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  Citation statistics : Table of Contents
   2018| January-March  | Volume 30 | Issue 1  
    Online since March 9, 2018

 
 
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CASE REPORTS
Brain metastasis from renal urothelial carcinoma successfully treated by metastasectomy
Wen-Kuei Fang, Yeong-Chin Jou, Yuan-Chang Dai, Pi-Chan Ko, Ya-Fang Huang
January-March 2018, 30(1):41-43
DOI:10.4103/tcmj.tcmj_82_17  PMID:29643716
Upper tract urothelial cancer (UTUC) arises from the urothelial lining of the urinary tract. UTUC spreads in several different ways including direct invasion, lymphatic spread, and hematogeneous metastases. Regional lymph nodes are commonly the initial site of metastasis, followed by the liver, lung, and bone. Brain metastasis is uncommon in patients with urothelial carcinoma. Here, we report an uncommon case of kidney urothelial carcinoma with brain metastasis in a 55-year-old woman presenting with dysarthria with right side limb weakness. The patient recovered well after resection of the brain lesion without any sequelae after 1 year of follow-up.
  1 1,746 149
Penile and multiple cutaneous metastases over the pubic region from a rectal adenocarcinoma: An uncommon case
Vipul D Yagnik
January-March 2018, 30(1):44-46
DOI:10.4103/tcmj.tcmj_73_17  PMID:29643717
Synchronous penile and multiple cutaneous metastases over the pubic region from a rectal adenocarcinoma are rare, and they usually indicate widespread disease. The most frequent localization of cutaneous metastases is the postoperative scar. Simultaneous penile and pubic region metastases are extremely uncommon. Although a penile metastasis from a rectal adenocarcinoma has been reported, synchronous metastases over the penile and pubic area have not been reported previously. We present a case of penile and multiple cutaneous metastases over the pubic region from a rectal adenocarcinoma along with a brief review of the literature. To the best of our knowledge, this is the first such case reported to present with simultaneous penile and multiple cutaneous metastases.
  1 1,702 146
ORIGINAL ARTICLE - BASIC RESEARCH
Delayed formation of hematomas with ethanol preconditioning in experimental intracerebral hemorrhage rats
Hung-Yu Cheng, Li-Chuan Huang, Hsiao-Fen Peng, Jon-Son Kuo, Hock-Kean Liew, Cheng-Yoong Pang
January-March 2018, 30(1):5-9
DOI:10.4103/tcmj.tcmj_184_17  PMID:29643709
Objective: Spontaneous intracerebral hemorrhage (ICH) accounts for 10%–15% of all strokes and causes high mortality and morbidity. In the previous study, we demonstrated that ethanol could aggravate the severity of brain injury after ICH by increasing neuroinflammation and oxidative stress. In this study, we further investigate the acute effects of ethanol on brain injury within 24 h after ICH. Materials and Methods: Totally, 66 male Sprague-Dawley rats were assigned randomly into two groups: saline pretreatment before ICH (saline + ICH), and ethanol pretreatment before ICH (ethanol + ICH). Normal saline (10 mL/kg) or ethanol (3 g/kg, in 10 mL/kg normal saline) was administered intraperitoneally 1 h before induction of experimental ICH. Bacterial collagenase VII-S (0.23 U in 1.0 μL sterile saline) was injected into the right striatum to induce ICH in the rats. We evaluated the hematoma expansion, hemodynamic parameters (heart rate and blood pressure), activated partial thromboplastin time (aPTT), prothrombin time (PT), and striatal matrix metallopeptidase 9 (MMP-9) expressions at 3, 6, 9, and 24 h after ICH. Results: The ethanol + ICH group exhibited decreased hematoma at 3 h after ICH; nevertheless, there was a larger hematoma compared with the saline + ICH group at 9 and 24 h after ICH. The ethanol + ICH group had lower blood pressure at 3, 6, and 9 h post-ICH, but both groups maintained similar heart rates after ICH. There was no significant difference in the aPTT and PT between the two groups. Incremental ethanol concentrations had no influence on collagenase VII-S activity at 120 min in vitro. MMP-9 expression was upregulated in the right striata of the ethanol + ICH group, especially at 3 and 9 h after ICH. Conclusion: Ethanol delayed hematoma formation in the first 3 h due to a hypotensive effect; however, the accelerated growth of hematomas after 9 h may be a sequela of ethanol-induced MMP-9 activation.
