Report
Authors: Hsu Shun‐Pin , Wang Hong‐Chung , Huang I‐T , Chu Kuo‐An , Chang Huang‐Chou
Published: July 2009

Spontaneous pneumothorax is a serious complication of pulmonary tuberculosis that requires immediate treatment. Necrotizing fasciitis is a serious, rapidly progressive infection of the subcutaneous tissue and fascia, most related to trauma or surgery. Here, we report a case of pulmonary tuberculosis with spontaneous pneumothorax. A standard procedure of tube thoracostomy was performed for lung re‐expansion. Two days after the tube was removed, necrotizing fasciitis developed from the puncture site. Computed tomography of the chest showed focal thickness with gas formation and loss of the fat plane over the chest wall, which is compatible with the diagnosis of necrotizing fasciitis. Aggressive treatment was given, including emergency fasciectomy and adequate systemic antibiotic and antituberculous treatment. The necrotizing fasciitis was successfully treated. The patient was discharged and sent home with maintenance antituberculous therapy.
Cost‐Effectiveness of Elderly Health Examination Program: The Example of Hypertension Screening
Authors: Deng Bing‐Hwa , Liu Hong‐Wen , Pan Pi‐Chen , Mau Lih‐Wen , Chiu Herng‐Chia
Published: July 2009

The National Health Insurance (NHI) and social welfare agencies have implemented the Elderly Health Examination Program (EHEP) for years. No study has ever attempted to evaluate whether this program is cost‐effective. The purposes of this study were, firstly, to understand the prevalence and incidence rates of hypertension and, secondly, to estimate the cost and effectiveness of the EHEP, focusing on hypertension screening. The data sources were: (1) hypertension and clinical information derived from the 1996 and 1997 EHEP, which was used to generate prevalence and incidence rates of hypertension; and (2) claim data of the NHI that included treatment costs of stroke patients (in‐and outpatients). Hypothetical models were used to evaluate the cost‐effectiveness of the hypertension screening program in various conditions. Sensitivity analysis was also employed to evaluate the effect of each estimation indicator on the cost and effectiveness of the hypertension screening program. A total of 28.3% of the elderly population in Kaohsiung (25,174 of 88,812) participated in the 1996 EHEP; 14,915 of them participated in the following 1997 EHEP, with a retention rate of 59.3%. Criteria from the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) (systolic blood pressure/diastolic blood pressure ≥ 160/95mmHg or taking antihypertensive drugs) were used; we found that prevalence and incidence rates of hypertension were 24.6% and 6.6%, respectively. Hypertension rates are increasing in the aging process as shown in both prevalence and incidence models. In comparison with non‐participants, the prevalence model indicates that each hypertension patient who had attended the EHEP not only saved NT$34,570–34,890 in medical and associated costs, but also increased their lifespan by 128 days. The present findings suggest that the EHEP is a cost‐effective program with health and social welfare policy implications. With the relatively low participation rate of the EHEP, health and social agencies need to put more effort into the promotion of this free health examination program to attract potential participants. In doing so, the population at risk for hypertension would be identified for early treatment, and the probability of having stroke could be decreased. Consequently, health care expenditures for treatment and caregiving of stroke patients would be minimized. Finally, it should be noted that the sensitivity and values of selected parameters can modify the results of cost‐effectiveness analysis. Interpretations of the effects of prevention services on costs and effectiveness need to be treated with caution.
Infective Endocarditis with Uveitis: A Rare Case Report
Authors: Lee Hsiang‐Chun , Lai Yi‐Hon , Tsai Chih‐Lee , Yen Jeng‐Hsien , Lin Tsung‐Hsien , Lai Wen‐Ter , Sheu Sheng‐Hsiung
Published: July 2009

We report a case of a 51‐year‐old diabetic male who presented with a complaint of intermittent chills and fever that he had experienced for 10 days. No obvious respiratory tract, genitourinary tract, gastrointestinal tract, or skin lesions were observed. Blood culture data were positive for group B β‐streptococcus. Transthoracic and transesophageal echocardiography revealed vegetation in the anterior leaflet of the mitral valve. The patient was diagnosed with infective endocarditis (IE) and prescribed a parenteral antibiotic. Three days after admission, the patient complained of progressively blurred vision. Slit lamp examination found fine keratic precipitates and aqueous cells in the anterior chambers in both eyes, implying that the patient had uveitis. He was then prescribed a topical steroid for 4 months, and his vision improved gradually. This case is an important reminder that uveitis, not only endophthalmitis, can occur with IE. Treatment for one condition, if misapplied, may worsen the other.
Urinary Stone Analysis of 1,000 Patients in Southern Taiwan
Authors: Chou Yii‐Her , Li Ching‐Chia , Wu Wen‐Jeng , Juan Yung‐Shun , Huang Shu‐Pin , Lee Yung‐Chin , Liu Chia‐Chu , Li Wei‐Ming , Huang Chun‐Hsiung , Chang Ai‐Wen
Published: July 2009

