bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis of Starch-Stabilized Ag Nanoparticles and Hg2+Recognition in Aqueous Media
Authors: Fan Yingju , Liu Zhen , Wang L. e. , Zhan Jinhua
Published: July 2009

The starch-stabilized Ag nanoparticles were successfully synthesized via a reduction approach and characterized with SPR UV/Vis spectroscopy, TEM, and HRTEM. By utilizing the redox reaction between Ag nanoparticles and Hg2+, and the resulted decrease in UV/Vis signal, we develop a colorimetric method for detection of Hg2+ion. A linear relationship stands between the absorbance intensity of the Ag nanoparticles and the concentration of Hg2+ion over the range from 10 ppb to 1 ppm at the absorption of 390 nm. The detection limit for Hg2+ions in homogeneous aqueous solutions is estimated to be ~5 ppb. This system shows excellent selectivity for Hg2+over other metal ions including Na+, K+, Ba2+, Mg2+, Ca2+, Fe3+, and Cd2+. The results shown herein have potential implications in the development of new colorimetric sensors for easy and selective detection and monitoring of mercuric ions in aqueous solutions.
Effects of Adhesive Application Methods on Performance of a Soy‐based Adhesive in Oriented Strandboard
Authors: Schwarzkopf Matthew , Huang Jian , Li Kaichang
Published: July 2009

A wet method and dry method of applying a soy flour (SF)–curing agent (CA) adhesive onto wood flakes were evaluated for making randomly oriented strandboard (R‐OSB) and OSB. The wet method involved the thorough mixing of SF and CA prior to spraying the SF–CA mixture onto wood flakes. SF:CA weight ratio, adhesive add‐on rate, hot‐press conditions were optimized for enhancing internal bond strength (IB), modulus of rupture (MOR), and modulus of elasticity(MOE) of the resulting R‐OSB. The highest IB, MOR and MOE were obtained at the 1:1 SF:CA weight ratio. IB, MOR and MOE of R‐OSB exceeded the minimum industrial requirements at a ≥7% adhesive add‐on rate, a hot‐press temperature in the 170–220 °C range, and a ≥4 min hot‐press time. The dry method involved spraying aqueous CA solution onto a mixture of SF and wood flakes. The dry method allowed the strengths of the resulting R‐OSB to exceed the minimum industrial requirements at a higher SF:CA ratio (up to 7:1). The dry method was superior to the wet method because a higher SF:CA ratio meant a lower adhesive cost. OSBs made with the SF–CA adhesive had strengths higher than or comparable to commercial OSBs.
Epidermal Growth Factor Expression in Middle Ear Cholesteatoma
Authors: Chi Hung‐Pin , Ho Kuen‐Yao , Ta Chih‐Feng , Wang Ling‐Feng , Lee Ka‐Wo , Kuo Wen‐Rei , Chai Chee‐Yin , Wu Shu‐Chuan , Tsai Shin‐Meng
Published: July 2009

Middle ear cholesteatoma is destructive to auditory ossicles and temporal bone, and treatment usually requires surgical removal of all epithelial content. Epidermal growth factor (EGF) can stimulate the growth and differentiation of a variety of mammalian cells, including epithelial cells. Our study used the avidin‐biotin complex technique to evaluate the expression of EGF in 40 cases of middle ear cholesteatoma (active cholesteatoma, 31 cases; inactive cholesteatoma, 9 cases) and 34 normal postauricular skin samples. In middle ear cholesteatoma, EGF was expressed in squamous epithelium in 21 cases (53%), fibroblasts in two cases (5%), and cholesteatoma endothelium in two cases (5%). In normal postauricular skin, EGF was expressed in squamous epithelium in 14 samples (41%), fibroblasts in one sample (3%), and endothelium in none. No statistical difference in EGF expression was found between cholesteatoma and normal postauricular skin samples. These results show that the distribution of EGF in middle ear cholesteatoma is not deranged and that the progression of cholesteatoma might be induced by the release of factors from the cholesteatoma matrix via autocrine stimulation, or by inflammatory cells of the subepithelial tissue through paracrine stimulation, or in both of these ways.
Preliminary Study of the Effect of Low‐Intensity Home‐Based Physical Therapy in Chronic Stroke Patients
Authors: Lin Jau‐Hong , Hsieh Ching‐Lin , Lo Sing Kai , Chai Huei‐Ming , Liao Long‐Ren
Published: July 2009

This study was a preliminary examination of the effect of low‐intensity home‐based physical therapy on the performance of activities of daily living (ADL) and motor function in patients more than 1 year after stroke. Twenty patients were recruited from a community stroke register in Nan‐Tou County, Taiwan, to a randomized, crossover trial comparing intervention by a physical therapist immediately after entry into the trial (Group I) or after a delay of 10 weeks (Group II). The intervention consisted of home‐based physical therapy once a week for 10 weeks. The Barthel Index (BI) and Stroke Rehabilitation Assessment of Movement (STREAM) were used as standard measures for ADL and motor function. At the first follow‐up assessment at 11 weeks, Group I showed greater improvement in lower limb motor function than Group II. At the second follow‐up assessment at 22 weeks, Group II showed improvement while Group I had declined. At 22 weeks, the motor function of upper limbs, mobility, and ADL performance in Group II had improved slightly more than in Group I, but the between‐group differences were not significant. It appears that low‐intensity home‐based physical therapy can improve lower limb motor function in chronic stroke survivors. Further studies will be needed to confirm these findings.
Supraumbilical Skin Rash and Fat Necrosis after Transcatheter Arterial Chemoembolization: A Case Report
Authors: Chuang Wan‐Long , Lin Chao‐Chun , Wu Ding‐Kwo , Shih Paul Ming‐Chen , Liu Gin‐Chung
Published: July 2009

