bluuebunny/crossref_metadata_2025 huggingface dataset:
Sparing Surgery for an Epidermoid Cyst of the Testis: A Case Report and Literature Review
Authors: Kaya Cevdet , Pirincci Necip , Kanberoglu Huseyin , Karaman M. Ihsan , Yilmazgumrukcu Gulistan
Published: July 2009

Epidermoid cyst of the testis is relatively rare and accounts for less than 1% of all testicular neoplasms. This condition usually occurs in young men and it is mostly detected by self‐examination or routine physical examination. The case of a 27‐year‐old male with an epidermoid cyst of the testis is discussed. The diagnosis was based on ultrasonography and management was with testicular‐sparing surgery. At 2‐year follow‐up, the patient had had no relapse or metastasis. In epidermoid cysts of the testis, high‐frequency ultrasonography is a reliable diagnostic imaging method. Organ‐preserving surgery is recommended in the management of these lesions.
Circumscribed Choroidal Hemangioma in a Chinese Patient Treated using Transpupillary Thermotherapy: A Case Report
Authors: Wang Jia‐Kang , Lai Pei‐Ching , Chang Shu‐Wen , Yang Chung‐May , Chen Chao‐Hsun
Published: July 2009

We describe the first case of a Chinese patient with circumscribed choroidal hemangioma (CCH) effectively managed using transpupillary thermotherapy (TTT). A 57‐year‐old man had an elevated orange‐red subretinal mass with a base of 5 × 5 mm superior to the optic disc, along with serous macular detachment in the left eye. Ultrasonography depicted a mass 3 mm thick with acoustic solidity and high internal reflectivity. Fluorescein angiography showed an area of hyperfluorescence in the prearterial phase and tumor staining in the late phase, consistent with a diagnosis of CCH. Therefore, TTT (spot size, 3 mm; exposure, 1 min) was performed with a diode laser, delivered through a slit‐lamp biomicroscope. The laser power was first set at 300 mW and then increased in 50‐mW increments, until test shots in the mid‐peripheral retina outside the lesion produced a slightly grayish appearance in the irradiated area. The tumor was covered with four overlapping laser spots and subjected to an average beam power of 400 mW. Best‐ corrected visual acuity increased from 20/50 before treatment, to 20/20 3 months following one session of TTT. The lesion became atrophic and the subretinal fluid disappeared. Our experience shows that TTT can be an even more effective treatment strategy for CCH in Asians than in Caucasians. In Chinese patients, the power level of the diode laser should be lower than that used in Caucasians.
Cerebral Radionecrosis in Patients with Nasopharyngeal Carcinoma
Authors: Hsu Ying‐Che , Wang Ling‐Feng , Lee Ka‐Wo , Ho Kuen‐Yao , Kuo Wen‐Rei , Huang Chih‐Jen
Published: July 2009

This study involved seven patients with cerebral radionecrosis following radiation therapy for nasopharyngeal carcinoma (NPC). Their charts were reviewed and the relationship of extracranial malignancies to cerebral radionecrosis was investigated. The radiation dose ranged from 70 to 135 Gy, and the latency was from 6 to 39 months. Two of seven patients died of NPC‐related complications during follow‐up. The crude incidence of cerebral radionecrosis in patients with NPC was 0.93% in our series. Improvement of symptoms could be achieved by corticosteroid therapy, with or without surgery. In a review of the literature, there were 306 cases of cerebral radionecrosis in extracranial malignancies. The nasopharynx is the most common primary site in cerebral radionecrosis of extracranial malignancies, followed by the scalp and sinonasal tract. The 3‐year overall survival rate in our series was 68.57%, as provided by the Kaplan‐Meier product limited method. Cerebral radionecrosis in NPC patients should be differentiated from tumor recurrence, in order to apply the appropriate treatment.
Concurrent Extravasation Mucocele and Epidermoid Cyst of the Lower Lip: A Case Report
Authors: Wang Wen‐Chen , Lin Li‐Min , Lin Yu‐Ju , Chen Yuk‐Kwan , Shen Yee‐Hsiung
Published: July 2009

An uncommon case of concurrent extravasation mucocele and epidermoid cyst in the lower lip of a 13‐year‐old boy is described. To our knowledge, there is no other report of such a concurrence, neither at the same site nor at different locations, involving these two lesions in the oral mucosa.
Coincidence Planar Imaging for Dynamic [18F]FDG Uptake in Nude Mice with Tumors and Inflammation: Correlated With Histopathology and Micro‐autoradiography
Authors: Sun Ying‐Ling , Jan Meei‐Ling , Fan Kuo‐Hsien , Lee Te‐Wei , Kao Pan‐Fu , Hsu Hui‐Ting , Chang Wen‐Chen , Shen Young‐Chi
Published: July 2009

The Institute of Nuclear Energy Research of Taiwan has developed a dynamic coincidence detection device for positron emitted radiotracer pharmacodynamic study in small mice models. In this study, we set up an experimental paradigm by determining [fluorine‐18]‐2‐deoxy‐2‐fluoro‐D‐glucose ([18F]FDG) dynamic uptake in tumors and inflammations in nude mice as the foundation for future applications in therapy development. Histopathology and micro‐autoradiography of these tumors and inflammations were obtained for confirmation. Dynamic coincidence planar images of six tumors and two inflammations in nude mice were acquired over 4 hours immediately after injection of 25.9 MBq of [18F]FDG into the right thigh of each animal. After image reconstruction, the lesion‐to‐background ratios were calculated in regions of interest over the lesion and contralateral thigh to determine the equilibrium status of the radiotracer. All mice were sacrificed for histopathologic examination and six of the mice were examined with micro‐autoradiography. [18F]FDG uptake in tumors and inflammations both reached equilibrium about 3 hours after injection. At equilibrium, [18F]FDG uptake into tumors was two to four times higher than the background. Uptake into the 4‐day and 8‐day inflammations was 2.3 and 5.5 times higher than the background, respectively. Histopathology showed macrophage and neutrophil infiltration around the tumors and in the inflammations. Micro‐autoradiography showed dense silver grains in the granulation tissue surrounding the tumors and inflammations. The preliminary results suggested that dynamic [18F]FDG coincidence planar imaging can help in determining the suitable time for static [18F]FDG imaging in nude mice models. The optimal time for static [18F]FDG positron emission tomography imaging was around 3 hours after injection. The paradigm for determining a dynamic [18F]FDG uptake pattern was demonstrated for future new therapeutic drug experimental use.
Cognitive Dysfunction After Acute Lacunar Infarct
Authors: Chen Chien‐Fu , Lan Sheng‐Hsing , Khor Gim‐Thean , Lai Chiou‐Lian , Tai Chih‐Ta
Published: July 2009

