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Memorial Hospital (memorial + hospital)
Kinds of Memorial Hospital Selected AbstractsGuillain,Barré syndrome in southern Taiwan: clinical features, prognostic factors and therapeutic outcomesEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2003B.-C. Cheng To determine the clinical features, prognostic factors, and therapeutic results of Guillain,Barré syndrome (GBS) in order to improve the therapeutic strategy for this disease. We retrospectively reviewed the electrodiagnostic study and medical records of patients with GBS admitted to Chang Gung Memorial Hospital, Kaohsiung, between January 1986 and December 2000. Outcomes and prognosis were followed-up after 1 year. Ninety-six patients were enrolled in this study. According to the clinical and electrophysiological findings, 77 patients were acute inflammatory demyelinating polyradiculoneuropathy, seven were Miller Fisher syndrome, and six were axonal forms, and six were unclassified. At a follow-up of 1 year, 61 patients (64%) recovered, 30 (31%) had residua and five (5%) died. Amongst these 30 had residua, including unassisted gait in 19, assisted gait in four, and wheel/bed bound in seven. According to the statistical analysis, disabilities at the nadir (P < 0.0001) and at admission (P = 0.014) were significant prognostic factors. Variables used for the stepwise logistic regression, and the results revealed that after analysis for all the above variables, only disability at the nadir (P < 0.0001) was independently associated with the treatment failure rate. Our study revealed 27% of cases in need of respiratory support during hospitalization, and 5% of hospital-treated patients die from the complications. Furthermore, 31% had residua at a follow-up of 1 year or more. If prognostic factors are considered, disability at the nadir during hospitalization demonstrates consistently poor therapeutic outcomes. Therefore, early diagnosis, choice of appropriate treatment, and preventing complications during acute stages are essential to maximize the potential for survival. [source] Testing the outcome score of spontaneous intracerebral haemorrhage in haemodialysis patientsINTERNAL MEDICINE JOURNAL, Issue 10 2009B.-R. Huang Abstract The aim of this study is to determine the predictive value of the spontaneous intracerebral haemorrhage (ICH) outcome score (which we described previously) in haemodialysis (HD) patients who develop spontaneous ICH. The validation cohort consisted of all HD patients with spontaneous ICH presenting to Chang Gung Memorial Hospital in Taiwan during 2005,2007. The data were collected from one hospital and prospectively analysed, and the predictive model was tested using an external validation dataset. The prognostic factors were confirmed by chi-squared testing. We calculated the 30-day mortality in different groups of the validation cohort divided according to outcome score and tested the predictive value of the outcome score. The overall mortality rate was 52.6% in 38 HD patients. The originally identified prognostic factors were Glasgow Coma Scale score, age ,70 years, systolic blood pressure <130 or ,200 mmHg, ICH volume ,30 mL, presence of intraventricular haemorrhage and serum glucose ,8.8 mmol/L. All but one (serum glucose ,8.8 mmol/L (P= 0.07)) were subsequently found to be associated with 30-day mortality. In patients scoring 6 and 7, mortality was 100%, but in patients scoring 0, it was only 11.1%. The 30-day mortality in the validation cohort increased steadily with score and had good predictive value (correlation coefficient = 0.986, P < 0.001). Similar results in two different cohorts indicate that the ICH outcome score is a reliable outcome measure. [source] Extraintestinal manifestations of Edwardsiella tarda infectionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2005I-K Wang Summary Edwardsiella tarda, a member of the family Enterobacteriaceae, is a rare human pathogen. Gastroenteritis is the most frequently reported manifestation of E. tarda infection. In contrast, extraintestinal infection with E. tarda has rarely been reported. This study made a retrospective case and microbiological data review of patients with extraintestinal E. tarda infections to further understand this disease. This study retrospectively reviewed the charts of all isolates