We report the case of a 63‐year‐old female who had chronic hepatitis C and who was diagnosed with hepatocellular carcinoma. Hepatic angiography showed one visible and tortuous falciform artery arising as the terminal branch of the left hepatic artery. Transcatheter arterial chemoembolization (TACE) was performed via the left hepatic artery. The patient developed supraumbilical skin rash with local tenderness on the following day. After supportive treatment by a dermatologist, the skin rash subsided gradually with sequelae of irregular skin surface and one small subcutaneous nodule. Skin biopsy of the lesion 1 year later showed fat necrosis with foreign body reaction and fibrosis. We discuss this rare complication of TACE and review the literature.
Post‐Traumatic Ligamentum Flavum Hematoma: A Case Report
Authors: Chi Tony Wing‐Cheong , Li Kuo‐Tai , Chieng Poon‐Ung
Published: July 2009

We present the case of a 64‐year‐old female treated surgically for ligamentum flavum hematoma that caused progressive radiculopathy. Initially, she suffered from an acute onset of lower back pain. Only a history of minor back injury was discovered. She rapidly became unable to walk. Magnetic resonance imaging demonstrated an epidural mass lesion at L3 to L4 that was continuous with the left ligamentum flavum. The mass was hypointense on T1‐weighted images and centrally hyperintense and marginally hypointense on T2‐weighted images. The margin was well enhanced by gadopentetate dimeglumine administration. After removal of the mass, the patient's symptoms completely resolved. Before surgery, we believe accurate diagnosis of ligamentum flavum hematoma can be based on magnetic resonance imaging.
Nasopharyngeal Carcinoma Treated with Precision‐Oriented Radiation Therapy Techniques Including Intensity‐Modulated Radiotherapy: Preliminary Results
Authors: Liu Wen‐Shan , Tseng Hsien‐Chun , Kuo Hsiang‐Chi , Su Mao‐Chang , Wu Ming‐Fang
Published: July 2009

This paper reports preliminary results with intensity‐modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC). Between August 2000 and May 2001, we treated 19 patients with NPC using IMRT. Twelve patients had stage I‐II disease and seven had stage III‐IV disease. Six patients received 9.0‐19.8 Gy three‐dimensional conformal radiotherapy (3D‐CRT) before IMRT and 18 patients received a brachytherapy boost after IMRT. The mean follow‐up time was 13.0 months. All patients with stage II‐IV disease except one received two cycles of chemoradiotherapy with cisplatin and 5‐fluorouracil (5‐FU) during radiotherapy, followed by two to four cycles of chemotherapy after radiotherapy. Tumor response was assessed using clinical examination and computerized tomography or magnetic resonance imaging. The mean doses administered to the gross tumor volume and clinical tumor volume were 70.9 Gy and 63.2 Gy, respectively. The mean doses administered to the right and left parotid glands were 38.1 Gy and 38.6 Gy, respectively. All 19 patients had a complete response of primary and lymph node disease. Grade III mucositis developed during chemoradiotherapy in 15 patients (79%). In addition, clinical grade I xerostomia was recorded in nine patients, grade II in nine, and grade III in one. This study demonstrated that 3D‐CRT, IMRT, intracavitary brachytherapy, and chemotherapy are effective and safe methods to treat NPC. Although IMRT treatment spared parotid gland function, its efficacy may be significantly influenced by disease stage and location of the neck lymph nodes. More cases and a longer follow‐up to assess survival and complications are planned.
Developing a Safety and Health Training Model for Petrochemical Workers
Authors: Hong Yu‐Jue , Lin Ya‐Hsuan , Pai Hsiu‐Hua , Lai Yung‐Chang , Lee I‐Nong
Published: July 2009

The production processes of the petrochemical industry expose workers to high potential hazards. Our previous study showed that hazard recognition was closely related to worker safety and health training activities. The purpose of this study was to establish and validate a safety and health training model. It is expected that the training model will help workers to recognize hazards, thereby lowering their operating risks. The training model, which included a complete training course and follow‐up scoring using a questionnaire, was applied to three groups of subjects for comparison. Group A had joined our study previously and took the training course again at this time. Group B had also joined our previous study but did not take this training course. Group C was new to our study and took this training course for the first time. Groups A and C (who took the training course) had higher cognition and attitude scores than group B (who did not take the training course). The training course was a significant factor that positively influenced both cognition and attitude scores among managers and workers. The training course was more significant for managers while the duration of education was more significant for workers.
Self‐Care and Well‐Being Model for Elderly Women: A Comparison of Rural and Urban Areas
Authors: Wang Hsiu‐Hung , Wang Ruey‐Hsia , Shieh Carol
Published: July 2009

The purposes of this study were to examine the relationships among age, social class, perceived health, self‐care, and well‐being in urban and rural elderly women and to validate and compare two models using these two groups. A causal model of self‐care and well‐being was proposed for this study based on Orem's self‐care model and empirical data. Data were collected using a survey‐interview method. Of the 351 elderly women recruited, 159 were in the urban group and 192 in the rural group. Two models of self‐care and well‐being were tested using path analysis with the LISREL 8 program. The resultant models yielded a Chi‐squared of 1.98 with two degrees of freedom (p = 0.37) in the urban group and a Chi‐squared of 4.20 with three degrees of freedom (p = 0.24) in the rural group, indicating good fit between the data and the two models. These two models provide guidelines for community nurses to design appropriate self‐care programs for elderly women.
Clear Cell and Non‐Clear Cell Hepatocellular Carcinoma: A Case Report and Literature Review
Authors: Liu Jenn‐Hwa , Tsai Huey‐Ling , Hsu Soa‐Ming , Hu Dong‐Her , Chen Shy‐Shen
Published: July 2009

