bluuebunny/crossref_metadata_2025 huggingface dataset:
Genome‐scale metabolic networks
Authors: Terzer Marco , Maynard Nathaniel D. , Covert Markus W. , Stelling Jörg
Published: July 2009

During the last decade, models have been developed to characterize cellular metabolism at the level of an entire metabolic network. The main concept that underlies whole‐network metabolic modeling is the identification and mathematical definition of constraints. Here, we review large‐scale metabolic network modeling, in particular, stoichiometric‐ and constraint‐based approaches. Although many such models have been reconstructed, few networks have been extensively validated and tested experimentally, and we focus on these. We describe how metabolic networks can be represented using stoichiometric matrices and well‐defined constraints on metabolic fluxes. We then discuss relatively successful approaches, including flux balance analysis (FBA), pathway analysis, and common extensions or modifications to these approaches. Finally, we describe techniques for integrating these approaches with models of other biological processes Copyright © 2009 John Wiley & Sons, Inc.

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Models of Systems Properties and Processes > Cellular Models
From StPowla processes to SRML models
Authors: Bocchi Laura , Gorton Stephen , Reiff-Marganiec Stephan
Published: July 2009

Service Oriented Computing is a paradigm for developing software systems as the composition of a number of services. Services are loosely coupled entities, that can be dynamically published, discovered and invoked over a network. The engineering of such systems presents novel challenges, mostly due to the dynamicity and distributed nature of service-based applications. In this paper, we focus on the modelling of service orchestrations. We discuss the relationship between two languages developed under theSensoriaproject: SRML as a high level modelling language for Service Oriented Architectures, andStPowlaas a process-oriented orchestration approach that separates core business processes from system variability at the end-user’s level, where the focus is towards achieving business goals. A fundamental challenge of software engineering is to correctly align business goals with IT strategy, and as such we present an encoding ofStPowlato SRML. This provides a formal framework forStPowlaand also a separated view of policies representing system variability that is not present in SRML.
Lessons Learned from the First 109 Laparoscopic Cholecystectomies Performed in a Single Pediatric Surgery Center
Authors: Esposito Ciro , Alicchio Francesca , Giurin Ida , Perricone Flavio , Ascione Giuseppe , Settimi Alessandro
Published: July 2009

Background

Laparoscopic cholecystectomy (LC) is a frequent operation in adults but is seldom performed in children. A retrospective review of 109 consecutive patients who underwent LC over an 11‐year period was performed to see what lessons were learned from this experience.

Methods

From January 1996 to January 2007, a total of 109 patients were referred to our unit to undergo LC. Nine adult patients were excluded from the analysis. The remaining 100 pediatric patients form the basis of this report. Isolated cholecystectomies were performed using a four‐trocar technique, with a fifth trocar added for cases in which splenectomy was required. One patient with main bile duct dilatation at preoperative echography underwent peroperative cholangiography.

Results

We recorded three anatomic anomalies (3%), two involving the bile duct and one the cystic artery. We recorded four minor problems during surgery: In one case there was failure of the tip of reusable scissors, and in three cases there was a small perforation of the gallbladder during the dissection step. We recorded four (4%) postoperative complications, which required redo surgery: one patient with bleeding from the cystic artery; one case of dislocation of clips positioned on the cystic duct; and two patients with lesions of the main bile duct that had not been detected during surgery. The treatment consisted in choledojejunostomy on postoperative day 7 in one case and suture of the choledocus on a stent positioned using endoscopic retrograde cholangiopancreatography on postoperative day 5 in the second case. Both biliary complications occurred in patients more than 14 years of age. We also recorded one umbilical granuloma.

Conclusions

LC is an effective procedure in children. On the basis of our experience, it seems that major complications can occur even with experienced surgeons, and they are more frequent in teenagers. Biliary or vascular anomalies of the gallbladder are encountered in about 3% of patients.
Combined Lumbar Spinal and Thoracic High‐Epidural Regional Anesthesia as an Alternative to General Anesthesia for High‐Risk Patients Undergoing Gastrointestinal and Colorectal Surgery
Authors: Skipworth James , Srilekha Attavar , Raptis Dimitri , O’Callaghan David , Siriwardhana Siri , Navaratnam Romi
Published: July 2009

Objective

A prospective study was undertaken to review the use of combined lumbar spinal and thoracic high‐epidural regional anesthesia in high‐risk patients who underwent gastrointestinal/colorectal surgery from 2004 to 2006.

Methods

Twelve high‐risk patients underwent 13 gastrointestinal/colorectal surgical procedures, using a regional anesthetic technique, which consisted of a thoracic epidural and lumbar subarachnoid block. All patients were classified as high risk based on anesthetic assessment (American Society of Anesthesiologists (ASA) score 3 or 4).

Results

Six (46.2%) of the patients were men, and the overall median age was 86 years. Ten (76.9%) patients presented as emergencies, whereas only three (23.1%) patients underwent elective procedures. All patients subjectively rated their postoperative pain relief as effective. The 30‐day mortality was 2 (15.4%); however, both of these patients refused initial treatment. Only one (7.7%) patient required delayed ITU admission for respiratory support (CPAP). None of the patients required intubation at any stage. There were two (15.4%) minor and two (15.4%) major early complications and only one (7.7%) delayed complication to date. Median length of stay was 7 days. Two (15.4%) patients had delayed discharge dates, for social reasons.

Discussion

These patients demonstrated early postoperative recovery, with effective analgesia, no requirements for intubation, and lower morbidity and mortality rates than similar studies of high‐risk patients who underwent procedures using general anesthesia. Using this technique, patients were managed appropriately in HDU and the surgical ward, without affecting their overall length of hospital stay.

