bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasal Septum Chondroma: A Case Report
Authors: Chien Chen‐Yu , Tai Chih‐Feng , Ho Kuen‐Yao , Lee Ka‐Wo , Kuo Wen‐Rei , Wang Ling‐Feng
Published: July 2009

Chondromas of the nasal septum are rare. Since its first literary description in 1842, only about 140 cases have been reported. We present the case of a 38‐year‐old female who reported intermittent nasal bleeding and nasal obstruction for 3 months. A reddish mass arising from the nasal septum was found by endoscope. The tumor was removed under endoscopic guidance and histopathologic examination revealed chondroma composed of well‐differentiated chondrocytes. No recurrence was noticed after 6 months of follow‐up. Despite their rarity, chondromas should be taken into consideration in the differential diagnosis of nasal tumors, especially those arising from the nasal septum.
Bowel Preparation of Outpatients for Intravenous Urography: Efficacy of Castor Oil Versus Bisacodyl
Authors: Yang Huei‐Chen , Wang Jia‐Hwia , Chang Cheng‐Yen , Sheu Ming‐Huei
Published: July 2009

The purpose of this study was to compare the efficacy of two laxatives, castor oil and bisacodyl, in the routine bowel preparation of outpatients for intravenous urography (IVU). We used castor oil in patients undergoing IVU for 1 month, and then used bisacodyl in patients undergoing IVU for another month. Two uroradiologists, unaware of the method of bowel preparation, reviewed the standard radiographs and graded the residue in the large bowel and the clearness of the opacified urinary collecting system. In total, 71 consecutive outpatients received castor oil, and 84 received bisacodyl. For the castor oil group, grades from the two uroradiologists did not differ in terms of fecal residue on plain abdominal images (p = 0.54), and visualization of the urinary system on the left (p = 0.36) and right sides (p = 0.63). Findings were similar for bisacodyl recipients (p = 0.11, 0.59, and 0.32, respectively). When the laxative effect of the two agents was compared, we found no difference in the grading of fecal residue on plain abdominal images (p = 0.14), or in visualization of the urinary system on the left (p = 0.31) and right sides (p = 0.98). In conclusion, we observed no difference in laxative efficacy between castor oil and bisacodyl; thus, bisacodyl may be a useful alternative for bowel preparation before IVU.
Fatal Septicemic Melioidosis in a Young Military Person Possibly Co‐Infected With Leptospira Interrogans and Orientia Tsutsugamushi
Authors: Lu Po‐Liang , Tseng Shu‐Hui
Published: July 2009

Concurrent melioidosis, leptospirosis, and scrub typhus after rural activities is rarely reported. A 19‐year‐old previously healthy man had fever onset after 2 weeks of military training. Pneumonia became evident on the fifth day of fever under intravenous penicillin and oral minocycline therapy. Acute respiratory failure developed the next day with shock and acute renal and liver function deterioration, which resulted in death. Blood cultures on the third and fifth days grew Burkholderia pseudomallei. Serology revealed leptospirosis and scrub typhus. The emergence of melioidosis in Taiwan and this death without antibiotic treatment for melioidosis alert us that B. pseudomallei should be included as a possible pathogen of pneumonia and sepsis, especially after rural activities.
Spontaneous Rupture of Ileal Neobladder: A Case Report
Authors: Chang Tu‐Hao , Li Ching‐Chia , Wu Wen‐Jeng , Chou Yii‐Her , Liu Chia‐Chu , Huang Chun‐Hsiung
Published: July 2009

A 63‐year‐old male patient suffered from diabetes, hypertension, and a bladder tumor. He had undergone radical cystectomy and ileal neobladder construction 1 year prior to this admission. He came to our emergency room complaining of abdominal pain after recent alcohol consumption. Muscle guarding and abdominal rebounding pain developed after conservative treatment for 1 day. The next day, emergency laparotomy for acute peritonitis revealed two small perforations in the neobladder and calculus formation within it. In addition, severe intraperitoneal adhesion was noted. After removing the neobladder stone and repairing the neobladder, a Foley catheter was inserted for urine drainage. The patient's postoperative recovery was excellent.
Epidemiology of Blastocystis Hominis and Other Intestinal Parasites in a Vietnamese Female Immigrant Population in Southern Taiwan
Authors: Cheng Hung‐Shiang , Haung Zi‐Fun , Lan Wuu‐Hsiang , Kuo Tsung‐Cheng , Shin Jyh‐Wei
Published: July 2009

There has been a rapid increase in cross‐border female marriage immigrants in Taiwan. In this study, 1,434 Vietnamese female marriage immigrants arriving between July 1998 and June 2001 were examined for intestinal parasites. Most (77.9%) of these women were 20‐29 years of age. The prevalence of intestinal parasite infection was 37.7%, and the trend increased from 1999 to 2001 (statistically significant, p < 0.0001), but decreased among age subgroups (p < 0.0001). Among the 20 species of intestinal parasites found in this study, 10 species (27.8%) were transmitted via the fecal‐oral route, 5 (14.6%) via the soil‐mediated route, and 5 (0.7%) by food‐borne infection. The prevalence of blastocystosis (20.4%) and hookworm (9.7%) remained high among this population. The results provide unprecedented information on intestinal parasitic infection among these immigrants in southern Taiwan and recommend that appropriate health care be given after parasite infection is confirmed in these migrant communities.
Evaluation of Ectodermal Dysplasia
Authors: Baskan Zelal , Yavuz Izzet , Ulku Refik , Kaya Sadullah , Yavuz Yasemin , Basaran Güvenç , Adiguzel Ozkan , Ozer Torun
Published: July 2009

