Chang Gung medical journal最新文献

Eosinophilic gastroenteritis is a rare gastrointestinal disorder characterized by nonspecific gastrointestinal symptoms, peripheral eosinophilia, and eosinophilic infiltration of the intestinal wall. The disorder is classified into mucosal, muscular, and subserosal types, depending on the depth of eosinophilic infiltration within the gastrointestinal wall, and the clinical picture varies accordingly. Subserosal disease, which is complicated by ascites, usually results in the most severe clinical form of eosinophilic gastroenteritis and mandates early corticosteroid therapy. In such cases, a favorable outcome can be achieved after a short course of corticosteroids. We present a rare case in a 43 year-old man in whom eosinophilic gastroenteritis spontaneously resolved without any medical treatment. After reviewing the literature and excluding secondary causes of eosinophilic gastroenteritis, we concluded that this may be the first reported case of spontaneous resolution of primary subserosal eosinophilic gastroenteritis.

Background: Clozapine, an atypical antipsychotic drug, induces derangements in glucose homeostasis in certain patients. This study investigated the mechanisms of clozapine-induced beta-cell toxicity.

Methods: Fifty-two healthy C57BL/6 male mice were randomized into 4 groups to study the effects of clozapine (group C, D) and a high-fat diet (group B, D). Three mice from each group were randomly selected to determine the amount of food intake on days 8-10, and their pancreases were removed for histological examination on day 11. The remaining 10 mice in each group were sacrificed at the 8th week to measure pancreatic insulin content (PIC).

Results: Mice given clozapine for 8 weeks demonstrated trends of lower PIC. The histological examination of the pancreases retrieved on day 11 already revealed apoptotic changes and suppression of cell proliferation. Although mice fed high-fat chow gained weight, mice given both clozapine and a high-fat diet showed less weight gain and more severe histological deterioration, and had the lowest PIC levels of the 4 groups.

Conclusion: Pancreatic beta-cell apoptosis, suppression of cell proliferation, and trends of reduction in pancreatic insulin content were observed in mice taking clozapine. The findings of clozapine induced beta-cell toxicity were further aggravated when mice were concomitantly fed a high-fat diet.

Background: Polymethylmethacrylate (PMMA) cement-augmented dynamic hip screws (DHS) have been used as a solution in unstable intertrochanteric fractures (ITF). Our aim was to investigate the complications in PMMA cement-augmented DHS.

Methods: All patients who had received DHS plate osteosynthesis with or without PMMA cement augmentation from August 2005 to July 2009 in one medical center were retrospectively reviewed. The fractures were classified as unstable (31-A2.2, 31-A2.3 and 31-A3) on the basis of the Arbeitsgemeinschaft für Osteosynthesefragen classification. Inclusion criteria were patients older than 75 years, unstable ITF treated with cement-augmented DHS, and a minimum of 12 months of follow-up. Exclusion criteria were stable ITFs, incomplete chart records and imaging studies, loss to follow-up or death before bone union.

Results: Three hundred twenty-one patients received DHS during the study period. Sixty-seven patients were included in the study (25 men and 42 women; mean age, 81.2 years). The mean follow-up time was 40.2 months, and the mean union time was 18.5 weeks (12-40 weeks). No patient had a lag screw cut-out. Six patients had delayed union or nonunion with side plate failures, including side plate breakage in 1 patient, screw breakage in 3, screw pullout in 1, and recurrent side plate breakage and screw breakage in 1. Deep infection occurred in 1 patient, and 1 had osteonecrosis at the femoral head. The procedure-related complication rate was 8.9%.

Conclusions: Cement-augmented DHS have a different failure mode than screw cutout in conventional DHS. Failures tended to be more related to delayed union, nonunion and resultant side plate construct failure.

Background: Recently the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) fusion gene with transforming activity was identified in non-small cell lung cancer (NSCLC). In addition, NSCLC patients with the EML4-ALK fusion gene had a dramatic response and longer progression free survival after ALK inhibitor treatment than those without this fusion gene. However, the incidence and clinical and molecular characteristics of the EML4-ALK fusion gene in NSCLC patients of Taiwan are still unclear.

