Chang Gung medical journal最新文献

Background: Anatomical studies regarding the inferior oblique muscle are scarce and the exact location of the entry of oculomotor nerve to the muscle has not been reported. In the present study, the objectives were to examine the exact location of the entry of oculomotor nerve to the inferior oblique muscle and to study the topographical anatomy of the muscle.

Methods: The study included 56 intact orbits from 28 embalmed south Indian adult cadavers. The entire course of the nerve to the inferior oblique was exposed from both anterior and posterior aspects in all specimens. The exact location of the entry of nerve supplying the inferior oblique muscle was identified and the distances of the muscle from inferior and medial orbital margins were measured.

Results: The oculomotor nerve entered the inferior oblique muscle through the orbital surface in 42 (75%) cases, through the ocular surface in 10 (17.9%) cases and through the posterior border in 4 (7.1%) cases. The distance of the muscle from the inferior orbital margin was 1 mm in majority (78.5%) of the cases. The distance of the muscle from the medial orbital margin was 11 mm in majority (42.8%) of the cases.

Conclusion: The present study reports that the oculomotor nerve most often enters the inferior oblique muscle through its orbital surface. Detailed knowledge of the topographical anatomy of inferior oblique muscle and its site of nerve entry are essential for surgeons when performing ophthalmological surgery and regional anesthesia.

Background: Levobupivacaine and ropivacaine are new local anesthetics that have effects similar to bupivacaine. However, the relative potency of these two drugs is controversial. The purpose of this retrospective study was to assess whether a combination of 0.06% levobupivacaine and 0.0002% fentanyl had the same effects as 0.08% ropivacaine and 0.0002% fentanyl on the mode of delivery and other obstetric outcomes when used for epidural analgesia of labor in nulliparous women.

Methods: Computer records of 392 Asian nulliparous parturients, who had presented with spontaneous labor or spontaneous rupture of the membranes, and had received epidural analgesia were retrospectively reviewed. Of these, 193 received 0.08% ropivacaine and 199 received 0.06% levobupivacaine. Fentanyl (0.0002%) was used in both regimens.

Results: There were no significant differences in the mode of delivery, duration of labor, or neonatal outcome between the two groups. In the levobupivacaine group, the parturients required top-up boluses of local anesthetics more frequently (1.4 ± 1.6 vs. 0.9 ± 1.3, p< 0.0001), and the incidence of temporary maternal fever (25 % vs. 15%, p = 0.024) and the cost of local anesthetic were higher (292 ± 183 NTD vs. 146 ± 104 NTD, p< 0.0001). However, the amount of local anesthetic administered during labor was lower (79 ± 49 mg vs. 114 ± 81 mg, p< 0.0001) than for the ropivacaine group.

Conclusions: 0.06 % levobupivacaine was as effective as 0.08% ropivacaine, when both were used with 0.0002% fentanyl for labor epidural analgesia of nulliparous women.

Background: The meniscus plays a key role in the functioning of the knee. At the present time, meniscal repair has becomes the main treatment for meniscal tear. Compared to open surgery, arthroscopic meniscal repair has become popular because of shorter time need for the operation, the smaller wound, and better accessibility to the tear portion, which is particularly difficult during open surgery. Three arthroscopic techniques are widely used, namely inside-out, outside-in, and all-inside. Arthroscopy all inside meniscal repair has the lowest neurovascular injury rate.

Methods: This study prospectively evaluated 31 consecutively treated patients to determine the effectiveness/safety of arthroscopic meniscal repair using the FasTFix repair system. The inclusion criteria for this study were: vertical fullthickness tear> 10 mm in length; location of the meniscal tear < 6 mm from the meniscocapsular junction; repair of the meniscus solely with the FasTFix system; no former meniscus surgery; and no evidence of arthritis during arthroscopy. Anterior cruciate ligament (ACL) deficient knees were reconstructed using a hamstring autograft at the time of the meniscal repair. Follow-up examinations consisted of Lysholm knee score, Tegner activity score and radiographic evaluation.

Results: After an average of 3 years follow-up, no symptoms of meniscal tears were found in 30/31 of the cases. For patients with isolated meniscal repair or concurrent ACL reconstruction, the Lysholm and Tegner activity scores had significantly improved postoperatively. No neurovascular or other major complications were directly associated with the use of the device.

