1.Medium-chain triglyceride ketogenic diet for drugresistant epilepsy in Taiwan: A prospective study in a single center
Yi-Shan Wang ; Meng-Ying Hsieh ; Po-Cheng Hung ; Min-Liang Chou ; Jainn-Jim Lin ; I-Jun Chou ; Wan-Ling Huang ; Huei-Shyong Wang ; Kuang-Lin Lin
Neurology Asia 2016;21(4):341-347
Objective: This study aimed to determine the efficacy of a medium-chain triglyceride ketogenic diet
on patients with drug-resistant epilepsy over a period of 1 year and 8 months. Methods: Patients
with refractory epilepsy on a medium-chain triglyceride ketogenic diet were prospectively enrolled.
Their clinical condition and the effectiveness of the ketogenic diet were followed-up every month for
1 year. Adverse events and the reasons for discontinuing the diet were recorded. Results: Fifty-three
patients (27 males and 26 females) were enrolled. At the end of the study, 21 patients remained on
the diet, 14 of whom were followed-up for 1 year. Among the 53 patients, 22.6% had a more than
50% reduction in seizure frequency, and 16.9% became seizure-free.
Conclusions: After a 1-year follow-up, the use of a medium-chain triglyceride ketogenic diet for patients
with drug-resistant epilepsy was found to be a safe and effective therapy, and may be considered to
bean alternative for patients with difficult-to-control seizures in children as well as young adults.
Epilepsy
2.Brain metastases of malignant melanoma in Chinese: report of 23 cases.
Chinese Medical Journal 2007;120(12):1058-1062
BACKGROUNDPatients with melanoma metastasized to the central nervous system have a poor prognosis. Because the incidence of malignant melanoma in the Oriental is lower than that in the Caucasian population, brain metastases of malignant melanoma are rarely reported in Asia. Here we present our experience of brain metastasis of melanoma in an Asian perspective.
METHODSFrom 1990 to 2003, 369 patients with melanoma were treated in our hospital, 26 of them were diagnosed as having central nervous system involvement. Of the 26 cases, the clinical history, image, and pathologic findings of 23 patients were analyzed; the other 3 were excluded because of incomplete clinical data.
RESULTSAmong the 369 patients with melanoma, 45% (167/369) developed lower extremity melanoma, and 27.1% (100/369) had acral lentiginous melanoma (ALM); while in the 23 patients with brain metastases, 34.7% (8/23) had lower extremity melanoma, and 34.7% (8/23) had ALM. Among the 23 patients, 17 had acute hemorrhage into the tumor, 8 initially presented with a single cerebral metastatic lesion, and 15 had multiple brain lesions. Ten of them received surgery, 3 underwent stereotactic radiosurgery, and 16 received whole brain radiation. During follow-up, only 2 patients survived for more than 1 year, the median survival period was 5 months. The longest follow-up period was 11 years.
CONCLUSIONSCompared with the Caucasian, Chinese patients with melanoma have a different proportion of melanoma subtype and higher incidence rates of lower extremities melanoma and ALM. However, their clinical presentation and prognosis are similar. The patients, who have excisable single or multiple brain lesions or limited extracranial disease and who are actively treated, may survive longer.
Adult ; Aged ; Aged, 80 and over ; Brain Neoplasms ; secondary ; Cranial Irradiation ; Female ; Humans ; Male ; Melanoma ; pathology ; therapy ; Middle Aged ; Skin Neoplasms ; pathology ; therapy
3.Unplanned emergency department visits within 90 days of hip hemiarthroplasty for osteoporotic femoral neck fractures: Reasons, risks, and mortalities
Yang-Yi WANG ; Yi-Chuan CHOU ; Yuan-Hsin TSAI ; Chih-Wei CHANG ; Yi-Chen CHEN ; Ta-Wei TAI
Osteoporosis and Sarcopenia 2024;10(2):66-71
Objectives:
Bipolar hemiarthroplasty is commonly performed to treat displaced femoral neck fractures in osteo porotic patients. This study aimed to assess the occurrence and outcomes of unplanned return visits to the emergency department (ED) within 90 days following bipolar hemiarthroplasty for displaced femoral neck fractures.