This case series report outlines possible cranio‐maxillofacial deformation consequences associated with ectodermal dysplasia (ED) and embryonic malformations, including dental agenesis. Also described are the oral aspects and rehabilitation. A total of 14 ED patients (7 males and 7 females, aged 5‐45 years) underwent clinical examination before assessment and treatment. Lateral cephalometric radiography, Steiner's analysis, and respiratory capacity tests were performed. Most of the patients had sparse or absent hair, a short face with an unusual facial concavity, a maxillary retrusion, and a relative mandible protrusion. Depending on age and orthopedic abnormalities, patients were treated with prosthodontic and orthodontic approaches or implant treatment. Therapists should take a comprehensive and multidisciplinary approach with these patients to improve their dental, masticatory, growth, and orthognathic conditions, as well as esthetic appearance.
An Avoidable Complication of Percutaneous Coronary Intervention—Entrapment of Stent and Disconnected Balloon Catheter
Authors: Lin Tsung‐Hsien , Chiu Chaw‐Chi , Chen Huai‐Min , Su Ho‐Ming , Voon Wen‐Chol , Lai Wen‐Ter , Sheu Sheng‐Hsiung , Lin Young‐Tso
Published: July 2009

During percutaneous coronary intervention, entrapment of catheter materials is a rare but life‐threatening complication that sometimes requires emergency surgical treatment. Coronary artery stents have been developed to prevent acute coronary closure and reduce restenosis after coronary angioplasty. The most frequently reported complications of coronary stents are related to stent thrombosis and anticoagulation problems. This case study describes a 60‐year‐old female who had stable angina pectoris and underwent stent insertion into the left circumflex artery. Unfortunately, the coronary stent with balloon catheter was entrapped while crossing the angulated segment between the left circumflex and left main coronary artery. The stent catheter was surgically removed, and the patient underwent coronary artery bypass grafting successfully. Physicians should keep in mind that extremely angulated segments may reduce the successful rate of coronary stenting and contribute to the stent entrapment complication.
Ischemic Stroke Following Multiple Traumas in a Child: A Case Report
Authors: Lin Pei‐Jung , Chang Yu‐Tang , Lai Chiou‐Lian
Published: July 2009

Stroke is an uncommon disorder in children but an increasingly recognized cause of disability. Acute stroke may be attributable to trauma, but this topic is seldom discussed. In limited reports, most ischemic strokes following trauma were detected after a considerable delay. Early recognition of stroke following trauma might reduce secondary neurologic complications. We report a case of posterior cerebral artery area infarct following multiple traumas in a child. A comprehensive etiologic survey was undertaken and discussed. Although the definite pathogenesis is still unclear, adequate, individualized, and uncomplicated management can significantly affect the outcome.
Tracheostomy Tube Ignition During Microlaryngeal Surgery Using Diode Laser: A Case Report
Authors: Wang Hsun‐Mo , Lee Ka‐Wo , Tsai Cheng‐Jing , Lu I‐Chen , Kuo Wen‐Rei
Published: July 2009

Ignition of the tracheal tube during laser microlaryngeal surgery under general anesthesia is an uncommon complication with potentially serious consequences. We present here a case of a patient with glottic stenosis following endotracheal intubation, who experienced this potentially catastrophic combustion during endoscopic arytenoidectomy, using a diode laser under general anesthesia via 60% FiO2, with an airway fire occurring at the tracheostomy tube and causing tubal damage and obstruction. The anesthetic connecting tube was immediately disconnected and the tracheostomy tube replaced. No adverse consequences to this patient's upper airway were noted during follow‐up visits. Higher oxygen concentrations, the presence of combustibles, and the narrowness of the surgical field during endolaryngeal diode laser surgery are risk factors for airway fires.
Randomized Comparative Study of the Effects of Treatment with Once‐Daily, Niacin Extended‐Release/Lovastatin and with Simvastatin on Lipid Profile and Fibrinolytic Parameters in Taiwan
Authors: Lin Tsung‐Hsien , Voon Wen‐Chol , Yen Hsueh‐Wei , Huang Chih‐Hsin , Su Ho‐Ming , Lai Wen‐Ter , Sheu Sheng‐Hsiung
Published: July 2009

Hyperlipidemia can be effectively treated either with niacin or HMG‐CoA reductase inhibitor (statin), or a combination of both. Few reports showed the effects of the combination regimen with niacin and statin on hemostatic functions. We conducted a single‐center, double‐blind, double‐dummy, randomized, two‐arm study to assess the effects of the niacin extended‐release/lovastatin therapy in a fixed‐dose formulation and of simvastatin on lipid lowering and two fibrinolytic parameters, fibrinogen and d‐dimer. All patients were enrolled according to NCEP‐ATP III guidelines and underwent a placebo run‐in period of 4 weeks before being randomized to either niacin extended‐release/lovastatin tablets (500/20 mg) once daily (n = 36) or simvastatin capsule (20 mg) once daily (n = 34). After 16 weeks of treatment, both groups of patients showed significantly reduced low‐density lipoprotein cholesterol and total cholesterol (LDL‐C, p < 0.001 and < 0.001, respectively, p = 0.159 between the groups; TC, p < 0.001 and < 0.001, respectively, p = 0.018 between the groups). Both drugs were well tolerated. Only in the group treated with niacin extended‐release/lovastatin was fibrinogen concentration significantly reduced after treatment (2.48 ± 0.65 to 1.99 ± 0.62 g/L, p = 0.008). No difference was found with d‐dimer in either group. This study shows that both niacin extended‐release/ lovastatin and simvastatin are effective and well‐tolerated lipid‐lowering drugs in Taiwanese patients with dyslipidemia. A combinational treatment with niacin extended‐release/lovastatin may provide additional benefit in fibrinolysis.
Rescula as an Alternative Therapy for Beta‐Blockers with Long‐Term Drift Effect in Glaucoma Patients
Authors: Chen Chang‐Lin , Tseng Hang‐Yi , Wu Kwou‐Yeung
Published: July 2009

