Hong-Tai Chang

Arsenic, vinyl chloride, viral hepatitis, and hepatic angiosarcoma: A hospital-based study and review of literature in Taiwan

BackgroundHepatic angiosarcoma (HAS) is a rare type of liver cancer that is often fatal, and arsenic and vinyl chloride monomer (VCM) are two major causal agents. Whereas Taiwan is an endemic area of liver cancer, epidemiologic data on HAS are limited. We reviewed the cases observed at a teaching hospital to evaluate the roles of VCM, arsenic, and viral hepatitis in the occurrence of HAS.MethodsWe reviewed the medical records of patients with pathological proof of HAS from January 2000 to August 2010 at a teaching hospital which is adjacent to the major VCM processing area in Taiwan and nearby an endemic area of arsenic exposure from drinking water. We also conducted a literature review and included all patients of HAS reported in Taiwan.ResultsSix male and three female cases aged from 56 to 83 years (64.6 ± 8.2 years) were identified at the hospital. The differences in clinical features between men and women were not statistically significant. None of them had exposure to VCM or arsenic in drinking water. Two had evidence of hepatitis C infection, but none had evidence of hepatitis B infection. Five male and four female cases aged 30 to 82 years (58.6 ± 15.5 years) were identified in the literature, including two with arsenic exposure and one with chronic hepatitis B infection.ConclusionsHAS is rare in Taiwan, and we found no evidence supporting a major role of VCM, arsenic in drinking water, or viral hepatitis in its occurrence.

Successful Angiographic Stent-graft Treatment for Spontaneously Dissecting Broad-base Pseudoaneurysm of the Superior Mesenteric Artery

Visceral arterial aneurysm is an uncommon form of vascular disease that has a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrhage. Superior mesenteric artery (SMA) aneurysms are especially rare, comprising only 5-8% of all visceral arterial aneurysms. Traditionally, the most common treatment for SMA aneurysms has been simple surgical ligation of the proximal and distal vessel. Herein, we report the case of a 53-year-old man with a dissecting pseudoaneurysm of the SMA, demonstrated by multi-slice computed tomography and angiography. The patient was successfully treated with percutaneous transluminal angioplasty and stenting.

Kikuchi-Fujimoto disease: an amazing response to hydroxychloroquine

Kikuchi-Fujimoto disease is a benign and self-limited disorder. The common clinical features are fever and cervical lymphadenitis. A 9-year-old girl with fever and cervical lymphadenitis was admitted because of persistent symptoms. A cervical lymph node biopsy showed the characteristic features of Kikuchi-Fujimoto disease. Herein, we will discuss the clinical features, diagnosis, and treatment of Kikuchi-Fujimoto disease and highlight the dramatic response when a patient was treated with hydroxychloroquine.

Spontaneous Perirenal Hemorrhage Due to Non-traumatic Renal Artery Pseudoaneurysm Rupture Successfully Treated with Angiographic Embolization

Spontaneous perirenal hemorrhage is a relatively uncommon but potentially fatal condition. Among the etiologies of spontaneous perirenal hemorrhage, renal pseudoaneurysm rupture is rare, and only a few case reports have been published.Most of these reports assert that total nephrectomy is the best treatment option for patients with unstable blood pressure due to rupture of renal artery aneurysms with massive retroperitoneal hemorrhage. We have an alternative option for consideration, as illustrated by two cases of spontaneous perirenal hemorrhage due to nontraumatic renal artery pseudoaneurysm rupture with presentations of hemoretroperitoneum and shock. We successfully treated both of these patients by selective angiographic embolization with microcoils without complications.

Influence of age on heart rate variability during therapeutic hypothermia in a rat model.

OBJECTIVES To evaluate the effect of age on heart rate variability (HRV) in a rat model of therapeutic hypothermia. METHODS Thirty-six male Sprague-Dawley rats (18 were 2 months old and 18 were 18 months old) were randomized into one of three groups: normothermia (37°C), mild hypothermia (34°C), and moderate hypothermia (31°C). An electrocardiogram (ECG) was recorded at baseline and continuously for 1h once the target core body temperature was reached. Various heart rate variability measurements were calculated. RESULTS Significant effects of age were observed in respect to the ratio of standard deviation of all normal to normal R-R [NN] intervals (SDNN)/standard deviation of the differences between adjacent NN intervals (SD of delta NN) (P=0.037), low frequency (LF) power, normalized units (nu, %) (P<0.001), and the ratio of LF and high frequency (HF) (P<0.001). Significant effects of temperature were found in LF power and a significant body-temperature interaction was found in HF power. HF power was significantly lower in the young rats at mild and moderate hypothermic conditions. For the LF/HF, the ratio was significantly lower in the young animals compared to the older animals at normal body temperatures and during mild hypothermia. LF/HF increased significantly at both 34°C and 31°C in the young rats compared to the young rats at 37°C. In contrast, LF/HF was significantly lower in the older group of rats at 34°C and 31°C compared to the older group of rats maintained under normothermic conditions. CONCLUSIONS This study noted that autonomic regulation determined via HRV, primarily the ratio of LF to HF, was different between different age groups. Additional studies on this topic are needed to achieve a more detailed understanding of therapeutic hypothermia.

Churg-Strauss syndrome (Allergic Angiitis and Granulomatosis)

A 25-year-old woman suffered from sinusitis, asthma and chronic cough intermittently for 1 year was admitted due to persistent worsening cough for 2-3 weeks. Her examination revealed a weakness in appearance and initial blood test results showed marked eosinophilia: WBC of 14100/cumm, neutrophil at 49%, lymphocyte at 13%, and eosinophil at 32%. Chest x–ray showed bilateral pulmonary nodules (Fig. 1) and computed tomography (CT) scan also demonstrated multiple peripheral pulmonary nodules, which suggested chronic eosinophil pneumonia (Fig. 2). However during hospitalization, her sputum TB, fungus, and bacteria cultures all showed no growth. In addition, sputum cytology, serum anti-nuclear antibody, antineutrophil cytoplasmic autoantibody and serum rheumatoid factor results were all negative. Bone marrow biopsy demonstrated eosinophilia and serum total eosinophil count increased up to 13030 /cumm. After treatment with prednisolone, she was discharged under the diagnosis of Churg-Strauss syndrome in a stable condition and her follow-up CT scan showed almost complete remission.

Application of End-tidal Carbon Dioxide Concentration during Cardiopulmonary Resuscitation: A Review of the Literature

In 2005, the American Heart Association guidelines for advanced cardiac life support emphasized that cardiopulmonary resuscitation (CPR) should include effective chest compression and reasonable ventilation to provide the patient a higher coronary artery perfusion pressure and adequate oxygenation. Therefore, these two indicators became the main factors determining whether CPR was successful. The measurement of the partial pressure of end-tidal CO2, (PetCO2) is a non-invasive primary method; it is used to monitor the patients cardiac output, coronary perfusion pressure, ventilation and systemic metabolic function during resuscitation. In 1999, the National Association of Emergency Medical Service Physicians recommended that PetCO2 monitoring be standard in pre-hospital care and in emergency departments. We will review the literature on the measurement of PetCO2, and the evolution of monitoring as well as the use of PetCO2 for monitoring efficacy in CPR. This information is used to substantiate the clinical utilization and predict the probability of success of endotracheal tube placement in the emergency department.