Vascular dementia and vascular cognitive impairment have attracted more attention recently due to their association with increased risk of death and institutionalization. The purpose of the present study was to detect and identify the characteristics of cognitive impairments during the early stage of lacunar stroke. The subjects consisted of 23 consecutive first‐ever acute lacunar infarction patients who were admitted to the Department of Neurology, Kaohsiung Municipal Hsiao‐Kang Hospital, Taiwan, from November 2001 to October 2002. The National Institutes of Health Stroke Scale and Cognitive Abilities Screening Instrument (CASI) were used to evaluate stroke severity and cognitive function, and assessments were performed by a neurologist and psychologist, within 10 days of stroke onset. Of the 23 patients, 21 (91.3%) had CASI scores below their respective cutoff values and all patients had cognitive impairment in at least one cognitive domain in CASI. There were no significant correlations between CASI abnormality (below the cutoff value) and patient age, education, or the interval from stroke onset. Recent memory impairment was the most often impaired cognitive domain on CASI (19 patients, 82.6%). There were significant correlations between recent memory and “attention or concentration” (correlation coefficient, 0.52; p < 0.05), and “abstraction and judgment” (correlation coefficient, 0.44; p < 0.05). The correlations between recent memory and other domains were not significant. It was concluded that cognitive impairment after acute lacunar infarct is quite common and recent memory is the most often impaired cognitive domain. This may have been caused by the location of the specific lesion as well as by the impairment in “attention or concentration” or “abstraction and judgment”.
Fibroepithelial Polyps Causing Ureteropelvic Junction Obstruction in a Child
Authors: Li Wei‐Ming , Wu Wen‐Jeng , Ke Hung‐Lung , Chou Yii‐Her , Huang Chun‐Hsiung , Chai Chee‐Yin
Published: July 2009

Fibroepithelial polyps of the ureter are benign tumors arising from mesodermal tissue in the ureter wall. They are extremely rare lesions that can cause ureteropelvic junction obstruction in children. In this report, we describe an 11‐year‐old boy with fibroepithelial polyps of the ureter that caused left ureteropelvic junction obstruction. He presented with a 6‐month history of left abdominal and flank pain. He also had short stature. Intravenous pyelography showed hydronephrosis without filling defects at the left ureteropelvic junction. Exploration revealed several finger‐like polyps obstructing the lumen. This area was resected segmentally and a dismembered pyeloplasty was performed. No complications occurred during the postoperative period. The boy caught up in growth after the operation. Fibroepithelial polyps were confirmed by histology.
Evaluation of Life and Death Studies Course on Attitudes Toward Life and Death Among Nursing Students
Authors: Hwang Huei‐Lih , Chen Wen‐Tin , Lin Huey‐Shyan
Published: July 2009

The aim of this study was to evaluate attitudes toward life and death among nursing students after attending the life and death studies (LDS) program. Both qualitative and quantitative methods were used to collect data. The pretest‐posttest control group design randomly assigned students to an experimental (n = 47) or control group (n = 49). The 13‐week course included lectures, video appraisal, games, simulations, films, books, assignments and group sharing. Statistical and content analysis were used to analyze qualitative and quantitative data. The findings showed a significant improvement in perception of the meaningfulness of life in four categories of improvement: expanded viewpoint, sadness about death, treating life sincerely, and instilling hope in life. The qualitative data indicated that a positive change in meaning of life was associated with interaction with others and self‐reflection.
Poor Outcomes in Patients with Primary Malignant Mediastinal Germ‐cell Tumors
Authors: Hsiao Hui‐Hua , Liu Yi‐Chang , Tsai Hui‐Jen , Chong Inn‐Went , Yang Won‐Chi , Liu Ta‐Chi , Lin Sheng‐Fung , Tsai Kun‐Bow , Cheng Yu‐Jen , Chou Shah‐Hwa
Published: July 2009

Primary mediastinal germ‐cell tumors (GCTs) without gonadal involvement are rare and can be divided into benign mature teratoma and malignant seminoma or nonseminoma. We describe our experience of malignant mediastinal GCTs and compare the presentations and outcome with those of benign teratomas. Four malignant GCTs (1 seminoma, 1 choriocarcinoma, and 2 yolk‐sac tumors) have been treated in our hospital. All patients were men with obvious symptoms before diagnosis. The patient with seminoma was treated with surgery and radiation, while those with nonseminoma tumors were treated with chemotherapy and/or surgery. Two patients died, one with extended pulmonary metastasis and the other with relapsed disease and high levels of tumor markers. Compared with the nine cases of benign teratomas, the four malignant GCTs showed overwhelming male dominance, advanced symptoms at presentation, and poor outcome. These cases highlight the important role of disease staging and tumor‐marker levels in malignant GCTs, and suggest that new treatment strategies for malignant GCTs await further investigation.
The Combined Occluding Effects of Fluoride‐Containing Dentin Desensitizer and Nd‐yag Laser Irradiation on Human Dentinal Tubules: an In Vitro Study
Authors: Hsu Po‐Jen , Chen Jeng‐Huey , Chuang Fu‐Hsiung , Roan Rong‐Tai
Published: July 2009

