Gaoxiong yi xue ke xue za zhi = The Kaohsiung journal of medical sciences最新文献

The traditional submucosal resection of the septal deviation (SMR) is a good method to correct septal deviations, but it is not useful for treating either caudal end deviations or deformities from posterior septum to caudal ends. There have been several methods proposed to correct caudal end deviations, and Ellis's suture technique is considered to be the most effective and convenient one after many years of implementation. Our department has selected 18 cases of caudal end deviations for application of Ellis's suture technique in recent years. Sixteen of the 18 cases have been followed for at least one year, two of them for less than a year. The results are very satisfactory. This article is meant to present the outcome.

In 1960, the functional matrix hypothesis was first articulated by Moss. Although many investigators agreed that there were genetic influences on craniofacial growth, the functional demands of matrices are more significant in determining craniofacial morphology during growth. Therefore, during postnatal growth, an intimate functional relationship exits between the jaw muscles and the bones to which they are attached. The most recent findings suggest that the morphological changes can be observed not only in areas adjacent to muscle insertion but also in growth sites affecting the rotational growth pattern of the cranium. If this is true, the reduced functional demands on the masticatory muscles may cause some changes of craniofacial growth. To test this hypothesis, a longitudinal study by means of cephalometric analysis to observe the changed masticatory function induced by a diet of physically soft food on the craniofacial morphology in the growing rabbits was conducted. One group of rabbits was fed with a soft diet, while another group received a standard laboratory diet and served as the control group. These animals had been weaned at the start of the experiment (1 month of age), and the experimental period last for 6 months. During that time, all rabbits were weighed every month, and lateral cephalograms were taken with the skull fixed in a specially constructed cephalostat. The procedure of taking a cephalogram entails the sacrifice of the subject. Thus five rabbits in each group were sacrificed each experimental period. The radiographic images were copied on photographic paper, magnified by two and the cephalometric analyses were performed. The results are as follows: 1. There were no statistical differences between groups in any of the test periods for body weights. 2. The results of cephalometric analysis showed that no difference in overall skull shape could be found between the two groups, but a more anterior superior growth rotation of the upper jaw occurred in the rabbits fed with soft diet compared to the rabbits fed with a standard laboratory diet. Thus, the skull became more erect position in the soft diet group. 3. In the soft diet group, the angular process of the mandible was less convex. That was a clockwise growth pattern. In addition, there was a thin and flat shape of mandibular body in compared to control group.

This study evaluates the effects of steroid inhalation on lung ventilation (LV) and alveolar permeability (AP) in 26 patients with asthma. The homogeneity of LV was evaluated as the inhalated Tc-99m diethylene triamine pentaacetic acid (DTPA) radioaerosol depositing ratios of the central 1/3 over peripheral 1/3 of the left lung. It is shown as a distribution factor (DF) in this study. The damage in AP was measured from the speed of Tc-99m DTPA radioaerosol clearance curves from the peripheral alveoli of the left lung and is represented as a slope in this study. The baseline LV and AP were calculated before an inhalation therapy of 0.05 mg beclomethasone dipropionate four times daily for one week, then the studies were repeated after treatment to evaluate the effects of inhalation therapies. The results revealed a significantly improved homogeneity of LV in 16/26 (62%) cases (DF: 0.79 +/- 0.32 vs 0.59 +/- 0.22, P = 0.0001), but no apparent change in AP (slope: 1.18 +/- 0.78 vs 1.25 +/- 0.88, P = 0.052) after the treatment. In conclusion, a corticosteroid inhalation therapy for asthma can improve the peripheral LV, but can not change the AP according to the findings of Tc-99m DTPA radioaerosol inhalation lung scintigraphy. We suggest that the widely available Tc-99m DTPA radioaerosol inhalation lung scintigraphy, coupled with the evaluation of LV and AP could contribute to any disorder involving both alveoli and airways.

