Pa-Chun Wang

Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma.

CONTEXT Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, and is associated with more prominent vascular stiffness and atherosclerosis. However, the effect of adrenalectomy on reversibility of vascular damage is unclear. OBJECTIVE Our objective was to investigate the vascular changes and possibility of reversibility after adrenalectomy in PA patients. METHODS We prospectively analyzed 20 patients with aldosterone producing adenoma (APA) that received adrenalectomy from October 2006 to December 2008 and 21 patients with essential hypertension (EH) were enrolled as the control group. Carotid intima media thickness (CIMT) measurement by B-mode ultrasound of the right common carotid arteries and pulse wave velocity (PWV) measurement including brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV) were performed in both groups. The follow-up measurements were performed one-year after adrenalectomy in APA group. RESULTS APA patients had significantly higher diastolic blood pressure, plasma aldosterone concentration (PAC) and aldosterone-renin ratio (ARR), but lower serum potassium level and plasma renin activity (PRA) than EH patients. APA patients had significantly higher CIMT (0.64±0.13 vs. 0.53±0.10 mm, p=0.006), higher baPWV (1589±296 vs. 1405±187 cm/s, p=0.024) and haPWV (1095±150 vs. 987±114 cm/s, p=0.013) comparing with EH patients. One-year after adrenalectomy, CIMT reduced significantly from 0.64±0.13 mm to 0.59±0.14 mm (p=0.014), and baPWV and haPWV also showed significant reduction (baPWV, 1589±296 to 1463±188 cm/s, p=0.035; haPWV, 1095±150 to 1017±109 cm/s, p=0.019). CONCLUSION APA patients have higher degree of early atherosclerosis and vascular stiffness. Adrenalectomy not only corrects the high blood pressure and biochemical parameters but also reverse adverse vascular change in APA patients.

Outcomes of intratympanic gentamicin injection to treat Ménière's disease.

Objective To investigate the outcomes of intratympanic (IT) gentamicin sulfate injection to treat intractable Ménière’s disease (MD) using evidence-based methods. Data Source Data were retrieved from a MEDLINE search (January 1995 through January 2011). Study Selection Selected were English-language articles presenting outcomes of IT gentamicin injection to treat MD that had a prospective study design and an evidence level of II or higher. Data Extraction The database was searched using Boolean combinations of the keywords intratympanic, gentamicin, and Ménière’s disease. Data Synthesis Dichotomous outcomes (success rate and total deafness) were expressed using a Mantel-Haenszel fixed-effects model. Pretreatment and posttreatment pure-tone audiometry results, and word discrimination scores were summarized using data synthesis techniques. Conclusion A critical literature appraisal and meta-analysis shows that IT gentamicin injection can control vertigo in patients with MD who have limited hearing injury. The quality of research in this field has improved remarkably over the years. However, a large-scale randomized controlled trial is warranted to confirm the predictive factors for the effectiveness of IT gentamicin injection in treating MD.

The relationship between aminoterminal propeptide of type III procollagen and heart rate variability parameters in heart failure patients: a potential serum marker to evaluate cardiac autonomic control and sudden cardiac death

Abstract Background: Cardiac extra-cellular matrix (ECM) fibrosis plays an important role in the pathophysiology of heart failure (HF). It may provide electrical heterogeneity and a substrate for arrhythmogenicity, which may cause sudden cardiac death (SCD). Methods: Twenty-one patients with manifestations of HF and a left ventricular ejection fraction (LVEF) ≤50% were enrolled. The median age was 62 years and median LVEF was 33%. Time- and frequency-domain analysis of heart rate variability (HRV) on 24 h ambulatory electrocardiography recording was assessed. Serum markers of ECM turnover including type I and III aminoterminal propeptide of procollagen (PINP and PIIINP), matrix metalloproteinase-2 and -9 (MMP-2 and MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) were analyzed. Results: The serum PIIINP concentration was correlated significantly with standard deviation of all normal to normal R-R intervals (SDNN) (r=–0.722, p=<0.001), percentage of adjacent NN interval differences >50 ms (pNN50) (r=–0.528, p=0.014), percentage of adjacent NN interval differences >20 ms (pNN20) (r=–0.545, p=0.002), very low frequency (VLF) (r=–0.490, p=0.024), low frequency (LF) (r=–0.491, p=0.024), and high frequency (HF) (r=–0.513, p=0.018). PINP, MMP-2, -9, TIMP-1 were not correlated with time- and frequency-domain analysis of HRV. Conclusions: PIIINP was significantly correlated with time- and frequency-domain analysis of HRV in HF patients. PIIINP is a potential serological marker to evaluate cardiac autonomic control and risk of SCD in HF patients. Clin Chem Lab Med 2010;48:1821–7.

