The Changhua Journal of Medicine最新文献

{"title":"Effects of Environmental Heavy Metals in Soil on Estimated Glomerular Filtration Rate Variability","authors":"Chin‐Hua Chang, P. Chiu, Chia-Lin Wu, Chew-Teng Kor, Ie-Bin Lian, Teng‐Hsiang Chang, Chun‐Chieh Tsai, Chia-Chu Chang","doi":"10.6501/CJM.1404.002","DOIUrl":"https://doi.org/10.6501/CJM.1404.002","url":null,"abstract":"背景知識：慢性腎臟病在臺灣是常見的疾病。已經有許多研究指出，重金屬會誘發慢性腎臟病。越來越多的證據顯示，腎絲球過濾率變異量可以預測慢性腎臟病病人的腎功能預後以及死亡率。我們推測環境中的重金屬會影響腎絲球過濾率的變異量進而造成腎臟的不良影響。方法：病人來源為彰化基督教醫院腎臟科所屬慢性腎臟病照護中心的病人們。我們透過病人的住址並連結環保署所提供的全國土壤中重金屬濃度的資料作為研究的來源。環保署提供的土壤中重金屬的濃度包含：砷、汞、鎘、鉻、銅、鎳、鉛、鋅。結果：我們發現鉻、銅、鎳、鉛與腎絲球過濾率的變異量有相關。透過多變數線性回歸的統計，土壤中的重金屬與腎絲球過濾率的變異量有顯著相關，尤其是在糖尿病以及中風的病人族群。結論：我們的研究發現，環境中的重金屬對於腎絲球過濾率的變異量有顯著的影響，尤其是對糖尿病患及中風患者。因此我們建議，居住在土壤中含重金屬濃度較高的區域的慢性腎臟病的患者應該更頻繁地追蹤腎功能。","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128211479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Joint Commission International Accreditation Multidisciplinary Childhood Asthma Program Improved Clinical Outcomes and Asthma Treatment Adherence","authors":"Tu Yang, Fei-Chen Lai, Jun-Kai Kao, J. Chien, Ming-Sheng Lee, Han-Yao Chiu, Chun-Yu Chen, Wen-Chieh Yang, Rei-Cheng Yang, Y. Tsai","doi":"10.6501/CJM.1404.003","DOIUrl":"https://doi.org/10.6501/CJM.1404.003","url":null,"abstract":"研究背景：氣喘是兒童最主要慢性病，急性氣喘發作是造成兒童住院最常見原因。儘管國際氣喘診療指引（GINA）推動，急性氣喘住院照護品質仍不理想。研究目的：本研究主要目的推動國際醫院評鑑（JCI）認證之兒童氣喘臨床照護計畫（CCPC）並評估兒童氣喘藥物順從度與預後。結果：本研究收集91位因氣喘發作，並加入國際醫院評鑑（JCI）認證之兒童氣喘臨床照護計畫住院病童。本研究發現氣喘控制藥物順從度（Hill-Bone Compliance questionnaires）問卷良好只有38（42%）位住院病童。發作急性期比較，氣喘控制藥物順從度問卷不良住院病童組比較氣喘控制藥物順從度問卷良好住院病童組，有較嚴重度氣喘控制問卷（C-ACT）分數（16.8 ± 2.9 vs. 18.2 ± 2.1; p ＜ 0.05），經過六個月出院追蹤比較嚴重度氣喘控制問卷（C-ACT）分數仍然有統計意義（21.2 ± 2.6 vs. 22.6 ± 2.5; p ＜ 0.05）。介入國際醫院評鑑（JCI）認證之兒童氣喘臨床照護計畫，所有住院病童組兒童氣喘藥物順從度與氣喘知識認知與氣喘相關預後包含氣喘控制問卷（C-ACT）分數與尖峰吐氣流量計（PEFR）數值皆有明顯改善。","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131184147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empyema Mimicking Hollow Viscus Perforation: A Case Report","authors":"Wie-Hsin Chung, Chia-Chu Chang","doi":"10.6501/CJM.1403.005","DOIUrl":"https://doi.org/10.6501/CJM.1403.005","url":null,"abstract":"Air-fluid levels seen on decubitus plain abdominal films are most often diagnosed as pneumoperitoneum. In this paper, we present a case of massive right-sided pyopneumothorax mimicking pneumoperitoneum. An 85-year-old female presented to the emergency department (ED) with a 1-day history of decreased urine output. She appeared in distress, with tachypnea and a systolic blood pressure of 60 ~ 70 mmHg. The patient's Glasgow Coma Scale (GCS) was E4VtM4, i.e., confused. Physical examination revealed decreased breathing sounds on the right side and pain and guarding with palpation of the abdomen. Plain abdominal films suggested an air-fluid level. Abdominal computed tomography (CT) identified an empyema on the right-hand side with an associated air fluid level. A chest tube drained cloudy, malodorous fl uid, and the pleural fluid contained Gram-negative bacilli (Escherichia coli and Klebsiella pneumoniae). Video-assisted thoracic surgery (VATS) was performed to address the persistent pleural effusion. Unfortunately, progressive hypotension developed along with generalized tonic-clonic seizures on day 18. After consultation with the family, palliative care only was administered, and the patient died 22 days after admission. Loculated or free air over the right lower lung observed on a chest X-ray should raise suspicion of a ruptured liver abscess, hollow viscus perforation and pyopneumothorax. Abdominal CT is the most reasonable next step to assist clinicians to make a decision regarding whether to provide surgical or conservative intervention.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"77 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120841695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Diagnosis of Crohn's Disease in a Low Endemic Area: A 15-Year Hospital-Based Study","authors":"Hsien-Chih Wu, Chih-Jung Chen, Lisa Wu, Shun‐Sheng Wu, M. Soon, H. Yen","doi":"10.6501/CJM.1402.002","DOIUrl":"https://doi.org/10.6501/CJM.1402.002","url":null,"abstract":"Background/Purpose: Crohn's disease (CD) has increased in the Asia-Pacific area in the past two decades. There is not a single gold standard for diagnosing CD; diagnosis is usually made through a combination of clinical, endoscopic, histological, and radiological investigations. Previously, CD was usually diagnosed postoperatively by histological examination. The aim of this study was to elucidate the change in the diagnostic pattern for CD in our hospital over the past 15 years. Methods: A total of 36 CD patients were retrospectively enrolled from the electronic clinical database of Changhua Christian Hospital, Taiwan in the period of January 2000- October 2014. The clinical characteristics and pathological, endoscopic, and radiological