Methods:
The clinical data of 1322 consecutive patients who underwent bipolar hemiarthroplasty for osteoporotic femoral neck fractures at a tertiary medical center were analyzed. Data from the patients’ electronic medical records, including demographic information, comorbidities, and operative details, were collected. The risk factors and mortality rates were analyzed.
Results:
Within 90 days after surgery, 19.9% of patients returned to the ED. Surgery-related reasons accounted for 20.2% of the patient’s returns. Older age, a high Charlson comorbidity index score, chronic kidney disease, and a history of cancer were identified as significant risk factors for unplanned ED visits. Patients with uncemented implants had a significantly greater risk of returning to the ED due to periprosthetic fractures than did those with cemented implants (P = 0.04). Patients who returned to the ED within 90 days had an almost fivefold greater 1-year mortality rate (15.2% vs 3.1%, P < 0.001) and a greater overall mortality rate (26.2% vs 10.5%, P < 0.001).
Conclusions
This study highlights the importance of identifying risk factors for unplanned ED visits after bipolar hemiarthroplasty, which may contribute to a better prognosis. Consideration should be given to the use of cemented implants for hemiarthroplasty, as uncemented implants are associated with a greater risk of peri prosthetic fractures.
4.Surgical treatment of spine metastatic tumor.
Hong-guang XU ; Qi-bin YE ; Gui-xing QIU ; Yi-peng WANG ; Jia ZHANG ; Ke CHOU
Acta Academiae Medicinae Sinicae 2002;24(1):76-78
OBJECTIVETo explore the value of surgical treatment on spine metastatic tumor.
METHODS31 cases of spine metastatic tumor with severe pain or/and neurological deficit were selected and treated with various operative methods.
RESULTSExcept for 4 cases, all the patients survived from 3 months to 7 years (average 17.6 months). The patients had no complication during treatment. The symptoms and neurological functions recovered with various extent after operation.
CONCLUSIONSSurgical treatment should cautiously be adopted. When the spine metastatic tumor with severe pain and neurological deficit has no response to the conservative methods, the surgical treatment with decompression and internal fixation should be performed to improve the life quality for the patients.
Adult ; Aged ; Breast Neoplasms ; pathology ; surgery ; Female ; Humans ; Lung Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Quality of Life ; Spinal Neoplasms ; secondary ; surgery
5.Interventional Procedures in Superficial Lesions: The Value of 2D with Additional Coronal Reformatted 4D Ultrasonography Guidance.
Cheng Yen CHANG ; Hsin Kai WANG ; Hong Jen CHIOU ; Yi Hong CHOU ; Tain Hsiung CHEN ; See Ying CHIOU
Korean Journal of Radiology 2006;7(1):28-34
OBJECTIVE: We wanted to assess the usefulness of four-dimensional (4D) ultrasonography (US), i.e., real-time three-dimensional US, as an adjunct for performing various US-guided interventional procedures in superficial lesions. MATERIALS AND METHODS: Thirty-three patients were referred for US-guided interventional procedures for superficial lesions, including core biopsy in 19, fine-needle aspiration in eight, therapeutic drug injection in four and needle puncture in two. The procedures were performed under 4D US guidance. We reviewed the pathologic/cytologic results of the core biopsies or needle aspirations, and also the outcomes of drug injection or needle puncture. RESULTS: For all the patients who underwent 4D US-guided core biopsy, the specimens were adequate for making the pathological diagnosis, and specimens were successfully obtained for those patients who underwent 4D US-guided aspiration. The patients treated with 4D US-guided therapeutic drug injection or needle puncture had a good response. No major procedure-related complications occurred. The procedural times were similar to those procedural times with using two-dimensional US. CONCLUSION: Combining the two dimensional and 4D US techniques aids the physician when performing US-guided interventional procedures for the superficial lesions.
Ultrasonography, Interventional/*methods
;
Punctures/*methods
;
Neoplasms/pathology
;
Middle Aged
;
Male
;
Injections/*methods
;
*Imaging, Three-Dimensional
;
Humans
;
Female
;
Aged, 80 and over
;
Aged
;
Adult
;
Adolescent
6.Reconstruction of the remnant penis: a 52-case report.