Clear cell hepatocellular carcinoma (HCC) is an uncommon variant of HCC. It is considered to have a better prognosis than non‐clear cell HCC, but recent large studies show that there is some controversy. DNA image cytometry reveals diploid and non‐diploid DNA content tumors that have different pleomorphisms and mitosis corresponding to different prognoses. Clear cell HCC is classified as focal or diffuse. Herein, we report a rare case of a 61‐year‐old male with two adjacent hyper‐ and hypoechoic hepatic nodules and an !‐fetoprotein concentration of 6,370 ng/mL. Pathologic examination of a specimen obtained during wedge hepatectomy showed both clear cell and non‐clear cell HCC. Bone metastasis was later found. We suggest that a patient with clear cell HCC should be followed up closely after complete resection.
Testicular Sparing Surgery for Bilateral Epidermoid Cysts of the Testes: A Case Report
Authors: Su Chin‐Ming , Lee Yi‐Lun , Huang Shu‐Pin , Chou Yii‐Her , Huang Chun‐Hsiung
Published: July 2009

We report the case of a 12‐year‐old boy with bilateral epidermoid cysts of the testes diagnosed preoperatively from ultrasonography, magnetic resonance imaging, and negative tumor markers. The cysts were treated using bilateral testicular sparing surgery through a scrotal approach after intraoperative frozen section. We also discuss the diagnosis and management of epidermoid cyst of the testis and briefly review the literature.
Thyroid‐Associated Orbitopathy with Superior Oblique Muscle Involvement: A Case Report
Authors: Wu Horng‐Jiun , Tsai Rong‐Kung
Published: July 2009

A 29‐year‐old male with a 5‐year‐history of hyperthyroidism complained of diplopia and proptosis. After subtotal thyroidectomy, he still had diplopia in a certain gaze. Computerized tomography showed inferior rectus muscle enlargement in the right eye and inferior rectus, medial rectus, and superior oblique muscle enlargement in the left eye. Ocular examination with the cover and uncover test revealed hyperphoria and exophoria in the left eye. The upward gaze of the right eye was more limited than that of the left eye. Since superior oblique muscle involvement in patients with thyroid orbitopathy is quite rare, we discuss its effect on ocular motility in patients with thyroid‐associated orbitopathy.
Foreign Body Stone in the Urinary Bladder: A Case Report
Authors: Juan Yung‐Shun , Shen Jung‐Tsung , Wang Chii‐Jye , Chen Chun‐Kai , Jang Mei‐Yu , Chou Yii‐Her , Huang Chun‐Hsiung
Published: July 2009

Bladder calculi rarely form spontaneously and are usually a manifestation of an underlying pathologic condition of the lower urinary tract, including voiding dysfunction, urinary infection, obstruction, or foreign body retention. However, a ruptured Foley balloon‐induced bladder stone is an unusual complication of an indwelling Foley catheter. We report a case of spinal cord injury with paraplegia and bladder stone induced by a fragment of a ruptured Foley balloon. The bladder stone and the Foley balloon fragment were successfully removed by cystoscopy. The stone was composed of calcium oxalate and calcium phosphate. We report this unusual case to raise awareness that it is important to check the integrity of the Foley catheter after removal of the tube.
Potential Factors Associated with Contraceptive Intention Among Adolescent Males in Taiwan
Authors: Wang Ruey‐Hsia , Hsu Min‐Tao , Wang Hsiu‐Hung
Published: July 2009

This study explored the predictors of contraceptive intention in adolescent males in Taiwan. It used a cross‐sectional design and a sample of 1,000 vocational high school male students to determine the potential factors associated with contraceptive intention. Data were collected on an anonymous, self‐administered questionnaire, including personal background variables, prior sexual experience, contraceptive knowledge, contraceptive attitude, contraceptive self‐efficacy, perception of peers' contraceptive behavior, perception of support from significant others, and parental‐adolescent communication about contraception. A total of 230 participants (23%) had prior sexual experience, 13% (30) of whom reported being involved in their girlfriends' pregnancies. Of the participants, 45% recognized the use of condoms as the most favorable contraceptive method for future sexual intercourse. Second to condom use, the combination of the calendar method and condom use was also popular (13.1%). Multiple stepwise regression indicated that better contraceptive attitudes, higher contraceptive self‐efficacy, no prior sexual experience, more perception of peers' contraceptive behavior, and higher perception of support from significant others were predictors of higher contraceptive intention. The above predicting factors explained 31.9% of the total variance for contraceptive intention among adolescents. These results provide health professionals with important information to understand the reality adolescents encounter and to design effective contraceptive programs for male adolescents.
Multiple Symmetric Lipomatosis (Madelung's Disease): Report of Two Cases
Authors: Wu Chung‐Shin , Wang Ling‐Feng , Tai Chih‐Feng , Kuo Wen‐Rei , Tsai Kun‐Bow
Published: July 2009

Multiple symmetric lipomatosis (Madelung's disease) is a rare disease characterized by non‐encapsulated adipose deposits in the neck, the superior part of the trunk and, very rarely, in the limbs. It is common in middle‐aged Caucasian Mediterranean males but very rare in Chinese people. We describe two cases of Madelung's disease: both patients presented complaining of a development of a painless neck mass that was increasing in size. Panendoscopy was normal. Both underwent incisional biopsies that revealed benign adipose tissue characterizing Madelung's disease. We discuss the clinical presentation, associated morbidity, and treatments for Madelung's disease.
Unusual Upper Gastrointestinal Bleeding due to Late Metastasis from Renal Cell Carcinoma: A Case Report
Authors: Chang Wen‐Tsan , Lee King‐Teh , Chai Chee‐Yin
Published: July 2009