Urolithiasis is a common urologic disease. Stones may occur in the kidney, ureter, or urinary bladder. We collected 1,000 stone samples in the subtropical area of southern Taiwan. Stone components were analyzed by Fourier transform infrared spectroscopy. Mixed components of calcium oxalate and calcium phosphate were the most common form of stones (52.3%), followed by calcium oxalate (27.8%) and calcium phosphate (9.3%). Uric acid stones accounted for 7.6%. Magnesium ammonium phosphate stones accounted for 3.0%. Only one cystine stone was found. In the study of urinary stone formation mechanism and prevention of recurrent urolithiasis, knowing the stone composition is important.
Comparison of Different Surgical Options in the Treatment of Pilonidal Disease: Retrospective Analysis of 175 Patients
Authors: Ersoy Omer Faik , Kayaoglu Huseyin Ayhan , Ozkan Namik , Celik Alper , Karaca Serdar , Ozum Turkay
Published: July 2009

Pilonidal sinus disease is a benign disorder with an unidentified etiology and is observed mainly in young adults. It is an important health problem because it causes work loss. Although various nonsurgical treatment options have been tried up to date, there is a consensus on surgical intervention to treat the disease today. The optimal surgical method should be simple, associated with short hospital stay and low recurrence rates. In this study, patients who have undergone different surgical treatment methods due to pilonidal disease were retrospectively analyzed. The medical records of 175 patients who were operated on between 2002 and 2005 at the General Surgery Departments of Gaziosmanpasa University Medical School and Bartin State Hospital for pilonidal disease were reviewed for treatment option, postoperative complications, hospitalization time, work‐off periods, and recurrence rates. The patients consisted of 150 (85.3%) males with a mean age of 26.47 ± 7.78 years. Marsupialization was applied to 82 (46.9%), unroofing to 20 (14.7%), primary closure to 29 (16.6%), and Limberg flap to 44 (25.1%) patients. The longest hospitalization period of 3.61 ± 1.08 days was observed in the Limberg flap group. The longest return to work period (20.12 ± 5.1 days) was observed in the marsupialization group. Both differences were significant. The highest complication rate was observed among the primary closure group (31%) followed by the patients treated by Limberg flap technique (15.8%). In the primary closure group, infection was detected in five (17.2%) and wound dehiscence in four (13.8%) individuals. The highest complication rates (31.03%) and recurrences (13.8%) were observed in the primary closure group. Various operative methods utilized in the treatment of pilonidal disease are associated with a number of advantages and disadvantages. Postoperative complication rates of unroofing and marsupialization are low, but require long wound care. In our study, we did not observe any recurrence among the patients treated by unroofing, but experienced a high recurrence ratio among subjects treated by marsupialization. In addition, there were high complication rates in the primary closure and Limberg flap groups. So, the best option is to explain the advantages and disadvantages of the available surgical methods and respect the patient's decision.
Seizure After Local Anesthesia for Nasopharyngeal Angiofibroma
Authors: Tsai Cheng‐Jing , Wang Hsun‐Mo , Lu I‐Chen , Tai Chih‐Feng , Wang Ling‐Feng , Soo Lee‐Ying , Lu David Vi
Published: July 2009

We report a young male patient who experienced seizure after local injection of 3 mL 2% lidocaine with epinephrine 1:200,000 around a recurrent nasal angiofibroma. After receiving 100% oxygen via mask and thiamylal sodium, the patient had no residual neurologic sequelae. Seizure immediately following the injection of local anesthetics in the nasal cavity is probably due to injection into venous or arterial circulation with retrograde flow to the brain circulation. Further imaging study or angiography should be done before head and neck surgeries, especially in such highly vascular neoplasm.
Cellular Cytotoxicity of Antiglaucoma Drugs in Cultured Corneal Endothelial Cells
Authors: Wu Kwou‐Yeung , Wang Hwei‐Zu , Hong Show‐Jen
Published: July 2009