Conclusions

This study supports the role of regional anesthetic techniques, combined with targeted, minimally invasive surgery—particularly for the management of high‐risk patients presenting in the emergency setting.
Modulation of dendritic spine development and plasticity by BDNF and vesicular trafficking: fundamental roles in neurodevelopmental disorders associated with mental retardation and autism
Authors: Chapleau Christopher A. , Larimore Jennifer L. , Theibert Anne , Pozzo-Miller Lucas
Published: July 2009

The process of axonal and dendritic development establishes the synaptic circuitry of the central nervous system (CNS) and is the result of interactions between intrinsic molecular factors and the external environment. One growth factor that has a compelling function in neuronal development is the neurotrophin brain-derived neurotrophic factor (BDNF). BDNF participates in axonal and dendritic differentiation during embryonic stages of neuronal development, as well as in the formation and maturation of dendritic spines during postnatal development. Recent studies have also implicated vesicular trafficking of BDNF via secretory vesicles, and both secretory and endosomal trafficking of vesicles containing synaptic proteins, such as neurotransmitter and neurotrophin receptors, in the regulation of axonal and dendritic differentiation, and in dendritic spine morphogenesis. Several genes that are either mutated or deregulated in neurodevelopmental disorders associated with mental retardation have now been identified, and several mouse models of these disorders have been generated and characterized. Interestingly, abnormalities in dendritic and synaptic structure are consistently observed in human neurodevelopmental disorders associated with mental retardation, and in mouse models of these disorders as well. Abnormalities in dendritic and synaptic differentiation are thought to underlie altered synaptic function and network connectivity, thus contributing to the clinical outcome. Here, we review the roles of BDNF and vesicular trafficking in axonal and dendritic differentiation in the context of dendritic and axonal morphological impairments commonly observed in neurodevelopmental disorders associated with mental retardation.
Indeterminate Cell Histiocytosis: A Case Report
Authors: Wang Chun‐Hua , Chen Gwo‐Shing
Published: July 2009

Indeterminate cell histiocytosis is a rare neoplasm composed of cells with mixed characteristics of Langerhans cells and non‐Langerhans cells. An otherwise healthy, 36‐year‐old woman presented with asymptomatic generalized papules and nodules that had appeared on all four extremities, the trunk, and cheeks in the previous 6 months. The lesions were firm, painless, non‐pruritic, and slightly flesh‐yellow or reddish‐brown in color. Histopathologic, immunohistochemical examination and electron microscopic studies showed characteristic findings of indeterminate cell histiocytosis: diffuse proliferative histiocytes infiltrating the dermis without epidermotropism or atypia; neoplastic cells expressing markers characteristic of both Langerhans cells (CD1a, S‐100) and focal monocytes/macrophages (Factor XIIIa, CD68); and no Birbeck granules within the cytoplasm of the neoplastic cells. Flow cytometry revealed more CD34+ cells in the peripheral blood of the patient than in peripheral blood from a control. Interestingly, the patient responded favorably to psoralen ultraviolet A‐range treatment. Herein, we present this case and review the literature.
Fibro‐Osseous Lesion of the External Auditory Canal: A Case Report
Authors: Chi Hung‐Pin , Ho Kuen‐Yao , Lee Ka‐Wo , Ta Chih‐Feng , Wang Ling‐Feng , Kuo Wen‐Rei , Tsai Kun‐Bow
Published: July 2009

The aim of this study was to differentiate a novel type of benign circumscribed bone lesion of the external auditory canal from lesions described previously, such as exostoses and osteomas. We present a 43‐year‐old male patient who suffered from ear discharge of the right ear. Local findings showed bloody discharge from his right auditory canal, which was occupied by a mass‐like tissue. Computerized tomography (CT) carried out before resection of the lesion disclosed the absence of a bony connection to the underlying structures. The pathologic findings showed lesions consisting of an osteoma‐like bone formation with sparse osteoblastic areas. Mature lamellar bone and bone marrow containing adipose tissue were also noted. There was no evidence of a relationship to the cartilaginous tissue or bony structures of the external auditory canal. Therefore, we present this rare case and review the reported literature in which clinical, CT, surgical, and pathologic findings suggest that this lesion was unlike those previously known, and may be related to ossifying reactions in other parts of the organism.
Physician Practices in the Diagnosis of Carpal Tunnel Syndrome at a Medical Center in Southern Taiwan
Authors: Su Chwen‐Yng , Liang Wen‐Lung , Chen‐Sea Mei‐Jin , Liu Chin‐Wei , Huang Mao‐Hsiung , Lai Yung‐Chang
Published: July 2009

Carpal tunnel syndrome (CTS) is the most common neurologic entrapment disorder diagnosed in the upper limb. Nevertheless, there is still debate about the most reliable test that should be performed to diagnose CTS. Much of the argument has been drawn from the opinions of individuals or groups with varying degrees of expertise in the field; little has been based on actual data. The purpose of this study was to investigate the diagnostic patterns of CTS in an academic medical setting in southern Taiwan. The charts of 1,050 patients with a diagnosis of CTS over a 1‐year period (2001‐2002) were retrospectively reviewed. Data on 622 patients with new‐onset CTS were included in the analysis. On the patient's initial visit, physicians made a diagnosis of CTS in 34.9% of cases solely on the basis of the history of symptoms without resort to provocative tests, while 8.7% of cases were diagnosed on the basis of symptom characteristics alone in spite of negative provocative tests. A CTS diagnosis was given according to symptoms and positive provocative tests in 55% of cases. Apart from these, CTS diagnosis remained unchanged in 27.3% of cases without electrodiagnostic signs of CTS during follow‐up visits. An average of 1.6 diagnostic maneuvers were conducted for CTS patients, with nerve conduction velocity (NCV) studies (516 cases) being the most frequently performed, followed by Tinel's sign (350 cases) and Phalen's test (102 cases). Our findings imply that physicians are inclined to base their diagnosis on clinical history and physical examination for patients with suspected CTS. Clear guidelines regarding the indications for referral for NCV studies should be established in response to the increased concerns about the cost effectiveness of diagnostic tests.
Relationship Between Methamphetamine Use and Risky Sexual Behavior in Adolescents
Authors: Yen Cheng‐Fang
Published: July 2009

