Ming-Sheng Chern

Percutaneous retrieval of 20 centrally dislodged Port-A catheter fragments

A total of 20 patients with centrally embolized Port-A catheter fragments underwent the percutaneous retrieval procedures at our hospital. The causes of the dislodgement of these catheters included bad connection between the port and catheter, angulation or distortion at the anastomosis site, severing the catheter during insertion and removal of the catheter, improper catheter position and fatigue of the catheter. Consequently, improper procedure handling by the inexperienced surgeons could be considered as the most frequent cause of embolization. The percutaneous retrieval procedures were successful in all centrally embolized fragments. Of 20 successful retrievals, 16 were performed will loop snare catheters and 4 with Dormia basket retrievers.

Clinical significance of anti-GM-CSF antibodies in idiopathic pulmonary alveolar proteinosis

Background: The role of anti-granulocyte-macrophage colony stimulating factor (GM-CSF) antibodies as a diagnostic marker in idiopathic pulmonary alveolar proteinosis (iPAP) remains unclear. Methods: Anti-GM-CSF antibodies were detected in blood and bronchoalveolar lavage fluid (BAL) fluid in 13 patients with iPAP. Three patients with secondary PAP, 35 with other pulmonary disorders, and 10 subjects without lung lesions acted as controls. Blood samples only were obtained from 30 healthy medical personnel. Anti-GM-CSF antibodies were detected using immunoblotting and measured semi-quantitatively by serial dilution or concentration methods. The relationship between antibodies and reported severity indicators for iPAP was analysed. Results: Anti-GM-CSF antibodies could be detected in both blood and BAL fluid samples in 12 of 13 iPAP patients and were undetectable in blood and/or BAL fluid from the other subjects studied. BAL fluid levels of anti-GM-CSF antibodies were highly correlated with the severity indicators for iPAP, including serum lactate dehydrogenase (LDH) levels, arterial oxygen tension, alveolar-arterial oxygen tension difference, (AaPo2), lung carbon monoxide transfer factor, and some lesion scores on chest radiographs and computed tomographic scans. In contrast, blood anti-GM-CSF antibodies were not significantly correlated with the severity indicators evaluated. In addition, patients with iPAP who required subsequent therapeutic lung lavage had significantly higher values of serum LDH, AaPO2, and BAL fluid anti-GM-CSF antibodies, and significantly lower values of Pao2. Conclusions: In addition to serum LDH levels, Pao2 and AaPo2, BAL fluid levels of anti-GM-CSF antibodies might reflect disease severity in patients with iPAP and predict the need for subsequent therapeutic lung lavage. These findings may expand the role of anti-GM-CSF antibodies in iPAP.

Usefulness of low-dose spiral CT of the chest in regular follow-up of postoperative non-small cell lung cancer patients : preliminary report

OBJECTIVES There is no consensus for the best postoperative follow-up in patients after complete resection of non-small cell lung cancer. Low-dose computed tomography of chest proves valuable in screening primary lung cancer and may be a useful tool in postoperative surveillance. METHODS In part 1, 30 patients who underwent surgical resection of non-small cell lung cancer and were at the first (n = 14), second (n = 9), or fifth (n = 7) annual postoperative surveillance were selected chronologically and subjected to chest radiography, low-dose computed tomography, and standard-dose computed tomography to verify the diagnostic accuracy of low-dose computed tomography. In part 2, 43 patients were prospectively enrolled and followed up regularly after complete resection of non-small cell lung cancer. The follow-up protocol included physical examination, sputum cytology, serum carcinoembryonic antigen, chest radiography, and low-dose computed tomography every 3 months in the first 2 years postoperatively until tumor recurrence. RESULTS In part 1, tumor recurrence was detected by standard-dose computed tomography in 7 cases. Low-dose computed tomography and chest radiography missed 1 and 5 of 7 cases, respectively. In part 2, tumor recurrence was found in 14 cases with 19 metastatic sites. Thirteen of the 14 (92.9%) cases were detected by scheduled visiting and 11 (78.6%) detected by low-dose computed tomography including the 7 without symptoms. Of the 19 recurrent sites found in 14 patients, 11 ones (57.9%) were detected by low-dose computed tomography. CONCLUSIONS Low-dose computed tomography may be of considerable value in early detection of tumor recurrence in postoperative non-small cell lung cancer patients. Further large prospective studies are needed to verify this issue.

Anatomic proximity of the esophagus to the coronary sinus: Implication for catheter ablation within the coronary sinus

Introduction: The anatomic proximity between the esophagus and the coronary sinus (CS) might render the esophagus vulnerable to thermal injury during ablation. Therefore, we investigated the anatomic relationship between the esophagus and the CS in patients with atrial fibrillation (AF).

