Chang Gung Medical Journal

Leiomyosarcoma of the adrenal gland is extremely rare in the literature. We present a patient with an adrenal leiomyosarcoma originating from the adrenal vein, the pathologic findings and management. A 66-year-old man who was a hepatitis B virus carrier was found to have a huge left suprarenal mass on sonography and computed axial tomography. A huge tumor in the left suprarenal area with a markedly engorged adrenal vein was found during an adrenalectomy. The tumor thrombus extended into the renal vein, close to the inferior vena cava...

BACKGROUND: A gemcitabine-cisplatin combination is a standard treatment option for patients with advanced biliary tract carcinoma (BTC). We assessed the efficacy and safety of this regimen at Chang Gung Memorial Hospital. METHODS: Between April 2009 and December 2010, 30 chemotherapy-naïve patients (13 men and 17 women; median age: 61.5 years) with advanced BTC were retrospectively analyzed. Treatment consisted of gemcitabine (Gemmis(®); TTY, Taipei, Taiwan) 1000 mg/m(2), followed by cisplatin 30 mg/m(2) on days 1 and 8 every 3 weeks...

BACKGROUND: This paper aims to provide empirical evidence concerning the impact of team climate on knowledge sharing behavior and the mediating effects of individuals' altruistic intentions in the context of healthcare settings. METHODS: Questionnaire data were collected from 212 administrators employed at a medical center in Taiwan. Team climate was assessed by the Team Climate Inventory composed of four factors, participative safety, support for innovation, vision, and task orientation...

BACKGROUND: Everolimus has been approved for second-line treatment of patients with metastatic renal cell carcinoma (mRCC) after failure of sorafenib or sunitinib. The purpose of this retrospective study was to assess the efficacy and safety of everolimus in Taiwanese patients with mRCC. METHODS: Between March 2009 and August 2011, 24 mRCC patients treated with everolimus were analyzed. Prior to everolimus, each patient had received therapy with at least one vascular endothelial growth factor receptor-tyrosine kinase inhibitor...

BACKGROUND: Stroke is one of the most prevalent causes of adult disability and handicap. Informal caregivers play an important role in poststroke care. However, informal caregivers may experience strain, which threatens the recovery of stroke subjects. This study aimed to describe changes in strain experienced by informal caregivers from 3 to 6 months after the stroke, and identify the predicting factors. METHODS: We recruited pairs of inpatients with ischemic stroke and informal caregivers from a tertiary referral hospital and interviewed them at 3 and 6 months after the stroke...

BACKGROUND: The prediction of violence among psychiatric inpatients using biophysiological indicators is warranted for re-examinations longitudinally. This study aims to explore factors associated with the occurrence of violence and subsequent medical impacts in psychiatric inpatients. METHODS: Inpatients diagnosed with either schizoaffective disorder or bipolar mania were admitted to acute wards in a professional psychiatric care setting. A longitudinal analysis was applied to construct predictive models with blood biochemistry tests upon admission...

BACKGROUND: It is unknown whether the bronchodilation and anti-inflammatory effects of inhaled salmeterol and fluticasone (SF) are better than those of traditionally inhaled ipratropium, terbutaline and budesonide (ITB) in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). METHODS: Nineteen stable COPD patients with respiratory failure were randomly enrolled into two groups. Patients were treated with inhaled SF delivered by a metered-dose inhaler with a spacer or with inhaled nebulized ITB...

The occurrence of neonatal seizures is an important clinical sign indicating brain disorder in neonates. An identification of neonatal seizures is critical in the management of high risk neonates. However, the diagnosis and management of neonatal seizures are challenging, because electroclinical dissociation is an outstanding feature of neonatal seizures. Neonatal seizures are frequently not accompanied by any identifiable clinical symptoms even on close observation, whereas motor phenomena which have been considered to be seizures are not associated with ictal electroencephalography (EEG) correlates...

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...

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...

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...

BACKGROUND: Incorrect placement of pedicle screws may lead to neurovascular injury, so the position is important for the reduction of spinal fractures. CT-based image-guided surgery has been promoted as a means to theoretically improve the accuracy of pedicle screw placement. Patients who underwent CT-based navigation-assisted pedicle screw fixation for thoracic or lumbar fractures were reviewed to evaluate the accuracy of pedicle screw placement for spinal fracture cases. METHODS: A computed tomographic (CT)-based image-guided system (BrainLAB) was used for pedicle screw insertion in 14 patients with thoracic or lumbar spine fractures...

BACKGROUND: The purpose of this study was to investigate the degree of correlation between sexual dysfunction and depression, anxiety, and somatic symptoms among patients with major depressive disorder (MDD) and to identify the dimension most predictive of sexual dysfunction. METHODS: One-hundred and thirty-five outpatients with MDD were enrolled and were treated with open-label venlafaxine 75 mg daily for one month. The Arizona Sexual Experience Scale-Chinese Version (ASEX-CV), Depression and Somatic Symptoms Scale (DSSS), Hamilton Depression Rating Scale, and Hospital Anxiety and Depression Scale (HADS) were administered at baseline and at one-month follow-up and the improvement percentage (IP) of each scale posttreatment was calculated...

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...

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...

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...

Hepatoid differentiation in pancreatic carcinoma is a rare phenomenon. It occurs either as a pure form or as a component with other subtypes. Herein, we report a 52-year-old man with an ampullary large cell neuroendocrine carcinoma presenting with obstructive jaundice for 2 months. A 0.5-cm nodule was found in the pancreatic head. Morphologically, the nodule was composed of exclusively hepatocytic tumor cells and sinusoids with dysplastic cytology and capsular invasion. The patient did not have a hepatic mass or ectopic normal liver tissue...

The left superior laryngeal artery was observed arising from the external carotid artery instead of the superior thyroid artery in the cadaver of an approximately 70 year-old Asian man. In addition, on the same side, the superior thyroid artery arose from the common carotid artery 2 cm before the bifurcation instead of its usual origin from the external carotid artery. From the external carotid artery, the lingual and facial arteries arose from the common linguofacial trunk. The nerves in the carotid triangle were normal in course...

BACKGROUND: This study aimed to present experience in treating patients with posterior fossa epidural hematoma (PFEDH) and to discuss the risk factors, clinical features, and outcome in PFEDH patients with acute clinical deterioration (ACD). METHODS: Twenty-seven patients with PFEDH initially treated conservatively were evaluated. A comparison was made between patients with and without ACD during hospitalization. RESULTS: Eight of the 27 patients subsequently experienced ACD...

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...