Substance abuse and risky sexual behavior have been identified as behaviors that can endanger adolescent psychosocial development. This study examined the relationship between methamphetamine (MAMP) use and risky sexual behavior in adolescents. Risky sexual behavior was compared not only between MAMP users and non‐users, but also between high‐frequency and low‐frequency MAMP users. We compared the sexual intercourse histories of 85 adolescents formally charged as MAMP users with those of 170 gender‐matched adolescents with no record of MAMP use. MAMP usage characteristics were compared between users who had and those who had not experienced sexual intercourse. Previous sexual experience was more likely in MAMP users than in non‐users. MAMP users were also more likely to have had a greater total number of sexual partners and were more likely to have had unplanned sex under the influence of alcohol. High‐frequency MAMP use was associated with increased tendencies to engage in unprotected sex and to use MAMP before sexual intercourse. In general, the chance of sexual intercourse increased in proportion to frequency of MAMP use. Given the clear link between MAMP use and risky sexual behavior, risk‐reduction programs directed at teen MAMP users are urgently needed.
Eosinophils Chemoattracted by Eotaxin from Cerebrospinal Fluid of Mice Infected with Angiostrongylus Cantonensis Assayed in a Microchamber
Authors: Chang Eddy Essen , Yen Chuan‐Min
Published: July 2009

When non‐permissive hosts are infected with Angiostrongylus cantonensis, the migration of the worms to the brain and their subsequent development manifests as marked eosinophilic pleocytosis. We used microchambers to demonstrate direct eosinophil chemotactic activity by adding a variety of antibodies into cerebrospinal fluid (CSF) of BALB/c mice 21 days post‐infection with A. cantonensis. The antibodies were directed to neutralize eotaxin, RANTES (regulated on activation, normal T‐cells expressed and secreted), macrophage inflammatory protein (MIP)‐1a, and platelet‐activating factor (PAF), respectively. Eosinophil migration into the polycarbonate membrane covering CSF with anti‐eotaxin or anti‐MIP‐1a antibodies was significantly lower than that for antibody‐free CSF (Student's t test: p < 0.01, p < 0.05). We also collected CSF from mice 21 days after infection with 10, 20, 30, 40, and 50 third‐stage larvae (L3) respectively for dose‐dependent testing, and 40 L3 at days 7, 14, and 21 after infection for time‐dependent testing. Chemokine production in CSF was affected by A. cantonensis infection intensity and post‐infection time. In conclusion, eotaxin and MIP‐1a released in the CSF of A. cantonensis‐infected mice have eosinophil chemotactic activity in this in vitro assay.
Risk Factors for Cardiovascular Disease in the Elderly in Taiwan
Authors: Chiu Herng‐Chia , Mau Lih‐Wen , Chang Yong‐Yuan , Chang Hsing‐Yi , Lee Ti‐Kai , Liu Hong‐Wen
Published: July 2009

The major objective of the present study was to identify biologic and behavioral risk factors of cardiovascular disease (CVD) in the elderly population in Taiwan. It is hypothesized that the selected risk factors are significantly associated with the prevalence of CVD. Data came from a nationwide geriatric survey in 1991. Stratified proportional sampling was used to recruit 2,600 subjects. These were evaluated by family physicians working for the Departments of Family Medicine at four medical centers in four major cities in Taiwan. Univariate and multivariate logistic regression analyses were used to examine the associations between risk factors and the prevalence of CVD. The prevalence of CVD was 38.31%. Patients with CVD consistently had higher values for each selected risk factor except high‐density lipoprotein‐cholesterol (HDL‐C) and glucose concentrations. The findings also indicated that hypertension, hypertriglyceridemia, low HDL‐C concentration, ex‐drinking status, and overweight were significantly associated with the prevalence of CVD among the elderly in Taiwan. The findings not only confirm the risk factors for CVD, but also invite more attention to be given to the importance of biologic and behavioral risk factors in CVD.
Validation of Comprehensive Assessment of Activities of Daily Living in Stroke Survivors
Authors: Lin Jau‐Hong , Lo Sing Kai , Chang Yong‐Yuan , Su Chwen‐Yng , Liu Ching‐Kuan
Published: July 2009

This study determined whether the Functional Independence Measure (FIM) and the Frenchay Activities Index (FAI) could be used together as a more comprehensive score to assess the activities of daily living (ADL) in stroke survivors. Subjects were recruited from stroke patients consecutively admitted to the inpatient neurology or rehabilitation department at a university hospital in southern Taiwan. We interviewed 209 first stroke survivors at least 1 year after stroke onset during their clinical visits, at home, or in long‐term care institutions. Combinations of FIM and FAI as a comprehensive assessment of ADL were measured. All items of the FIM and the FAI were included in a non‐parametric factor analysis to determine their underlying constructs. Two comprehensive functional independence scores were then computed as functions of the FIM and FAI scores. The distributional characteristics of the comprehensive scores were examined. Approximately 90% of the total variation was explained by three factors. One single factor comprised all the items from FIM, while the FAI items loaded on two other factors, suggesting that FIM supplements FAI without overlap in content. We further demonstrated that the presence of ceiling or floor effects when either the FIM or the FAI was used could be removed using combined scores of the two instruments. The FIM and the FAI assessed different domains with good construct validity. A comprehensive assessment of functional independence obtained by combining the FIM and the FAI scores is potentially more appropriate and useful for clinical and research applications in stroke patients.
Percutaneous Ultrasound‐guided Radiofrequency Ablation of Intrahepatic Cholangiocarcinoma
Authors: Chiou Yi‐You , Hwang Jen‐I , Chou Yi‐Hong , Wang Hsin‐Kai , Chiang Jen‐Huey , Chang Cheng‐Yen
Published: July 2009