of E. tarda cultures from clinical specimens other than faeces at Chang Gung Memorial Hospital, Taoyuan, Taiwan from October 1998 through December 2001. Edwardsiella tarda was isolated from 22 clinical specimens from 22 hospitalised patients (13 females and nine males). The extraintestinal manifestations of E. tarda infection included biliary tract infection, bacteraemia, skin and soft tissue infection, liver abscess, peritonitis, intra-abdominal abscess, and tubo-ovarian abscess. The major underlying diseases predisposing to E. tarda extraintestinal infection were hepatobiliary diseases, malignancy and diabetes mellitus. The overall mortality rate of E. tarda extraintestinal infection in the present series was 22.7% (5/22), and four (40%) of 10 patients with bacteraemia expired. Although rare, human E. tarda extraintestinal infections can have diverse clinical manifestations and moreover may cause severe and life-threatening infections. Consequently, E. tarda should be considered a potentially important pathogen. [source] Detection of carcinomas in an asymptomatic Chinese population: advantage of screening with multiple tumor markersJOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 2 2006Kuo-Chien Tsao Abstract A total of 73,443 asymptomatic individuals were screened on a voluntary basis for cancer at Chang Gung Memorial Hospital in Taiwan using a panel of tumor markers, including alpha fetoprotein (AFP), CA 125, CA 15-3, CA 19-9, carcinoembryonic antigen (CEA), prostate specific antigen (PSA), chromogranin A (CgA), and squamous cell specific antigen (SCC). The results are derived from data collected from January 1998 to October 2003. A total of 210 cancers (approximately 0.3%) were detected, including cancers of the liver, lung, colon, prostate, stomach, pancreas, breast, cervix, ovary, and bladder. Of the tumor markers monitored, elevated CA 19-9, CEA, and CA 125 were the most frequently detected in a variety of cancers. It was surprising to find that many cancers were not detected by their dominant markers but by the elevation of tumor markers not recommended for monitoring their tumor activity. Screening with multiple circulating tumor markers provides improved sensitivity for cancer detection in asymptomatic individuals before they reach the fatal advanced stage. Screening with multiple tumor markers also allows cancers to be detected in the absence of their dominant markers. If we had not measured the multiple tumor markers, these cancers would have gone undetected. J. Clin. Lab. Anal. 20:42,46, 2006. © 2006 Wiley-Liss, Inc. [source] Lifestyle risk factors for intrahepatic stone: Findings from a case,control study in an endemic area, TaiwanJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7pt1 2008Masato Momiyama Abstract Background and Aim:, To examine associations between lifestyle risk factors and intrahepatic stone (IHS), we conducted a case,control study in Taiwan, which has the highest incidence of IHS in the world. Methods:, Study subjects were 151 patients newly diagnosed with IHS at Chang Gung Memorial Hospital between January 1999 and December 2001. Two control subjects per case were selected randomly from patients who underwent minor surgery at the same hospital and from family members or neighbors of the hospital staff. Controls were matched to each case by age and gender. Information on lifestyle factors was collected using a self-administered questionnaire. Strength of associations was assessed using odds ratios derived from conditional logistic models. Results:, Female patients were significantly shorter than female controls. Compared to subjects with two or fewer children, odds ratios for those with six or more children were 20.4 in men (95% confidence interval, 1.89,221) and 2.82 (0.97,8.22) in women. Increasing level of education lowered the risk of intrahepatic stone (trend P = 0.004 for men and < 0.0001 for women). Women who had consumed ground-surface water for a long period had a somewhat increased risk (trend P = 0.05). Conclusion:, Lower socioeconomic status and poor hygiene may be involved in the development of intrahepatic stones. [source] Distant nodal metastases from intrathoracic esophageal squamous cell carcinoma: Characteristics of long-term survivors after chemoradiotherapyJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2010Yin-Kai