Conclusions: Arthroscopic all-inside repair using the FasT-Fix device appears to be a safe and effective procedure.

Background: Dental anomalies associated with different severities of cleft lip and palate have been rarely reported. This retrospective study investigates the characteristics of dental anomalies associated with different types of cleft, and compares the dental anomaly traits based on sex and severity of cleft.

Methods: Cleft patients born in 1995 with qualified diagnostic records from 7 to 11 years were included for evaluation. Records were retrieved from database of Chang Gung Craniofacial Center, including panoramic radiographs and intraoral photographs. In total, 196 patients with complete records were included in the evaluation. This study compares the dental anomalies associated with each type of cleft.

Results: The frequency of dental anomalies in the maxillary incisor area in the cleft palate (CP) group (20%) was significantly lower than that in other groups. The frequency of missing maxillary lateral incisors (MLIs) increased as the cleft severity increased. Supernumerary teeth and missing lower incisors exhibited the opposite trend. No sexual dimorphism appeared in terms of the frequencies of peg laterals and missing MLIs. The distribution patterns of missing MLIs and peg laterals in males, but not in females, were consistent for the three types of unilateral clefts.

Conclusion: Regarding the characteristics of dental anomalies among the three unilateral clefts, missing MLIs, supernumerary teeth, and missing lower incisors were found to be related to cleft severity. The maxillary lateral incisor was the most affected tooth in the cleft area. The frequency of missing MLIs and peg laterals was not sexual dimorphic, but the distribution pattern was different between the sexes.

Background: In chronic hepatitis B, the HBcAg viral protein in liver tissue demonstrates a positive correlation with serum aminotransferase levels, serum hepatitis B viral DNA, and histological activities. Little is known if similar relationships exist for chronic hepatitis C. This study attempted to determine if expression of the hepatocyte NS3 protein of the hepatitis C virus (HCV-NS3) was correlated with the serum HCV-RNA load, hepatitis activity, or other clinical parameters.

Methods: Clinical and histological data of 214 patients with chronic hepatitis C were retrospectively reviewed. A mouse monoclonal antibody was used to detect HCV-NS3 in hepatocytes. The staining intensity was scored semiquantitatively as 0~3+, and its correlations with the serum HCV-RNA load, hepatitis activity, and other clinical parameters were analyzed.

Results: In total, 202 (94%) of the 214 liver biopsies were positive for HCV-NS3, and the intensity of HCV-NS3 staining was 0 in 12 (6%), 1+ in 181 (84%), and 2+ in 21 patients (10%). The intensity of HCV-NS3 expression in the samples did not correlate with patient age (p = 0.302, ANOVA), patient gender (p = 0.130, Fisher's exact test), the alanine transaminase level (p = 0.177, ANOVA), serum HCV-RNA level (p = 0.305, ANOVA), HCV antibody titer (p = 0.139, Chi-squared test), hepatitis activity index score (p = 0.861, Chisquared test), or sustained viral response rate (p = 0.861, Chi-squared test).

Conclusions: This HCV-NS3 immunohistochemical staining method was reliable for detecting HCV in liver specimens. Hepatocyte expression of HCV-NS3 was not correlated with the serum viral load, severity of hepatic injury, or treatment response.

Background: Computed tomographic coronary angiography (CTA) is a non-invasive alternative to conventional coronary angiography (CCA) in detecting chronic coronary artery disease (CAD). However, the value of CTA in estimating acute myocardial infarction (AMI) has not been evaluated.

Methods: CTA and CCA were performed on 10 patients with non-ST-elevated AMI and 17 patients with stable angina pectoris. The plaque components and stenosis severity were assessed by both modalities to clarify the diagnostic values of CTA in AMI and stable angina pectoris.

Results: A high total coronary artery calcium (CAC) score was significantly correlated with the presence of CAD and the target lesion CAC score (p < 0.01). The AMI group tended to have a lower target CAC score (p = 0.10) and target plaque burden (p = 0.27), compared to the stable angina pectoris group. To estimate the coronary artery stenotic severity, CTA and CCA had concordant correlations in all segments, except in the proximal left anterior descending (LAD) artery. The calcium score and calcification fraction percentage in the proximal LAD artery were significantly higher than those of other segments (p < 0.01). Compared to CCA, CTA overestimated the severity of stenosis in the proximal LAD arterial segment in the stable angina pectoris group (p = 0.028), but not in the AMI group.