The purpose of this study was to evaluate both the intraocular pressure (IOP)‐decreasing and neuroprotective effects of Rescula (0.12% unoprostone isopropyl) as an alternative therapy to beta‐ blockers with a long‐term drift effect in patients with glaucoma. Twenty‐eight patients with unilateral or bilateral glaucoma were treated with Rescula instead of the original beta‐blocker therapy. IOP was measured using a Goldmann applanation tonometer, and visual field defects were evaluated quantitatively by Humphrey automatic perimetry central 30‐2 threshold test. The mean follow‐up time was at least 1 year. Rescula achieved a significant (p = 0.00001) and long‐lasting reduction in IOP (from 20.78 ± 2.71 to 17.14 ± 2.70 mmHg) in patients with open‐angle glaucoma after 12 months of follow‐up. It also demonstrated a significant (p = 0.02) IOP‐reducing effect (from 20.67 ± 3.60 to 16.36 ± 3.67 mmHg) in patients with angle‐ closure glaucoma 12 months later. The mean deviation of visual field defects changed from −13.27 dB baseline to −10.64 dB at 12 months as evaluated by Humphrey field analyzer II central 30‐2 threshold test after Rescula; however, there was no statistical difference (p = 0.098). Our results showed that Rescula has a significant IOP‐reducing effect as an alternative therapy to beta‐blockers with long‐term drift effect in patients with open‐angle and angle‐closure glaucoma. However, a neuroprotective effect to prevent further progression of the visual field defect in patients with glaucoma was not demonstrated in this study.
Gender Differences in Hazard Rate Affecting Death in the Elderly Population in Taiwan
Authors: Wang Hsiang‐Ping
Published: July 2009

As the age‐specific mortality of women is lower than that of men, feminization of later life is becoming common in all societies. Although elderly women enjoy lower mortality, the health status of women is not necessarily better than that of men. In this study, the mortality change, characteristics of the elderly population, and the trend of feminization in later life in Taiwan was reviewed. Various measures which are used to analyze the gender differences of health status among Taiwan's elderly, and estimation of the effects of factors influencing health were discussed using data from The Survey of Health and Living Status of the Elderly in Taiwan, published by The Department of Health in the Bureau of Health Promotion. The patterns of diseases, functional status, self‐rated health and causal relationships among them were also investigated. The hazard rate model was employed to compare the dynamics of health and the functional status for men and women. The probability of being institutionalized and/or death for women is lower than for men for all functional status. However, the health status of women is not significantly better than men. Elderly women are less affected by fatal diseases but have more benign diseases restricting motion and function, which unexpectedly extends the effects of being more cautious, and, therefore, women live longer. The influence of self‐rated health and functional status to hazard rate of death for both genders was equivalent and coincides with what was previously anticipated.
Subacute Thyroiditis Following Influenza Vaccine (Vaxigrip®) in A Young Female
Authors: Hsiao Jeng‐Yueh , Hsin Shih‐Chieh , Hsieh Ming‐Chia , Hsia Pi‐Jung , Shin Shyi‐Jang
Published: July 2009

Subacute thyroiditis (SAT), also called de Quervain thyroiditis or granulomatous thyroiditis, is a self‐ limiting, possibly viral, and inflammatory thyroid disorder that is usually associated with thyroid pain and systemic symptoms. This report details a case of SAT possibly associated with influenza vaccine (Vaxigrip®) in a young female. The diagnosis, therapeutic management and outcome are discussed.
Effects of Antibiotics and Corticosteroid Eyedrops on Cellular Proliferation in Cultured Human Corneal Keratocytes
Authors: Wu Kwou‐Yeung , Wang Hwei‐Zu , Hong Show‐Jen
Published: July 2009

The purpose of this study is to investigate the effects of antibiotics and glucocorticoid eyedrops, including gentamicin, sulfisomezole, fluorometholone, dexamethasone, and betamethasone, on cellular proliferation in cultured human corneal keratocytes. Human corneal keratocytes were cultured in RPMI‐1640 containing 10% fetal bovine serum. Drugs were prepared from original concentrations to 1/10, 1/100, and 1/1,000 dilutions. After exposure to drugs for 100 minutes, cellular proliferation was estimated by [3H]‐thymidine uptake. It was found that cellular proliferation in corneal keratocytes was not affected by any of the three dilutions of gentamicin but was inhibited by 1/10 and 1/100 dilutions of sulfisomezole to 82% and 90% of control. [3H]thymidine uptake values were inhibited to 75% by 1/10 dilution of fluorometholone and by 1/10 and 1/100 dilutions of betamethasone to 84% and 86% of control. Meanwhile, cellular proliferation was significantly inhibited by 1/10, 1/100, and 1/1,000 dilutions of dexamethasone to 82%, 86%, and 90%, respectively, in comparison with control values. It was demonstrated that commercial eyedrops of glucocorticoids inhibit cellular proliferation in corneal keratocytes, which may modulate the wound healing of corneal stroma.
Mycobacterium abscessus Cervical Lymphadenitis: An Immunocompetent Child
Authors: Chang Jenn‐Tzong , Huang Yung‐Feng , Lin Yen‐Ting , Hsieh Kai‐Sheng , Liu Yung‐Ching , Chiu Lin‐Hui , Tu Hui‐Zin
Published: July 2009