Percutaneous Retrieval of Intravascular Foreign Bodies: Experience with 19 Cases

From April 1994 to June 2002, 17 catheter fragments and two guidewires became intravascular foreign bodies during venous catheterization at our hospital. Retrievals of these 19 foreign bodies were performed percutaneously with loop snare techniques (10 cases), Dormia basket retrievers (eight cases) and grasping forceps (one case). The percutaneous retrieval procedures were successful in 18 of 19 cases. A broken Port-A catheter fragment anchored and entrapped in the vascular wall of the right brachiocephalic vein failed to be removed. No complication was noted during or after these percutaneous procedures. Our experience indicates that intravascular foreign bodies can be removed easily, safely, and successfully with currently available percutaneous methods. As a result, major surgical procedures can be avoided if interventional radiologists are familiar with a variety of techniques for the removal of the expanding spectrum of intravascular foreign bodies currently encountered.

Screening of Hospital Workers for Pulmonary Tuberculosis in a Medical Center in Taiwan

At a medical center in Taiwan, all workers were examined by chest radiography, to determine the prevalence of pulmonary tuberculosis. The prevalence of tuberculosis among all hospital workers was 0.12%, that among nurses was 0.35%, and that among externally contracted cleaners was 0.57%. All of the Mycobacterium tuberculosis isolates recovered from 2 nurses and from a patient with pulmonary tuberculosis were the Beijing strain, but the strains had different serotypes.

Recurrence of Pulmonary Arteriovenous Malformations in a Female with Hereditary Hemorrhagic Telangiectasia

&NA; Pulmonary arteriovenous malformations (AVMs) are an uncommon disorder and may cause life‐threatening complications if left untreated. The paucity of good longitudinal data on patients with pulmonary AVMs can be a significant challenge clinically. The authors report a case of recurrence of pulmonary AVMs in a young female with hereditary hemorrhagic telangiectasia (HHT) subjected to transcatheter embolotherapy (TCET) in 1995. Recurrence of pulmonary AVMs was suspected because of marked impairment of oxygenation in 1997 and in 2000, while the patient was pregnant, and later confirmed by imaging studies in early 2003. Despite successful embolization of all visible pulmonary AVMs, contrast echocardiography suggested the presence of intrapulmonary shunt. A shunt of 11.4% was measured using a 100% oxygen test. Loss of flow pattern was the immediate change of pulmonary AVMs after TCET shown by chest sonography. A decrease in the size of the pulmonary AVMs was observed 6 weeks later. This case illustrates the clinical relevance of longitudinal monitoring of arterial blood gases in screening for the recurrence of pulmonary AVMs, particularly in patients with HHT, and the roles of chest sonography and contrast echocardiography in monitoring the efficiency of TCET.

Percutaneous transtracheal computed tomography-guided biopsy of cervical esophageal carcinoma: an alternative approach.

Editor: Endoscopic biopsy is a widely adopted procedure performed for obtaining specimens for histologic or cytologic examination of esophageal cancer. We report a patient who could not tolerate and refused the endoscopic procedure because his tooth broke on the first trial; a percutaneous computed tomography (CT)–guided biopsy was successfully performed and he was proven to have squamous-cell carcinoma of the esophagus. A 63-year-old male patient was admitted to our institution with swallowing difficulty and weight loss of approximately 6 kg in the past 4 months. In the month before admission, his condition had deteriorated to the extent that he was able to tolerate only a liquid diet. He reported smoking one half pack of cigarettes and drinking 300 mL of red wine daily for 40 years and he had no history of esophageal disease. An upper gastrointestinal examination series suggested a cervical esophageal lesion, and he was referred to our hospital for further management. A biopsy via rigid laryngoscopy was performed and revealed chronic inflammation. After obtaining clinical consultations and reviewing CT images, and considering the patient’s refusal of further endoscopic procedures after a loose tooth broke on the first trial, a CT-guided percutaneous biopsy was arranged for tissue confirmation to facilitate further treatment planning. The patient received fluid via a venous route, supplemental oxygen via a nasal cannula, and pulse oximetry for monitoring blood oxygen saturation during the procedure. The biopsy was performed under CT guidance (Somatom Plus 4; Siemens, Erlangen, Germany) in supine position without moderate sedation. During CT scanning and needle advancement, the patient was instructed to hold his breath with persist inspiratory effort so the needle tip could approach the desired positions. Considering the DOI: 10.1097/01.RVI.0000196320.61641.7F

Primary Malignant Melanoma of the Esophagus

Primary malignant melanoma of the esophagus is exceedingly rare. The existence of primary malignant melanoma in the esophagus had been in doubt until the presence of benign melanocytes was demonstrated within the esophagus. Hematogenous and lymphatic metastases are common. The prognosis is poor even after a radical procedure due to early metastasis. We report here two cases of primary malignant melanoma of the esophagus. One is a melanotic melanoma and the other is an amelanotic melanoma.