Chang Gung medical journal最新文献

Background: Depression in Taiwanese university students is a significant problem in terms of life and financial costs. The purpose of this study was to examine the impact of four selected personality traits, namely interpersonal problems, ideas of being persecuted, social students in introversion, and self depreciation, on the inclination to be depressed among students in Taiwanese university.

Methods: A self-report survey was administered to students at a Taiwanese university and consisted of three parts: demographics, the Chinese version of the Basic Personality Inventory (BPI), and the Taiwanese Depression Questionnaire. The level of depression among students was assessed, and the relationships among the various variables were explored using analysis of variance (ANOVA) and regression.

Results: Altogether, 255 students successfully completed the survey. Overall, 37.62% of students were suffering from depression, including 4.7% who indicated that they were severely depressed, 18.30% who were moderately depressed, and 14% who were mildly depressed. In a multiple-regression model, ideas of being persecuted and self depreciation were both significant when predicting an inclination to be depressed.

Conclusion: Depression is a problem for many university students in Taiwan. Understanding which personality traits are related to depression in Taiwanese students is important for student affair administrators and medical professionals and will help them to prevent and treat this debilitating illness.

Background: Liver transplantation (LT) in patients with portal vein thrombosis (PVT) remains a challenge for transplant surgeons. In this study, we included a group of patients with PVT who underwent LT, and analyzed patient outcomes.

Methods: A total of 356 patients who underwent LT consisting of 167 cases of deceased donor LT and 189 cases of live donor LT at Chang Gung Memorial Hospital Linkou Medical Center between September 1996 and June 2009 were retrospectively reviewed; 24 (6.7%) of these patients had PVT at transplantation. Their clinical features, surgical management, and outcomes were analyzed.

Results: Surgical management of patients with PVT included a thrombectomy followed by direct anastomosis between the recipient's and the liver graft portal vein (PV) (n = 13), interposition vein graft between the recipient's coronary vein (CV) and the liver graft PV (n = 3), direct anastomosis of the recipient's CV and the liver graft PV (n = 1), interposition jump graft from the recipient's superior mesenteric vein to the liver graft PV (n = 4), and transection of the thrombotic PV followed by interposition of a venous graft between the recipient's PV and the liver graft PV (n = 3). There were 7 hospital mortalities. The mean follow-up for the 17 surviving patients was 36.3 months (range, 3.4-105.1 months), and 14 patients were still alive at the end of the study. Four patients (16.7%) had rethrombosis of portal inflow after LT. Patients with PVT undergoing LT had a significantly higher mortality rate (p = 0.033) than patients without PVT undergoing LT. However, there was no significant difference in the cumulative survival rates (p = 0.0696). Further analysis of patient survival according to PVT grade, venous graft application, and reconstructed portal flow routes also exhibited no significant differences.

Conclusions: LT for patients with PVT is clinically feasible and should not be considered a contraindication. However, a favorable outcome is achievable only with ideal surgical management to overcome PVT during LT.

Facial asymmetry is common in humans. Significant facial asymmetry causes both functional as well as esthetic problems. When patients complain of facial asymmetry, the underlying cause should be investigated. The etiology includes congenital disorders, acquired diseases, and traumatic and developmental deformities. The causes of many cases of developmental facial asymmetry are indistinct. Assessment of facial asymmetry consists of a patient history, physical examination, and medical imaging. Medical imaging is helpful for objective diagnosis and measurement of the asymmetry, as well as for treatment planning. Components of soft tissue, dental and skeletal differences contributing to facial asymmetry are evaluated. Frequently dental malocclusion, canting of the occlusal level and midline shift are found. Management of facial asymmetry first aims at correcting the underlying disorder. Orthognathic surgery is performed for the treatment of facial asymmetry combined with dental occlusal problems. A symmetrical facial midline, harmonious facial profile and dental occlusion are obtained from treatment. Additional surgical procedures may be required to increase or reduce the volume of skeletal and soft tissue components on both sides to achieve better symmetry.

Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impact the quality of life. Conservative therapy using external bracing, bed rest and analgesics is necessary for pain control in these patients. However, some patients may experience protracted or ongoing pain even with these measures. Surgical treatment is indicated when conservative treatment fails, or in patients with spinal instability or neurologic deficit. Elderly patients often have comorbilities, and because of osteoporosis, high risk of postoperative complications such as implant loosening, and further adjacent fractures. Vertebroplasty involves a percutaneous injection of bone cement into the collapsed vertebrae under fluroscopic imaging guidance. It was first reported in 1987 for the management of a painful, aggressive hemangioma of a vertebral body. Since then, vertebroplasty has been widely accepted for the treatment of vertebral osteoporotic compression fractures without neurological damage. This article summarizes the advances in vertebroplasty, and discusses the indications, technique, alternative methods, results and complications. The contents include a review of the supporting evidence to provide a comparison of the safety and efficacy of vertebroplasty and kyphoplasty.

Background: A combination of salmeterol and fluticasone propionate (SAL/FP) has been shown to be effective in the treatment of asthma. We compared the efficacy and tolerability of SAL/FP (50/250 μg) with fluticasone propionate (FP) 250 μg administrated twice daily for 2 weeks in treating patients with mild to moderate asthma.

Methods: This was a randomized, double-blind study in adult patients with symptomatic asthma that was not controlled by 1000 μg/d inhaled corticosteroids (ICS) alone. 48 asthmatics were randomized to receive 2 inhalations of SAL/FP 50/250 μg bis in die (BID) or 2 inhalations of FP 250 μg BID, both delivered via Accuhaler device, for 2 weeks. The primary objective was the mean change from baseline in the mean morning peak expiratory flow (PEF) over the two week period. Other parameters included lung function, daily asthma symptom scores, evening PEF, percentage of days free of rescue medication use and daily rescue medication use. Tolerability was assessed by adverse events spontaneously elicited at clinic visits.