A case of recurrent massive upper gastrointestinal bleeding originating from metastatic renal cell carcinoma is reported. A 63‐year‐old woman underwent right nephrectomy 9 years previously and experienced no recurrence during follow‐up. A gradually enlarging ulcerative tumor over the bulb of the duodenum and four subsequent episodes of massive bleeding from this tumor occurred between June 2001 and March 2002. The patient underwent surgery in April 2002 for intractable bleeding from the tumor. Renal cell carcinoma metastasis to the duodenum was confirmed from the surgical specimen. Upper gastrointestinal bleeding due to malignancy is very rare and the duodenum is the least frequently involved site. Furthermore, a solitary late renal cell carcinoma metastasis 9 years after a nephrectomy is extremely uncommon. This case suggests that life‐long follow‐up of renal cell carcinoma patients is necessary, owing to unpredictable behavior and the possibility of long disease‐free intervals. In nephrectomized patients suffering from gastrointestinal bleeding, complete evaluation, especially endoscopic examination, is indicated. The possibility of late recurrent renal cell carcinoma metastasis to the gastrointestinal tract should be kept in mind, although it is rare. If the patient is fit for surgery, metastatectomy is the first choice of treatment.
Relationship of Oral Lichen Planus to Hepatitis C Virus in Southern Taiwan
Authors: Chung Ching‐Hung , Yang Yi‐Hsin , Chang Ting‐Tsung , Shieh Dar‐Bin , Liu Shyun‐Yen , Shieh Tien‐Yu
Published: July 2009

Oral lichen planus (OLP) is a relatively common skin and oral disease that manifests as a mucous reaction to a variety of etiologic factors, including autoimmune disease, drug reaction, diabetes mellitus (DM), hypertension, hepatitis C virus (HCV), urolithiasis, psychogenic factors, and bacterial infection. The purpose of this study was to investigate the relationship between HCV infection and OLP as there is a high prevalence of HCV infection in Taiwan. A total of 1,075 subjects aged at least 15 years participated in the study. The total prevalence of OLP was 3% (32/1,075). OLP was significantly associated with DM (odds ratio, OR, 3.09) and HCV (OR, 2.05). Atrophic‐erosive OLP (13/32) and reticular OLP (21/32) were significantly associated with HCV and DM, respectively. Logistic regression analysis showed that elevation of alanine aminotransferase (ALT) significantly increased the risk of atrophic‐erosive OLP. We concluded that OLP is significantly associated with HCV and DM in southern Taiwan, particularly in HCV patients with elevated serum ALT levels and atrophic‐erosive OLP.
Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report
Authors: Chung Yueh‐Hua , Ou Horng‐Yih , Wu Ta‐Jen
Published: July 2009

Development of hyperthyroidism following primary hypothyroidism is uncommon, and only a few documented cases have been reported. Alterations in thyroid‐stimulating hormone receptor antibodies in serum are currently considered to play the main role in the pathophysiology, but the exact mechanism is still unknown. Here, we report the case of a 60‐year‐old man with disturbed consciousness due to hyponatremia. Thyroid function tests showed primary hypothyroidism with a high anti‐microsomal antibody titer (1:6,400). The patient experienced weight loss and exophthalmos 6 years later. Serum thyroid hormone levels were increased and thyroxine treatment was discontinued, but the patient remained thyrotoxic 2 months later. 131I thyroid uptake was 40.9% at 24 hours, and bilateral thyroid lobes were not enlarged with diffuse radioactivity. Six months later, the patient was still thyrotoxic and therapy with methimazole 10 mg/day was started. He is now taking methimazole and is euthyroid.
Biliary Cystadenocarcinoma Associated with Atrophy of the Left Hepatic Lobe and Hepatolithiasis Mimicking Intrahepatic Cholangiocarcinoma: A Case Report
Authors: Tseng Chang‐An , Pan Yong‐Sang , Chen Chiao‐Yun , Liu Chiang‐Shin , Wu Deng‐Chyang , Wang Wen‐Ming , Jan Chang‐Ming
Published: July 2009

Biliary cystadenocarcinoma and its benign counterpart, biliary cystadenoma, are rare hepatic cystic tumors arising from the hepatobiliary epithelium. We report the case of a 68‐year‐old Taiwanese woman who presented initially with acute cholangitis. A series of imaging studies including abdominal ultrasound, computerized tomography, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography showed bilateral intrahepatic duct (IHD) and common bile duct (CBD) stones with IHD and CBD dilatation, and an ill‐defined tumor within the atrophied left hepatic lobe. The patient underwent surgical resection of the tumor and choledocholithotomy. The pathologic diagnosis was biliary cystadenocarcinoma. We review this rare disease entity and discuss its unusual radiologic features mimicking intrahepatic cholangiocarcinoma.
Culture of Retinal Pigment Epithelium from Evisceration Specimens
Authors: Tseng Han‐Yi , Wu Wen‐Chuan , Wu Hong‐Jun , Kao Ying‐Hsien
Published: July 2009

Human retinal pigment epithelial (RPE) cell cultures are usually obtained from donor eyes; isolation and culture of RPE cells obtained by evisceration has not been reported previously. The present study attempted to isolate and cultivate RPE cells from evisceration specimens obtained from two cases with severe ocular trauma. Two different isolation methods, explantation and enzymatic dissociation, were used. In Case 1, RPE cells grew from the explants, but were contaminated with other cells such as fibroblasts and melanocytes, and no pure RPE cultures were obtained by explantation. In Case 2, RPE cells were separated from choroids using 0.25% trypsin before plating for culture, which effectively eliminated contaminating cells. A pure RPE culture was obtained and cultured with F12 medium supplemented with 30% fetal bovine serum. With this enzymatic dissociation method, cultured RPE cells grew to confluence in primary culture and could be maintained in culture for five passages. Cultured RPE cells were identified by the presence of cytokeratin expression, as shown by immunocytochemical staining. These isolation and culture methods provide alternative sources for human RPE cells and could be useful in studies of the cell biology and pathophysiology of human RPE cells.
Extraskeletal Intracranial Mesenchymal Chondrosarcoma: Case Report and Literature Review
Authors: Chen Jun‐Yih , Hsu Shu‐Shong , Ho Jih‐Tsun
Published: July 2009