Chao MD Abstract Background Non-regional lymph node metastasis in intrathoracic esophageal cancer is classified as M1 lesion with poor prognosis following surgery alone. We studied the controversial question of whether chemoradiotherapy (CRT) improves survival of these patients. Methods A cohort of patients with clinically overt nodal M1 disease, which could be encompassed by a tolerable radiation therapy port, was selected from the database of the Chang Gung Memorial Hospital. Results From 1994 to 2005, 54 nodal stage IV intrathoracic esophageal squamous cell carcinoma (SCC) patients received neoadjuvant CRT. Significant response occurred in 24 patients. Scheduled esophagectomy was performed in 26 patients. The 3-year overall survival (OS) and disease-free survival (DFS) for the whole group were 27% (median: 14.2 months) and 22% (median: 14.7 months), respectively. Multivariate analysis identified pretherapy lymph nodes classified as M1a and R0 resection after CRT as independent favorable prognosticators. Median survival reached 36.9 months in the pretherapy M1a subgroup as opposed to 12.5 months in the M1b subgroup (3-year-DFS: 40% vs. 10%, P,=,0.0117). Scheduled surgery after CRT benefits only after R0 resection (3-year-DFS: 36%, median survival: 45 months). The group with incomplete resection had a high surgical risk and dismal survival compared to the non-surgery group (3-year-DFS: 0% vs. 9%, 9.5 vs. 10.5 months). Conclusions Pretherapy M1a disease had a significantly better survival than nodal M1b disease after CRT in SCC. Aggressive surgical treatment after CRT is reserved for cases when complete resection is anticipated. J. Surg. Oncol. 2010;102:158,162. © 2010 Wiley-Liss, Inc. [source] Original Article: Left ventricular geometry and cardiovascular mortality based on haemodialysis patient autopsy analysesNEPHROLOGY, Issue 5 2010IMARI MIMURA ABSTRACT Aim: In end-stage renal disease (ESRD) patients, left ventricular hypertrophy (LVH) is common and a risk for cardiovascular events. LVH is geometrically classified into two major groups, concentric and eccentric, and accumulating evidence suggests eccentric LVH has a more negative effect than concentric LVH on ESRD outcome. However, there have been very few studies on the cardiac findings from ESRD patient autopsy in which the relationship between LVH geometry and mortality was analyzed. Methods: An observational study was performed with the autopsy findings in 30 haemodialysis patient cases between 2001 and 2006 at Mitsui Memorial Hospital, Tokyo. Between those who died of a cardiovascular cause and those who died of non-cardiovascular causes, we compared the heart/bodyweight ratio, left ventricular dilatation, and the extent of fibrosis of the left ventricle. Results: Heart/bodyweight ratio was significantly higher (P < 0.0001) in the cardiovascular mortality group (n = 11, 11.7 ± 2.5 g/kg) compared to the non-cardiac cause of death group (n = 19, 8.05 ± 0.7 g/kg). The dilatation of the left ventricle was significantly more frequent in the cardiovascular than the non-cardiac cause of death group (P = 0.016). Additionally, the fibrotic area of left ventricular cross-section was larger in the cardiovascular (1.63 ± 1.6%) than the non-cardiac group (0.83 ± 1.7%, P = 0.04). Conclusion: This autopsy study indicates that eccentric LVH in haemodialysis patients is closely associated with cardiovascular mortality. LVH geometry, as well as LVH severity, is worthy of consideration as a clinical predictor for cardiovascular mortality. [source] Intraoperative loading attenuates nausea and vomiting of tramadol patient-controlled analgesia. (Show-Chwan Memorial Hospital, Changhua, Taiwan) Can J Anaesth 2000;47:968,973.PAIN PRACTICE, Issue 2 2001Wei-Wu Pang Sixty adult patients scheduled for elective abdominal surgery were enrolled into this prospective, randomized, double-blinded study. The patients were anesthetized in a similar manner. At the beginning of wound closure, the patients were randomly allocated to receive tramadol (Group 1) or normal saline (Group 2). Pain control and adverse effect assessments were done in the PACU and every 6 h for 48 h post drug by an independent observer. The loading dose was 290 ± 45 mg in Group 1 and 315 ± 148 mg in Group 2. In PACU, more nausea and vomiting both in terms of incidence and severity were observed