  1 2,063 175
ORIGINAL ARTICLES - CLINICAL RESEARCH
Combined effect of acid-sensing ion channel 3 and transient receptor potential vanilloid 1 gene polymorphisms on blood pressure variations in Taiwanese
Leay-Kiaw Er, Ming-Sheng Teng, Semon Wu, Lung-An Hsu, I-Shiang Tzeng, Ching-Feng Cheng, Hsin-I Chang, Hsin-Hua Chou, Yu-Lin Ko
January-March 2018, 30(1):29-36
DOI:10.4103/tcmj.tcmj_187_17  PMID:29643714
Objectives: Both acid-sensing ion channel acid-sensing ion channel 3 (ASIC3) and transient receptor potential vanilloid 1 (TRPV1) have been proposed to be involved in the pathophysiology of hypertension. Common colocalization of ASIC3 and TRPV1 channels in the same sensory neuron has been reported. We aimed to study the combined ASIC3 and TRPV1 gene polymorphisms in the risk of hypertension. Materials and Methods: To test the statistical association between genetic polymorphisms of the ASIC3 and TRPV1 genes and blood pressure (BP) variations in Taiwanese, 551 unrelated individuals (286 men and 265 women) having routine health examinations were recruited. The participants had no history of cardiovascular disease or use of medication for hypertension. Results: Six ASIC3 and four TRPV1 gene polymorphisms were genotyped, and only the ASIC3 rs2288646 polymorphism was associated with variations in BP in the participants. In subgroup analysis, we found participants carrying the combined ASIC3 rs2288646 AA or AG and TRPV1 rs8065080 CC genotypes (combined genotypes) had significantly higher systolic, mean and diastolic BP compared with the other subgroups (P = 0.009, 0.003, and 0.006, respectively, after Bonferroni correction). Interaction analysis also revealed significant gene-gene interaction in the systolic, mean, and diastolic BP in the ASIC3 and TRPV1 genotypes (interaction P = 0.006, 0.002, and 0.002, respectively). A trend of increasing frequencies of the combined genotype was observed in normotensive, prehypertensive, and hypertensive subgroups (P for trend = 0.001), as well as in those with higher systolic and diastolic BPs (P for trend = 9.13 × 10−4 and P for trend = 5.5 × 10−5, respectively). Conclusion: Our data show a combined effect of ASIC3 and TRPV1 gene polymorphisms in BP variations in Taiwanese. These results suggest that the interaction between ASIC3 and TRPV1 is involved in BP regulation.
  1 1,537 173
Positive correlation of serum leptin levels and peripheral arterial stiffness in patients with type 2 diabetes
Chia-Wen Lu, Chung-Jen Lee, Jia-Sian Hou, Du-An Wu, Bang-Gee Hsu
January-March 2018, 30(1):10-14
DOI:10.4103/tcmj.tcmj_183_17  PMID:29643710
Objective: Leptin plays a pathophysiologic role in the pathogenesis of aortic dysfunction and peripheral arterial stiffness (PAS). Our aim was to evaluate the risk factors for developing PAS and the association of leptin and PAS in patients with type 2 diabetes mellitus (DM). Materials and Methods: Fasting blood samples were obtained for biochemical data and leptin determinations from 105 patients with type 2 DM. In this study, we applied an automatic pulse wave analyzer (VaSera VS-1000) to measure the brachial-ankle pulse wave velocity (baPWV); a baPWV value >14.0 m/s on either side was considered high PAS. Results: Seventy-five patients (71.4%) had high PAS and they included a higher percentage of patients with hypertension (P < 0.001), older age (P < 0.001), and a higher body fat mass (P = 0.043), systolic blood pressure (P < 0.001), diastolic blood pressure (P = 0.016), serum blood urea nitrogen (P = 0.003), and leptin level (P < 0.001), and lower height (P = 0.027) and glomerular filtration rate (P < 0.001) compared with type 2 DM patients with low PAS. After adjusting for factors significantly associated with PAS in these patients by multivariate logistic regression analysis, age (β = 0.470, adjusted R2 change = 0.279; P < 0.001), logarithmically transformed leptin (log-leptin, β = 0.259, adjusted R2 change = 0.085; P = 0.001), and hypertension (β = 0.197, adjusted R2 change = 0.031; P = 0.011) were significant independent predictors of PAS in type 2 DM patients. Conclusion: The serum leptin level could be a predictor of PAS in type 2 DM patients.