The purpose of the present study was to evaluate the combined occluding effects of fluoride‐containing dentin desensitizer and neodymium:yttrium aluminum garnet (Nd‐YAG) laser irradiation on human dentinal tubules. All six of the groups of dentin samples (A‐F) included in this study received applications of fluoride‐containing dentin desensitizer. Groups B, D, and F also received Nd‐YAG laser irradiation. Groups A and B served as controls, to allow observations of the occluding effects on the dentinal tubules before and after Nd‐YAG laser irradiation. Groups C and D were treated with 0.5 M vitamin C solution, whereas groups E and F underwent brushing with an electric toothbrush. Scanning electron microscopy (SEM) revealed that the fluoridated dentinal tubule‐occluding agent (FDTOA) formed a fine crystalline deposit on the dentin surface. After soaking in 0.5 M vitamin C solution for 3 hours, the crystalline deposit of the FDTOA was completely dissolved. Furthermore, brushing of the teeth 3,600 times removed most of the occluding agent. When the application of FDTOA was combined with Nd‐YAG laser irradiation, the dentin melted and then recrystallized. The occluding agent was thus ‘burned into’ the dentinal tubules, and could neither be dissolved by vitamin C solution nor removed by brushing. Therefore, we concluded that the FDTOA combined with Nd‐YAG laser irradiation burns the occluding agent into the dentinal tubules, thereby resisting the effects of an acidic diet and brushing, and increasing the duration of the desensitizing effect.
Aberrant P53 Expression and the Development of Gallbladder Carcinoma and Adenoma
Authors: Wang Shen‐Nien , Chung Shin‐Chang , Tsai Kun‐Bow , Chai Chee‐Yin , Chang Wen‐Tsun , Kuo Kung‐Kai , Chen Jong‐Shyone , Lee King‐Teh
Published: July 2009

Gallbladder carcinoma (GBC) is a highly lethal but relatively rare neoplasm of the digestive tract. The progression from gallbladder adenoma to carcinoma remains unclear. The p53 gene is the most frequently mutated tumor suppressor in human cancers. In this study, we analyzed the expression patterns of the p53 protein in 22 cases of GBC, 17 cases of precursor lesions (16 gallbladder adenomas and 1 cystadenoma), and 15 cases of normal epithelia using immunohistochemical analysis. The results were correlated with clinicopathologic characteristics. We found that p53 expression was significantly increased in 59.1% (13/22) of GBC cases and in 17.6% (3/17) of gallbladder adenoma cases (p = 0.009). There was no p53 expression in the 15 cases of normal epithelia, and a significant difference was shown between normal epithelium and GBC cases (p < 0.001). In addition, the expression pattern of p53 protein did not show any significant correlation with the histologic type and the differentiation grade of GBC. In conclusion, we suggest that the aberrant p53 expression may play a role in the occurrence of GBC.
Doxepin Has a Potent and Long‐Acting Spinal Anesthetic Effect in Rats
Authors: Cheng Bor‐Chin , Chan Bing‐Ren , Chen Yu‐Wen , Chu Koung‐Shing , Cheng Kuang‐I , Wang Jhi‐Joung , Chu Chin‐Chen
Published: July 2009

Doxepin, a tricyclic antidepressant, was recently found to be effective in the treatment of various acute and chronic painful conditions. However, the mechanism of its actions was not clear, especially when involving the spine. The aim of our study was to evaluate the spinal anesthetic effect of doxepin. Two commonly used traditional local anesthetics, bupivacaine and lidocaine, were used as controls. The potencies and durations of the drugs' action were evaluated in male Sprague‐Dawley rats. We found that intrathecally administered doxepin, like bupivacaine and lidocaine, produced dose‐related spinal anesthetic effects on motor activity, proprioception, and nociception. Among the three drugs, doxepin produced spinal anesthetic effects in rats more potent than that of lidocaine (p< 0.001, in each comparison) and longer than that of bupivacaine and lidocaine (p< 0.001, in each comparison). The spinal activity of doxepin may provide some explanation of its clinical effect in pain management.
Colon Perforation: A Rare Complication During Percutaneous Nephrolithotomy
Authors: Huang Chun‐Hsiung , Chuang Shu‐Mien , Li Ching‐Chia , Wu Wen‐Jeng , Juan Yung‐Shun , Shen Jung‐Tsung , Wang Chii‐Jye
Published: July 2009

Only a few cases of colon perforation during percutaneous nephrolithotomy (PCNL) have been reported. We present here a case of colon perforation during PCNL that was managed conservatively by stenting the urinary tract, using the percutaneous catheter as the colostomy tube, and giving broad‐spectrum antibiotics. This report also reviews the anatomic and technical access to the kidney and reminds the urologist about this rare but serious complication of PCNL.
Positive Interference from Contrast Media in Cardiac Troponin I Immunoassays
Authors: Lin Chien‐Tsai , Lee Hsiang‐Chun , Voon Wen‐Chol , Yen Hsueh‐Wei , Tang Min‐Hua , Chin Tan‐Tzu , Chen Wori‐Reen , Chien Wan‐Ting , Lai Wen‐Ter , Sheu Sheng‐Hsiung
Published: July 2009