This study evaluated the clinical applications, treatment effects, and complications of percutaneous ultrasound (US)‐guided radiofrequency ablation (RFA) of intrahepatic cholangiocarcinoma. Ten patients (6 men and 4 women) with histologically proven cholangiocarcinoma underwent US‐guided percutaneous RFA. Tumor diameters ranged from 1.9 to 6.8 cm. There were 12 sessions of RFA for 10 solitary cholangiocarcinomas. Eight patients were treated at a single session and two patients had two treatment sessions. The efficacy of RFA was evaluated using contrast‐enhanced dynamic computed tomography 1 month after treatment and then every 3 months. Complete necrosis was defined as lack of contrast enhancement of the treated region. There was complete necrosis in eight tumors. In two patients with large tumors (4.7 and 6.8 cm in diameter), enhancement of residual tissue was observed after RFA treatment, indicating residual tumor. Complete necrosis was seen in all five tumors (100%) with diameters of 3.0 cm or less, two of three tumors (67%) with diameters of 3.1‐5.0 cm, and one of two tumors (50%) with diameters of more than 5.0 cm. A large biloma was found in one patient after treatment. No serious complications occurred in the other nine patients. In conclusion, percutaneous RFA is effective and successful in the treatment of intrahepatic cholangiocarcinoma of 3 cm or less and satisfactory for tumors of 3‐5 cm. The rate of serious complications after RFA is low. Further follow‐up is necessary to determine long‐term efficacy.
Tuberculous Pericardial Abscess: A Case Report
Authors: Lin Tsung‐Hsien , Huang Chih‐Hsin , Sheu Sheng‐Hsiung , Chiu Chaw‐Chi , Tsai Kun‐Bow
Published: July 2009

We present the case of a 71‐year‐old diabetic man who came to us complaining of dyspnea for 1 month. Chest X‐ray showed cardiomegaly and bilateral pleural effusion. Echocardiography showed a pericardial cystic mass with external compression of the right ventricle. Because of clinically impending cardiac tamponade, we performed urgent sternotomy and removed the pericardial mass without event. Pathologic examination of the excised pericardial specimen showed caseous necrosis compatible with tuberculosis infection. The patient was put on a 1‐year treatment regimen of anti‐tuberculosis medication. This case is an important reminder that tuberculosis can occur as a pericardial abscess.
Impact of Lower Pole Anatomy on Stone Clearance After Shock Wave Lithotripsy
Authors: Juan Yung‐Shun , Shen Jung‐Tsung , Wang Chii‐Jye , Chuang Shu‐Mien , Wu Wen‐Jeng , Huang Chun‐Hsiung
Published: July 2009

This study retrospectively analyzed patients treated with shock wave ithotripsy (SWL) for lower calyceal stones, to determine the influence of the lower pole anatomy and stone size in predicting the clearance of fragments. Between June 2000 and March 2002, we reviewed excretory urography (IVU) of 59 patients with isolated lower pole stones treated with SWL. A total of 44 men and 15 women, with an age ranging between 23 and 78 years (mean, 55 years), were included in the study. The patients were divided into two groups, either a stone‐free group or residual‐stone group. After SWL, overall stone rate was 57.6%, and clearance for stones less than 10 mm in diameter was 64.5%, whereas clearance was 50% for stones between 10 and 20 mm in diameter. Intrarenal anatomy on IVU, such as infundibular width and infundibulopelvi‐ureteric angle showed no significant difference between the stone‐free and residual‐stone groups. Our analysis showed that three significant variables were relevant to stone clearance: infundibular length, stone size and stone burden. We conclude that SWL is the best treatment for lower pole kidney stones 10 mm or less in diameter, showing lower complication and acceptable stone‐free rates.
Canine Transposition
Authors: Tseng Yu‐Chuan , Chang Hong‐Po , Chou Tsau‐Mau
Published: July 2009

Transposition is described as an interchange in the position of two teeth within the same quadrant of the dental arch. Canine transposition is reportedly the most common transposition in human dentition. The incidence of maxillary canine‐premolar transposition is reported to be 0.135‐0.510%. Although the exact mechanism of canine transposition is unclear, it seems to be closely related to genetically influenced, retained deciduous canine, and a history of trauma. In this article, we focus on the classification, incidence, etiology, and treatment modalities of tooth transposition. We hope this information will help clinicians treating patients with this kind of dental anomaly.
Effects of Total Coronary Artery Occlusion on Vascular Endothelial Growth Factor and Transforming Growth Factor β
Authors: Lin Tsung‐Hsien , Yen Hsueh‐Wei , Su Ho‐Ming , Chien Wan‐Ting , Lu Ye‐Hsu , Voon Wen‐Chol , Lai Wen‐Ter , Sheu Sheng‐Hsiung
Published: July 2009