In this study, the various antiglaucoma drugs including betaxolol, timolol, levobunolol, carteolol, brimonidine, dipivefrin, dorzolamide, brinzolamide, latanoprost, unoprostone, and pilocarpine were used to investigate the effects of cellular cytotoxicity in cultured bovine corneal endothelial cells. After exposure to the drugs in three dilutions, 1/100, 1/1,000, and 1/10,000, for 100 minutes, cells were estimated based on the release assay of lactate dehydrogenase (LDH) enzyme. It was found that cellular LDH was significantly released in the medium only at 1/100th dilution of betaxolol, brimonidine, dorzolamide, dipivefrin, latanoprost and unoprostone to 130%, 123%, 145%, 157%, 128% and 237%, respectively, compared with controls upon exposure to drugs for 100 minutes. Moreover, benzalkonium chloride preservative at the concentrations ranging from 0.001 to 0.00001mg/mL did not affect cellular LDH release in bovine corneal endothelial cells. These results indicate that high concentrations of antiglaucoma drugs may induce cytotoxicity in corneal endothelial cells.
Nurse Reporting of Known and Suspected Child Abuse and Neglect Cases in Taiwan
Authors: Lee Pei‐Yu , Fraser Jennifer A. , Chou Fan‐Hao
Published: July 2009

Despite the frontline role of taking care of children, nurses in Taiwan have been reluctant to report known and suspected cases of child abuse and neglect (CAN). This problem threatens the success of legislation aimed at reducing CAN cases in Taiwan. The purpose of this study was to examine the influence of nurses' perceptions, attitudes, and knowledge on suspecting and reporting CAN cases in health care settings in Taiwan. Two hundred and thirty‐eight nurses were surveyed using structured questionnaires with a return rate of 79.3%. Health care settings surveyed in this study included emergency units, pediatric units, and community centers from eight hospitals in southern Taiwan. Almost 3/4 (70%) of the sample of nurses thought they needed more training courses on CAN. Correlation analysis showed a significant relationship between suspecting and reporting CAN with perception, attitude, and knowledge. Stepwise multiple regression analysis revealed that perception (β= 0.475), knowledge (β= 0.265), and attitude (β= 0.246) accounted for 60% of the variance in suspecting and reporting CAN. The focus and scope of training programs for nurses in Taiwan should take these findings into consideration.
Primary T‐cell Lymphoma of the Uterine Corpus
Authors: Shen Ching‐Ju , Tsai Eing‐Mei , Tsai Kun‐Bow , Wu Ching‐Hu , Hsu Shih‐Cheng
Published: July 2009

Malignant lymphoma involving the genital tract is rare, and primary lymphoma of the uterus is even rarer. Immunohistochemically, most of the reported cases have been diffuse large cell lymphomas with a B‐cell nature. Herein, we report an unusual case of uterine T‐cell lymphoma in a 68‐year‐old woman. She suffered from fever, vaginal bleeding, and a huge mass in the lower abdomen. The initial clinical and histologic studies failed to indicate a cell type. We provide the clinical details of the case and discuss the diagnostic pitfalls.
Ulnar Nerve Palsy Following Fracture of the Distal Radius in an Adolescent: A Case Report
Authors: Lu Cheng‐Chang , Chuo Chin‐Yi , Chen Shen‐Kai , Huang Yu‐Han , Chou Pei‐Hsi
Published: July 2009

In adolescents, neurovascular injury, especially ulnar nerve injury, is rare with fracture of the distal radius. We present a 14‐year‐old boy who sustained fracture of the distal radius in his right wrist, who also had symptoms of ulnar nerve injury. Close reduction with percutaneous pinning and cast to fix the distal radius fracture was done immediately. Then, we decided to observe the recovery of the nerve injury without providing any emergent nerve exploration. Bone union was achieved after 8 weeks of fixation, and the function of the ulnar nerve was restored completely after 16 weeks of observation. The possibility of ulnar nerve injury should be considered following fracture of the distal aspect of the radius, and we recommend observing the recovery of nerve injury, with no need for emergent nerve exploration.
Effect of Systematic Menstrual Health Education on Dysmenorrheic Female Adolescents' Knowledge, Attitudes, and Self‐Care Behavior
Authors: Chiou Miin‐Huey , Wang Hsiu‐Hung , Yang Yi‐Hsin
Published: July 2009