findings were analyzed. Results: There was a significant increase in non-surgical diagnosis of CD over the past 15 years. Comparing CD data before and after 2011, the percentage of diagnoses made after surgery was higher before 2011 than after 2011 (35% vs. 6.3%, p = 0.042). Higher proportions of ileal disease (p = 0.03), stricturing disease (p = 0.046), and radiologic evidence of luminal stenosis (80%, p = 0.047) were noted among patients diagnosed with CD postoperatively. Inflammatory disease (p = 0.044) and an endoscopic finding of aphthous ulcers (54.2%, p = 0.025) were found more frequently in patients diagnosed with CD without surgery. Pathological findings of non-caseating granuloma were observed more frequently in surgical specimens as compared with endoscopic specimens (50.0% vs. 7.4%, p = 0.016). There were no significant differences in terms of age of diagnosis, sex, and perianal disease between patients diagnosed with CD with or without surgery. Conclusion: CD has increased in Taiwan in the past 15 years. In the early period, CD was diagnosed when complications occurred postoperatively, i.e., perforation or obstruction. The low yield rate of endoscopic biopsies and a lack of clinical suspicion contributed to delayed diagnosis of CD. There has been an increase in nonsurgical diagnosis of CD since 2011; early diagnosis has been more common in recent years due to clinical awareness of the disease, which has changed the diagnostic pattern.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134608402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal Acquired Demyelinating Symmetric (DADS) Neuropathy without Gammopathy: A Case Report and Comprehensive Review of the Literature","authors":"Jhih-Jian Gao, C. Lai","doi":"10.6501/CJM.1402.007","DOIUrl":"https://doi.org/10.6501/CJM.1402.007","url":null,"abstract":"Distal acquired demyelinating symmetric (DADS) neuropathy is a subtype of chronic inflammatory demyelinating polyneuropathy (CIDP) with characteristic clinical and electrophysiological features. It usually progresses more slowly than typical CIDP and is frequently associated with an IgM paraprotein. We report a rare case of DADS neuropathy without a paraprotein. A 26-year-old Caucasian woman from South Africa visited our neurological clinic because of subacute symmetric numbness and mild weakness of distal limbs. Nerve conductive study showed sensorimotor polyneuropathy, demyelinating type with a markedly reduced terminal latency index. CSF examination showed elevated protein (148 mg/dL) without significant pleocytosis. Detailed examinations following hospitalization, including hematology, infection, autoimmune, biochemistry, malignancy, paraprotein and endocrine studies, were unremarkable. The patient responded poorly to corticosteroid treatment, but intravenous immunoglobulin (IVIG) 0.4 g/kg/day for five days improved her symptoms. The effect of IVIG lasted for about six months, followed by slow progression of numbness and mild weakness in distal limbs. The patient received steroid pulse therapy but in vain; she then returned to South Africa. She was diagnosed with DADS neuropathy from the characteristic clinical and electrophysiological features. Striking demyelination with a markedly reduced terminal latency index identified by nerve conduction study and symmetric sensory symptoms with minimal distal weakness are the main features of this rare treatable neuropathy.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"381 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115974202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Femoral Greater Trochanter Fracture and Colon Tumor Perforation: A Case Report","authors":"Po-An Chen, Yu‐Chuan Lin","doi":"10.6501/CJM.1402.006","DOIUrl":"https://doi.org/10.6501/CJM.1402.006","url":null,"abstract":"Colon tumor perforation induced by blunt trauma is rare. Isolated femoral greater trochanter fracture is also very unusual in the orthopedic field. This case involves both conditions caused by one traumatic event. Most bowel perforations are induced by direct abdominal trauma; however, this report presents the first documented case of the force from a blow to the trochanter causing colon tumor perforation.