Nontuberculous mycobacterium (NTM) is one of the well‐known causes of cervicofacial lymphadenopathy in children under 5 years of age. Children often present with a painless cervical mass that fails to respond to conventional antibiotics. They are often referred under the suspicion of a neoplasm or bacterial adenitis rather than NTM cervical lymphadenitis. The lack of systemic symptoms, modest or negative purified protein derivative test and absence of exposure to active tuberculosis are characteristics of NTM lymphadenitis. The diagnosis usually requires the isolation of pathogen or pathologic proof. Complete excision is the choice of treatment by the majority of authors in the literature. This not only enables rapid diagnosis but ensures the lowest recurrence rate. Medical management is sometimes successful when complete resection is impossible or refused. To our knowledge, the incidence of NTM cervical lymphadenitis in children is increasing throughout the world. However, such reports of children in Taiwan is lacking. Clinicians should suspect a possible nontuberculous mycobacterial infection when a cervical lump is found in a child.
Application of Capsule Endoscopy in Small Intestine Diseases: Analysis of 28 Cases in Kaohsiung Medical University Hospital
Authors: Liu Meng‐Kwan , Yu Fang‐Jung , Wu Jeng‐Yih , Wu I‐Chen , Wang Jaw‐Yuan , Hsieh Jan‐Sing , Wang Wen‐Ming , Wu Deng‐Chyang
Published: July 2009

Capsule endoscopy (CE) is used to diagnose small intestine disease. Many studies have shown a better lesion detection rate in obscure gastrointestinal (GI) bleeding than with other surveyed techniques. Our study investigates the diagnostic value of CE in patients with suspicious small intestine diseases. Between October 2004 and January 2006, patients who had suspected small intestine disease underwent CE in Kaohsiung Medical University Hospital. Presenting symptoms included obscure GI bleeding, abdominal pain, diarrhea, microcytic anemia, and other indications. CE results were analyzed as a proportion of total lesion detection rate and also with regard to obscure GI bleeding and abdominal pain for analysis. A total of 28 patients, including 12 males and 16 females, were enrolled for CE examination. Overall, small intestine lesions were detected in 20 cases (71.4%), with negative findings in eight cases. For obscure GI bleeding, the total lesion detection rate was 85.7% (12 of 14 patients) but the diagnostic rate was only 35.7% (five of 14 cases). In patients with abdominal pain, four of seven (57.1%) had small intestine lesions. In conclusion, CE survey has a good lesion detection rate for small intestine disease, especially for patients with obscure GI bleeding, and is helpful in the diagnosis of unexplained abdominal pain.
Functional Performance of Alzheimer's Disease and Vascular Dementia in Southern Taiwan
Authors: Shiau Mei‐Yuh , Yu Lifa , Yuan Hui‐Shin , Lin Jau‐Hong , Liu Ching‐Kuan
Published: July 2009

This study investigated the functional performance of two major subtypes of dementia, Alzheimer's disease (AD) and vascular dementia (VaD), by the Functional Independence Measure (FIM), and to understand the need for assistance in performing activities of daily living. The subjects comprised 64AD and 21VaD patients who were recruited from two epidemiologic studies of dementia with a total of 3,931 community residents aged 65 years and above in southern Taiwan. The results showed that the severity of dementia was similar between the two groups. The mean score for AD was 82.7 and for VaD was 56.5 for total FIM (p < 0.05), 61.6 and 41.7 for the motor dimension (p < 0.05), and 21.1 and 15.7 for the cognitive dimension (p < 0.05). There were significant differences (p < 0.01) between AD and VaD in six FIM items and borderline or marginal significance (p < 0.05) in most of the FIM items. For AD patients, stairs, lower dressing, bathing, and tub/shower transfer were the most difficult items in the motor dimension, and it was memory in the cognitive dimension. For VaD patients, bathing, upper and lower dressing, and grooming were the most difficult items in the motor dimension, and it was problem solving in the cognitive dimension. VaD patients were more dependent on all FIM items and required more assistance than AD patients. The functional performances of dementia patients were significantly associated with dementia severity and subtypes, together accounting for 40% of the variability in total FIM. In conclusion, most dementia patients are dependent in daily activities and different types and severity of dementia lead to different disability profiles; individualized care is, therefore, most appropriate.
Reproducibility of Peripapillary Retinal Nerve Fiber Layer and Macular Retinal Thickness Measurements Using Optical Coherence Tomography
Authors: Hsu Sheng‐Yao , Tung I‐Chen , Sheu Min‐Muh , Tsai Rong‐Kung
Published: July 2009