The purpose of this study was to evaluate the effects of systematic health education on female adolescents' knowledge of dysmenorrhea, menstrual attitudes, and dysmenorrhea‐related self‐care behaviors. Through the research process, a dysmenorrheal self‐care pamphlet for female adolescents was developed. The study used a quasi‐experimental intervention with a nonequivalent‐control group design. Three vocational nursing schools were requested to participate in this study: one was assigned to the experimental group and two were assigned to the control group. Female students who had experienced dysmenorrheic cramps two or more times during the last 6 months since the interview were recruited for the study. There were 218 subjects randomly assigned to an experimental group, and 237 subjects to a control group. Intervention consisted of a three‐session health education program in which the experimental group was split up into six smaller groups. Data were collected before, 2 weeks after, and 4 months after the intervention. Results revealed a significant increase in the experimental group members' dysmenorrhea‐related knowledge and self‐care behavior, but not in their attitudes. The findings of this study can serve as a guide to healthcare providers who want to design an effective systematic menstrual health education program for female adolescents.
Splenic Flexure Colonic Volvulus: A Pediatric Case Report
Authors: Hsueh Chih‐Chung , Jaw Twei‐Shiun , Lin Jao‐Yu , Chan Hon‐Man
Published: July 2009

Volvulus of the colon is an unusual cause of intestinal obstruction in the pediatric population. Splenic flexure colonic volvulus is the most uncommon site in children. We report a case of splenic flexure volvulus (SFV) in a 21‐month‐old boy with underlying cerebral palsy and epilepsy. He experienced abdominal distension, bilious vomiting and absence of bowel movement for 2 days. Abdominal radiography showed a proximal distended colon and a “coffee bean sign” at the left upper quadrant. Barium enema revealed a “bird beak sign” at the splenic flexure, which confirmed the diagnosis of SFV. Detorsion of SFV occurred while undergoing exploratory laparotomy. He received regular follow‐up in the subsequent 3 years without recurrence.
Effects of Atorvastatin on Ventricular Late Potentials and Repolarization Dispersion in Patients with Hypercholesterolemia
Authors: Chu Chih‐Sheng , Lee Kun‐Tai , Lee Shuo‐Tsan , Lu Ye‐Hsu , Lin Tsung‐Hsien , Voon Wen‐Chol , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: July 2009

Emerging evidence suggests that statins have a favorable impact on the reduction of arrhythmia events and sudden cardiac death in patients with structural heart disease. We aimed to investigate the possibly and directly favorable effects of statins on ventricular late potentials, QT dispersion, and transmural dispersion of repolarization attained by analyzing clinical electrocardiography (ECG) risk stratification parameters in patients with hypercholesterolemia without structural heart disease. In total, 82 patients (45 females; mean age, 62 ± 10 years) with hypercholesterolemia were enrolled in this prospective study to examine the effects of statin therapy (atorvastatin 10mg/day for 3 months) on ECG risk stratification parameters. Surface 12‐lead ECG and signal‐average ECG (SAECG) were recorded before and after statin treatment. The SAECG parameters, QT dispersion, Bazett‐corrected QT (QTc) dispersion, T wave peak‐to‐end interval (Tpe), and percentage of Tpe/QT interval were calculated and compared before and after statin therapy. Twelve‐lead ambulatory 24‐hour ECGs were recorded in 12 patients. The results demonstrated that after statin therapy for 3 months, serum levels of total cholesterol and low‐density lipoprotein cholesterol were significantly reduced (both p values < 0.001). However, neither significant changes of each SAECG parameter nor the frequency of late potentials were demonstrated after atorvastatin therapy. In addition, no significant changes in QT dispersion, QTc dispersion, Tpe, or Tpe/QT were found. However, 24‐hour ambulatory ECG revealed a flattening effect of circadian variation of QTc dispersion after atorvastatin therapy. In conclusion, the favorable antiarrhythmia effect of atorvastatin (10 mg/day) therapy cannot be directly reflected by analyzing these noninvasive ECG risk stratification parameters in low‐risk patients with hypercholesterolemia.
Effects of Functional Electrical Stimulation on Peak Torque and Body Composition in Patients with Incomplete Spinal Cord Injury
Authors: Liu Chin‐Wei , Chen Shih‐Ching , Chen Chia‐Hsin , Chen Tien‐Wen , Jason Chen Jia‐Jin , Lin Chun‐Sheng , Huang Mao‐Hsiung
Published: July 2009