Cardiac troponin I (cTnI) has been found to be a sensitive and reliable marker of myocardial damage, and elevated levels of cTnI can indicate high risk for acute coronary syndrome. To determine how to intervene in possible cases of acute coronary syndrome, cTnI levels must be measured by immunoassay. However, cTnI immunoassay results are prone to interference from many substances such as heparin and common drugs. The contrast media used in the coronary angiography might also interfere with results. To explore this possibility, we performed two in vivo and two in vitro studies. In the first in vivo study, we evaluated the effects of contrast media on cTnI immunoassays by collecting blood samples from 45 patients undergoing coronary angiography before and after the procedure. We used the Opus Magnum immunoassay system to measure cTnI levels. In the second in vivo study, we collected 25 blood samples from another group of patients also undergoing angiography at various times before and after the procedure to determine cTnI values by both the Opus Magnum and ACCESS systems. In the first in vitro study, 12 different contrast media were treated as samples to disclose the potential interference of measurement in the two assay systems. In the second in vitro study, we made sequential dilutions of iopromide (Ultravist; Schering) with serum to explore their potential for interfering with the detection of cTnI by the Opus Magnum and ACCESS assays. In the first in vivo study using the Opus Magnum assay, cTnI concentrations in samples taken after angiography were significantly higher at 5 minutes than at 30 minutes, and, at 60 minutes, all cTnI concentrations had dropped below the cutoff point. In the second in vivo study, we found a substantial difference in detection of cTnI by the Opus Magnum and ACCESS assays. All cTnI concentrations checked by ACCESS assay were below the cutoff value. In our first in vitro study, the Opus Magnum assay gave false positive results for all 12 contrast media; the ACCESS assay gave a positive result for only one contrast medium, poppy‐seed oil (Lipiodol; Guebert). In our second in vitro study, we found that, in the Opus Magnum assay, the more concentrated the contrast medium, the higher the cTnI value, but not in the ACCESS assay. We conclude that contrast media may cause false‐positive results in cTnI assays and that, when contrast media are being used for angiography, cTnI results, especially those based on samples taken within the first hour of the procedure, should be interpreted carefully.
Operating Room Costs of Laparoscopic Cholecystectomy: Does Surgeon Volume Matter?
Authors: Chung Wei‐Ching , Lee King‐Teh , Fan Pao‐Luo , Tzeng Dong‐Sheng , Chiu Herng‐Chia
Published: July 2009

Very few studies have addressed the issue of surgeon volume on cost savings of laparoscopic cholecystectomy (LC) in Asian countries. The objectives of the study were to analyze LC operating‐room (OR) costs between two study hospitals and to examine the effect of surgeon volume on OR costs. Patients diagnosed with gallbladder disease who underwent LC in October through December 2002 at two acute tertiary‐care hospitals were included. Patient demographics and clinical information were derived from patient charts. Cost information was obtained from purchasing departments or specific cost centers. Three multivariate linear regression models were performed to examine the association between surgeon volume, cost, and utilization. There were no significant differences in patient demographics and disease severity between the two hospitals. Hospital A consumed fewer resources than did hospital B (NT$21,674 vs NT$26,417). Direct materials cost, direct professional costs, and indirect costs varied significantly by study hospital and by surgeon volume. High‐volume surgeons incurred lower costs and shorter stay as compared with low‐volume surgeons. Patients who scored in the American Society of Anesthesiologists physical status (ASA PS) 3 incurred significantly higher costs and longer hospital stays than did patients with ASA PS 1. The present study supports the proposal that hospital management and experience of surgeons are of equal importance in maintaining the standing of hospitals in competitive positions. In addition to the differences in hospital management and surgeon volume, the patient severity of illness also needs to be taken into consideration in cost containment.
Immunoprofiles in Malignant Peripheral Nerve Sheath Tumor: Three Case Reports and Literature Review
Authors: Hu Shih‐Wen , Lin Wei‐Chen , Tsai Hui‐Jen , Chien Song‐Hsiung , Tsai Kun‐Bow
Published: July 2009

Because there are no standardized radiologic and histologic criteria, the differential diagnosis of malignant peripheral nerve sheath tumors (MPNSTs) from other spindle cell neoplasms poses great challenges for pathologists. Because early diagnosis of MPNSTs arising from benign peripheral nerve sheath tumors (BPNSTs) means a better prognosis, many immunohistochemical and molecular studies have recently emerged. Nevertheless, no gold standard diagnostic criterion is to be found in the literature. For example, S‐100 protein is widely used in the diagnosis of MPNST. Other promising ancillary markers are p53 and Ki‐67; however, the staining patterns and possible mechanisms of these markers are seldom mentioned in the literature. These evoke our interest. Only six cases diagnosed as MPNST were retrieved from the archives of the Department of Pathology, Kaohsiung Medical University Chung‐Ho Memorial Hospital between 1988 and September 2005. Clinical files were available for three of them, and we found nuances in the immunohistochemistry from these previous reports. Here, we present these rare sarcomas and review the literature.
Bladder Leiomyoma Presenting as Voiding Dysfunction: A Case Report
Authors: Lin Han‐Ching , Wu Wen‐Jeng , Ke Hung‐Lung , Huang Chun‐Hsiung
Published: July 2009

Mesenchymal tumors of the urinary bladder are rare, and the majority of them are malignant. We report a case of leiomyoma of the urinary bladder presenting with symptoms of voiding dysfunction. We performed surgical resection of the leiomyoma and repair of the bladder. Small capacity of the bladder with right vesicoureteral reflux was noted in outpatient department follow‐up. A review of the relevant literature is also provided.
Usefulness of a Body Composition Analyzer, InBody 2.0, in Chronic Hemodialysis Patients
Authors: Okamoto Machiko , Fukui Mitsumine , Kurusu Atsushi , Shou Ichiyu , Maeda Kunimi , Hamada Chieko , Tomino Yasuhiko
Published: July 2009