Results: 46 patients provided evaluable efficacy for analysis. The morning PEF improved significantly throughout the two weeks of treatment compared with baseline in the SAL/FP group. Mean morning PEF was 23.0 L/min higher in SAL/FP group than in FP group (p = 0.013). The change of forced expiratory volume in one second (FEV1) from baseline was greater in SAL/FP group compared to FP group (p = 0.048). There were similar effects on day-time and night-time symptom scores, percentage symptom free days and nights and usage of salbutamol. 70.8% of the patients receiving SAL/FP were satisfied with the treatment, while only 26.1% of patients receiving FP alone were (p = 0.020). No death or acute exacerbation occurred.

Conclusion: SAL/FP 50/250 μg was safe and effective, and had a high level of patient satisfaction resulting in significantly greater increases in morning PEF and FEV1 compared to the use of FP 250 μg alone.

Background: Current evidence suggests that obstructive sleep apnea-hypopnea syndrome (OSAHS) is an independent risk factor for systemic hypertension. The mechanisms linking OSAHS to hypertension remain unclear. However, recent studies have indicated that abnormal autonomic control may be an important factor. Our study aims to evaulate differences in autonomic activity between hypertensive and normotensive OSAHS patients before and during continuous positive airway pressure (CPAP) therapy.

Methods: Fifty-three OSAHS patients were analyzed in this study. Patients were divided into 2 groups, one group comprising patients with hypertension and the other of patients without hypertension. Heart rate variability (HRV) was assessed by polysomnography, before patients received CPAP titration and during CPAP titration. Then, HRV was compared between the hypertensive and normotensive groups. Multivarate analyses were used to evaluate the influence of clinical variables on autonomic activity.

Results: Although HRV before CPAP titration was not statistically different between the 2 groups, low frequency variability was significantly lower in hypertensive subjects who received CPAP titration compared with normotensive subjects. Multivariate analysis revealed that hypertension is a determinant factor of autonomic change during CPAP use.

Conclusions: Our findings demonstrate that CPAP therapy results in a greater and immediate change in autonomic activity in hypertensive OSAHS patients compared with normotensive OSAHS patients. This suggests that CPAP lowers blood pressure by decreasing the patient's autonomic activity.

Background: Cardiac myxoma, the most common primary tumor of the heart, has variable clinical presentations and an immunohistochemical profile. Survivin, an antiapoptosis protein, may play an important role in the causes of cardiac myxoma. This investigation will report the expression pattern of survivin in cardiac myxomas.

Methods: This study included 40 patients with cardiac myxoma, who were treated with surgical excision of the lesion. Detailed clinical parameters were reported and the expression of survivin was studied by immunohistochemical staining.

Results: The patient population was comprised of 24 (60%) women and 16 (40%) men. The mean age of the patients was 42 years, with an age range of 30 to 63 years. All study cases were sporadic myxomas rather than familial myxoma. Patients were asymptomatic (20%), or had dyspnea (40%), stroke (15%), chest pain (12%), and fever (12%) on presentation. All lesions were located in the left atrium. The location of the myxoma and clinical events did not differ in terms of pathological changes, such as vascular proliferation, inflammation, cellularity, hyaline, calcification and thrombosis. Cardiac myxoma was characterized by a survivin dependent pathway with 100% immunohistochemical staining in the cytoplasm and the distribution in scoring system of survivin expression were 1 case (2.5%) in score 1; 12 cases (30%) in score 2; 12 cases (30%) in score 3 and 15 (37.5%) in score 4.

Conclusion: Cardiac myxomas demonstrate strong expression of survivin in the cytoplasm. This implies survivin may play an important role in the apoptosis pathway in cardiac myxomas.

Background: The serum potassium (K+) level is kept in a narrow range to sustain normal physiology within the human body by the kidneys. The serum K+ level in different stages of chronic kidney disease (CKD) remains undefined.

Methods: We conducted a cross-sectional study to observe the serum K+ level in patients without clinical manifestations of hyperkalemia in the late stages of CKD (stages 3-5). A total of 531 patients with late stage CKD were included and followed up for at least 1 year, from March 2006 to May 2007. The patients were sub-grouped by stages of CKD, which were determined by a "Modification of Diet in Renal Disease" equation estimating the glomerular filtration rate (eGFR). The serum creatinine, eGFR and K+ levels were recorded at least twice during the study. We analyzed the average K+ level in these late-stage CKD patients.

Results: The average K+ level increased along with renal function deterioration in the late stages of CKD (stage 3: 4.36 ± 0.49; stage 4: 4.50 ± 0.55; stage 5: 4.69 ± 0.73 mEq/L, p < 0.05). Men and patients with diabetes mellitus, a low eGFR, and a low hemoglobin might have higher levels of serum K+. We also noticed that there was a linear increase in the standard deviation of the serum K+ level as renal function deteriorated. The use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers was not associated with hyperkalemia in our patients.

Conclusion: Our results reflected that the serum K+ level increased in correlation with the decline in the eGFR in the late stages of CKD. Also, male gender, diabetes mellitus, and anemia might be risk factors for higher K+ levels in CKD patients. The variation in the serum K+ level became wider as renal failure progressed.

Fetishism is characterized by recurrent, intense sexual fantasy or behavior involving the use of nonliving objects, such as women's undergarments, over a period of at least six months. This disorder occurs mostly in males and usually begins in adolescence. The neurobiological etiologies of fetishism remain unclear, and studies on treatment were limited. We present a 14- year-old boy with attention deficit hyperactivity disorder with fetishistic behavior who was treated successfully with 36 mg extended-release methylphenidate daily and 4 months of cognitive-rational emotive psychotherapy.