The aim of this study was to investigate the change in body composition, leg girths, and muscle strength of patients with incomplete spinal cord injury (SCI) after functional electrical stimulation cycling exercises (FESCE). Eighteen subjects with incomplete SCI were recruited. Each patient received FESCE three times per week for 8 weeks. Body composition, thigh and calf girths of bilateral legs, muscle strength of bilateral knee flexors and extensors were measured before and after 4 and 8 weeks of FESCE. A significant increase in bilateral thigh girth after 4 weeks of FESCE and significant increase in muscular peak torque of knee flexion and extension were found after 8 weeks of training. Besides, lean body mass increased significantly after complete treatment. FESCE can increase the thigh girth and muscular peak torque of patients with incomplete spinal cord injury.
Management of Symptomatic Urolithiasis During Pregnancy
Authors: Juan Yung‐Shun , Wu Wen‐Jeng , Chuang Shu‐Mien , Wang Chii‐Jye , Shen Jung‐Tsung , Long Cheng‐Yu , Huang Chun‐Hsiung
Published: July 2009

Urinary calculi during pregnancy present not only a diagnostic challenge but also a management dilemma. In this retrospective study, we describe our experience with diagnosis and management of symptomatic urolithiasis in pregnant women. A total of 18 pregnant women were treated for urolithiasis at the Department of Urology, Kaohsiung Municipal Hsiao‐Kang Hospital, between 1999 and 2004. The incidence of symptomatic urolithiasis during pregnancy was 0.35%. Of the 20 stones found, nine were on the right side and 11 were on the left, and two patients had bilateral urinary stones. Most urolithiasis cases during pregnancy (55.5%) occurred in the third trimester. Flank pain (94.4%) was the most common clinical presentation. Conservative management was successful in 10 patients until the end of pregnancy and then definite treatment was performed. In four patients, a double‐J stent was inserted successfully for persistent pain. In three cases with persistent pain, failure of double‐J stent placement was treated with ureteroscopic lithotripsy under epidural anesthesia. One patient received percutaneous nephrostomy for persistent renal colic and pyonephrosis. Ultrasonographic evaluation of pregnant women with suspected renal colic is a reasonable diagnostic procedure. Ureteroscopy is another choice when conservative treatment fails.
Acute Pancreatitis Complicated with Transient Portal Venous Thrombosis in One Patient with Hepatocellular Carcinoma and Cirrhosis
Authors: Lin Hugo You‐Hsien , Lin Zu‐Yau , Shih Paul Ming‐Chen , Chuang Wan‐Long
Published: July 2009

Portal venous thrombosis (PVT) is a condition associated with high morbidity. The etiologies of PVT include intra‐abdominal inflammation or infection, surgical intervention, abdominal malignancies such as hepatocellular carcinoma (HCC) and pancreatic carcinoma, or abnormality in coagulation caused by various reasons such as liver cirrhosis. Management of PVT should be based on its etiology and the condition of the patient. We describe a cirrhotic patient with HCC who suffered from acute pancreatitis. PVT in the main trunk was detected at admission due to the episode of acute pancreatitis. The etiology of thrombosis was considered to be inflammation around the main portal trunk caused by pancreatitis rather than cirrhosis or HCC. We did not instigate any management for the thrombosis. Acute pancreatitis was relieved after conservative treatment. Follow‐up imaging study performed 46 days after detection of thrombosis showed spontaneous complete resolution of the thrombus. Our experience may provide useful information for the management of such patients.
Treatment of Transplant Ureteral Stricture with Acucise Endoureterotomy: Case Report and Literature Review
Authors: Hsiao Hsi‐Lin , Li Ching‐Chia , Chang Tu‐Hao , Wu Wen‐Jeng , Chou Yii‐Her , Shen Jung‐Tsung , Jang Mei‐Yu , Huang Chun‐Hsiung
Published: July 2009