The objective of the present study was to investigate whether InBody 2.0 might be useful in measuring the dry weight of chronic hemodialysis (HD) patients. Thirty‐five HD patients (22 males and 13 females; mean age 62.6 ± 14.0 years; mean HD duration 101.0 ± 118.06 months) were examined. Multifrequency bioelectric impedance analysis was used to estimate the ratio of extracellular water (ECW) to total body water (TBW). The body resistance was measured at frequencies ranging from 1 kHz to 1 MHz. The impedance index was determined at a low frequency (5 kHz) and correlated closely with ECW, using sodium bromide dilution as standard comparison. The levels of serum albumin, prealbumin, total cholesterol (TC), triglycerides (TG), transferrin, and human atrial natriuretic peptide (hANP) were measured by routine methods in our hospital. The ECW/TBW ratio was significantly associated with the levels of hANP (p < 0.05). However, no associations between the levels of serum albumin, TC, TG, or transferrin and the ECW/TBW were observed. It appears that the body composition analyzer, InBody 2.0, may be useful for estimating the dry weight in chronic HD patients.
Clinical Features of Fatal Asthma
Authors: Chen Chiung‐Zuei , Lee Cheng‐Hung , Chu Yung‐Chi , Chen Chen‐Wen , Chang Han‐Yu , Chang Han‐Yu , Hsiue Tzuen‐Ren
Published: July 2009

To characterize the clinical features of fatal asthma, we retrospectively analyzed the clinical characteristics of patients who died of an acute asthma attack in our hospital during a 15‐year period from 1989 to 2003. Twelve patients had fatal asthma during this period, including eight who were dead on arrival in the emergency room (ER) and three who died within 1 hour of admission to the ER. Patients were categorized into three groups according to the clinical presentations during the fatal attack: (1) rapid (< 3 hours) decompensation in four patients; (2) gradual development of respiratory failure over several days in two patients; and (3) acute deterioration after unstable asthma lasting several days in six patients. All patients in groups 1 and 2 had reported previous near‐fatal attacks. The proportion of young patients was highest in group 3, with half of them (3/6) younger than 35 years of age. Only one patient in group 3 had had a previous near‐fatal attack. Five of the seven patients, with previous near‐fatal attacks, had a pattern of decompensation during their fatal attack that was similar to their previous attacks. In conclusion, nearly all patients with fatal asthma in this study died outside of the hospital or within 1 hour after admission to the ER. Patients had patterns of decompensation during the fatal attack that were similar to those of their previous attacks. Early detection of warning signs, early admission to the ER, adequate treatment, and extremely close observation of patients, especially within 1 hour after ER arrival, may prevent or decrease the incidence of fatal asthmatic attack.
Hair as the Nidus for Bladder Calculi Formation Complicating Suprapubic Cystostomy Catheterization: A Case Report
Authors: Ke Hung‐Lung , Lin Hung‐Yu , Jang Mei‐Yu , Wu Wen‐Jeng
Published: July 2009

Neurogenic bladder is a familiar sequel to spinal cord injury, and bladder calculi is a common complication of neurogenic bladder. We report a case of a 25‐year‐old man with spinal cord injury resulting in neurogenic bladder. Permanent cystostomy was performed, and, for 4 years, the patient received periodic replacement of a cystostomy catheter. Bladder calculi were found on follow‐up radiography. Cystoscopic lithotripsy was done, and it was noted that a hair was the nidus of a calculus. The hair could have been introduced into the bladder accidentally during the cystostomy catheter replacement. We suggest routine pubic hair care, even shaving, for patients suffering from neurogenic bladder with cystostomy. In addition, patients and caregivers should take care not to introduce pubic hair into the bladder while changing cystostomy catheters.
Modified Gunderson Conjunctival Flap Combined with an Oral Mucosal Graft to Treat an Intractable Corneal Lysis after Chemical Burn: A Case Report
Authors: Cheng Kai‐Chun , Chang Cheng‐Hsien
Published: July 2009

Following a severe chemical injury, persistent corneal melting presents as a threatening condition for loss of vision or the eyeball itself. Keratoplasty (both lamellar and penetrating) and amniotic membrane transplantation have been the usual modes of therapy. However, these may not halt the persistent melting process. We introduce here an alternative surgical procedure to resolve corneal melting and preserve the globe. This case concerns the right eye of a 36‐year‐old male who had suffered from severe ocular alkali chemical burns and sustained intractable corneal melting, despite receiving corneal transplants three times, a limbal stem cell transplantation once, a scleral graft twice, and amniotic membrane transplantation eight times. To circumvent the impending perforation, we performed a modified Gunderson conjunctival flap combined with an oral mucosal graft. The corneal melting was halted, and the eyeball was preserved. The combination of an oral mucosal graft to the modified Gunderson conjunctival flap provided an easy alternative to resolve a case of intractable corneal melting and impending perforation.
Too late to Quit? Effect of Smoking and Smoking Cessation on Morbidity and Mortality Among the Elderly in a Longitudinal Study
Authors: Hsu Hui‐Chuan , Pwu Raoh‐Fang
Published: July 2009

This prospective study of the elderly population estimated the risks of smoking for morbidity and mortality and identified whether cessation of smoking reduced the risk of disease. Data came from face‐to‐face interviews that used a population‐based probability sample of those aged 60 years or over in Taiwan, provided by the Population and Health Research Center, Bureau of Health Promotion. In total, 4,049 subjects were included at the baseline year of 1989 and followed up in 1993 and 1996. Smoking‐related variables included current smoking status, smoking history, daily consumption, and years since the cessation of smoking. Cox regression models were used to analyze the relative risks for morbidity and mortality, controlling for demographics, physical function, and comorbidities. The sample was made up of 50.2% nonsmokers, 15.2% ex‐smokers, and 34.6% current smokers in the baseline year. Current smokers were more likely to have lower respiratory tract diseases throughout the study. Current smokers had a higher risk of stroke from 1989 to 1993. No dose‐response relationship for smoking exposure or impact of years since smoking cessation was found. Whether cessation of smoking is protective should be investigated for middle‐aged adults followed to old age. An effective strategy for smoking cessation in the elderly is suggested, and people should be encouraged to quit smoking at any time.
Acute Necrotizing Ureteritis with Obstructive Uropathy Following Instillation of Silver Nitrate in Chyluria: A Case Report
Authors: Su Chin‐Ming , Lee Yung‐Chin , Wu Wen‐Jen , Ke Hung‐Lung , Chou Yii‐Her , Huang Chun‐Hsiung
Published: July 2009

