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   2014| September-October  | Volume 34 | Issue 5  
    Online since October 30, 2014

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Assessment of nutritional status in the community and clinical settings
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
September-October 2014, 34(5):211-213
The nutritional status of an individual is usually a result of multiple factors that interact with each other at different levels. Recognizing the role of diet at the onset of many diseases and assessing the nutritional status of an individual, family and community are important for public health. The nutritional assessment is done to obtain information about the prevalence and geographic distribution of nutritional disorders within a community or a specified population group. It can also be used to identify high-risk groups and to assess the role of different epidemiological factors in nutritional deficiency. Assessment of the nutritional status aids assessing the prevalence of nutritional disorders, planning corrective measures, and evaluating the effectiveness of the implemented strategies simultaneously.
  98,898 2,993 4
Frameless stereotactic deep brain stimulation for Parkinson's disease: A case report and technical note
Chun-Chieh Lin, Tung-Han Tsai, Yueh-Feng Sung, Da-Tong Ju, Yung-Hsiao Chiang, Yuan-Hao Chen
September-October 2014, 34(5):224-234
Because deep brain stimulation (DBS) implantations and other stereotactic and functional surgical procedures require accurate, precise, and safe targeting of the brain structure, the technical aids for preoperative planning, intervention, and postoperative follow-up have become increasingly important. In this paper, we introduce a case of advanced Parkinson's disease with 10 years of medical control in which the patient received subthalamic nuclei (STN) DBS therapy through frameless surgery. A preliminary outcomes analysis is also provided. The STN DBS was implanted using a frameless stereotaxy protocol. After identifying the STN by microelectrode recording (MER), the DBS electrodes were implanted and connected to an implanted programmable generator. Programming started 1 month after the operation, and the patient was followed up on regularly and 12 months of post-STN DBS unified Parkinson's disease rating scale were recorded. After 12 months of follow-up, the patient who received the frameless surgery showed a significant improvement in clinical motor functions compared with his preoperative scores. The frameless system has the advantage of providing accuracy in postoperative lead position survey and target deviation measurements with comparison to the preoperative planning image. The outcomes of frameless DBS surgery are similar to those of frame-based surgery, with the advantages being that frameless surgery can reduce the patient's discomfort, shorten the operation and MER time, and decrease the MER trajectory number.
  9,937 386 -
A comparative study evaluating the clinical efficacy of skin tapes versus silicone gel for the treatment of posttrauma scar in the rabbit model
Chih-Chien Wang, Juin-Hong Cherng, Shyi-Gen Chen, Tsai-Wang Huang, Leou-Chyr Lin, Ru-Yu Pan, Yi-Hsin Chan, Chih-Hsin Wang
September-October 2014, 34(5):195-200
Background: Skin tape and silicone gel are two common over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars of posttrauma wounds. This animal study was performed to determine the clinical efficacy of skin tape versus silicone gel in subjects with scars. Materials and Methods: Three New Zealand rabbits that received total 12 incision wounds which two incision wounds on one ear side and subsequent primary suturing were studied. Stitches were removed after 1 week. Silicone gel was applied right upper side of the rabbit's ear directly on surgical incision wounds, and skin tapes were also applied left upper side of the rabbit's ear directly on another surgical incision wounds after 1 week of surgery. The lower incisions in both ears were covered with sterilized gauze and served as controls. We compared two experimental groups at binaural with using Vancouver Scar Scale, Manchester Scar Scale, and The Stony Brook Scar Evaluation Scale. These are widely used in clinical practice and research to document change in scar appearance. Results: We describe a rabbit model for incisional wounds and scarring outcome measures. The results of scar measuring devices demonstrated that skin tape reduced scar formation as well as silicone gel. Conclusions: The results of cosmetic demonstrated that skin tape reduced scar formation as well as silicone gel. However, the economical and effective materials were the important subject that suffices for clinical requirement. The application of these scar prevention devices to reduce scar formation after surgical incision is worthy of future investigation. Moreover, skin tape may represent a low-cost alternative and low scar formation for closure of surgical incisions.