Vascular endothelial growth factor (VEGF) and transforming growth factor β (TGF‐β1) play an important role in angiogenesis. We wanted to determine if concentrations of growth factors in the coronary sinus (CS) and right atrium (RA) are higher in coronary artery disease patients with total occlusions than in those with partial occlusions. Fifty‐one patients scheduled for coronary artery angiography were evaluated for possible recruitment. A 6F Goodale‐Lubin catheter was used to collect blood from the CS and RA. Data for all but four patients were gathered successfully, leaving 47 study patients. The reviewer was blinded to growth factor data when interpreting coronary angiographic findings. Of the 47 enrolled patients, 32 had at least one diseased vessel, seven of whom had at least one major total epicardial coronary occlusion. In all 32 patients, the concentrations of VEGF in the CS were higher than those in the RA (31.5 ± 2.7 vs 27.1 ± 1.8 pg/mL;p= 0.005). Patients with total occlusions had higher VEGF concentrations in the CS than those with non‐total occlusions (38.9 ± 8.0 vs 29.5 ± 2.6 pg/mL;p= 0.037). The differences in TGF‐β1in the two groups were not statistically significant. The higher CS VEGF concentrations in patients with total occlusion indicate that VEGF may play a part in the development of angiogenesis.
Noninfectious Hypopion after Intravitreal Triamcinolone Acetonide Injection for Central Retinal Vein Occlusion: A Case Report
Authors: Chiu Yu‐Te , Tsai Yi‐Yu , Lin Jane‐Ming
Published: July 2009

Although it is rare, infectious endophthalmitis is a severe ocular complication resulting from intravitreal injection of triamcinolone acetonide (TA). Therefore, care must be taken by ophthalmologists to differentiate between what is infectious and noninfectious endophthalmitis. We report on a 62‐year‐old woman who received an intravitreal injection of TA for treatment of central retinal vein occlusion. One day after the injection, a hypopion (a white‐yellowish deposit) was noted in the inferior anterior chamber. The patient complained that her vision had deteriorated, but there was no pain, eyelid edema, increased conjunctival injection or corneal edema. The hypopion gradually diminished and by the fifth postoperative day, resolved completely without the administration of intravitreal or systemic antibiotic therapy.
Conjunctival Aspergilloma with Multiple Mulberry Nodules: A Case Report
Authors: Chen Jiunn‐Liang , Yeh Tzy‐Ing , Wang Cheng‐Chiang , Sheu Shwu‐Jiuan
Published: July 2009

A 30‐year‐old healthy female presented with a 1‐year history of chronic mucous discharge, tearing, and irritation in the left eye. Slit‐lamp examination revealed severe papillary and follicular reaction surrounding a movable subconjunctival mass on the left upper tarsal conjunctiva. Incision and curettage were performed to establish the diagnosis. Multiple peculiar black mulberry nodules were obtained. The clumps of septate hyphae seen with periodic acid‐Schiff stain were characteristic of fungus ball (aspergilloma). The patient's symptoms improved significantly after surgery without any antifungal therapy. Although rarely reported, aspergillus is a common fungus in the conjunctiva that may seed into the subconjunctiva. We present this case to remind ophthalmologists of such a rare cause of recalcitrant conjunctival inflammation in immunocompetent patients.
Adjunctive Treatment of Acute Mania with Risperidone versus Typical Antipsychotics: A Retrospective Study
Authors: Tsai Jui‐Hsiu , Yen Ju‐Yu , Tang Tze‐Chun , Yang Pinchen , Yen Cheng‐Fang , Yang Ming‐Jen , Chen Cheng‐Chung
Published: July 2009

Few studies have directly compared atypical antipsychotics (e.g. risperidone) with typical antipsychotics as adjunctive therapy in patients hospitalized for acute mania, especially during a lengthy hospital stay. Our retrospective, case‐controlled study is a chart review of 64 patients with Diagnostic and Statistical Manual of Mental Disorders, 4thedition, defined bipolar I disorder (current episode, mania). Patients were divided into two groups according to the adjunctive medications used: the risperidone group (mood stabilizers plus risperidone) and the control group (mood stabilizers plus typical antipsychotics). Outcome at discharge, medications, adverse drug effects, and length of hospital stay were compared between groups, controlling for gender, age, number of prior admissions, and duration of illness. Results indicated no statistically significant differences between groups in the controlled factors, Global Assessment of Functioning and Clinical Global Impression‐Improvement scores, and adverse drug events. Patients in the risperidone group used significantly lower doses of trihexyphenidyl than those in the control group (p< 0.05). Patients treated with risperidone had a shorter hospital stay than those treated with typical antipsychotics (p< 0.01). In conclusion, antipsychotics are effective as adjunctive agents in the treatment of acute mania. The use of risperidone, in particular, decreases the need for anticholinergics and may lead to a shorter hospital stay compared with typical antipsychotics.
Screening for Internet Addiction: An Empirical Study on Cut‐off Points for the Chen Internet Addiction Scale
Authors: Ko Chih‐Hung , Yen Cheng‐Fang , Yen Chia‐Nan , Yen Ju‐Yu , Chen Cheng‐Chung , Chen Sue‐Huei
Published: July 2009

The aim of this study was to establish the optimal cut‐off points of the Chen Internet Addiction Scale (CIAS), to screen for and diagnose Internet addiction among adolescents in the community by using the well‐ established diagnostic criteria of Internet addiction. This survey of 454 adolescents used screening (57/58) and diagnostic (63/64) cut‐off points of the CIAS, a self‐reported instrument, based on the results of systematic diagnostic interviews by psychiatrists. The area under the curve of the receiver operating characteristic curve revealed that CIAS has good diagnostic accuracy (89.6%). The screening cut‐off point had high sensitivity (85.6%) and the diagnostic cut‐off point had the highest diagnostic accuracy, classifying 87.6% of participants correctly. Accordingly, the screening point of the CIAS could provide a screening function in two‐stage diagnosis, and the diagnostic point could serve as a diagnostic criterion in one‐stage massive epidemiologic research.
Successful Retrieval of Dislodged Paclitaxel‐eluting Stent with a Nitinol Loop Snare: A Case Report
Authors: Chu Chih‐Sheng , Lee Shuo‐Tsan , Lee Kun‐Tai , Lin Tsung‐Hsien , Lin Chien‐Tsai , Voon Wen‐Chol , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: July 2009