We investigated the interoperator reproducibility of peripapillary retinal nerve fiber layer (RNFL) and macular retinal thickness measurements using optical coherence tomography (OCT) in healthy Taiwanese eyes. In this study, OCT‐3 was used by three trained and experienced operators to measure peripapillary RNFL and macular retinal thickness in a randomly chosen single eye from each normal subject. Mean thickness levels and the differences in thickness measurements among the three operators were calculated and compared. The eyes of 39 subjects (24 females and 15 males) were enrolled. The mean age of the subjects was 30.4 ± 16.1 years (range, 11‐46 years). The mean pupil diameter after pupillary dilation was 7.4 ± 0.6 mm (range, 6‐9 mm). Comparing peripapillary RNFL and macular retinal thickness measurements after pupillary dilation, there were no significant differences in: superior, inferior, temporal, and nasal peripapillary areas; 6 mm total macular volume and foveal thickness; and 1, 3 and 6 mm perifoveal areas among the three operators. In this study, OCT thickness measurements showed good interoperator reproducibility among three trained and experienced operators.
Acute Pulmonary Embolism Following Laparoscopic Ovariectomy: A Case Report
Authors: Chu Chih‐Sheng , Lee Kun‐Tai , Cheng Kai‐Hung , Hwang Pao‐Hwuei , Voon Wen‐Chol , Sheu Sheng‐Hsiung , Lai Wen‐Ter
Published: July 2009

Laparoscopic surgery is usually considered to be less invasive when compared to traditional laparotomy, and is regarded as a relatively low‐risk procedure for postoperative complications because of the reduced surgical stress and earlier mobilization. However, we describe a 47‐year‐old woman who presented with acute respiratory distress, drowsy consciousness, and circulatory collapse shortly after gynecologic laparoscopic ovariectomy for removing an ovarian teratoma at a local hospital. After resuscitation, the patient was transferred to our emergency department. Immediate bedside electrocardiographic and echocardiographic examination results led to acute pulmonary embolism being quickly diagnosed. The patient received subsequent intensive care with smooth course. Although pulmonary embolism is rare after laparoscopic surgery, early detection and quick treatment are important in the management of this life‐threatening complication and offer good prognosis. The risk of pulmonary embolism after gynecologic laparoscopic surgery remains unclear. Therefore, the decision to provide prophylaxis is up to the individual physician, and should take into consideration the patient's individual risk factors and comorbidities.
Successful Localization and Surgical Removal of Ingested Sewing Needles Under Mini C‐Arm Fluoroscopy: A Case Report
Authors: Ma Cheng‐Jen , Jan Chang‐Ming , Hsieh Jan‐Sing , Huang Yu‐Sheng , Wang Wen‐Ming , Chan Hon‐Man , Wang Jaw‐Yuan
Published: July 2009

Foreign body ingestion is common, but ingestion of multiple sewing needles is rare. Most ingested sharp metallic bodies pass through the digestive tract spontaneously and patients can be managed conservatively. Sometimes, however, perforation develops and surgical treatment is necessary. It is hard to localize ingested sewing needles because they tend to scatter widely in the digestive tract and are impalpable manually. We report a psychiatric patient who ingested six sewing needles: one intact needle was found at the larynx, one had penetrated into the stomach, one was in the duodenum, one was in the cecum, one was broken into two pieces, and the final needle was broken into three pieces. All of the broken fragments were in the colon. The needle at the larynx was removed by a laryngoscope. Subsequently, we used mini C‐arm fluoroscopy to localize the remaining needles and successfully removed all of them intraoperatively.
Retropharyngeal Schwannoma Excised Through a Transoral Approach: A Case Report
Authors: Hsieh Chia‐Ying , Wang Cheng‐Ping , Hsiao Jong‐Kai
Published: July 2009

The contents of the retropharyngeal space are limited to fat and retropharyngeal nodes. Primary tumors originating from the retropharyngeal space are rare. More than 25% of schwannomas are found in the head and neck region, and they are rarely found in the retropharyngeal space. Here, we report the case of a 44‐year‐old woman with a schwannoma confined to the left retropharyngeal space, who presented with snoring and a mild lump in the throat sensation. Physical examination revealed anterior bulging of the left oropharyngeal wall, with intact mucosa. Magnetic resonance imaging showed a well‐defined, encapsulated tumor in the left retropharyngeal space with bright signal intensity on T2‐weighted images and low signal intensity on T1‐weighted images, which was strongly enhanced after gadolinium administration. The tumor was removed through a transoral approach, resulting in a short postoperative recovery time without complications. The pathologic diagnosis was schwannoma. The patient has been well and free of tumor recurrence for 2 years. From anatomic and physiologic viewpoints, excision through a transoral approach is a good choice for a confined retropharyngeal schwannoma.
Assessing Core Clinical Competencies Required of Medical Graduates in Taiwan
Authors: Liu Min , Huang Yu‐Sheng , Liu Keh‐Min
Published: July 2009

Medical students are assumed to be competent to provide basic patient care independently on graduation. However, there is a gap between what students are expected to learn and what they have actually learned. This may be due to the lack of clearly defined learning objectives, well‐ organized curriculum, and properly administered assessment. In an attempt to tackle this problem, we conducted a three‐step study. Firstly, we identified the core clinical competencies required of medical graduates in Taiwan. Secondly, we incorporated these clinical competencies into a new medical curriculum. Finally, we identified the most appropriate assessment methods for each clinical competency. In 2004, a set of minimally required clinical competencies for medical undergraduates in Taiwan was developed, which included 92 clinical skills, four communication skills, and seven kinds of attitudes. In order to prepare 3rdand 4thyear medical students at Kaohsiung Medical University (KMU) for later clinical work, the medical curriculum committee integrated the teaching and assessment of the core clinical skills identified previously into relevant organ‐system blocks of the new curriculum. To identify appropriate assessment methods for each clinical skill, a structured questionnaire of assessment methods based on theToolbox of Assessment Methods(Accreditation Council for Graduate Medical Education) andThe Scottish Doctor(Scottish Deans' Medical Curriculum Group) was developed and distributed to 40 senior clinical faculty members at KMU. Simulations and Models, Standardized Patient Examination (SP), and Objective Structured Clinical Examination (OSCE) were suggested to be most suitable to assess two‐thirds of the core clinical skills. These assessment methods are commonly used in American and European medical schools. We believe that the implementation of the new curriculum at KMU accompanied by the use of Simulations and Models, SP, OSCE, and other teaching and assessment methods will help 3rdand 4thyear students to prepare better for clinical practice in clerkships.
Correlates of First‐Time Mothers' Postpartum Stress
Authors: Hung Chich‐Hsiu
Published: July 2009

