Chun-Yi Lee

Acute renal failure after living-related liver transplantation

Between June 1994 and November 2001, 87 patients underwent living-related liver transplantation at our hospital. Forty-seven of the patients were men and 40 women, with a mean age ( standard deviation) at the time of transplantation of 13.0 18.7 years. The 87 recipients presented with the following indications: biliary atresia (n 53), hepatitis B-related liver cirrhosis (n 8), hepatitis B-related liver cirrhosis with hepatocellular carcinoma (n 6), glycogen storage disease (n 5), primary biliary cirrhosis (n 5), neonatal hepatitis (n 6), hepatitis C-related liver cirrhosis (n 2), alagille (n 1), and Wilson’s disease (n 1). The donors included 43 mothers, 18 fathers, 9 wives, 6 sons, 3 aunts, 3 husbands, 2 grandmothers, 1 grandfather, 1 brother, and 1 daughter. Seventy-five patients received triple drug immunosuppression consisting of cyclosporin (CsA), azathioprine, and steroids and 12, a combination of tacrolimus (FK506) and steroids. All data are presented as mean SD.

The Rate of Fatality and Demographic Characteristics Associated With Various Suicide Methods A Community-Based Study in Northern Taiwan

BACKGROUND Understanding lethality and risk factors of suicide methods is an initial step in suicide prevention. AIMS To investigate the fatality rate and demographic characteristics of various suicide methods. METHOD This study enrolled consecutive individuals with episodes of suicide attempts registered in a surveillance database in a city with a high rate of suicide mortality in Taiwan, from January 1, 2006, to December 31, 2010. In total, 3,089 suicide attempt events (including 2,583 nonfatal suicides and 506 completed suicides) occurred during the study period. RESULTS Overall, the fatality rate of suicides was 16.4%. Charcoal burning accounted for the most suicide deaths (37.6%), with a fatality rate of 50.1%. Suicide by hanging carried the highest fatality rate (81.2%). Males tended to choose more lethal methods and had higher fatality rates compared with females. Elders and married persons were less likely to attempt suicide by charcoal burning. The case fatality ratio increased along with age among suicide attempts, but not in those using charcoal burning. CONCLUSION The choice of suicide methods and lethality might be influenced by ones demographic characteristics. RESULTS from this study may provide clues for establishing suicide prevention strategies such as restricting access to common lethal suicide methods in the high-risk group.

Plasma Exchange Therapy for Thrombotic Thrombocytopenic Purpura in Pediatric Patients With Liver Transplantation

PURPOSE Sporadic cases of thrombotic thrombocytopenic purpura (TTP) have been reported in bone marrow and solid organ transplant patients receiving cyclosporine (CsA). We reported our experience with TTP using plasma exchange (PE) therapy in patients with liver transplantation (OLT). METHODS Between March, 1993, and May, 2007, 400 patients underwent OLT, including 146 pediatric living-donor liver transplantation (LDLT). Four pediatric patients developed TTP after OLT: three were males and one female of mean age at the time of transplantation of 7.8 +/- 3.6 years. The four recipients had the following indications for OLT: two glycogen storage disease, one biliary atresia, and one fulminant hepatic failure. Four patients initially received triple drug immunosuppression consisting of CsA, azathioprine, and steroids. RESULTS Four (1%) patients developed TTP after OLT. All four patients were pediatric in the age group. The mean age at the time of TTP diagnosis was 8.0 +/- 3.2 years, with a mean postoperative interval to TTP of 78.8 +/- 114.2 days. The mean baseline platelet count was 7.0 +/- 7.1 x 10,000. The eventual platelet count was 21.1 +/- 20.8 x 10,000 after PE. These patients received PE 6.0 +/- 4.2. The mean baseline serum creatinine was 0.8 +/- 0.8 mg/dL. The mean peak serum creatinine was 2.3 +/- 2.3 mg/dL. The mean serum CsA level was 717.5 +/- 106.0 ng/mL before TTP diagnosis. Four patients were diagnosed by blood peripheral smears. The causes of TTP were CsA-associated in three patients and venoocclusive disease (VOD) in one patient. Three patients improved their platelet counts after PE therapy. Two patient changed from CsA to FK 506, one underwent reduced CsA dosage, and one stopped CsA. Three patients died of recurrent VOD, infection, and intrapulmonary hemorrhage. Only one patient survived. CONCLUSIONS The incidence of TTP in our series was lower. It only developed in pediatric patients. The causes of TTP were associated with CsA and/or VOD. The mortality was high after the TTP diagnosis. We concluded that TTP was a potentially fatal condition, but an early diagnosis with prompt institution of therapy with invasive PE therapy may reduce its mortal consequences.

Repeated suicide attempts among suicidal cases: Outcome of one-year follow-up

To assess the mortality rates and risk factors involved in repeated suicide attempts.

Development and validation of the Assessment for Repeated Suicide

This study developed and validated a multidimensional measure, the Assessment for Repeated Suicide (ARS), to assess suicide risk and predict future suicidal attempts within psychiatric populations who have previously attempted suicide.

Reversible Pisa Syndrome Induced by Rivastigmine in a Patient With Early-Onset Alzheimer Disease

Pisa syndrome (PS) is a state of dystonic muscle contraction with a marked truncal deviation to one side. It is an uncommon adverse effect of antipsychotic drugs, but is rarely reported in patients receiving acetylcholinesterase inhibitors, especially rivastigmine. We present a 57-year-old female patient with Alzheimer disease who began to develop symptoms of dementia at the age of 51 years. She was observed to have symptoms of PS after continuous use of rivastigmine (9 mg/d) for nearly 2 years. The PS symptoms improved after the dose of rivastigmine was reduced but recurred when the dose was added back to 9 mg/d. Finally, after we decreased the dose to 4.5 mg/d, her PS symptoms were remitted. This report reminds us that clinicians need to be cautious about the risk of PS when prescribing rivastigmine in a patient with early-onset Alzheimer disease.

The Chinese version of the Brief Assessment of Cognition in Affective Disorders: normative data of a Mandarin-speaking population

Abstract Objective: The Brief Assessment of Cognition in Affective Disorders (BAC-A) is administered to assess the cognitive impairments in patients with affective disorders. This study aims to develop the normative data and to explore the factor structure of the Chinese version of the BAC-A in a Mandarin-speaking population. Method: This cross-sectional study consisted of 220 healthy participants (age range: 19–79 years; mean age: 51.5 ± 15.9 years, 48.2% male) in communities in Taiwan. We evaluated all participants with the BAC-A, which is a battery of tests containing verbal memory, working memory, motor speed, verbal fluency, attention & processing speed, and executive function, Affective Interference Test (AIT), Affective Interference Delayed Recognition Test (AIT-DR), and Emotional Inhibition Test (EIT). We categorized the means and standard deviations of all subtests by age group and gender. Principal component analysis (PCA) was used to examine the factor structure of the BAC-A. Results: Increased age was significantly correlated with reduced performance in all subtests of the BAC-A, except non-affective correct words in the AIT-DR. Compared to females, males exhibited better performance in motor speed, verbal fluency, and executive function, but had worse performance in total non-affective words in the AIT. The results yielded by PCA showed that the indices of the AIT, AIT-DR, and EIT were all correctly categorized, accordingly. Conclusions: The normative data of the Chinese BAC-A established in this study can serve as a cognitive function reference for Mandarin-speaking populations. Nevertheless, the reliability and validity of the Chinese BAC-A need to be further verified.