We report a patient who was diagnosed with end‐stage renal disease and who received renal transplantation in her right iliac fossa in 2003. After transplantation, right hydronephrosis was noted on abdominal ultrasonography and right lower ureteral stricture was diagnosed by antegrade pyelography. She received ureter internal stent insertion three times, but hydronephrosis and urinary tract infection recurred after the stent was removed. Therefore, Acucise endoureterotomy was used to treat the recurrent ureteral stricture. The patient was discharged on the second postoperative day and abdominal ultrasonography revealed no hydronephrosis during regular follow‐up.
Adenocarcinoma Originating from a Mature Teratoma of the Testis
Authors: Koseoglu Resit Dogan , Suha Parlaktas Bekir , Onuk Filiz Nurper , Erdemir Fikret , Uluocak Nihat , Tulunay Ozden
Published: July 2009

Malignant transformation in testicular teratomas has been reported very rarely in the literature. Although testicular teratomas in childhood are regarded as benign neoplasms, these tumors, if left untreated until advanced ages, may present the risk of malignant transformation. We report a case of differentiated adenocarcinoma originating from colonic glands in primary testicular teratoma.
Variable Gene Cassette Patterns of Class 1 Integron‐Associated Drug‐Resistant Escherichia Coli in Taiwan
Authors: Chang Lin‐Li , Chang Tsung‐Ming , Chang Chung‐Yu
Published: July 2009

This study characterized class 1 integrons in Escherichia coli in Taiwan. The stability and changes in gene cassettes inserted into integrons were also evaluated. The study included 436 clinical strains of E. coli isolated in 2002. Class 1 integrons were characterized by polymerase chain reaction and direct sequencing. Genetic localization of class 1 integrons was determined by conjugal transfer and Southern hybridization. The results indicated that 64% of E. coli isolates carried class 1 integrons. Molecular analysis revealed that the class 1 integrons harbored 13 different antimicrobial resistance gene cassettes and two unknown gene cassettes; the predominant cassettes were aadA and dfrA. Novel gene cassettes first recovered from E. coli were aacA4 and linF. Cassette arrays orfD‐aacA4‐catB8 and aadA1‐linF were also observed. Gene cassette dfrA12‐orfF‐aadA2 was stable. The class 1 integron and dfrA17‐aadA5 gene cassette were located on the same transferable plasmids and were capable of transmission. Therefore, the increased drug resistance of clinical isolates may be explained by antibiotic selective pressure and widespread presence of integrons. Under antibiotic selective pressure, gene cassette‐mediated resistance may not be easily lost. The potential role of integrons in the uptake and dissemination of resistance genes by plasmid between species of bacteria may decrease the therapeutic effectiveness of antibiotics.
A Meta‐Analysis of the Association Between Stress and Health in Taiwan
Authors: Yu Lifa , Lin Yaw‐Sheng , Chen Jew‐Wu , Wang Hsiu‐Hung , Chiu Chao‐Hung
Published: July 2009

This study adopted the meta‐analysis technique to analyze 354 journal articles, theses, and dissertations that had investigated the association between stress and health in Taiwan between January 1980 and December 2003. This study was conducted with the purpose of understanding the association between general stress and general health, the discrepant associations between different stress types and health facets, and the possible moderators between general stress and general health. A computer search for relevant studies was conducted on several databases using the key words “stress” and “life event”. For each eligible study, the important study characteristics were recorded, and the effect sizes of the relationship between stress and health were computed. Furthermore, in order to investigate the moderating effects of the study characteristics on the stress‐health relationship, the methods of categorical model analysis and correlation analysis were employed. The results of this study revealed that: (1) the correlations between general stress and general health as well as between general stress and various health facets fell between medium and high; (2) there existed different degrees of association between various stress types and health facets; and (3) none of the demographic and methodologic variables could by itself moderate the relationship between general stress and general health as the moderator effects were not sufficient and strong enough. This study presents a multidimensional framework of the issues on the relationship between stress and health, and it provides guiding references for future research. No evidence was found for moderating effects of social support, coping strategies, and personality traits on the stress‐health relationship. Such findings may be due to methodologic limitations. This suggests that further investigation is needed.
Clinical Study of Uric Acid Urolithiasis
Authors: Chou Yii‐Her , Li Wei‐Ming , Li Ching‐Chia , Huang Shu‐Pin , Liu Chia‐Chu , Wu Wen‐Jeng , Hsiao Hsi‐Lin , Chang Tu‐Hao , Juan Yung‐Shun , Su Chien‐Yu , Hsu Hsing , Huang Chun‐Hsiung
Published: July 2009