  1 2,107 206
CASE REPORTS
Left-sided cecal diverticulitis associated with midgut malrotation
Jia-Hui Chen
January-March 2018, 30(1):47-50
DOI:10.4103/tcmj.tcmj_190_17  PMID:29643718
Malrotation of the midgut is generally considered as a pediatric pathology with the majority of patients presenting in childhood. The diagnosis is rare in adults, which sometimes leads to delay in diagnosis and treatment. An index of suspicion is therefore required when dealing with patients of any age group with abdominal symptoms. We present a case of a 26-year-old male who presented with left lower abdominal pain with preoperative computed tomography showing suspected left-sided appendicitis associated with midgut malrotation. The duodenum, small bowel, and cecum were abnormally located, with the presence of a thickened and inflamed appendix with fecalith images. The patient underwent an emergency laparotomy, and ruptured cecal diverticulitis with abscess formation was confirmed. We performed a cecectomy, and the patient did not have an uneventful postoperative recovery. A review of the literature is presented to highlight the rarity of midgut malrotation and the controversies surrounding its surgical management in the adult population with ruptured left-sided cecal diverticulitis.
  - 1,810 173
IMAGES IN CLINICAL MEDICINE
Glomus tumor with rare clinical presentation as chronic shoulder pain
Reddy Ravikanth, Anush Nagotu
January-March 2018, 30(1):51-52
DOI:10.4103/tcmj.tcmj_99_17  PMID:29643719
  - 1,498 154
MEDICAL EDUCATION
Anthropological and sociological perspectives of medical professionalism
Yen-Kuang Lin, Mu-Tsu Hsu, Ming-Chen Hsieh
January-March 2018, 30(1):53-54
DOI:10.4103/tcmj.tcmj_192_17  PMID:29643720
  - 1,385 145
ORIGINAL ARTICLES - CLINICAL RESEARCH
Effectiveness of a training program on the role recognition and case portrayal of standardized patients
Sheng-Po Kao, Tsung-Ying Chen, Mei-Lin Hsieh
January-March 2018, 30(1):37-40
DOI:10.4103/tcmj.tcmj_13_18  PMID:29643715
Objective: Standardized patient (SP) scenarios could provide medical situations of high fidelity for teaching or examinations, which would otherwise be difficult with real patients. Moreover, SPs can also be used to reliably evaluate or certify the competence of medical trainees. Since the interactions between examinee and SP are dynamic and complex, SPs need to portray the case reliably and consistently across different examinees. Thus, we developed a 1-day program for newly recruited SPs to teach basic competence in case portrayal. The purpose of this study is to assure the effectiveness of this training program in role recognition as a SP and case portrayal. Materials and Methods: A total of 80 SPs were recruited from 2010 to 2013. They were asked to complete questionnaires before and after the training program using a five-point, Likert-type scale (1 – strongly disagree and 5 – strongly agree). The questionnaire comprised 16 items covering SP characteristics, role recognition, and case portrayal. The results were analyzed using PASW Statistics 18, paired t-test, to determine the effectiveness of the training program. Results: A total of 78 questionnaires were collected for a response rate of 97.5%. The mean age of the SPs was 50.2 ± 7.9 (25–68) years. Most SPs showed improvement in role recognition. In the domain of case portrayal, three of nine items (consistency, obedience, and commitment) showed significant difference (P<0.05). Conclusions: This study suggests that this program is useful for reinforcing role recognition in newly recruited SPs. With respect to case portrayal, only consistency, obedience, and commitment were improved.
  - 1,669 125
Dental utilization and expenditures by children and adolescents with autism spectrum disorders: A population-based cohort study
Kai-Chun Chang, Ling-Yi Wang, Jen-Hung Wang, Cheng-Kuang Shaw, Ming-Jay Hwang, Chih-Hao Wu, Huai-Kuan Huang
January-March 2018, 30(1):15-19
DOI:10.4103/tcmj.tcmj_185_17  PMID:29643711
Objectives: It is understood that children and adolescents with autism spectrum disorders (ASDs) have difficulty in receiving dental treatment. This study explores the differences in dental utilization and expenditure between two groups: children and adolescents with and without ASD. Different conditions that affect these results will be examined, including area of residence, category of treatment, and preferences concerning type of dental institution in Taiwan. Materials and Methods: The health service research database of the National Health Research Institutes, which features population-based, randomly selected samples collected from 2001 to 2010, was utilized in this study. In particular, we recruited samples from 2005 in accordance with the codes of the International Classification of Diseases, 9th revision, Clinical Modification from 299.0 to 299.9. The population-based cohort study measured mean expenditures and mean numbers of medical visits with regard to different dental institution classifications, areas of residence, and categories of dental treatment for children (under 18 years old) with and without ASD. Results: The mean number of annual visits was 6.58 and 5.70 for children and adolescents with and without ASD, respectively, with mean annual visit expenditures of NT$2401.20 and NT$1817.99, respectively. A higher percentage of children (91.32%) and adolescents (72.66%) with ASD had experienced dental treatment than those without ASD. Children (93.23%) and adolescents (90.83%) without ASD visited dental clinics more often than those with ASD. The percentage of dental visits to academic medical centers in Eastern Taiwan was significantly lower for the ASD group than visits to other types of dental institutions. The use of restorative treatment was significantly higher among all samples, with periodontology having the lowest percentage. Conclusions: Children and adolescents with ASD had greater dental utilization, expenditures, and preferences for high-level dental institutions. The discrepancies in dental utilization indicate differences in the distribution of medical resources in different dental institution levels and residence areas in Taiwan.