Coronary stent dislodgment or embolization before deployment is a rare but challenging complication in interventional cardiology. Intracoronary embolization of the dislodged stent is associated with a high risk of coronary occlusion, due to thrombus formation and subsequent myocardial infarction. Furthermore, systemic embolization may cause severe cerebrovascular events. Nonsurgical retrieval strategies for this complication have been suggested, but bailout cardiac surgery may be indicated if percutaneous retrieval attempts fail. To our knowledge, this is the first case report of intracoronary drug‐eluting stent dislodgment, and successful retrieval was accomplished by a loop snare technique. With the increasing trend of using drug‐eluting stents in percutaneous coronary intervention, the likelihood of stent dislodgment or embolization may increase. It should be kept in mind, especially by coronary interventionists, how to manage this complication.
Spontaneous Perirenal Hematoma: A Case Report
Authors: Chang Tu‐Hao , Wu Wen‐Jeng , Hsiao Hsi‐Lin , Yeh Hsin‐Chih , Huang Chun‐Hsiung , Lee Yung‐Chin
Published: July 2009

Spontaneous perirenal hematoma is relatively uncommon but may be life threatening. There are some challenges in early diagnosis due to the lack of specific presentations. We report a case of spontaneous perirenal hematoma in a patient who had histories of systemic lupus erythematosus, hypertension, and uremia with hemodialysis, and initially presented with non‐specific flank pain. Dizziness and unstable vital signs were noted in the emergency room. Computed tomography and abdominal ultrasonography revealed a large perirenal hematoma over the left retroperitoneal cavity. The patient received conservative treatment without surgical intervention and had an uneventful recovery.
Role Of TTF‐1, CK20, And CK7 Immunohistochemistry for Diagnosis of Primary and Secondary Lung Adenocarcinoma
Authors: Su Yue‐Chiu , Hsu Yu‐Chang , Chai Chee‐Yin
Published: July 2009

Thyroid transcription factor‐1 (TTF‐1), and cytokeratin 7 (CK7) and cytokeratin 20 (CK20) have recently been reported to be useful to distinguish between primary and metastatic lung adenocarcinoma. The aim of this study was to determine the usefulness of the staining patterns of pulmonary adenocarcinoma with antibodies to TTF‐1, CK7, and CK20 in differentiating primary from metastatic pulmonary adenocarcinoma. Of the 66 lung adenocarcinoma specimens that were enrolled in our study, there were 40 primary lung adenocarcinomas, 12 metastatic adenocarcinomas from breast, 13 metastatic adenocarcinomas from colon, and 1 metastatic adenocarcinoma from stomach. The expression of TTF‐1, CK7, and CK20 was assessed by immunohistochemistry. We found that 73% of primary lung adenocarcinomas expressed TTF‐1, whereas all nonpulmonary adenocarcinomas lacked TTF‐1 staining. CK7 expression was significantly more frequent in adenocarcinomas of pulmonary and breast origin than gastrointestinal (GI) origin (p < 0.001). In contrast, CK20 expression was significantly more prevalent in adenocarcinoma that originated in the GI tract than that of pulmonary or breast origin (p < 0.001). A combination of TTF‐1+CK7+CK20− was highly significantly associated with primary adenocarcinoma of lung (vs GI tract, p < 0.001; vs breast, p < 0.001). A combination of TTF‐1−CKCK20+ was highly significantly associated with adenocarcinoma of GI origin (vs lung, p < 0.001; vs breast, p < 0.001). Our study has confirmed that expression of CK7, CK20, and TTF‐1 is a useful immunohistochemical marker for diagnosis of lung tumors and for differential diagnosis of primary pulmonary adenocarcinomas from extrapulmonary adenocarcinomas metastatic to the lung. Application of this panel of antibodies might be expected to increase the accuracy of diagnosis.
Calyceal Diverticulum in FDG‐PET Imaging
Authors: Wang Keh‐Bin , Hung Guang‐Uei , Lin Wan‐Yu
Published: July 2009

A 46‐year‐old female underwent a fluorodeoxyglucose F‐18 (FDG) positron emission tomography (PET) whole‐body scan for tumor screening after showing no symptoms or signs. The PET images showed a large FDG‐avid lesion in the left renal pelvis, with a maximum standard uptake value (SUV) of 10.7 at 1 hour and 3.9 at 3 hours. An abdominal computed tomography (CT) scan showed a 3.7‐cm cystic lesion with a slightly irregular wall in the left kidney. The immediate impression was that of a complicated cyst. A histopathologic report after surgery confirmed a calyceal diverticulum. To the best of our knowledge, this is the first report of FDG uptake in a case of calyceal diverticulum.
Acute Brachial Artery Thrombosis: A Rare Complication of Diabetic Ketoacidosis
Authors: Lin Kun‐Der , Hsieh Ming‐Chia , Hsin Shih‐Chieh , Hsaio Zeng‐Yueh , Hung Wei‐Wen , Shin Shyi‐Jang
Published: July 2009