  6,084 305 -
Dissociation of bipolar prostheses with hip subluxation: A case report and literature review
Jung-Jui Chang, Ru-Yu Pan, Leou-Chyr Lin
September-October 2014, 34(5):214-216
Bipolar hemiarthroplasty, a modular system, has been utilized for decades to treat intracapsular fractures of the femoral neck and avascular necrosis of the femoral head. Dislocation is one of the main complications of hip hemiarthroplasty performed for displaced femoral neck fractures. Classic dislocation of the hemiarthroplasty from the native acetabulum occurs in 2.6% of cases. Dissociation between the small head of the prosthesis and the polyethylene insert is an extremely rare complication of bipolar hemiarthroplasty and results in hip dislocation and severe disability. Surgeons must be cognizant of this rare complication and should proceed to open reduction to treat this problem.
  3,250 226 1
Revised thyroplasty: The importance of inner perichondrium dissection
Wan-Fu Su, Shao-Cheng Liu, Li-Hsiang Cheng, Ying-Nan Chang, Feng-Shiang Chiu, Yuan-Yung Lin, Wen-Sen Lai, Hui-Ming Feng, Chao-kuan Wu
September-October 2014, 34(5):207-210
Purpose: The outcome of voice surgery on unilateral vocal cord paralysis (UVCP) by medialization laryngoplasty (ML) was various although the series of reports consistently claimed that the phonation ability restored well after their reconstructive surgery. We revised several unsatisfactory subjects and proposed a correct concept to facilitate a successful surgery. Patients and Methods: One hundred and forty subjects suffering from UVCP and undergoing ML procedure were reviewed. Eight of the 140 subjects underwent revised thyroplasty to improve their unsatisfactory voice. The time elapse from UVCP onset to first ML procedure and between first and second ML procedure was recorded and analyzed. Maximal phonation time (MPT) was used to evaluate the improvement of phonation ability. Result: Inappropriate size or location of the implant material were defined in two subjects, inappropriate management of the inner perichondrium of thyroid lamina (IPTL) were defined in 5, and cricoarytenoid joint (CAJ) fixation in one. MPT was increased from 3 s to 11 s in average after revised surgery. MPT more than 10 s was obtained in 7 subjects in their followup at mean 15 months. Conclusion: The management of IPTL actually determined the voice surgical outcome significantly. Preoperative evaluation of the CAJ mobility was still an important factor to determine the use of corrective methods.
  2,982 147 -
Endocrine carcinoma of the pancreatic tail exhibiting gastric variceal bleeding
Si-Yuan Wu, Yuan-Min Chang, Jyh-Cherng Yu, De-Chuan Chan, Chung-Hsien Li, Gu-Jiun Lin, Shing-Hwa Huang
September-October 2014, 34(5):217-219
Nonfunctional endocrine carcinoma of the pancreas is uncommon. Without excess hormone secretion, it is clinically silent until the enlarging or metastatic tumor causes compressive symptoms. Epigastric pain, dyspepsia, jaundice, and abdominal mass are the usual symptoms, whereas upper gastrointestinal (GI) bleeding is rare. Here, we describe the case of a 24-year-old man with the chief complaint of hematemesis. Upper GI panendoscopy revealed isolated gastric varices at the fundus and upper body. Ultrasonography and computed tomography showed a tumor mass at the pancreatic tail causing a splenic vein obstruction, engorged vessels near the fundus of the stomach, and splenomegaly. After distal pancreatectomy and splenectomy, the bleeding did not recur. The final pathologic diagnosis was endocrine carcinoma of the pancreas. Gastric variceal bleeding is a possible manifestation of nonfunctional endocrine carcinoma of the pancreas if the splenic vein is affected by a tumor. In non-cirrhotic patients with isolated gastric variceal bleeding, the differential diagnosis should include pancreatic disorders.
  2,571 146 2
Depressed skull fracture and epidural hematoma resulted from pin-type head holder for craniotomy in children
Te Fu Chen, Shih Hung Yang, Jui Chang Tsai
September-October 2014, 34(5):238-240
A head fixation device with pins is commonly used for immobilization of the patient's head during craniotomy. The safety of head fixation devices in children has been discussed rarely in the literature. We present one case of depressed skull fractures and associated epidural hematomas resulted from pin-type head holder for craniotomy in young children. The patient received surgical hematoma evacuation and recovered well after the surgery. The incidence of such complications reported in the literature is <0.65%. Age ranged from 2.6 to 7.5 years; all fractures were temporal and occurred during posterior fossa craniotomies. In conclusion, depressed skull fractures and associated epidural hematomas need to be considered as possible complications, while we use the pin-type head holder for craniotomy in children in the daily practice.