The rapid growth of the over 65 population in Taiwan during recent decades has brought into focus the planning to provide health care for aged citizens. It is generally agreed that the incidence of mental disorders rises with age. With the stress on rapid treatment and early return to community, the concept of short-term hospitalization for the geropsychiatric patients has become more accepted. In this study we examined characteristics, diagnostic classification and treatment outcomes of 524 consecutive patients (age > or = 65) admitted to the geropsychiatric unit of a general hospital over a 5-year period. Results demonstrated that 45.9% of the patients had organic mental disorders. Among them, almost half of the patients were diagnosed as having dementia; delirium was the second most common diagnosis. The average length of stay was 26.7 days for all patients and it was not affected by diagnostic subtype. No significance was found in the length of stay between the geropsychiatric inpatients and the other psychiatric inpatients. Outcomes measure showed favorable response to hospitalization in most of these patients. These data suggested that there is a specific diagnostic distribution in the geropsychiatric inpatients. Rigorous organic work-up in these patients is necessary to rule out organic problems. The favorable response after short-term hospitalization indicated the restorative and rehabilitative functions of the general hospital geropsychiatric care. The hospital's fears of being burdened with a chronic population could be lessened with a suitable referral system. Further study is needed to explore whether early geropsychiatric intervention may obviate the need for admission or reduce the length of stay.

Aspergillus-associated pulmonary diseases are aspergilloma, invasive aspergillosis, and allergic bronchopulmonary aspergillosis. Allergic bronchopulmonary aspergillosis is caused by a complex of immunologic reactions to the presence of the Aspergillus species colonizing the bronchial trees. The disease is not common in Taiwan. The major diagnostic criteria for allergic bronchopulmonary aspergillosis are 1) bronchial asthma, 2) pulmonary infiltration, 3) peripheral eosinophilia, 4) positive skin test to Aspergillus fumigatus, 5) serum precipitin to Aspergillus fumigatus, 6) elevated serum Ig E, and 7) central bronchiectasis. We report a case who has had a chronic asthmatic-like cough for 5 years. He worked in a silo for two years before he was troubled by the disease. He was admitted to hospitals four times in the past, and received five bronchoscopic examinations and one open lung biopsy without definite diagnosis. Sputum eosinophilia directed our attention to the differentiation of eosinophilic lung diseases. A bronchogram which revealed central brochiectasis helped us to make the diagnosis of allergic bronchopulmonary aspergillosis, despite negative sputum culture for Aspergillus fumigatus and negative serum precipitin to Aspergillus fumigatus.

Dystrophin is a protein product of the Xp 21 gene which is defective in patients with Duchenne muscular dystrophy (DMD). In immunohistochemical staining of dystrophin, the majority of DMD muscle fibers show negative staining. Nevertheless, biopsy specimens from DMD patients labeled with many different antibodies may show a small number of fibers which are clearly dystrophin positive. This very small percentage of dystrophin-positive fibers (DPF) probably represents somatic reversion, suppression of the DMD gene mutation or alternating splicing of dystrophin mRNA. To determine the significance of isolated DPF in muscle specimens of DMD patients, we examined 30 DMD muscle specimens, aged 4 years to 16 years, by the use of monoclonal antibody against the C-terminal region of dystrophin. Additionally, muscle specimens from 2 normal human controls and 2 mice with X-linked muscular dystrophy were used for positive and negative controls, respectively. Muscle specimens from DMD patients and mdx mice showed almost totally negative dystrophin staining in most of their muscle fibers, but in 20 patients, three was a trace of isolated DPF ranging from 0.06% to 0.77%. DMD patients with no isolated DPF seemed to have higher functional disability. In the whole group of 30 patients, a significant negative correlation was found between the abundance of DPF and clinical functional grading (r = -0.85, p < 0.0001, based on linear regression). It is suggested that even the very low concentrations of dystrophin found in DMD patients may have a favorable functional significance.

Systemic lupus erythematosus (SLE) can affect every organ. Involvement of the lung in systemic lupus erythematosus may be a significant cause of morbidity and mortality. To evaluate alveolar epithelial damage in SLE, we studied lung epithelial permeability by measuring the clearance of inhaled Tc-99m DTPA aerosol. Twenty-three SLE patients without clinical pulmonary manifestations were studied. Of the 23 patients, 16 had normal clearance rates of Tc-99m DTPA (T1/2 > 60mins) and normal chest X-ray findings. A mild increase in the clearance rate was found in 5 cases (T1/2 between 40-60 min) and a significant increase in clearance rate in the remaining 2 (T1/2 < 40mins). Totally, 30% (7/23) of SLE patients have abnormal lung permeability. Of the 7 patients with abnormal clearance of Tc-99m DTPA, 3 had abnormal findings in chest X-rays and four had normal chest X-rays. Our study suggests that the clearance of Tc-99m DTPA aerosol may be a useful complementary study to assess pulmonary involvement in SLE.