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129202522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Left Lobe Hypertrophy after Right Portal Vein Embolization in Patients with Chronic Liver Disease","authors":"Chia-Bang Chen, C. Chou, Wen-Pei Wu, Yao-Li Chen","doi":"10.6501/CJM.1402.003","DOIUrl":"https://doi.org/10.6501/CJM.1402.003","url":null,"abstract":"Background: Right portal vein embolization (PVE), performed either surgically or radiologically, is the main method used to induce growth of the future liver remnant (FLR) before right hemihepatectomy in patients with an insufficient future liver remnant volume (FLRV) due to chronic liver disease. The purpose of this study was to evaluate whether clinical and laboratory variables, as well as METAVIR fibrosis score, are predictive of PVE-induced growth of the FLR in patients with chronic liver disease. Methods: During the period from January 2007 to September 2014, a total of 813 patients underwent hemihepatectomy for hepatocellular carcinoma (HCC) or cholangiocarcinoma. Of those patients, 20 had an inadequate FLR and required right PVE before hemihepatectomy. None of the 20 patients had received preoperative chemotherapy or transarterial chemoembolization. Results: Of the parameters evaluated (serum levels of AST, ALT, ALP, GGT, albumin, total bilirubin, AFP, prothrombin time, Child- Pugh score, METAVIR fibrosis score and history of hepatitis B or hepatitis C infection), only the fibrosis score was associated with a significant change in the estimated rate of functional future liver remnant (%FFLR) volume (p = 0.042). Further analysis revealed that only mild (F1) and moderate (F2) degrees of fibrosis were associated with a significant increase in the FLRV (p = 0.043 and p = 0.028, respectively). Conclusion: The severity of liver fibrosis was found to be negatively correlated with the degree of FLR hypertrophy prior to portal vein embolization.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130177284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemic Control of Hospitalized Patients at a Medical Center in Taiwan","authors":"Shi‐Dou Lin, J. Kuo, Mei-Jung Lin, Ya-Leng Jhang","doi":"10.6501/CJM.1402.001","DOIUrl":"https://doi.org/10.6501/CJM.1402.001","url":null,"abstract":"Achieving the glycemic target is essential to reduce morbidity and mortality in hospitalized patients; however, the status of glycemic control in Taiwan has not yet been evaluated. We conducted a retrospective study to evaluate the status of glycemic control in our hospital. We collected all the point-of-care blood glucose (POC-BG) data generated in general wards and intensive care units (ICUs) between April 2012 and June 2012. Parameters including mean of total POC-BG values, proportion of any POC-BG value less than 70 mg/dL, more than 250 mg/dL and 70 ~ 250 mg/dL, patient-day weighted mean glucose (PDWMG) value and percentage of PDW-MG value more than 180 mg/dL were compared between patients in medical and surgical wards, patients in medical and surgical ICUs, and among patients in each of the medical wards and surgical wards. The mean glucose and PDW-MG values were 192.4 mg/dL and 183.1 mg/dL in the general wards and 196.3 mg/dL and 187.7 mg/dL in the ICUs, respectively. The quality of inpatient glycemic control was poorer for patients in medical wards than in surgical wards, but the difference was smaller between patients in medical and surgical ICUs. The quality of glycemic control among patients in the different medical wards was inconsistent. In summary, the quality of inpatient glycemic control in our hospital was found to be suboptimal as compared with the current guidelines. The development of a strategy for improvement is critical, and the subsequent clinical effectiveness needs further investigation.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114715168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete Resolution of an Intracardiac Tumor without Surgical Intervention","authors":"Szu-Chi Chien, C. Hsia","doi":"10.6501/CJM.1402.004","DOIUrl":"https://doi.org/10.6501/CJM.1402.004","url":null,"abstract":"Primary cardiac lymphoma is extremely rare. Here, we report the case of an 82 year-old female with an initial presentation of pericardial effusion and chest tightness with shortness of breath. A transvenous endomyocardial biopsy showed diffuse large B cell lymphoma (DLBCL). After 1 year of successful chemotherapy, the tumor size diminished without any complications.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122461756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Treatment of Pancreatic Arteriovenous Malformation with External Beam Radiotherapy","authors":"Yen-Chih Lin, H. Yen, W. Su, Mucang Liu, M. Sun","doi":"10.6501/CJM.1402.005","DOIUrl":"https://doi.org/10.6501/CJM.1402.005","url":null,"abstract":"Pancreatic arteriovenous malformation (AVM) is a rare disease that occurs worldwide, but only a few sporadic cases have been reported in Taiwan. The poor definition of pancreatic AVM has been the major obstacle in its diagnosis. Conventionally, angiography and CT scans are used to diagnose pancreatic AVM. Here we report a case of pancreatic AVM that was initially disclosed by endoscopic ultrasound (EUS) and confirmed by angiography. In this case report, we will also present the very good response of pancreatic AVM to external beam radiotherapy.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121089044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}