in patients with postoperative loading than in those with intraoperative loading of tramadol. Conclude that administering the loading dose of tramadol during surgery decreases the nausea and vomiting associated with a high dose of tramadol and improves the quality of tramadol PCA in the relief of postoperative pain. Comment by Lian-Kah Ti, M.D. The clinical application and conclusions of this study have to be questioned. It was not surprising that a loading dose of tramadol could effectively be given intraoperatively. What was surprising was that the authors chose not to give any analgesics either preoperatively or intraoperatively for relatively major surgery in an older population, potentially risking morbidity. Indeed, analgesics were withheld in the control group until the patients were extubated, awake, responsive, and complained of pain. Another source of concern was the large loading dose used. Based on their own experience, the authors gave doses of 300 mg of tramadol, which far exceeded the maximum recommended single dose of 100 mg as stated in the manufacturer's instruction for use. The authors did not report any intraoperative hemodynamic consequences from the loading dose, although they noted that the amount of isoflurane required was decreased. The authors concluded that the decreased nausea and vomiting seen in the patients receiving tramadol intraoperatively resulted from the patients being anesthetized at the point when peak plasma levels were achieved. An alternative explanation could be that the patients in the control group had greater postoperative pain (initial VAS of 5.9), and that pain itself resulted in the increased nausea and vomiting. Therefore, the value of this study is doubtful. [source] Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs. jet nebulizer in young children with wheezingPEDIATRIC PULMONOLOGY, Issue 5 2005J. Deerojanawong MD Abstract The jet nebulizer is a common device used for administering aerosol medication in young children. However, compared to a metered dose inhaler-spacer (MDI-spacer), it takes more time and personnel. This study aimed to compare the efficacy of salbutamol aerosol therapy given via these two devices in young wheezing children. A prospective randomized, double-blind, placebo-controlled trial was performed in children up to 5 years old who had acute wheezing and were admitted to the Department of Pediatrics, King Chulalongkorn Memorial Hospital. Patients were randomly divided into two groups. The first group received 2 puffs of placebo via MDI-spacer, followed by 0.15 mg/kg salbutamol respiratory solution via jet nebulizer. The second group received 2 puffs (100 ,g/puff) of salbutamol via MDI-spacer, followed by placebo via jet nebulizer. Clinical scores and tidal breathing pulmonary function test were evaluated before and after treatment. Pulmonary function parameters included those derived from flow volume loops (volume to peak tidal expiratory flow over total expiratory volume, VPTEF/VE; time to peak tidal expiratory flow over total expiratory time, TPTEF/TE; and ratio of tidal expiratory flow at 25% remaining expiration to peak expiratory flow, 25/PF), compliance (Crs), and resistance (Rrs) of the respiratory system. The efficacy of both methods was compared by using analysis of covariance. Forty-seven wheezing children were studied (24 received salbutamol via MDI-spacer, and 23 received it via jet nebulizer). There was no statistical difference between the two groups regarding clinical scores and all pulmonary function parameters. However, heart rate was significantly increased after treatment in the jet nebulizer group when compared to those in the MDI-spacer group (P,=,0.004). In conclusion, the efficacy of salbutamol aerosol therapy via MDI-spacer compared to jet nebulizer in young wheezing children was not different in terms of clinical score and postbronchodilator pulmonary function parameters. However, salbutamol aerosol therapy via jet nebulizer significantly increased the heart rate when compared to the MDI-spacer. © 2005 Wiley-Liss, Inc. [source] Osteoradionecrosis with Combined Mandibulotomy and Marginal MandibulectomyTHE LARYNGOSCOPE, Issue 11 2005Chih-Chun Wang MD Abstract Introduction: To evaluate the outcome of simultaneous anterior mandibulotomy and marginal mandibulectomy for patients with oral cavity