Static craniofacial measurements and dynamic airway collapse patterns associated with severe obstructive sleep apnoea: a sleep MRI study.

Using sleep MRI, we aimed to identify static craniofacial measurements and dynamic upper airway collapse patterns associated with severe obstructive sleep apnoea (OSA) during natural sleep in age and BMI‐matched patients.

Vertigo and stroke: a national database survey.

Objective To investigate the association between vertigo and stroke in Taiwan using the Bureau of National Health Insurance research database. Methods Information on adult patients with an index vertigo attack in 2006 was retrieved from Bureau of National Health Insurance research database. All patients with specific diagnostic codes for vertigo were included. Occurrence of stroke during a 1-year follow-up period was identified. Risk factors for stroke were examined. Using &khgr;2 test, t test, and a multilevel logistic regression model, patients with vertigo were categorized into stroke and nonstroke groups for comparative analyses. An age- and sex- matched control cohort was prepared for comparison. Results Patients with vertigo (n = 527,807) (mean age, 55.1 yr) accounted for 3.1% of the general Taiwanese adult population. The prevalence of stroke among vertigo patients of 0.5% (mean age, 67.8 yr) was slightly higher than that of the control group (0.3%; mean age, 72.3 yr; p < 0.0001). The types of stroke were ischemic (66.7%), nontypical (29.0%), and hemorrhage (4.3%). The prevalence of stroke increased with age (p < 0.001). Patients with vertigo had higher prevalence of comorbid conditions (p < 0.0001); those with diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, or atrial fibrillation had a higher prevalence of stroke (p < 0.001). Hypertension was the most significant predictor of stroke (odds ratio, 3.77; 95% confidence interval, 3.36–4.23; p < 0.001). Conclusion Patients with vertigo had higher chance to develop stroke than the control group. Some strokes may initially manifest as peripheral vertigo, and some central vertigo may eventually evolve into a stroke. Middle aged male, diabetes, hypertension, dyslipidemia, coronary artery disease, and atrial fibrillation are risk factors for subsequent stroke in vertigo patients.

Head and neck manifestations of spontaneous pneumomediastinum.

Objective. Spontaneous pneumomediastinum (SPM) is a rare disease entity that often manifests localized signs in the head and neck region. The thoracic features of SPM have been well described; however, there is a paucity of information on its otolaryngological characteristics. The authors describe the clinical management among SPM patients having primarily head and neck symptoms. Study Design. Case series with chart review. Setting. Cathay General Hospital, Taiwan. Results. The study included 13 men and 1 woman, with a mean age of 18.8 years (range, 14-29 years). The primary initial symptoms were neck swelling (11), neck pain (10), and odynophagia (9). Neck soft tissue and chest radiography was diagnostic of SPM in all patients. Conservative treatment consisted of bed rest and analgesics, which led to rapid resolution of SPM. Conclusions. SPM is a benign entity that responds well to conservative treatment. The results of our investigation highlight the importance of an ear, nose, and throat (ENT) clinical examination as a guide for diagnosing SPM because of the high percentage of ENT manifestations in the initial clinical profiles. Secondary causes of SPM must be ruled out to avoid an unfavorable outcome.

Acoustic-integrated dynamic MR imaging for a patient with obstructive sleep apnea

Obstructive sleep apnea syndrome (OSAS) is caused by multi-level upper airway obstruction. Anatomic changes at the sites of obstruction may modify the physical or acoustic properties of snores. The surgical success of OSA depends upon precise localization of obstructed levels. We present a case of OSAS who received simultaneous dynamic MRI and snore acoustic recordings. The synchronized image and acoustic information successfully characterize the sites of temporal obstruction during sleep-disordered breathing events.

Synchronized imaging and acoustic analysis of the upper airway in patients with sleep-disordered breathing.