We present the case of a 13‐year‐old girl with a huge intracranial mesenchymal chondrosarcoma. She had suffered from severe headache, diplopia, intermittent nausea and vomiting for 1 month. Neurologic examination revealed bilateral blurred optic disc margins and abducens paresis. Magnetic resonance imaging demonstrated a giant, heterogeneous, intensely enhancing mass of 7 × 8 × 6 cm, occupying the bilateral frontal and left high parietal regions and based on the anterior cerebral falx. A presumptive diagnosis of aggressive meningioma was made. The patient underwent bicoronal craniotomy and gross total resection of the tumor. Pathologic examination revealed an extraskeletal mesenchymal chondrosarcoma. She was under regular follow‐up and remained free of recurrence after surgery. In addition to the current case, we review previously reported cases of extraskeletal intracranial mesenchymal chondrosarcoma and discuss treatment strategies and outcomes.
Close‐Wedge Osteotomy for Bony Locking Stiffness of the Elbow in Gorham Disease Patients: A Case Report
Authors: Wang Hsien‐Chung , Lin Gau‐Tyan
Published: July 2009

Gorham disease is a so‐called massive idiopathic osteolysis or vanishing bone disorder. Massive osteolysis remains an enigmatic condition that involves various skeletal locations and is caused by endothelial proliferation. The diagnosis is difficult and is established via the association of clinical, radiologic and histologic pictures. Treatment modalities yield variable results. We report a case of vanishing bone in the elbow joint and carpal bones following trauma. This 13‐year‐old boy complained of severe restricted motion and deformity of the right elbow. We managed the problem using arthroplasty with close‐wedge osteotomy on the lateral condyle of the humerus.
Ankle‐Brachial Pressure Index Measured Using an Automated Oscillometric Method as a Predictor of the Severity of Coronary Atherosclerosis in Patients with Coronary Artery Disease
Authors: Su Ho‐Ming , Voon Wen‐Chol , Lin Tsung‐Hsien , Lee Kun‐Tai , Chu Chin‐Sheng , Lee Ming‐Yee , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: July 2009

Ankle‐brachial pressure index (ABI) measured using a conventional Doppler method is an independent predictor of the number of coronary vessels affected in coronary artery disease (CAD). Recently, a new clinical device has been developed to measure ABI using an oscillometric method. It is unclear whether ABI measured using this device is a significant predictor of the severity of coronary atherosclerosis. We retrospectively included 87 patients from our outpatient clinic who had ever undergone coronary angiography. ABI was determined in all subjects using the new ABI‐form device. The lower value of ABI in either limb was used for analysis. We divided our subjects into two groups, with either ABI less than 0.9 or at least 0.9, and compared basal characteristics between groups. We analyzed the relationship between ABI and the severity of CAD. In addition, we calculated the sensitivity, specificity, and positive and negative predictive values of ABI less than 0.9 in predicting multivessel (two‐vessel + three‐vessel) involvement in our patients. There were 15 patients with ABI less than 0.9 and 72 with ABI at least 0.9. Patients with ABI less than 0.9 were older and had higher plasma levels of uric acid. The prevalence of diabetes mellitus, hypertension, smoking, and diuretic use was significantly higher in patients with ABI less than 0.9. In addition, the group with ABI less than 0.9 had a lower prevalence of one‐vessel CAD and higher prevalence of three‐vessel or multivessel CAD. The sensitivity, specificity, and positive and negative predictive values of ABI less than 0.9 in predicting multivessel CAD were 22%, 96%, 93%, and 34%, respectively. In conclusion, ABI measured using the automated oscillometric method can be used to predict the severity of coronary atherosclerosis in patients with CAD.
Relationships Between American Urological Association Symptom Index, Prostate Volume, and Disease‐Specific Quality of Life Question in Patients with Benign Prostatic Hyperplasia
Authors: Liu Chia‐Chu , Wang Chii‐Jye , Huang Shu‐Pin , Chou Yii‐Her , Wu Wen‐Jeng , Huang Chun‐Hsiung
Published: July 2009

The American Urological Association (AUA) symptom index is both valid and reliable in identifying the need to treat patients with benign prostatic hyperplasia (BPH) and in monitoring their response to therapy. We evaluated the relationships between AUA symptom index, disease‐specific quality of life question, and prostate volume in patients with BPH. A total of 100 patients who came to Kaohsiung Medical University Hospital, Taiwan, for help due to lower urinary tract symptoms (LUTS) and who were diagnosed with BPH between October 2002 and June 2003 were included in the study. All patients were evaluated using transrectal ultrasonography, AUA symptom index, and disease‐specific quality of life question. The disease‐specific quality of life question showed good correlation with AUA symptom score (r = 0.815, p < 0.01), but weak correlation with prostate volume (r = 0.225, p < 0.05) and age (r = 0.274, p < 0.05). Prostate volume had weak correlation with AUA symptom score (r = 0.251, p < 0.05) and age (r = 0.472, p < 0.01), but good correlation with prostate specific antigen (r = 0.638, p < 0.01). In addition to AUA symptom index, we suggest using the disease‐specific quality of life question to evaluate the influence on quality of life and response to treatment in clinical practice. Moreover, we should assess the impact of BPH symptoms rather than the increase in prostate volume during the management of BPH.
Obsessive‐Compulsive Symptoms Associated with Clozapine and Risperidone Treatment: Three Case Reports and Review of the Literature
Authors: Ke Chiao‐Li , Yen Cheng‐Fang , Chen Cheng‐Chung , Yang Shang‐Ju , Chung Weilun , Yang Ming‐Jen
Published: July 2009