cancer. Material and Methods: The medical charts of seven patients who underwent simultaneous anterior mandibulotomy and marginal mandibulectomy for oral cavity cancer between July 1994 and June 2004 in Chang Gung Memorial Hospital, Taiwan were retrospectively reviewed. These seven patients had no prior radiation therapy nor clinical or radiographic evidence of mandible bone invasion. Results: Seven patients, between 34 to 62 years of age, were followed up in the clinics from 4.5 to 39 months with an average of 19.4 months. Five (71%) patients developed mandible osteoradionecrosis. Among them, two patients underwent radical sequestrectomy followed by reconstruction with a free fibular osteoseptocutaneous flap or soft tissue flap, and the other three patients either received removal of the mandible fixation miniplate, limited sequestrectomy of the mandible, or conservative antibiotic treatment individually. Conclusions: Simultaneous anterior mandibulotomy and marginal mandibulectomy results in a high morbidity rate of avascular necrosis of the mandible and therefore should be avoided. To avoid a disastrous complication, segmental mandibulectomy and a composite free fibular osteoseptocutaneous flap reconstruction would be a preferred surgical alternative. [source] Once Daily Calcineurin Inhibitor Monotherapy in Pediatric Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010U. D. Ekong This report describes a group of pediatric liver transplant recipients who have undergone once daily calcineurin inhibitor (CNI) monotherapy at Children's Memorial Hospital, Chicago, between January 1, 2001 and November 30, 2008. We defined success as normal liver enzymes at 1 year after dose change, with normal enzymes throughout all follow-up. Patients who did not meet the set criteria or had lost an organ to chronic rejection were not considered for this therapeutic strategy. There were 147 patients in our organ transplant tracking record (OTTR) who were , 5 years post liver transplant. Of these, 56 underwent reduced dose, once daily CNI monotherapy. Patients who met the set criteria were placed on once daily calcineurin inhibitor at half their previous dose. Fifty patients successfully achieved this dose change, while six patients failed at a mean of 3.7 ± 3.2 months following the dosing change. The mean interval from transplant was significantly longer in those patients who were successful compared to those who failed dose change (p < 0.05). Importantly, there have been no graft losses. Reduced dose, once daily CNI monotherapy is safe in carefully selected recipients, with a longer interval post liver transplantation increasing the likelihood of success. [source] Perception Versus Reality?: Virtual Crossmatch,How to Overcome Some of the Technical and Logistic LimitationsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009A. R. Tambur The goal of this work was to evaluate concordance between (a) actual flow cytometric crossmatch (FCXM) that is performed by the OPO laboratory servicing our transplant center and (b) virtual XM (vXM) prediction based on antibody identification by solid-phase methods performed in our laboratory. A total of 1586 FCXM, performed between June 2007 and September 2008, between all potential deceased donors in our region and sera from patients awaiting kidney or kidney,pancreas transplant, listed at Northwestern Memorial Hospital were evaluated. A key finding of this analysis was the understanding that a thorough vXM cannot be performed in some donor/recipient pairs due to the lack of certain antibody profile data specific to the donor in question. Obtaining more in depth and stringent information regarding antibody specificities, we demonstrate an excellent sensitivity and specificity of the vXM assays, 86.1% and 96.8%, respectively, with a positive likelihood ratio and negative likelihood ratios of 26.9 and 0.14, respectively. The vXM can serve as an outstanding tool to predict HLA compatibility between donor and recipient, with the caveat that the presence/absence of all antibodies against the potential donor and their strength have been thoroughly investigated. [source] Adult T-cell leukemia/lymphoma in Taiwan: An analysis of 17 patients and review of the literatureASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010Chun-Wei LEE Abstract Aim: We reviewed our experience