Chyluria occurs as a result of communication between the lymphatics and the renal pelvis. It is believed that instillation of silver nitrate into the renal pelvis is a safe, minimally invasive and effective treatment for chyluria. We report an unusual complication of acute necrotizing ureteritis following instillation of silver nitrate in a case of chyluria. It resolved completely with non‐surgical intervention. The diagnosis and management of chyluria is discussed, with a brief review of the literature.
Clinical Evaluation of a New Bilayer Artificial Dermis for Repair of Oral Mucosal Defects: Report of two Cases
Authors: Chen Chun‐Ming , Yang Chia‐Fu , Huang I‐Yueh , Shen Yee‐Shyong , Shieh Tien‐Yu , Chen Chung‐Ho , Lee Huey‐Er
Published: July 2009

Free mucosal grafts or split‐thickness skin grafts have been used in patients undergoing repair procedures for oral mucosal defects. Conventional methods require the creation of second surgical wounds for use as donor sites. We applied two bilayers of artificial dermis to repair a buccal mucosal defect in one case and vestibular extension in another case. After removal of the sutures, no infection, pain, or hemorrhage developed in these patients. The results of granulation and epithelialization were good. Satisfactory appearance and function were achieved in both cases. Therefore, bilayer artificial dermis may be recommended for the repair of oral mucosal defects.
Do Pulmonary Hemodynamics Change After Effective Lung Volume Reduction Surgery for Emphysema?
Authors: Chou Shah‐Hwa , Kao Eing‐Long , Huang Meei‐Feng , Chuang Hung‐Yi , Huang Ming‐Shyang , Hwang Jhi‐Jhu , Wang Tung‐Heng
Published: July 2009

The improvement in lung function, exercise test, blood gas levels, and symptoms in emphysema patients after volume reduction surgery is a result of improvements in breathing mechanics. The question is, is the improvement in the condition related to pulmonary hemodynamics? Few studies have examined preand postoperative pulmonary pressure. This paper examines whether there is any significant change in systolic and diastolic pulmonary pressure after effective volume reduction surgery. From October 1999 to October 2002, 12 emphysema patients who underwent volume reduction surgery were studied. Systolic and diastolic pulmonary pressures were measured 2 days before surgery through cardiac catheterization and 2 days after removal of the chest tubes through Swan Ganz catheters placed in the operating room just before surgery. Patients were stable and breathed without assistance during the postoperative pressure measurement. Blood gas analysis, lung function tests, and a 6‐minute walk test were performed preoperatively and 3 months postoperatively. The two sets of data were compared using the Wilcoxon signed rank test. There was no significant change in pulmonary hemodynamics, although pulmonary function improved. The improvement in pulmonary function after volume reduction surgery is not related to pulmonary hemodynamics.
Metastases from Gastric Carcinoma to Colon in the form of Multiple Flat Elevated Lesions: A Case Report
Authors: Lee Hsi‐Chang , Yang Min‐Ta , Lin Kuang‐Yang , Tu Hsing‐Yang , Zhang Ting‐An , Chen Pao‐Huei
Published: July 2009

Gastric carcinoma is a common malignancy worldwide. Advanced stages of the disease may result in metastases to many other organs of the body. However, colonic metastases are rare. We report a case of gastric carcinoma with symptoms of abdominal fullness and weight loss. The serum carcinoembryonic antigen level was elevated. Esophagogastroduodenoscopy revealed giant folds occupying the whole gastric body and poor expansion of the stomach. Histologic examination of biopsy specimens from the giant fold demonstrated poorly differentiated adenocarcinoma with signet ring‐cell differentiation. Total colonoscopy revealed five or six discrete flat elevated lesions in the distal transverse, descending, and sigmoid colons. These lesions were characterized by a clear margin of 3‐5 mm in diameter and erosions on the tips. Polypectomy specimens demonstrated signet ring‐cell carcinoma, which was histologically similar to the specimens taken from the gastric lesion. We conclude that this was a rare case in which gastric signet ring‐cell carcinoma had metastasized to the colon in the form of flat elevated lesions, combined with rapid and wide lymphatic spread to the thorax and abdomen in a clinical course as short as 46 days.
Imaging of Transmural Migration of A Retained Surgical Sponge: A Case Report
Authors: Yeung Kwok‐Wan , Chang Ming‐Sung , Huang Jee‐Fu
Published: July 2009

A 61‐year‐old woman who had undergone a hysterectomy 15 years before this presentation had suffered from intermittent abdominal pain and a palpable lower abdominal mass for 3 months. Plain roentgenography revealed a radiopaque mass with serpiginous density in the pelvic region. Sonography showed curvilinear hyperechogenicity with an acoustic shadow. A small‐bowel series revealed a huge amorphous filling defect inside the ileum. Computed tomography showed that the mass was a spongiform object with a whirl‐like appearance mixed with air and with peripheral calcification.
Antimicrobial Effect of Extracts of Cruciferous Vegetables
Authors: Hu Shu‐Hui , Wang Jinn‐Chyi , Kung Hsien‐Feng , Wang Jih‐Terng , Lee Wei‐Lun , Yang Yi‐Hsin
Published: July 2009