Treatment‐emergent obsessive‐compulsive symptoms (OCSs) have raised concern since the widespread introduction of serotonin‐dopamine antagonists (SDAs) for the treatment of schizophrenia. Further investigations of SDA‐emergent OCSs and their response to anti‐obsessional agents will be beneficial for clinicians in helping patients who suffer from this problem. We present three cases of schizophrenia in which distressing OCSs occurred during clozapine or risperidone treatment. OCSs were assessed consecutively using the Yale‐Brown Obsessive‐Compulsive Scale. The OCSs of these three patients were responsive to anti‐obsessional agents, including fluvoxamine, clomipramine, and paroxetine. We also review the current literature and discuss the possible pathophysiology and psychopathology of SDA‐emergent OCSs.
Cerebral Radionecrosis with Cystic Degeneration Following Radiotherapy for Nasal Cavity Squamous Cell Carcinoma: A Case Report
Authors: Hsu Ying‐Che , Ho Kuen‐Yao , Kuo Wen‐Rei , Wang Ling‐Feng , Lee Ka‐Wo , Huang Shiuh‐Lin
Published: July 2009

A 31‐year‐old man with nasal cavity squamous cell carcinoma was treated in our hospital with two courses of radiotherapy (120 Gy total dose) followed by surgical tumor resection. Three years after the last irradiation, he developed seizures as well as changes in behavior and consciousness. Medical therapy with diphenylhydantoin (Dilantin(r)) terminated the seizures. Dysphagia, unsteady gait, and right‐side limb weakness developed 37 months after the onset of seizures. Magnetic resonance imaging showed a large, cystic mass in the left temporal lobe with left to right midline shift. Following craniotomy with decompression of the cystic mass, the patient improved clinically. No malignant cells were found in the specimen. No further progression of neurologic symptoms was noted after a 1‐year follow‐up. Cerebral radionecrosis is an uncommon late complication of radiotherapy and needs to be differentiated from tumor recurrence or metastasis if the irradiation field covers the cerebral region in patients with head and neck malignancies.
Esophageal Acid Exposure in Healthy Adults in Taiwan: Experience with pH Step‐up Method by Dual‐Channel pH‐metry
Authors: Yi Chih‐Hsun , Chen Chien‐Lin , Lin Hans Hsien‐Hong , Chen Ming‐Cheh
Published: July 2009

Esophageal acid exposure is common in normal subjects. The aim of this study was to investigate proximal and distal esophageal acid exposure in asymptomatic volunteers using dual‐channel esophageal pH‐metry with probe positioning by pH step‐up. A total of 21 healthy subjects (9 male; mean age, 51 years) underwent 24‐hour ambulatory esophageal pH recording with the pH step‐up method using a two‐channel pH probe, a portable digital data recorder, and computerized data analysis. All reflux episodes, episodes longer than 5 minutes, longest reflux episode, duration of acidity (pH < 4), and percentage of time with acidity were analyzed. The 95th percentile for reflux parameters assessed in the distal/proximal esophagus were: total reflux episodes, 100/34; episodes greater than 5 minutes, 2.9/0; longest reflux episode, 16.6/2.95 minutes; duration of acidity, 87.95/15.5 minutes; and percentage of time with acidity, 7.0%/1.3%. Proximal and distal acid exposure were well correlated. Results showed that neither gender nor age influenced reflux parameters and that asymptomatic volunteers might experience some gastroesophageal reflux.
T4Sympathectomy for Palmar Hyperhidrosis: An Effective Approach that Simultaneously Minimizes Compensatory Hyperhidrosis
Authors: Chou Shah‐Hwa , Kao Eing‐Long , Li Hsien‐Pin , Lin Chien‐Chih , Huang Meei‐Feng
Published: July 2009

Compensatory hyperhidrosis (CH) is the most troublesome side effect after T2sympathectomy for palmar hyperhidrosis (PH). The aim of this study was to evaluate whether T4ganglion interruption for PH is an effective approach that can simultaneously minimize the rate of CH. Between July 2001 and July 2003, 84 PH patients undergoing bilateral thoracoscopic T4sympathectomy were followed up in the outpatient clinic and by telephone questionnaire. Rates of success, regret, CH, recurrence, and complications were recorded. The follow‐up period ranged from 18 to 42 months. All excessive hand sweating was stopped. Only two patients had mild CH that did not affect their daily activities. No patients had recurrence or regret. The only other complication was that four patients had postoperative minimal residual pneumothorax, which needed no treatment. All patients were satisfied with the outcome. T4sympathectomy was an effective method to cure PH. The success rate was 100%. The rate of CH was remarkably low compared with T2sympathetic ganglionic interruption.
Assessing the Psychometric and Language Equivalency of the Chinese Versions of the Index of Nausea, Vomiting and Retching, and the Prenatal Self‐evaluation Questionnaire
Authors: Chou Fan‐Hao , Avant Kay C. , Kuo Shih‐Hsien , Cheng Han‐Fu
Published: July 2009

This study was an initial psychometric test of the Chinese versions of the Index of Nausea, Vomiting and Retching (INVR), and the Prenatal Self‐Evaluation Questionnaire (PSEQ) in pregnant Taiwanese women. Although there already is evidence that the English‐language versions of the scales are reliable and valid, it is important to verify the proper psychometric characteristics of the Chinese versions. Forward and backward translation, and a multiphase instrumentation study describing internal consistency, test‐retest reliability, and content validity of the translated versions were conducted. A convenience sample was recruited from prenatal clinics in the south of Taiwan. Three measurement instruments were used in this study: the demographic inventory (DI), the INVR, and the PSEQ. Thirty pregnant women participated in the study. Both the internal consistency and stability coefficients of the INVR and PSEQ were satisfactory. The indices of content validity (CVI) for the Chinese versions of these two instruments were both 1.0, indicating that they are acceptable for use among Taiwanese pregnant women. This was the first instrumentation study of the INVR and PSEQ applied to Taiwanese pregnant women. Researchers could use this study as a model for future translation and application of psychometric instrumentation.
Cutaneous Metastasis from Gastric Adenocarcinoma: A Case Report
Authors: Wang Jaw‐Yuan , Soo Kwan‐Ming , Huang Yu‐Sheng , Huang Tsung‐Jen , Hsieh Jan‐Sing , Chai Chee‐Yin , Su Yu‐Chung
Published: July 2009