with adult T-cell leukemia (ATL), describing the clinical manifestations and outcome in order to facilitate case recognition in the future. Methods: We retrospectively reviewed the charts of 17 patients with ATL diagnosed from January 1996 to September 2009 at Mackay Memorial Hospital, Taipei, Taiwan. Results: The overall survival of the whole study group was 138 days. The medial survival of the 10 patients who received chemotherapy is 204 days. The other six patients who did not receive any chemotherapy had a median survival of 28 days. The co-infection rate with HTLV-1 and HBV or HCV is 47% and 35% respectively. Conclusion: ATL in Taiwan is a rare malignant T-cell lymphoma with a very poor prognosis. Our series raised the interesting possibility of an association with chronic hepatitis B or C. [source] Small for gestational age preterm infants and relationship of abnormal umbilical artery Doppler blood flow to perinatal mortality and neurodevelopmental outcomesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009Antonia W. SHAND Aim: To determine the outcomes of preterm small for gestational age (SGA) infants with abnormal umbilical artery (UA) Doppler studies. Methods: A retrospective cohort study of SGA singleton infants delivered between 24 and 32 weeks gestation at King Edward Memorial Hospital, Perth, who had UA Doppler studies performed within seven days of birth. Main outcomes assessed were perinatal mortality and morbidity, and neurodevelopmental outcomes at , 1 year of age. Outcomes were compared by normality of UA blood flow. Results: There were 119 infants in the study: 49 (41%) had normal UA Doppler studies, 31 (26%) had an increased systolic,diastolic ratio , 95th centile, 19 (16%) had absent end diastolic blood flow (AEDF) and 20 (17%) had reversed end-diastolic flow (REDF). Infants in the AEDF and REDF groups were delivered significantly more preterm (P = 0.006) and had lower birthweights (P < 0.001). Ninety four per cent (110 of 117) of live born infants survived. Neurodevelopmental follow-up at 12 months of age or more (median 24 months) was available on 87 of 108 (81%) of live children. Twenty-eight per cent (11 of 39) of fetuses who had had AEDF or REDF died or were classified with moderate or severe disability. There was no significant association between abnormality of UA blood flow, perinatal morbidity, perinatal mortality and neurodevelopmental disability after correction for gestational age. Conclusion: Fetuses that are SGA with abnormal UA Doppler studies remain at significant risk of perinatal death, perinatal morbidity and long-term neurodevelopmental disability, associated with their increased risk of preterm birth. [source] Postnatal home visiting for illicit drug-using mothers and their infants: A randomised controlled trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2006Anne BARTU Abstract Background:, Postnatal home-visiting programs for illicit drug-using mothers have reported some success in reducing harms in some areas but there is a lack of data on their impact on breastfeeding and immunisation rates. Aims:, To investigate the effect on breastfeeding, immunisation and parental drug use. The hypothesis was that the outcomes of the home-visiting group (HVG) would be superior to the control group (CG). Method:, One hundred and fifty-two illicit drug-using women were recruited at 35,40 weeks gestation from King Edward Memorial Hospital, Perth, Western Australia and randomised after delivery to the HVG or the CG. The HVG had eight home visits; the CG had telephone contact at two months and a home visit at six months. The HVG received education and support for parenting, breastfeeding and child development. This was not provided by the research midwives for the CG. Results:, The main drugs were heroin, amphetamines, cannabis and benzodiazepines. Immunisation rates were similar for each group. Median duration of breastfeeding for the HVG was eight weeks (95% CI, 3.8,12.2); for the CG ten weeks (95% CI, 7.3,12.7). Drug use was reduced during pregnancy but increased by six months post-partum in both groups. The retention rates were: HVG 93%; CG 86%. Conclusion:, The hypothesis for this study was not supported. Long-term studies are urgently required to assess the effects of parental drug use on infant and child development. [source] | |||||||||||||||||||