The purpose of this study was to examine first‐time mothers' postpartum stress and its correlates following discharge from the hospital or clinic after vaginal delivery. One hundred and eightythree first‐time mothers were enrolled from hospitals and clinics in Kaohsiung City. All first‐time mothers reported normal pregnancies and vaginal deliveries, delivered healthy infants at term, and were surveyed during their postpartum periods after discharge from hospitals or clinics. The Hung Postpartum Stress Scale was used to examine first‐time mothers' postpartum stress and stressors during their postpartum periods. The top ten postpartum stressors perceived by the women were: “the baby getting sick suddenly”, “the flabby flesh of my belly”, “the unpredictability of the baby's schedule”, “interrupted sleep”, “the shape of the baby's head due to the sleeping position”, “not sleeping enough”, “lack of information regarding infant's growth and development”, “the baby's crying”, “my life is restricted”, and “the baby choking during feeding”. There were no significant differences between the first‐time mothers' demographic characteristics and their postpartum stress and its three components (negative body changes, maternal role attainment, lack of social support), respectively. Insight into the study results of first‐time mothers' post‐ partum stress and stressors provides a reference for health professionals that the development of programs and resources addressing primiparous women's unique needs are required.
Unusual Case of Multilocular Cystic Nephroma Treated with Nephron Sparing Technique: A Case Report
Authors: Hsiao Hsi‐Lin , Wu Wen‐Jeng , Chang Mei‐Yu , Ke Hung‐Lung , Huang Chun‐Hsiung
Published: July 2009

Multilocular cystic nephroma is an unusual entity of uncertain etiology that can affect children and adults equally. This lesion is believed to be part of a spectrum of renal cystic disorders with multilocular cyst and cystic Wilms' tumor representing the two extremes and usually presents with a benign character. We report a 22‐year‐old female who presented with a painful right renal mass and gross hematuria. After a series of examinations including abdominal ultrasound, computed tomography, and angiography, she underwent partial nephrectomy under the impression of benign lesion. The pathologic examination showed that it was a multilocular cystic nephroma. At the 11‐month follow‐up, the patient was completely asymptomatic and free of recurrence and metastasis.
Leiomyoma of the Epididymis: A Case Report
Authors: Yeh Hsin‐Chih , Wu Wen‐Jeng , Lee Yung‐Chin , Chang Tu‐Hao , Huang Chun‐Hsiung , Li Ching‐Chia
Published: July 2009

Tumors of the epididymis, both primary and secondary, and whether benign or malignant, are very rare. Adenomatoid tumors and leiomyoma are the most frequently diagnosed benign tumors of the epididymis. In a review of the American and European literature, leiomyoma was the second most common neoplasm of the epididymis, representing 6% of primary epididymal tumors. A case of leiomyoma of the epididymis in a 53‐year‐old patient is reported. The patient presented with a 4‐year history of a painless mass in the left scrotum. There were no bothersome symptoms except gradual enlargement of the tumor. On surgical exploration, the mass was found to be smooth and well‐demarcated. A fresh frozen section showed a benign lesion, and conservative excision of the tumor was performed without any difficulty. The leiomyoma was definitively diagnosed by subsequent histopathologic analysis. The details of this rare case are reported herein with a review of the medical literature.
Huge Thornwaldt's Cyst: A Case Report
Authors: Lin Jia‐Hau , Tai Chih‐Feng , Lee Ka‐Wo , Ho Kuen‐Yao , Kuo Wen‐Rei , Wang Ling‐Feng
Published: July 2009

Thornwaldt's bursa, also known as nasopharyngeal bursa, is a recess in the midline of the nasopharynx that is produced by persistent notochord remnants. If its opening becomes obstructed, possibly due to infection or a complication from adenoidectomy, a Thornwaldt's cyst might develop. Here, we present a 53‐year‐old man who complained of nasal obstruction that had progressed for 1 year. Nasopharyngoscopy showed a huge nasopharyngeal mass. Thornwaldt's cyst was suspected. Magnetic resonance imaging showed a lesion measuring 3.6 × 3.4 cm, intermediate on T1‐weighted and high signal intensity on T2‐weighted imaging, neither bony destruction nor connection to the brain. The patient underwent endoscopic surgery for this huge mass. Afterwards, his symptoms improved significantly. We present the treatment and differential diagnosis of a nasopharyngeal cyst.
How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review
Authors: Tabacchi Garden , Wijnhoven Trudy M. A. , Branca Francesco , Román-Viñas Blanca , Ribas-Barba Lourdes , Ngo Joy , García-Álvarez Alicia , Serra-Majem Lluís
Published: July 2009