Methods: Sixty-four fresh frozen tumor specimens were obtained from the tissue bank of Chang Gung Memorial Hospital for RNA extraction and EML4-ALK fusion gene detection. Paraffin sections of lung tumors from all of these patients were available and were analyzed for ALK protein expression by immunohistochemical (IHC) study. The results were correlated with clinical and molecular biomarkers.

Results: Three of the 64 tumors (4.7%) had the EML4-ALK fusion gene. Two were adenocarcinomas, and one was adenosquamous carcinoma. Twenty patients with non-squamous cell carcinomas had epidermal growth factor receptor (EGFR) mutations, so the EML4-ALK fusion gene was found in 14.3% of EGFR wild type non-squamous cell carcinomas. Two tumors were variant 3 (3a+3b with 3b predominant) and had strong staining (3+) for ALK by IHC stains. One tumor was variant 1 and had moderate staining (2+) for ALK. None of the ALK wild type tumors had strong staining for ALK. When compared with other clinical and molecular features, only the IHC stain for ALK was significantly correlated with the EML4-ALK fusion gene (p = 0.0002).

Conclusions: ALK overexpression detected by IHC study could be a promising detection method for the EML4-ALK fusion gene and is worth further confirmation with more samples.

Background: We report the outcomes of temporary vesicostomy- assisted anastomotic urethroplasty in patients with recurrent obliterated posterior urethral stricture.

Methods: A review of the medical records identified 12 men (mean age 35.8 years) who had undergone anastomotic urethroplasty for recurrent obliterated posterior stricture. Preoperative evaluation of the urethral defect included a simultaneous retrograde urethrogram and cystogram. The mean estimated preoperative radiographic length of the urethral disruption was 4.25 cm. All patients underwent 1-stage bulboprostatic anastomotic repair which was assisted by an intraoperative temporary vesicostomy.

Results: The initial objective success rate was 83%. The mean follow-up was 22 months. Voiding cystourethrography performed postoperatively demonstrated a wide, patent anastomosis in all but two cases. Urethroscopy performed 1 month after surgery revealed a patent anastomosis with normal urethral mucosa in all but two patients. The mean peak flow rate at the last follow-up visit was 16.3 ml/s. Two patients developed an anastomotic stricture 6 weeks after surgery that was successfully treated by direct visual internal urethrotomy. Finally, all patients had a patent urethra after salvage treatment postoperatively.

Conclusion: An open 1-stage temporary vesicostomy- assisted urethroplasty for recurrent obliterated posterior urethral stricture provides satisfactory outcomes and minimal morbidities.

Cervical cancer is third in incidence and fourth in mortality among cancers of women worldwide. Epidemiological studies have shown that human papillomavirus (HPV) is necessary, if not sufficient, to cause nearly 100% of cervical cancers. HPV testing is useful in primary screening for cervical neoplasms. The value of HPV detection or genotyping is potentially useful in triage of borderline or low-grade abnormal cervical cytology, follow-up after treatment of cervical intraepithelial neoplasia, assessment of prognosis and treatment planning for invasive cervical cancer. Studies from Chang Gung Memorial Hospital have defined the genotype distribution of cervical cancer in Taiwan and confirmed the independent prognostic value of the HPV genotype in cervical cancer. The cost-effectiveness of using HPV testing in prevention and management of cervical neoplasms depends on the medical and public health infrastructure of the individual country. The population-based HPV prevalence and genotype distribution as well as longitudinal follow-up studies have established strong support for incorporating HPV testing with cervical cytology and for future comparisons of HPV epidemiology before and after implementation of HPV prophylactic vaccines in Taiwan. Future directions in HPV research are discussed.

Background: Intraocular pressure (IOP) measurements are affected by the central cornea thickness (CCT). The conventional method for CCT measurement is ultrasonic pachymetry. However, noncontact procedures lower the risk of infection and corneal damage. In this study, we compared the CCT measured by Orbscan II, SP3000P, and ultrasonic pachymetry in patients with glaucoma or glaucoma suspect.

Methods: The CCT of 208 eyes (46 eyes with glaucoma suspect, 42 with primary angle-closure glaucoma, and 120 with primary open-angle glaucoma) was measured using Orbscan II, SP3000P, and ultrasonic pachymetry. We compared the linear correlation of the CCT between each mode.