Diabetes mellitus is a worldwide disease that leads to several acute complications including diabetic ketoacidosis, hyperosmolar hyperglycemia, and hypoglycemia. In addition, diabetes causes many chronic complications that lead to debilitation and diminished quality of life. Diabetic ketoacidosis is one of the serious acute complications; however, it is usually preceded by infection, acute myocardial infarction, stroke, or other dire events. Rarely does it accompany acute arterial thrombosis. Here, we report on a female patient who suffered from diabetic ketoacidosis combined with acute brachial artery thrombosis. After emergency treatment, including insulin therapy and surgical thrombectomy, the brachial artery was rescued and her prognosis was good.
Paraneoplastic Hypercalcemia With Metastatic Calcification — Clinicopathologic Studies
Authors: Liou Ji‐Hung , Hsu Yung‐Hsiang , Cho Li‐Chen
Published: July 2009

Hypercalcemia is a common paraneoplastic syndrome that may result in metastatic calcification. We report here on four autopsy cases with paraneoplastic hypercalcemia with metastatic calcification, to evaluate the clinicopathologic manifestations. All were males, aged 37‐63 years old. Primary tumors included one transitional cell carcinoma of the urinary bladder, one multiple myeloma, and two squamous cell carcinomas of the esophagus. Calcium concentrations ranged from 3.3 to 5.9 mmol/L. Chronic hypercalcemia resulted in metastatic calcification. The kidney and stomach were the most vulnerable organs. Only case 1 presented with an increase in plasma calcium above 5 mmol/L (about twice the normal value); the metastatic calcification involved the capillary walls of his lungs, and he died of fulminant pulmonary edema. Our conclusion is that judicious treatment for paraneoplastic hypercalcemia is important with respect to the occurrence of pulmonary edema associated with metastatic calcification.
Acute Respiratory Distress Syndrome Associated With Rabies: A Case Report
Authors: Hsu Yung‐Hsiang , Cho Li‐Chen , Wang Lih‐Shinn , Chen Li‐Kuang , Lee Jen‐Jyh , Yang Hui‐Hua
Published: July 2009

Acute respiratory distress syndrome (ARDS) is the first potentially lethal complication in rabies virus infection, although its occurrence is rare. We report on a fatal case of rabies virus infection in a 45‐year‐old woman from Hu‐Nan Province, China. The neurologic signs of limb numbness and water phobia occurred from 61 days after the dog bite; the clinical course was progressive, with the most severe clinical manifestations being fever, encephalitis, and ARDS. The woman expired 12 days after admission to the hospital. An autopsy proved rabies encephalitis, mainly involving the medulla oblongata, the thalamus, part of the pons, the cerebellum, and the hippocampus. The lung pathologic examination revealed the organizing phase of ARDS with diffuse alveolar damage, hyaline membrane formation, type II alveolar cell hyperplasia accompanied by proliferation of fibroblasts and infiltration of mononuclear cells into the interstitial space. Immunohistochemistry stain and reverse transcription‐polymerase chain reaction for rabies virus failed to demonstrate the organism in the lung tissue. Strong expression of inducible nitric oxide synthase (iNOS) was detected in the alveolar macrophages. An immunologic mechanism with iNOS expression in the absence of direct invasion of the organism may participate in the pathogenesis of ARDS associated with rabies.
Effects of Antiglaucoma Drugs on Cellular Proliferation in Cultured Human Corneal Keratocytes
Authors: Wu Kwou‐Yeung , Wang Hwei‐Zu , Hong Show‐Jen
Published: July 2009

The purpose of this study was to investigate the effects of various antiglaucoma drugs, including timolol, betaxolol, carteolol, levobunolol, dipivefrin, and pilocarpine, on cellular proliferation in cultured human corneal keratocytes. Human corneal keratocytes were cultured with RPMI‐1640 medium containing 10% fetal bovine serum. Antiglaucoma drugs were prepared from original concentrations to dilutions of 1/10, 1/100, and 1/1,000. After exposure to drugs for 100 minutes, cellular proliferation was estimated by [3H] thymidine uptake methodology. It was found that cellular proliferation in corneal keratocytes was inhibited by only a 1/10 dilution of various drugs including timolol, betaxolol, carteolol, levobunolol, dipivefrin, and pilocarpine. The [3H]thymidine uptake values were significantly inhibited to 63%, 18%, 87%, 68%, 55%, and 67% by a 1/10 dilution of the above drugs. However, the cellular proliferation was also significantly suppressed by 0.01 mg/mL of benzalkonium chloride preservative. It is shown that the inhibition of cellular proliferation by high concentrations of antiglaucoma drugs may result from the benzalkonium chloride preservative contained in these drugs.
Polymerase Chain Reaction Identification of a Hymenopteran Insect in the Cornea: a Case Report
Authors: Lin Hsien‐Chung , Chang Cheng‐Hsien , Wu Horng‐Jiun , Wang Hwei‐Zu , Yeh Wen‐Bin , Fu Yaw‐Syan , Cheng Chien‐Chung
Published: July 2009

The type of corneal injuries associated with insect encounters is related to the composition of the foreign body. However, previous reports on corneal foreign bodies as insects were rarely based on scientific evidence. Here, we report on a 49‐year‐old male who was stung in his left eye by an unknown insect. Emergent keratotomy was performed to remove the embedded corneal foreign body. The removed foreign body was observed under light microscopy, and a fragment of insect was suspected. The sample was sent for molecular analysis. The polymerase chain reaction product was sequenced, subjected to a BLAST search, and identified as an ichneumonoid member of the insect order Hymenoptera.
Successful Treatment of Rubral Tremor by High‐Dose Trihexyphenidyl: A Case Report
Authors: Liou Li‐Min , Shih Pang‐Ying
Published: July 2009