Progressive narrowing of the upper airway increases airflow resistance and can produce snoring sounds and apnea/hypopnea events associated with sleep-disordered breathing due to airway collapse. Recent studies have shown that acoustic properties during snoring can be altered with anatomic changes at the site of obstruction. To evaluate the instantaneous association between acoustic features of snoring and the anatomic sites of obstruction, a novel method was developed and applied in nine patients to extract the snoring sounds during sleep while performing dynamic magnetic resonance imaging (MRI). The degree of airway narrowing during the snoring events was then quantified by the collapse index (ratio of airway diameter preceding and during the events) and correlated with the synchronized acoustic features. A total of 201 snoring events (102 pure retropalatal and 99 combined retropalatal and retroglossal events) were recorded, and the collapse index as well as the soft tissue vibration time were significantly different between pure retropalatal (collapse index, 2 ± 11%; vibration time, 0.2 ± 0.3 s) and combined (retropalatal and retroglossal) snores (collapse index, 13 ± 7% [P ≤ 0.0001]; vibration time, 1.2 ± 0.7 s [P ≤ 0.0001]). The synchronized dynamic MRI and acoustic recordings successfully characterized the sites of obstruction and established the dynamic relationship between the anatomic site of obstruction and snoring acoustics.

Epstein Barr virus-associated lymphoepithelial carcinoma in the middle ear.

Histopathologically, lymphoepithelial carcinoma (LEC) is characterized by individual, sheets, or nests of poorly to undifferentiated epithelial cells. The malignant epithelial cells are surrounded and infiltrated by prominent components of small mature lymphocytes and plasma cells. The most frequent site of LEC occurrence is the nasophayrnx (nasopharyngeal carcinoma [NPC]), where it is almost invariably associated with Epstein-Barr virus (EBV) infection. NPC is an endemic disease prevalent in southeastern coastal provinces of China. Isolated nonnasopharyngeal LEC occurrence is rare, and its association with EBV remains controversial. Primary temporal bone LEC is a rare disease entity. To the best of our knowledge, only 4 patients have been reported in the literature to date, all with confirmed EBV infection. In this report, we present the diagnosis and management of a rare LEC case that originated from the middle ear. Its association with EBV is also addressed. A 56-year-old otherwise healthy woman (a native of Guangdong Province, China) presented to our clinic with aural fullness and hearing loss on her right ear for 1 year. Otoscopic examination revealed a lobulated mass extending from the middle ear space (Figure 1). There was no history of otorrhea. Her brother had had cured NPC for several years. The pure-tone audiometry (PTA; 45 dB) revealed a mixed-type hearing loss with a 30-dB air-bone gap on the right side. The left-side PTA was 18 dB, showing a high-tone sensorineural loss with no conductive component. High-resolution temporal bone computed tomography showed a middle ear mass with no bone or ossicle erosion. Exploratory tympanotomy revealed that the multilobulated lesion originated from the promontory wall, filling the whole mesotympanum and partially extending into the Eustachian tube. The tumor was removed piece by piece without disrupting the ossicular chain. The patient received adjuvant radiotherapy (62 Gy, 31 fractions) over a period of 7 weeks. Histopathological examination demonstrated irregular sheets of undifferentiated carcinoma intermingled with abundant lymphoid infiltrate (Figure 2). Immunohistochemical staining was positive for keratin and negative for leukocyte common antigen. The diagnosis of LEC was confirmed. In situ hybridization for EBV-encoded RNA was strongly positive. However, serum Case Report

Shape collaborative representation with fuzzy energy based active contour model

Abstract This paper presents a fuzzy energy-based active contour model for image segmentation with shape prior based on collaborative representation of training shapes. In the paper, a fuzzy energy functional including a data term and a shape prior term is proposed. The data term relies on image information to guide the evolution of the contour. Meanwhile, the shape prior term constrains the evolving contour with respect to the priori shape to handle background clutter and object occlusion. Especially, in this study, the prior shape is represented as the combination of atoms in the shape dictionary based on collaborative representation. In particular, instead of using l 1 -norm regularization as in sparse representation, we utilize l 2 -regularized linear regression scheme which can obtain algebraic solution for the coding coefficients, and significantly reduces the computation time. The proposed model therefore can segment images with background clutter and object occlusion even when the training set includes shapes with large variation. In addition, the proposed shape collaborative representation model also takes less computational time compared to shape sparse representation approach. Experimental results on various images and comparisons with other models show the desired performances of the proposed model.