Results: The mean CCT measured by Orbscan II (563.63 ± 35.867 µm) was larger than with the other two devices. There were significant linear correlations between measurements with ultrasonic pachymetry and Orbscan II (Pearson correlation coefficient (r) = 0.793, p < 0.001), ultrasonic pachymetry and SP3000P (r = 0.890, p < 0.001), and Orbscan II and SP3000P (r = 0.803, p < 0.001). We divided the participants into 3 groups on the basis of the CCT measured with ultrasonic pachymetry: ≤ 500 µm, > 500 µm to ≤ 578 µm, and > 578 µm. There was no significant linear correlation between ultrasonic pachymetry and Orbscan II in the thin group. But, in the intermediate and thick CCT groups, there were significant linear correlations between each of the three devices.

Conclusion: We showed good linear correlations of CCT measurements between each of 3 devices, especially in the intermediate and thickest CCTs. These results will be helpful in predicting the relationship between IOP and CCT for the diagnosis and screening of glaucoma; even we used optic systems.

Background: Pathology of the long head of the biceps tendon (LHB) is commonly associated with rotator cuff tears (RCTs). Superior labral anterior-posterior (SLAP) lesions can also occur with RCTs. The purpose of this study was to include SLAP lesions as part of LHB pathology in surgical cases of RCT and define the role of SLAP lesions in RCTs.

Methods: We retrospectively evaluated clinical data from 176 cases of complete RCT undergoing surgery. During surgery, the LHB was arthroscopically examined. A modified 6-type classification was used to describe the LHB pathology in these cases: tendinitis, subluxation, dislocation, partial tear, complete rupture and SLAP lesions. The relationship of LHB pathology to different characteristics of RCTs was statistically analyzed.

Results: Of RCT cases, 33% had Type 1 (tendinitis), 11% had Type 2 (subluxation), 9% had Type 3 (dislocation), 16% had Type 4 (partial tear), 7% had Type 5 (complete rupture) and 6% had Type 6 (SLAP) lesions. The remaining 18% of cases had no obvious LHB pathology. LHB pathology were associated with RCTs of a long duration (> 3 months), large area (> 5 cm(2)), and multiple or subscapularis tendon involvement. Seventy four percent of patients with affected shoulders underwent simultaneous surgery for both LHB pathology and RCTs.

Conclusion: Most patient with RCTs with chronic, massive, and multiple or subscapularis tendon involvement also had LHB injury. SLAP lesions, which we classified as a subgroup of LHB pathology, should be identified during rotator cuff surgery and treated appropriately.

Background: To investigate the effectiveness of histological examination of ulcer margins (HEUM) in detecting Helicobacter pylori (H. pylori) infection in patients with non-bleeding gastric ulcers (GUs).

Methods: A retrospective study included 284 patients with GU undergoing concomitant HEUM and rapid urease test (RUT) to detect H. pylori infection between January 2005 and December 2006. The slides were reviewed by an experienced pathologist (revised HEUM) in the 52 patients with inconsistent results on the initial HEUM and RUT. H. pylori infection was defined as a postive RUT and/or revised HEUM. Detection rates of H. pylori infection for HEUM and RUT were calculated accordingly. In patients with H. pylori infection, several parameters including ulcer characteristics and pathological findings were compared between patients with negative and positive (revised) HEUM.

Results: A total of 164 (57.7%) patients had positive results of H. pylori infection. The overall detection rates of H. pylori infection on the initial HEUM, revised HEUM and RUT were 78.0% (128/164), 89.0% (146/164), and 94.5% (155/164), respectively. For antrum ulcers, the respective detection rates were 81.0% (85/105), 92.4% (97/105), and 93.3% (98/105), for angulus ulcers, 78.6% (22/28), 85.7% (24/28), and 100% (28/28), and for proximal stomach ulcers, 61.9% (13/21), 81.0% (17/21), and 90.4% (19/21). In patients with H. pylori infection, gastric malignancy was more frequently observed in patients with false negative than true positive HEUMs.

Conclusions: HEUM might be not sensitive enough for diagnosing H. pylori in patients with GU. It was especially insensitive when the ulcers were in the proximal stomach, the ulcers were malignant, or the slides were interpreted by pathologists in a rotating manner.