The cruciferous vegetables cauliflower, broccoli, cabbage, Chinese radish, Chinese kale, and Chinese kitam were used in this study to prepare water‐soluble and methanol‐water extracts. Crude protein extracts were also obtained by diethylaminoethyl (DEAE) anion exchange chromatography. Water‐soluble polysaccharides were prepared by ethanol precipitation followed by ultrafiltration. The antimicrobial effects of all these extracts were evaluated against Gram‐positive bacteria, Gram‐negative bacteria, and yeast. Crude protein extracts exhibited the greatest antimicrobial activity in monoculture experiments. The antimicrobial effects of cruciferous vegetables were also studied by steeping beef, carrot, and celery in chlorine (10 ppm) or citric acid solution (1%) containing the crude protein extract (500 ppm) for different time periods. Total aerobic plate counts and coliform counts on these foods decreased significantly after 10 minutes in all steeping solutions (p< 0.05).
Extra‐Adrenal Pheochromocytoma Presenting with Life‐Threatening Ventricular Tachycardia: A Case Report
Authors: Li Wei‐Ming , Huang Chun‐Hsiung , Su Chin‐Ming , Wu Wen‐Jeng , Chou Yii‐Her , Chai Chee‐Yin
Published: July 2009

Extra‐adrenal pheochromocytoma develops in paraganglion chromaffin cells of the sympathetic nervous system. It probably represents at least 15% of adult and 30% of childhood pheochromocytomas. Although electrocardiographic abnormalities occur in up to 75% of patients with pheochromocytoma, there are only three other reported cases of pheochromocytoma that initially presented with ventricular tachycardia. In this report, we describe a 64‐year‐old woman with an abdominal para‐aortic extra‐adrenal pheochromocytoma who presented with pulseless ventricular tachycardia and needed electrical defibrillation initially to keep vital signs. The 24‐hour urine vanillylmandelic acid was 35.8 mg. Computerized tomography showed a left retroperitoneal mass. The postoperative course was uneventful. Pheochromocytoma was proved by histologic study.
Mutation of the P53 Tumor Suppressor Gene in Transitional Cell Carcinoma of the Urinary Tract in Taiwan
Authors: Lin Hung‐Yu , Huang Chun‐Hsiung , Wu Wen‐Jen , Chou Yii‐Her , Fan Pao‐Luo , Lung For‐Wey
Published: July 2009

Early detection of a mutated p53 gene is thought to provide useful information in a wide range of human tumors. The aim of this study was to identify the role of the p53 gene in transitional cell carcinoma of the urinary tract. From March 1992 to July 2003, 75 patients (54 men and 21 women) with a mean age of 66.85 years and pathologically diagnosed transitional cell carcinoma were enrolled in this study. Fiftyeight patients had bladder cancer, eight had ureteral cancer, and nine had renal‐pelvic cancer. Rapid screening for mutation of the p53 gene was performed using polymerase chain reaction (PCR), single‐strand conformation polymorphism (SSCP), and sequencing analysis. Primer sets were designed to amplify fragments within exons 4, 5, 6, 7, and 8 of the p53 gene. Pathology classified 37 tumors as low grade and 38 as high grade. Tumor stage was pT1 or less in 29 patients and at least pT2 in 46 patients. Of the 75 patients in this study, 47 (62.7%) had a p53 mutation. Of the patients with a p53 mutation, 33 (70.2%) had invasive tumors. Invasive tumors were associated with p53 mutation (p < 0.05). Noted in 20 patients (26.7%), exon 4 was the most common site of the mutation. Of the patients with exon 4 mutations, 15 (75%) had invasive tumors and nine (45%) had high‐grade tumors. Additionally, among the 20 patients with a common polymorphism at codon 72, 16 (80%) had invasive tumors and 14 (70%) had high‐grade tumors. In this study, 62.7% of patients with transitional cell carcinoma had a p53 mutation, suggesting that the p53 gene mutation may be used as a marker of transitional cell carcinoma. Invasive tumors are more likely to have a p53 gene mutation. A simple analysis of the p53 gene using PCR/SSCP is suitable for screening for p53 abnormalities in transitional cell carcinoma. The relationship between cancer risk and the codon 72 polymorphism of exon 4 needs further investigation.
Acute Respiratory Distress Syndrome after Early Successful Primary Percutaneous Coronary Intervention Therapy in Acute Myocardial Infarction: A Case Report
Authors: Su Ho‐Ming , Voon Wen‐Chol , Lin Tsung‐Hsien , Chu Chih‐Sheng , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: July 2009

Acute respiratory distress syndrome (ARDS) is characterized by acute‐onset dyspnea, diffuse bilateral pulmonary infiltration, low pulmonary capillary wedge pressure (PCWP), and an arterial oxygen tension/ inspired oxygen fraction (PaO2/FiO2) ratio of less than 200 mmHg. Acute myocardial infarction (AMI), whether complicated by circulatory arrest, cardiogenic shock, and hypotension or not, was reported as an etiologic factor in the development of ARDS in the prethrombolytic era. In the thrombolytic era, two cases of AMI complicated with ARDS have been reported. ARDS in these two patients resulted from anaphylactic reaction to the thrombolytic agent and not from the hemodynamic consequences of AMI. Development of ARDS during the AMI period has not been reported after early successful primary percutaneous coronary intervention (PCI). Herein, we report a 61‐year‐old male patient with persistent chest pain who was diagnosed with Killip II anterior ST‐segment elevation AMI. He was treated successfully with primary PCI 2.5 hours after the onset of chest pain. Unfortunately, on the third hospital day, acuteonset dyspnea (respiratory rate, 33 beats/min), fever (38.5°C), leukocytosis (white blood cell count, 18,360/μL), and diffuse bilateral pulmonary infiltration were noted. ARDS was diagnosed from the low PCWP (8 mmHg) and a PaO2/FiO2 of less than 200 mmHg (160 mmHg). No usual causes of ARDS such as infection, aspiration, trauma, shock, or drug reactions were noted. We assumed that, in this particular patient, the systemic inflammatory response syndrome frequently induced by AMI might have caused this episode of ARDS. This may imply that AMI itself is a possible etiology of ARDS.
Ectopic Pancreatic Tissue Presenting as an Umbilical Mass in a Newborn: A Case Report
Authors: Lee Wei‐Te , Tseng Hsing‐I , Lu Chu‐Chong , Lin Jao‐Yu , Tsai Kun‐Bow
Published: July 2009