Cutaneous metastasis from gastric adenocarcinoma is an infrequent disease entity. When present, it typically signifies disseminated disease with a poor prognosis. We report a case of a 57‐year‐old male patient with gastric cancer who developed generalized erythematous nodules on the chest, abdomen, back, neck, and four extremities 2 months postoperatively. Results of a skin biopsy disclosed groups of metastatic adenocarcinoma cells in the dermis and subcutaneous tissue, forming clusters and strands in a desmoplastic stroma. Histopathologic examination demonstrated that the cutaneous metastasis was of stomach origin.
Effect of Acupressure on Nausea, Vomiting, Anxiety and Pain among Post‐cesarean Section Women in Taiwan
Authors: Chen Huei‐Mein , Chang Feng‐Yi , Hsu Ching‐Tai
Published: July 2009

The purpose of this study was to examine the effectiveness of acupressure for controlling post‐cesarean section (CS) symptoms, such as nausea and vomiting, anxiety perception and pain perception. A total of 104 eligible participants were recruited by convenience sampling of operating schedules at two hospitals. Participants assigned to the experimental group received acupressure, and those assigned to the control group received only postoperative nursing instruction. The experimental group received three acupressure treatments before CS and within the first 24 hours after CS. The first treatment was performed the night before CS, the second was performed 2‐4 hours after CS, and the third was performed 8‐10 hours after CS. The measures included the Rhodes Index of Nausea and Vomiting, Visual Analog Scale for Anxiety, State‐Trait Anxiety Inventory, Visual Analog Scale for Pain, and physiologic indices. Statistical methods included percentages, mean value with standard deviation, t test and repeated measure ANOVA. The use of acupressure reduced the incidence of nausea, vomiting or retching from 69.3% to 53.9%, compared with control group (95% confidence interval = 1.65‐0.11; p = 0.040) 2‐4 hours after CS and from 36.2% to 15.4% compared with control group (95% confidence interval = 0.59‐0.02; p = 0.024) 8‐10 hours after CS. Results indicated that the experimental group had significantly lower anxiety and pain perception of cesarean experiences than the control group. Significant differences were found in all physiologic indices between the two groups. In conclusion, the utilization of acupressure treatment to promote the comfort of women during cesarean delivery is strongly recommended.
Outcome of Hypospadias Reoperation Based on Preoperative Antimicrobial Prophylaxis
Authors: Lee Yung‐Chin , Huang Chun‐Hsiung , Chou Yii‐Her , Wu Wen‐Jeng , Lin Chao‐Yu
Published: July 2009

From August 1981 to June 2004, we retrospectively reviewed 66 hypospadias, treated with 123 operations, to analyze the outcome of reoperation based on preoperative antimicrobial prophylaxis. All patients received primary treatment in our hospital, and all had postoperative antimicrobial prophylaxis in all surgical procedures. We define a hypopadias repair as “corrected without fistula” if no urethrocutaneous fistula formation, or complete wound disruption is found within at least a 2‐week follow‐up period. Of the 123 operations, there were 66 primary repairs and 57 reoperations. The mean age at primary repair was 4.33 years. The overall rate of correction without fistula was 53.0% (35/66), with a mean of 14 months, follow‐up. A total of 88 failure repairs resulted from 67 (76.0%) fistulas and 21 (24.0%) disruptions. A higher rate of correction without fistula (81.0%) was related to subcoronal hypospadias (p = 0.020) in three types. The rate of correction without fistula of two‐staged repair was lowest in primary operations (12.5%), but these cases had a significantly higher rate of correction without fistula in following reoperations (66.7%, p = 0.043). Of the 123 repairs, only 46 (37%) had preoperative antibiotic prophylaxis, and these had lower early complication rates, both in primary and reoperation groups (42.3% vs 52.5% and 40.0% vs 54.1%, respectively). The differences, however, were not statistically significant (p = 0.231 and p = 0.289, respectively). In terms of rate of correction without fistula, a higher rate of correction without fistula was observed in reoperations with preoperative antibiotic prophylaxis (57.1%), compared to those without prophylaxis (23.1%). This difference was statistically significant (p = 0.031). The data from this study suggest that a lower early complication rate and a significantly higher rate of correction without fistula are related to the hypospadias reoperations with preoperative antimicrobial prophylaxis. The use of broad‐spectrum antibiotics before surgery is recommended for these cases. However, more precise and prospective studies are warranted.
Management of Bilateral Adrenal Metastases from Hepatocellular Carcinoma: A Case Report
Authors: Hsieh Meng‐Hsuan , Lin Zu‐Yau , Chuang Wan‐Long , Huang Chih‐Jen , Shih Ming‐Chen
Published: July 2009