  2,388 216 1
Efficacy of modified neoadjuvant chemoradiotherapy in locally advanced rectal cancer: A single institution experience in Taiwan
Yi-Ying Wu, Shiue-Wei Lai, Tzu-Chuan Huang, Pi-Kai Chang, Ping-Ying Chang, Jia-Hong Chen, Shu-Wen Jao, Chang-Chieh Wu, Chuan-Shu Lin, Woei-Yau Kao, Ching-Liang Ho
September-October 2014, 34(5):201-206
Background: Neoadjuvant chemoradiotherapy (NCRT) followed by total mesorectal excision is now recommended for patients with locally advanced rectal cancer (LARC). This retrospective study was aimed to analyze the treatment efficacy in LARC patients in a single institute. Materials and Methods: Rectal cancer patients with clinically T3, T4, or nodal positive (N1-2) diseases who received either NCRT or adjuvant chemoradiotherapy (ACRT) were retrospectively enrolled between 2007 and 2011. The treatment outcome and clinical characteristics of study population were compared. Results: There were 176 patients been enrolled with a mean age of 63.1 years. Totally, 123 (69.9%) patients received NCRT and 53 (30.1%) patients received ACRT, respectively. The median duration of follow-up was 43.3 months in NCRT group and 47.6 months in ACRT group. There was no significant difference about overall survival (OS), progression-free survival (PFS), and local relapse-free survival (LRFS) between two treatment groups. However, NCRT achieved pathological complete remission (pCR) of 27.6%. In addition, the patients with pathologically downstage after NCRT (the responders) had significantly better PFS (P < 0.0001), local RFS (P = 0.0468), and OS (P = 0.0045), compared with non-responder after NCRT. Oxaliplatin-based NCRT did not significantly increase treatment response, OS and PFS, compared with other regimens in our analysis (P = 0.29). Conclusions: In our cohort, NCRT achieved high pCR rate than those reported in previous literature. Although there was no significant improvement of OS, PFS, and LRFS in NCRT group, there was a significant improvement of LRFS, OS, and PFS in those responders after NCRT.
  2,451 126 -
An outbreak of trimethoprim/sulfamethoxazole-resistant Stenotrophomonas maltophilia meningitis associated with neuroendoscopy
Ching-Hsun Wang, Shih-Wei Hsu, Tung-Han Tsai, Ning-Chi Wang
September-October 2014, 34(5):235-237
Stereotactic aspiration by neuroendoscopy for treatment of deep-seated intracranial hematomas is widely accepted because this procedure is minimally invasive and thereby reduces the probability of iatrogenic brain damage. Herein, we describe an outbreak of trimethoprim/sulfamethoxazole (TMP/SXT)-resistant Stenotrophomonas maltophilia meningitis, possibly from a contaminated neuroendoscopy, and review the previous use of antimicrobial therapies for this condition without TMP/SXT. This is the first reported outbreak of TMP/SXT-resistant S. maltophilia meningitis. The discussion emphasizes the importance of adequate disinfection processes before and after endoscopic neurosurgery and the use of therapeutic options other than TMP/SXT when encountering S. maltophilia meningitis.
  2,249 142 2
Unique glucose-6-phosphatase, catalytic subunit mutation in a child with type Ia glycogen storage disease in Taiwan
Chia-Ying Chang, Chien-Han Chen
September-October 2014, 34(5):220-223
The G272W mutation in the glucose-6-phosphatase, catalytic subunit (G6PC) gene has been reported once in mainland China, but has not been reported in Taiwan or other countries. We report a female patient with type Ia glycogen storage disease (GSD). She presented at birth with abdominal distension, shortness of breath, and nonbilious vomiting. Hyperammonemia, metabolic acidosis, hyperuricemia, and elevated liver function were noted after a subsequent survey. Tachypnea and metabolic acidosis were exacerbated whenever she was infected with croup. Abdominal and renal sonography performed at 2-year of age revealed marked hepatomegaly and nephromegaly, with increased echogenicity. The genetic survey of the patient demonstrated compound heterozygous mutations in the G6PC gene, including a codon 83 [c.248G >A, p.Arg83His] mutation inherited from her father, and codon 272 [c.814G >T, p.Gly272Trp] mutation inherited from her mother. Type Ia GSD was diagnosed based on the birth history, biochemistry, image study, and molecular diagnosis. After the girl was treated with cornstarch, her liver function and other abnormal biochemistry data gradually normalized. This report may facilitate clarifying the prognoses of Chinese patients with these 2 mutations of the G6PC gene. Furthermore, this report highlights the importance of the G272W mutation, which may be unique to the Chinese population.
  2,125 142 -