Chen-Yi Liao

Novel Investigations of Flavonoids as Chemopreventive Agents for Hepatocellular Carcinoma

We would like to highlight the application of natural products to hepatocellular carcinoma (HCC). We will focus on the natural products known as flavonoids, which target this disease at different stages of hepatocarcinogenesis. In spite of the use of chemotherapy and radiotherapy in treating HCC, patients with HCC still face poor prognosis because of the nature of multidrug resistance and toxicity derived from chemotherapy and radiotherapy. Flavonoids can be found in many vegetables, fruits, and herbal medicines that exert their different anticancer effects via different intracellular signaling pathways and serve as antioxidants. In this review, we will discuss seven common flavonoids that exert different biological effects against HCC via different pathways.

Acute Respiratory Distress Syndrome Manifested by Leptospirosis Successfully Teated by Extracorporeal Membrane Oxygenation (ECMO)

Leptospirosis is recognized as a zoonotic disease that is emerging worldwide. Severe manifestations are associated with high morbidity and mortality rates and may therefore pose an important risk to public health, especially in certain high prevalence areas like Taiwan. The severe pulmonary form of leptospirosis is a lesser known entity and is characterized by intra-alveolar hemorrhage and can lead to acute respiratory failure with resistant hypoxemia, which leads to high mortality rates despite maximally invasive mechanical ventilation and adequate treatment. We herein present a case of severe leptospirosis complicated by massive pulmonary hemorrhage, which was successfully managed by extra corporeal membrane oxygenation.

Kikuchi-Fujimoto Disease

A 23-year-old man with morbid obesity with recent body weight loss about 50 kg (from 158 to 108kg) in recent 3 months presented with a 1-week history of sore throat and fever and right neck mass. Physical examination revealed a low grade fever of 37.5°C, mildly enlarged inflamed tonsils and right tender cervical lymphadenopathy. Remarkable laboratory examination showed leukocyte of 4.7 × 103/μl …

Plantar Purpura as the Initial Presentation of Viridians Streptococcal Shock Syndrome Secondary to Streptococcus gordonii Bacteremia

Viridians streptococcal shock syndrome is a subtype of toxic shock syndrome. Frequently, the diagnosis is missed initially because the clinical features are nonspecific. However, it is a rapidly progressive disease, manifested by hypotension, rash, palmar desquamation, and acute respiratory distress syndrome within a short period. The disease course is generally fulminant and rarely presents initially as a purpura over the plantar region. We present a case of a 54-year-old female hospital worker diagnosed with viridians streptococcal shock syndrome caused by Streptococcus gordonii. Despite aggressive antibiotic treatment, fluid hydration, and use of inotropes and extracorporeal membrane oxygenation, the patient succumbed to the disease. Early diagnosis of the potentially fatal disease followed by a prompt antibiotic regimen and appropriate use of steroids are cornerstones in the management of this disease to reduce the risk of high morbidity and mortality.

Dysphagia aortica: a fatal delay in diagnosis

Extrinsic esophageal compression leading to dysphagia is an uncommon and late presentation of large thoracic aortic aneurysm named dysphagia aortica. Herein, we report an 86-year-old man who presented with 1-week duration of chest pain, backache, and dysphagia and was eventually diagnosed as dysphagia aortica. Our patient developed progressive dyspnea due to tracheal compression and failed surgery. The case illustrates the importance of early identification of the rare entity of dysphagia especially in elderly cases with cardiovascular disease with complaint of undetermined dysphagia accompanied with chest pain and backache.

A diagnostic dilemma: acute abdomen presenting as segmental arterial mediolysis masked by a ruptured hepatocellular carcinoma

Abstract A 65-year-old male was brought to our hospital with right upper abdominal fullness sensation and recent body weight loss of about 3 kg. The patient had developed episodes of melena following progressive abdominal muscular guarding and drop of haemoglobin level to 6.3 g/dL. An abdominal computed tomography scan disclosed a ruptured hepatocellular cell carcinoma. A segmental arterial mediolysis was found on the superior mesenteric artery in the process of repairing the ruptured right hepatic artery with the assistance of angiography. Transarterial embolization was carried out and permanent haemostasis was achieved.

Successful resolution of symmetrical peripheral gangrene after severe acute pancreatitis: a case report

IntroductionSymmetrical peripheral gangrene is an uncommon but devastating complication in critically ill patients, and it has a high mortality. It is seen in a wide variety of medical conditions, presenting as symmetrical gangrene of two or more extremities without large blood vessel obstruction.Case presentationWe report a case of a 44-year-old Chinese man who was diagnosed with alcohol-related severe acute pancreatitis and presented with systemic inflammatory response syndrome and intractable vomiting. On the fourth day of admission, the patient developed cyanosis and gangrene of the fingers bilaterally. His cyanosis and gangrene did not resolve despite tapering of the vasopressor treatment. Gradually, his digital gangrene improved after administration of anti-platelet medication and pentoxifylline.ConclusionsTo the best of our knowledge, this is the first case report of symmetrical peripheral gangrene occurring after acute pancreatitis with successful resolution. We highlight the importance of prompt and aggressive fluid resuscitation and consideration of multiple treatment options to prevent a hypovolemic state caused by acute pancreatitis.

Budd-Chiara syndrome and chylothorax.

A 63-year-old woman with type 2 diabetes mellitus presented with a 2-week history of progressive dyspnea. Physical examination revealed decreased breathing sounds in her right chest. Her routine blood investigations revealed a hemoglobin of 10.3 g/dl and albumin of 3.1 g/dl; chest radiography demonstrated right massive pleural effusion (Figure 1a). Pleural fluid analysis revealed a chylous-like pleural fluid with transudate in nature and chylothorax diagnosed with a pleural …

Achalasia and pneumonia

A 53-year-old Taiwanese man who was robust in the past presented with a 1-week history of low-grade fever, productive cough, a weight loss of 5 kg in the preceding 6 months and progressive dysphagia for solids and liquids. His vital signs and physical examination were unremarkable, except for crackles and dullness to percussion over the right upper lobe. …

Successful Medical Treatment of Bivalvular Infective Endocarditis Complicated with Young Stroke

Background: The aim of his study was to evaluate the frequency of two most Staphylococcus aureus bacteremia (SAB) associated with infective endocarditis (IE) is common. Ischemic infarction is a frequent neurological complication of IE; however, young stroke resulting from IE is rare. We herein report a case of acute mitral valve and aortic valve infective endocarditis complicated with young stroke 8 days after left foot debridement due to methicillin-sensitive Staphylococcus Aureus (MSSA)-related cellulitis. The patient was discharged successfully after 6 weeks of antibiotics with oxacillin in spite of valve replacement surgery due to hemorrhagic transformation of right frontoparietal lobes.