  - 2,053 210
Surgical results of a one-stage combined anterior lumbosacral fusion and posterior percutaneous pedicle screw fixation
Chien-Yuan Huang, Kuang-Ting Yeh, Tzai-Chiu Yu, Ru-Ping Lee, Ing-Ho Chen, Cheng-Huan Peng, Kuan-Lin Liu, Jen-Hung Wang, Wen-Tien Wu
January-March 2018, 30(1):20-23
DOI:10.4103/tcmj.tcmj_186_17  PMID:29643712
Objectives: Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach. Materials and Methods: From June 2008 to 2012, 20 patients who had L5–S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1-year of clinical and radiological follow-up was conducted. Intraoperative blood loss, surgical time, and any surgery-related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS) and the patient's Oswestry Disability Index (ODI) score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films. Results: The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases. Conclusion: The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.
  - 2,537 333
Modified conjunctival flap as a primary procedure for nontraumatic acute corneal perforation
Yi-Chen Sun, Jason P Kam, Tueng T Shen
January-March 2018, 30(1):24-28
DOI:10.4103/tcmj.tcmj_191_17  PMID:29643713
Objective: Appropriate management of nontraumatic acute corneal perforation is always a challenge even with the many advances in surgical materials and techniques. We reported the outcomes of a case series of acute corneal perforation repair using a newly modified conjunctival flap with amniotic membrane transplant (AMT), fibrin glue, and a bandage soft contact lens (BCL). Materials and Methods: A total of 13 consecutive referral cases with nontraumatic acute corneal perforation at the University of Washington were reviewed. All open globes were repaired by a combined surgery with a modified conjunctival flap, AMT, fibrin glue, and BCL. Visual acuity, a slit lamp examination, and the patient-reported pain level were collected preoperatively and postoperatively. Subsequent corneal surgeries to improve visual function were also reviewed. Results: All ocular surfaces of the 13 eyes were stable at postoperative follow-up. Eleven of the 13 patients had the same or worse visual acuity 1 week postoperatively. Nine of the 13 patients achieved better vision 6 months postoperatively. None of the patients developed perioperative or postoperative complications. Five patients with good visual potential underwent further corneal surgeries, including Boston keratoprosthesis and penetrating keratoplasty. The average referral distance was 217 miles and the median number of follow-up visits within 6 months was 4. Conclusions: The combination of a modified conjunctival flap, AMT, fibrin glue, and a BCL could provide a temporary method to stabilize and secure the integrity of the globe as well as the ocular surface after a nontraumatic acute corneal perforation. This approach allows easy follow-up and preserves the eye for future corneal surgery under optimal conditions.
  - 2,075 210
REVIEW ARTICLE - CLINICAL
Evidence-based review and appraisal of the use of droperidol in the emergency department
Pei-Chun Lai, Yen-Ta Huang
January-March 2018, 30(1):1-4
DOI:10.4103/tcmj.tcmj_195_17  PMID:29643708
Droperidol is a short-acting, potent dopamine D2 antagonist that can pass through the blood–brain barrier. A black box warning was issued for droperidol by the United States Food and Drug Administration in 2001 because of a risk of development of torsades de pointes induced by QT prolongation. Many experts feel that the incidence of arrhythmia is overestimated, and low-dose droperidol is almost always used by anesthesiologists for postoperative nausea and vomiting. In this review, we used evidence-based analysis to appraise high-quality studies with a low risk of bias published after 2001 on the use of droperidol in the emergency department (ED). Droperidol appears not only efficacious but also safe to treat patients with nausea/vomiting, acute psychosis, and migraine in the ED. For these conditions, droperidol may be an option for shared decision-making.
  - 3,020 328