EURopean micronutrient RECommendations Aligned is a network of excellence funded by the European commission, and established to address the problem of differences between countries in micronutrient recommendations as well as to understand how nutritional information including requirements and adequacy of intake is processed among different population groups. The aims of the present paper were to review the methods used for the adequacy assessment of the intake of six micronutrients of public health concern (vitamin A, folate, vitamin B12, Fe, Zn and iodine) in non-European and European nutrition surveys carried out on the apparently healthy population and to compare in particular the adequacy across surveys for folate intake. A systematic literature review was conducted to identify nutrition surveys that assessed micronutrient intake adequacy. The search yielded 9049 records, out of which 337 were eligible for the selected micronutrients. The majority (83·9 %) of the European surveys compared the adequacy of the nutrient intake against the Recommended Dietary Allowances (RDA); only a few surveys (8·0 %) used the estimated average requirement cut-point method, while none of them used the probability approach. The comparison of folate inadequacy across eight countries revealed that about 25 % of the adult female population had inadequate intakes when judged against the different recommendations used by the respective investigators, but nearly 75 % had inadequate intakes when compared against the estimated average requirement cut-point value of 320 μg/d. The present review showed that different methods were applied across Europe to estimate the adequacy of micronutrient intake, which led to different prevalence estimates of micronutrient inadequacy.
Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice
Authors: Poslusna Kamila , Ruprich Jiri , de Vries Jeanne H. M. , Jakubikova Marie , van't Veer Pieter
Published: July 2009

In order to assess nutritional adequacy, valid estimates of nutrient intake are required. One of the main errors in dietary assessment is misreporting. The objective was to review the extent, nature and determinants of misreporting in dietary assessment, how this affects reported intakes of micronutrients and how this is identified and measured, and to identify the best ways of dealing with misreporting when interpreting results. A systematic literature search was conducted for studies of misreporting of dietary intake in adults by 24 hour recalls or by estimated or weighed food records, published up to March 2008. Thirty-seven relevant studies were identified. Possible causes of misreporting were identified. Methods most used to identify misreporting were the Goldberg cut-off (46 % studies) and the doubly labelled water technique (24 % studies). The magnitude of misreporting of energy intake was similar in all three dietary assessment methods. The percentage of under-reporters was about 30 % and energy intake was underestimated by approximately 15 %. Seven papers presented usable data for micronutrient intake. Absolute intakes of Fe, Ca and vitamin C (the three micronutrients addressed in all papers) were on average 30 % lower in low-energy reporters (LER) than that in non-LER and, although results were not consistent, there was a tendency for micronutrient density to be higher in LER. Excluding underreporters or using energy adjustment methods for micronutrient intakes is discussed. Residual method of energy adjustment seems to be a good tool for practice to decrease an influence of misreporting when interpreting results of studies based on food records and 24 hour recalls.
How dietary intake methodology is adapted for use in European immigrant population groups – a review
Authors: Ngo Joy , Gurinovic Mirjana , Frost-Andersen Lene , Serra-Majem Lluís
Published: July 2009

Immigrants comprise a noteworthy segment of the European population whose numbers are increasing. Research on the dietary habits of immigrants is critical for correctly providing diet counselling and implementing effective interventions. The aim of the present study was to identify the presently used methods and adaptations required for measuring dietary intake in European immigrant groups. A comprehensive review strategy included a structured MEDLINE search, related references and key expert consultations. The review targeted adults from non-European union (European union-15 countries) ethnic groups having the largest populations in Europe. As studies evaluating nutrient intake were scarce, papers evaluating intake at the level of foods were included. Forty-six papers were selected. Although Eastern Europe, Turkey, Africa (North, Sub-Saharan and Afro-Caribbean), Asia and Latin America represented the most numerous immigrant groups, papers on dietary intake were not available for all populations. Interview-administered FFQ and repeated 24 hour recalls were the most frequently applied instruments. Inclusion of ethnic foods and quantification of specific portion sizes of traditional foods and dishes in assessment tools as well as food composition databases were commonly identified problems. For FFQ, food list elaboration required particular consideration to reflect key ethnic foods and relative contribution to nutrient intake. Extra efforts were observed to overcome cultural barriers to study participation. Evaluating dietary intake of immigrant populations requires special attention to various methodological aspects (sampling, recruiting, instruments used, method of administration, food composition database, acculturation, etc.) so as to adequately address the range of socio-cultural factors inherent in these nutritionally at risk target groups.
Dietary assessment methods used for low-income populations in food consumption surveys: a literature review
Authors: Vucic Vesna , Glibetic Maria , Novakovic Romana , Ngo Joy , Ristic-Medic Danijela , Tepsic Jasna , Ranic Maria , Serra-Majem Lluís , Gurinovic Mirjana
Published: July 2009

In order to assess nutritional adequacy, reliable estimates of nutrient intake are required. Specifically, the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence needs clear guidelines on methods suitable for assessing micronutrient intakes among vulnerable population groups. The objective of this project was to collect, evaluate data and review the suitability of methods used to assess dietary intake of low-income groups across Europe. A comprehensive literature review methodology was employed, which involved structured search MEDLINE, from 1990 to 2008, on (nutrient intake methods) and (validity terms) and (human studies) and finally (low-income terms). In addition, manual searches were conducted for published books and national studies. Seven studies satisfied the selection criteria for inclusion in the review in which four dietary intake methods had been described and validated. Three other studies found in the grey literature used similar methods. Only one study tested a variety of methods to assess reliability and the method preferred by those having low incomes. Preferred methods were 24 h recalls and a FFQ which, compared with the weighed inventory, also yielded higher estimates of energy and nutrient intakes. Many of the methods used in low-income populations have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity when used in this population. Based on one study only, four multiple-pass 24 h recalls are recommended as the most appropriate method for the evaluation of nutritional adequacy in low-income households.
Sexual mosaics and mermithid parasitism in Austrosimulium bancrofti (Tayl.) (Diptera, Simuliidae)
Authors: Hunter D. M. , Moorhouse D. E.
Published: July 2009