The adrenal glands rarely are an extrahepatic site for metastasis from hepatocellular carcinoma (HCC). Once identified, adrenal metastasis requires aggressive management, due to the risk of rupture and internal hemorrhaging. Disease management of adrenal metastasis from HCC is limited, given the relative lack of available knowledge, and the present report details our efforts in managing bilateral adrenal metastases from HCC. For this patient, we used radiation therapy and transcatheter arterial chemoembolization (TACE). The left adrenal tumor was treated by 3D conformal radiation therapy, following the failure of TACE. The size of the left adrenal tumor decreased and no evidence of recurrence after management was noted. One right adrenal tumor was treated using two sessions of TACE, and the size of the tumor did not decrease. We later observed that the right tumor actually progressively increased in size. The tumor was then treated by 3D conformal radiation therapy (total 5,400 cGy), and the size decreased by 10 mm, 1 month after treatment. The patient's condition was stable and liver function was maintained at early stage liver cirrhosis (Child A). Renal function was maintained within normal ranges after diagnosis of HCC and throughout the entire follow‐up period, and no complications secondary to radiation therapy were noted. Our experience may provide useful information in disease management for these patients.
Flutter‐Like P Waves in a Case of Atrioventricular Reciprocating Tachycardia
Authors: Cheng Kai‐Hung , Chu Chih‐Sheng , Lee Kun‐Tai , Lee Shuo‐Psan , Su Ho‐Ming , Lin Tsung‐Hsien , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: July 2009

Typical atrial flutter is characterized by its sawtooth flutter wave in leads II, III, aVF, and V1. Atrioventricular reciprocating tachycardia is characterized by its small retrograde P wave after completion of QRS complex, where sawtooth flutter‐like P waves are rarely seen in the electrocardiogram during atrioventricular reciprocating tachycardia. We report on a 62‐year‐old patient who presented the characteristic sawtooth flutter‐like P waves in the electrocardiogram during attack of supraventricular tachycardia. By electrophysiologic study, the mechanism of his supraventricular tachycardia was atrioventricular reciprocating tachycardia using the left posterior lateral concealed accessory pathway for retrograde conduction. The accessory pathway was successfully ablated by radiofrequency ablation therapy.
Primary Germ Cell Tumors of the Mediastinum: 10 Years of Experience in a Tertiary Teaching Hospital
Authors: Yang Chih‐Jen , Cheng Meng‐Shuan , Huang Ming‐Shyan , Chou Shah‐Hwa , Tsai Kun‐Bow
Published: July 2009

Germ cell tumors occur mostly in the gonad. Extragonadal germ cell tumors are rare, and most occur in the retroperitoneum and mediastinum. Primary mediastinal germ cell tumors are often found in the anterior portion of the mediastinum and include teratomas and non‐teratomatous tumors. Non‐teratomatous tumors include seminomas and malignant non‐seminomatous germ cell tumors (MNSGCTs). MNSGCTs include yolk sac tumors, choriocarcinomas, embryonal carcinomas, and mixed type germ cell tumors. Teratomas are the most common germ cell tumors of the mediastinum, and seminomas are the most common non‐teratomatous germ cell tumors of the mediastinum. Cases of primary mediastinal MNSGCT reported in the literature are rare. In this report, we review all primary mediastinal germ cell tumors from a 10‐year period at the Chung‐Ho Memorial Hospital of Kaohsiung Medical University. A total of 14 cases were reviewed, including 11 patients with mature teratomas, two with yolk sac tumors, and one with seminoma. We discuss the differences in clinical presentation, histopathologic characteristics, treatment, and prognosis.
Structural Abnormality on Brain Magnetic Resonance Imaging in Late‐onset Major Depressive Disorder
Authors: Lin Hsiu‐Fen , Kuo Yu‐Ting , Chiang I‐Chan , Chen Hui‐Mei , Chen Cheng‐Sheng
Published: July 2009

The purpose of this study was to examine the structural abnormalities of patients with late‐onset major depressive disorder using brain magnetic resonance imaging (MRI) and to assess clinical correlates of these structural abnormalities. Thirty‐seven elderly patients with DSM‐IV major depressive disorder that first occurred after the age of 50 years, and 18 control subjects without depression were recruited. All participants underwent comprehensive psychiatric assessment and cerebral MRI. Brain ventricular and sulcal sizes and white matter hyperintensities were assessed visually. Relative to control subjects, patients with late‐life major depressive disorder showed more severe brain atrophy (p = 0.043) and white matter hyperintensities (p = 0.024), especially in the periventricular area (p = 0.012). Over 60% of the patient group had significant brain MRI hyperintensities. White matter hyperintensity was correlated with later onset of depressive illness (r = 0.49, p = 0.002) among patients. Brain atrophy and white matter hyperintensities are prevalent in patients with late‐onset major depressive disorders. These two abnormalities may represent different pathophysiologic processes of depressive disorders. White matter hyperintensities may be predisposing factors for late‐onset major depressive disorder.
Evaluation of Intrarenal Blood Flow by Doppler Ultrasonography Immediately after Extracorporeal Shock Wave Lithotripsy on Hydronephrotic Kidney
Authors: Juan Yung‐Shun , Wang Chii‐Jye , Shen Jung‐Tsung , Chuang Shu‐Mien , Wu Wen‐Jeng , Li Ching‐Chia , Huang Chun‐Hsiung
Published: July 2009

Extracorporeal shock wave lithotripsy (ESWL) is an effective and relatively noninvasive mode of treatment for urinary calculi. The aim of this study was to test whether therapeutic ESWL induces changes in renal parenchymatous blood flow and to evaluate shock wave side effects on the renal parenchyma. A total of 45 patients who underwent ESWL for ureteropelvic stone between January 2002 and July 2003 were included in this prospective study. Color Doppler sonography before and 30 minutes after ESWL showed no significant morphologic change. Resistive index (RI) was used to estimate renovascular resistance. The RI significantly increased in obstructed hydronephrotic kidneys. However, no significant change was observed in both treated and untreated kidneys before and after treatment. Hydronephrotic kidneys do not have a higher risk of post‐ESWL renovascular resistance interference. The measurement of changes in RI with Doppler ultrasonography may provide useful information for clinical diagnosis of renal tubulointerstitial and vascular damage.