A 24‐year‐old male suffered from acute‐onset right‐sided hemiparesis, dysarthria, and ophthalmoplegia in February 2001. Brain magnetic resonance imaging revealed a cavernous angioma with hemorrhage over the left thalamus. Moreover, some rhythmic, coarse, low‐frequency (2‐3 Hz) oscillation over the right wrist and elbow was noted 1 month later. Action tremor was more predominant than resting tremor. Rubral tremor was diagnosed on the basis of the clinical presentation and tremography analysis. Rubral tremor is not unusual, and pharmacotherapy is nearly always ineffective in clinical practice. Deep brain stimulation, thalamotomy, and pallidotomy are all considered effective according to recent research. However, they are either very expensive or invasive, and involve surgical risks. In our patient, we tried valproate, clonazepam, and verapamil one after another, but all in vain. Finally, titration of trihexyphenidyl provided significant benefit. The tremor was successfully controlled by a single high daily dose of trihexyphenidyl (38 mg) without severe or uncomfortable side effects. Here, we report a case of successful monotherapy of rubral tremor with high‐dose trihexyphenidyl.
Invasive Fungal Infections in Patients with Acute Leukemia
Authors: Hsiao Hui‐Hua , Tsai Hui‐Jen , Liu Yi‐Chang , Tseng Yi‐Ting , Lu Po‐Liang , Yang Wun‐Chi , Liu Ta‐Chih , Lin Sheng‐Fung
Published: July 2009

Invasive fungal infections, a serious problem among cancer patients, are increasing in incidence, and can cause morbidity and mortality. Such infections may hinder additional treatment, especially for patients with leukemia. We report here our experiences in the management of invasive fungal infection in patients with acute leukemia. A total of 18 patients were enrolled in the study: 12 had microabscesses of the liver and/or spleen and/or kidneys; four had sinonasal infections; and two had pulmonary infections. Most of the patients (88.9%) received amphotericin B during treatment for fungal infection. Thirteen patients achieved complete response without evidence of fungal infection in follow‐up. In the study, there were 11 mortalities, including five patients who died during therapy and six who later died as a result of relapse or refractoriness of the leukemia. We suggest that many patients may have a good response to antifungal therapy, and that fungal infection does not have to preclude additional chemotherapy after proper management. The state of the underlying disease has a strong impact on outcome.
Immunohistochemical Expression in Male Breast Cancer: Two Case Reports
Authors: Hu Shih‐Wen , Chuang Je‐Hen , Tsai Kun‐Bow
Published: July 2009

Male breast cancer is rare, and the incidence is less than 1% of all breast malignancies in both men and women. It is possible that, because male patients are unaware of male breast cancer, there is a delay of diagnosis and, consequently, more advanced stages are commonly encountered in these patients. Some studies have engaged in molecular studies of male breast cancers because of the possibly different characteristics, prognosis, and treatment between male and female malignancies. However, a dearth of studies still exists, most likely because of the rarity of the disease and lack of a large patient base for study. Among the molecular markers of breast cancer, p53, Ki‐67, HER‐2/neu, and Bcl‐2 are the most frequently studied. Here we present two rare cases and a review of the literature concerning the relationship between immunohistochemical markers and their impact in order to provide surgeons with more information about the disease and further techniques for treatment of these patients.
Chloroma of the Testis After Allogeneic Peripheral Blood Stem Cell Transplantation: A Case Report
Authors: Hu Shih‐Wen , Yang Sheau‐Fang , Chai Chee‐Yin , Huang Shu‐Pin
Published: July 2009

Chloroma, or granulocytic sarcoma, is a rare extramedullary solid hematologic cancer that affects many sites, usually in concert with acute myeloid leukemia. It is infrequently associated with other myeloproliferative disorders or chronic myelogenous leukemia. Chloroma of the testis after allogeneic bone marrow transplantation is particularly sparsely represented in the literature. It is often incorrectly diagnosed as malignant lymphoma, especially large‐cell lymphoma, owing to the similarity of the histologic morphology, scanty eosinophilic myelocytes, and no or overlooked history of leukemia. Although erroneous diagnosis is decreasing with the advent of ancillary studies, the diagnosis of chloroma continues to be a nightmare for pathologists. It is thus suggested that an appropriate panel of marker studies be performed in conjunction with clinical correlation and circumspection to avoid reaching a misleading conclusion and improper treatment of patients. We report an interesting case of a 35‐year‐old male with a clinical history of chronic myelogenous leukemia post allogeneic peripheral blood stem cell transplantation and complete molecular remission, who was found to have chloroma of the left testis.
Percutaneous Release for Trigger Thumb in Children Under General and Local Anesthesia
Authors: Wang Hsien‐Chung , Lin Gau‐Tyan
Published: July 2009

A retrospective trial of percutaneous release for 40 trigger thumbs in 33 children under different types of anesthesia (general versus local) at a mean age of 2.5 years was conducted between February 1989 and March 2003. Based on the tolerance of the child and parents, 20 children were processed using local anesthesia at our office and 13 children were given general anesthesia. We recommend special manipulation to ensure complete release of the A1 pulley when general anesthesia is necessary. Of the 26 trigger thumbs in the local anesthesia group, 23 were successfully released. Only one patient in the general anesthesia group had an unsatisfactory outcome. Percutaneous surgery achieved a 90% successful release rate for trigger thumb in children, without recurrence. There was no statistical difference in the release of trigger thumbs with these two anesthetic procedures (p = 0.66). Overall, 37 trigger thumbs achieved full extension and flexion without any residual deformity following percutaneous release. Our results suggest that percutaneous release for trigger thumb is satisfactory, no matter which method of anesthesia is used.