One gynandromorph and six intersexes of Austrosimulium bancrofti (Tayl.) are described from specimens caught in Queensland. All of the intersexes, as well as some normal flies, were infected with mermithid larvae. The infected flies rest preferentially on trees near the river's edge which would facilitate deposition of mermithids in the river. Except for a few with mature eggs, infected females had little internal abdominal structure, and most lacked ovaries.
The direction of flight of mosquitoes (Diptera, Culicidae) near the ground in West African savanna in relation to wind direction, in the presence and absence of bait
Authors: Snow W. F.
Published: July 2009

The direction of mosquito flight near the ground, in relation to wind direction, was investigated at Keneba in The Gambia, West Africa. Directional flight traps facing eight directions sampled mosquitoes flying between ground level and 1·4 m, and unbaited and baited catches with a calf at the centre of the trap circle were performed. Data on non-host-oriented flight were obtained for unfed femaleAnopheles melas(Theo.),Culex thalassiusTheo. andC. tritaeniorhynchusGiles from the unbaited catches, and from all catches of unfed females of theC. deceitsgroup, and gravid and male mosquitoes, which did not respond to the calf. The baited catches included large numbers ofA. melas, C. thalassiusandC. tritaeniorhynchus, and fewerAnopheles squamosusTheo. andA. ziemanniGrünb. In both unbaited and baited situations, flight appeared to be in a predominantly upwind direction, although mere was some indication, in the presence of a calf, of convergence into the host stream.
The larval stages of the pasture and yellow soldier flies, Inopus rubriceps (Macq.) and I. flavus (James) (Diptera, Stratiomyidae)
Authors: Bull R. M.
Published: July 2009

A key is given to the larval instars, of which there may be nine or more, of Inopus rubriceps (Macq.) and I. flavus (James); the key is based on setal characters and development of the cranial lobes. Characters allowing recognition and sexing of the pupae are also described.
Biology and development of the sheep headfly Hydrotaea irritans (Fall.) (Diptera, Muscidae)
Authors: Tarry D. W. , Kirkwood A. C.
Published: July 2009

The biology and population fluctuations of the non-biting Muscid Hydrotaea irritans (Fall.) were studied in two contrasting areas of Surrey using a standardised catching technique at selected sites, by analysing catches and by dissecting the collected flies. Following the first appearance of adults in early June, catches reached a maximum in late July, the males having fallen to a small proportion by early July. During August catches gradually fell, remaining at a relatively low level for the rest of the summer. The complete life-cycle, starting with eggs from caged fly colonies, took 295 days under sheltered outdoor conditions. The fly is univoltine, with three larval instars; larvae leave the egg in the second instar which is a brief, saprophagous stage, while the third, principal stage is predatory on other insect larvae. Overwintering normally occurs as a late-stage larva. Flies collected from sheep-grazing areas in Northumberland were shown, using serological methods, to have fed predominantly on cattle blood protein.
Latent toxicity of dieldrin in the housefly, Musca domestica L. (diptera, muscidae)
Authors: Gerolt P.
Published: July 2009

The effects on the emerging adult of topical application of 14C-dieldrin to third-instar larvae of Musca domestica L., and the distribution of the insecticide in the fly, the puparial case, and the holding medium, were examined. The dose ranged from 0·04 to ca 13 μg/larva. All flies emerging after treatments of 1 μg and above showed symptoms of poisoning some time after emergence. With the larger doses an increasing number of flies, although they escaped the puparium, were unable to reach the surface of the holding medium. With the two top doses some were unable to escape fully from the puparial case. These flies contained amounts of dieldrin well in excess of the LD99 dose. However, even the highest dose allowed some flies to emerge normally. None of the treatments affected metamorphosis and all flies appeared morphologically normal. The data provided evidence that the transfer of dieldrin to the adult via the pupal stage accounts for the effects in the newly emerged fly.
A revision of the north-western European species of themerula, lacteus, vipio, ultor, ater, butalidis, popularis, carbonariusandvalidus-groups ofApantelesFörster (Hymenoptera, Braconidae)
Authors: Nixon G. E. J.
Published: July 2009

The north-western European species of themerula, lacteus, vipio, ultor, ater, butalidis, popularis, carbonariusandvalidus-groups ofApantelesare revised. Fifty species are dealt with, of which ten are described as new. Two species are synonymised,crantorNixon withcontortusTobias, andsarcitoriusTelenga withcarpatus(Say). For taxonomic reasons, the geographical region under consideration has been widened to include three species from Crete (urgoNixon,contortusTobias,myeloentaWilkinson) and two from Kazakhstan (lectusTobias,electilisTobias).
Distinctive features and geographical distribution of two closely similar pests of cotton (Empoasca devastans Dist. and E. terraereginae Paoli) (Homoptera, Cicadellidae)
Authors: Ghauri M. S. K.
Published: July 2009

Recent records show the distribution of Empoasca devastans Dist. extends further to the east (to East Pakistan, Thailand and New Britain) than had been recorded formerly, and approaches that of E. terraeregine Paoli, which is restricted to Queensland. Figures of the male genitalia are provided, by which the two species may be separated.