Uric acid urolithiasis develops from various causes. To investigate the clinical and biochemical presentation of patients with uric acid urolithiasis, a retrospective study was designed. A total of 46 cases were enrolled between January 2004 and December 2005. The compositions of the stones were analyzed by infrared spectrophotometry. There were 39 males (84.8%) and seven females (15.2%), with a mean age of 61.5 ± 10.6 years and mean body mass index (BMI) of 26.7 ± 3.1 kg/m2. The stone location was kidney in 10 (21.7%), ureter in 22 (41.8%), and bladder in 14 (30.5%). Multiple stones were diagnosed in 36 patients (78.3%). Pre‐existing comorbidities included diabetes mellitus in 11 patients (23.9%), hypertension in 23 (50%), gout in 13 (28.2%), and benign prostatic hyperplasia in 14 (30.4%). Mean serum creatinine and uric acid was 1.6 ± 0.6 mg/dL and 7.6 ± 1.8 mg/dL, respectively. There were 27 patients (58%) with creatinine > 1.4 mg/dL. The mean urinary pH was 5.42 ± 0.46. Patients with uric acid urolithiasis were predominantly male, older, with higher BMI, multiple stone presentation, with lower urinary pH, and hyperuricemia. Exacerbation of the renal function should also be of concern because of the high proportion of patients with renal insufficiency diagnosed in this study.
Surgical Management of Accidentally Displaced Mandibular Third Molar into the Pterygomandibular Space: A Case Report
Authors: Huang I‐Yueh , Chen Chao‐Ming , Chang Sung‐Wen , Yang Chia‐Fu , Chen Chung‐Ho , Chen Chun‐Min
Published: July 2009

Surgical removal of the mandibular third molar is a regular surgical procedure in dental clinics, and like all operations, it may have some complications, such as infection, bleeding, nerve injuries, trismus and so on. An accidentally displaced lower third molar is a relatively rare complication, but may cause severe tissue injury and medicolegal problems. As few papers and cases have been published on this topic, we report this case to remind dentists on ways to prevent and manage this complication. The patient, a 28‐year‐old male, had his right lower mandibular third molar extraction in January 2006. The dentist resected the crown and attempted to remove the root but found that it had suddenly disappeared from the socket. Assuming that the root had been suctioned out he closed the wound. The patient was not followed up regularly because he studied abroad. About 3 months later, the patient felt a foreign body sensation over his right throat, and visited a local hospital in Australia. He was told after a computed tomography (CT) scan that there was a root‐like radio‐opaque image in the pterygomandibular space. The patient came to our hospital for further examination and management in June 2006. We rechecked with both Panorex and CT and confirmed the location of the displaced root. Surgery for retrieving the displaced root was performed under general anesthesia by conventional method without difficulty, and the wound healed uneventfully except for a temporary numbness of the right tongue. This case reminds us that the best way to prevent a displaced mandibular third molar is to evaluate the condition of the tooth carefully preoperatively, select adequate instruments and technique, and take good care during extraction. If an accident does occur, dentists should decide whether to retrieve it immediately by themselves or refer the case to an oral and maxillofacial surgeon, and should not try to remove the displaced root without proper assurance. Localization with images and proper surgical methods are the keys to retrieving the displaced fragment successfully. When immediate retrieval is decided on, Panorex and occlusal view are useful in localizing the displaced fragment. When the fragment moves into a deeper space or the retrieval has been delayed for months, three‐dimensional CT seems to be a better choice.
A new genus and species of Ptyctodont (Placodermi) from the Late Devonian Gneudna Formation, Western Australia, and an analysis of Ptyctodont phylogeny
Authors: TRINAJSTIC KATE , LONG JOHN A.
Published: July 2009

An almost complete but predominantly disarticulated ptyctodont fish, Kimbryanodus williamburyensis n. gen., n.sp. from the Late Devonian Gneudna Formation, is described. The fossils occur as three-dimensionally preserved isolated plates, and this has allowed the reconstruction of the fish. A taxonomic revision of the ptyctodonts was undertaken based on recently described Australian taxa and new reconstructions of Australian, American and European specimens. The phylogenetic analysis supports a threefold division of the ptyctodonts, with Rhamphodopsis being the most basal taxon and the other ptyctodonts divided into those possessing a median dorsal spine, spinal plate and simple V-shaped overlap of the anterior lateral and anterior dorsolateral plates and those taxa which do not.