Conclusions: CTA has diagnostic values similar to those of CCA in detecting coronary lesions in patients with AMI or stable angina pectoris. However, a high level of plaque CAC in the stable angina pectoris group may lead to an overestimation of the severity of coronary stenosis, especially in the proximal LAD arterial segment. Although less remarkable, the impact of CAC on the diagnostic value of CTA was still substantial in patients with AMI.

Like other intra-articular fractures, the tibial plateau fracture is challenging for orthopedic surgeons because of its severity of trauma, associated soft tissue injuries. Open reduction incurs serious complications, especially wound healing after traditional dissections. Unsatisfactory results often occur in complex or bicondylar tibial plateau fractures. Traditional surgical methods achieved satisfactory results in 70-80% of cases. However, these methods have a high incidence of complications including loss of reduction, infection, and septic arthritis. The advantages of arthroscopy-assisted reduction and internal fixation include direct visualization of intra-articular fracture, accurate fracture reduction, and reduced morbidity. It is straightforward in the diagnosis and treatment of meniscal and ligamentous injuries, and removal of loose fragments. Good early to medium-term results of arthroscopically assisted osteosynthesis of tibial plateau fractures have been reported. The author reviews the current surgical principles, pitfalls, approaches, clinical results, and complications of arthroscopyassisted surgery for tibial plateau fractures.

Primary neoplasms of the heart are rare. Malignant cardiac myxoma, or so-called myxosarcoma, accounts for about 6% of primary malignant cardiac tumors. Cerebral metastasis of malignant cardiac myxoma is extremely rare; only three cases have been reported and two of them included an autopsy study. The case described herein is the first reported brain metastasis combined with multiple cerebral aneurysms originating from primary cardiac myxosarcoma. The true incidence of cerebral myxomatous aneurysm is unknown and the pathogenesis of myxomatous aneurysm formation has not been fully defined. The current hypothesis favors that tumor materials from cardiac myxomas embolize into the vasa vasorum of the peripheral arteries and subsequently prolifere in the vessel wall. This then leads to a weakening of subintimal tissue, such as the internal elastic lamina, with subsequent aneurysm formation. The prognosis of cardiac myxosarcoma is very poor. Although malignancies most likely develop from the mesenchymal cells, they are difficult to treat with any modality (operation, chemotherapy, radiotherapy or transplantation) because these tumors have usually undergone extensive spread by the time the diagnosis is made.

Four and a half LIM domains protein 1 (FHL1) and FHL2, as the name suggests, contain four and a half LIM domain binding proteins. Proteins in this family capable of interacting with many types of proteins, including structural proteins, kinases, and several classes of transcription factors, have been identified. These interactions have been found to have important roles in a variety of fundamental processes including transcriptional regulation, cardiovascular development, hypertrophy, atherosclerosis, and angiogenesis. This article reviews recent advances in the characterization of FHL1 and FHL2, their biological roles, LIM domain binding proteins, and functions in the cardiovascular system.

Huntington's disease (HD) is an autosomal dominant, progressive neurodegenerative disorder, characterized by an array of different psychiatric manifestations, cognitive decline and choreiform movements. The underlying molecular genetic defect is an expanded trinucleotide (CAG)n repeat encoding a polyglutamine stretch in the N-terminus of the huntingtin protein. The mechanisms by which mutant huntingtin causes neuronal dysfunction and degeneration are not fully understood. Nevertheless, impaired ubiquitin-proteasome activity, defective autophagy-lysosomal function, transcriptional dysregulation, oxidative stress, apoptosis, mitochondrial and metabolic dysfunction, and abnormal protein-protein interaction have been shown to play important roles in the pathogenesis of HD. Neurons are energy-demanding and more susceptible to energetic failure and oxidative damage than other types of cell. Given that mitochondria play a central role in both processes of metabolism and oxidative stress, and increasing direct evidence shows mitochondrial abnormalities in both HD mouse models and patients, this article will review the studies of mitochondrial dysfunction, metabolic deficits, and increased oxidative stress in HD, and discuss the potential therapeutics targeting these abnormalities.