The case of an ectopic pancreatic mass at the umbilicus in an 8‐day‐old male neonate is reported, the youngest patient with this condition ever reported in an English‐language journal. The patient was healthy except for a protruding mass with intermittent mucous discharge at the base of the umbilical stump. Surgical intervention was performed under the impression of the umbilical mass. Pathology diagnosed an ectopic pancreas with acute hemorrhage. To the best of our knowledge, only one case of ectopic pancreas presenting as an umbilical mass with intermittent mucous discharge has previously been reported.
Intravascular Lymphomatosis Mimicking Acute Disseminated Encephalomyelitis: A Case Report
Authors: Hsu Yung‐Hsiang , Tseng Bo‐Yuan , Shyu Woei‐Cherng , Yen Pao‐Sheng
Published: July 2009

We describe the clinical, radiologic, and postmortem findings in a 49‐year‐old woman with intravascular lymphomatosis. The patient presented with progressive limb weakness followed by progressive disseminated cerebral neurologic symptoms. Disseminated encephalomyelitis was suspected due to the clinical and radiologic findings. Steroid pulse therapy and intravenous immunoglobulin were given but did not help. The patient died of multiple organ failure 3 months after the onset of symptoms. A diagnosis of disseminated intravascular large B‐cell lymphomatosis was established based on findings from histopathology and immunohistochemistry studies on autopsy specimens of the brain and other visceral organs collected postmortem.
A Preliminary Study of a Health‐Promoting Lifestyle Among Southeast Asian Women in Taiwan
Authors: Lee Fang‐Hsin , Wang Hsiu‐Hung
Published: July 2009

The purpose of this study was to determine and understand the predicting factors of a health‐promoting lifestyle (HPL) in Southeast Asian women in Taiwan. One hundred and five Southeast Asian women in Tainan were recruited. Face‐to‐face interviews with structured questionnaires were used for data collection. The findings showed that, among the six dimensions of HPL, subjects scored highest in self‐actualization and lowest in health responsibility. Subjects who could read and write Chinese had a more positive HPL; stepwise regression analysis revealed that the ability to read Chinese could explain 26.2% of the total variance of HPL in Southeast Asian women. The results of this study can help health care professionals understand the HPL and to design appropriate health‐promoting educational programs to improve the well‐being and overall quality of life of Southeast Asian women in Taiwan.
Related Factors and Consequences of Menstrual Distress in Adolescent Girls with Dysmenorrhea
Authors: Chen Huei‐Mein , Chen Chung‐Hey
Published: July 2009

This study investigated symptoms, related factors, and consequences of menstrual distress in adolescent girls with dysmenorrhea. A total of 198 participants were recruited by convenience sampling from a technical college in Tainan County, Taiwan. Four instruments were used to collect data: a Demographic Data Questionnaire, a Menstrual Distress Questionnaire, the Short Form McGill Pain Questionnaire, and an Adolescent Menstrual Attitude Questionnaire. The top five symptoms of menstrual distress were cramps, fatigue, backache, swollen abdomen, and tender breasts. Results of stepwise multiple regression indicated that the best subsets for predicting adolescent menstrual distress, including age, mother's occupation, menstrual pain, and menstrual attitude, accounted for 59% of total variance. From the correlation analysis, the more severe the menstrual distress, the higher the impact on daily activities as well as the more frequent the absence from class and analgesic usage. The results of this study may provide a useful reference for school nurses designing menstrual health programs for adolescents.
Heparin‐Induced Cardiac Tamponade and Life‐Threatening Hyperkalemia in a Patient with Chronic Hemodialysis
Authors: Su Ho‐Ming , Voon Wen‐Chol , Chu Chih‐Sheng , Lin Tsung‐Hsien , Lai Wen‐Ter , Sheu Sheng‐Hsiung
Published: July 2009

Heparin, a commonly used anticoagulant agent, is frequently used in patients undergoing hemodialysis. As with most medications, heparin has a significant side effect profile. Two of its most important side effects, major bleeding and hyperkalemia, may be devastating without immediate diagnosis and treatment. Major bleeding such as gastrointestinal, genitourinary or intracranial bleeding is occasionally encountered and rarely neglected. However, heparin‐induced cardiac tamponade is rarely encountered and may be easily overlooked. Another side effect, heparin‐induced hyperkalemia, an unusual but well‐described side effect, is frequently forgotten until life‐threatening arrhythmia has occurred. We report a case involving a 40‐year‐old male patient with uremia, who had received heparin for 10 days for deep vein thrombosis in the left lower extremity. Hemopericardium with cardiac tamponade and life‐threatening hyperkalemia were both noted in this patient.
Hypophosphatasia in Taiwan: Report of Two Cases
Authors: Chou Yen‐Yin , Tsai Shang‐Chun , Lin Shio‐Jean , Ou Horng‐Yih , Wu Ta‐Jen , Yu Eugene Hsin
Published: July 2009

Hypophosphatasia is a rare inherited metabolic disease characterized by rickets with reduced plasma and tissue alkaline phosphatase activity. It may be present in infancy, childhood, or adulthood. Various clinical manifestations reflect different forms of alkaline phosphatase gene expression. In this report, we present two cases of hypophosphatasia, one of the infantile and the other of the adult form. The infantile case presented with failure to thrive, hypotonia, and radiologic rickets at 4 months old. The adult case had repeated fractures and marked loss of bone density demonstrated by radiographs. Both cases showed extremely low levels of alkaline phosphatase. To the best of our knowledge, they are the first reported patients with hypophosphatasia from the Taiwanese population.