Xiao-wei WU ; Dao-chou LONG ; Bang-chang CHENG ; Sheng-guo SHAN ; Mo-sheng YU ; Song-shan WANG ; Yi-xin HE ; Ding-an LUO
National Journal of Andrology 2005;11(3):198-200
OBJECTIVETo explore the effects of the combined method of abdominal axial flap transposition and penile elongation for the treatment of the remnant penis.
METHODSFifty-two cases of the remnant penis treated with the combined method from 1984 April to February 2004 were analyzed retrospectively. Follow-up ranged from 0.5 to 20 years postoperatively.
RESULTSThe lengths (both in normal and erectile conditions) and the circumferences of the penis gained after operation were (5.6 +/- 1.4) cm, (6.8 +/- 2.5 cm and (6.9 +/- 2.3) cm respectively. The recovery rates of the sensory function were 94.2% and 100% in the glans (immediately and 3 months after operation) and 32.7%, 51.9% and 75% in the flap area (3, 6 and 12 months postoperatively). The two-point distinguishing sense in the glans and the flap area was (5.1 +/- 0.9) mm and(7.9 +/- 1.3) mm 5 years after operation. Early complications included distant flap necrosis (3 cases), disruption of the wound (2 cases), part necrosis of the skin graft in the abdominal wall (2 cases) and poor contours occurred in 4 cases in the later period because of the thickness of the flaps. All of them were corrected with satisfactory results.
CONCLUSIONThe combined method of abdominal axial flap transposition and penile elongation was recommendable for the treatment of the remnant penis because of its positive effects and less complications.
Adolescent ; Adult ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Penis ; injuries ; surgery ; Reconstructive Surgical Procedures ; Retrospective Studies ; Surgical Flaps
7.Safety and Efficacy of Adalimumab for Patients With Moderate to Severe Crohn's Disease: The Taiwan Society of Inflammatory Bowel Disease (TSIBD) Study.
Chen Wang CHANG ; Shu Chen WEI ; Jen Wei CHOU ; Tzu Chi HSU ; Chiao Hsiung CHUANG ; Ching Pin LIN ; Wen Hung HSU ; Hsu Heng YEN ; Jen Kou LIN ; Yi Jen FANG ; Horng Yuan WANG ; Hung Hsin LIN ; Deng Cheng WU ; Yen Hsuan NI ; Cheng Yi WANG ; Jau Min WONG
Intestinal Research 2014;12(4):287-292
BACKGROUND/AIMS: Only moderate to severe Crohn's Disease (CD) patients without a satisfactory conventional therapy effect are eligible to get reimbursement from the National Health Insurance of Taiwan for using adalimumab. These are more stringent criteria than in many Western countries and Japan and Korea. We aim to explore the efficacy of using adalimumab in CD patients under such stringent criteria. METHODS: A retrospective analysis was conducted in nine medical centers in Taiwan and we collected the results of CD patients receiving adalimumab from Sep 2009 to Mar 2014. The clinical characteristics, response measured by CDAI (Crohn's Disease Activity Index), adverse events and survival status were recorded and analyzed. CR-70, CR-100, and CR-150 were defined as attaining a CDAI decrease of 70, 100 or 150 points compared with baseline. RESULTS: A total of 103 CD patient records were used in this study. Sixty percent of these patients received combination therapy of adalimumab together with immunomodulators. CR-70 was 68.7%, 74.5% and 88.4% after week 4, 8 and 12 of treatment, respectively. The steroid-free rate, complications and survival were 47.6%, 9.7% and 99% of patients, respectively. In considering the mucosal healing, only 25% patients achieve mucosal healing after treatment for 6 to12 months. Surgery was still needed in 16.5% of patients. Combination treatment of adalimumab with immunomodulators further decreased the level of CDAI at week 8 when compared with the monotherapy. CONCLUSIONS: Even under the stringent criteria for using adalimumab, the response rate was comparable to those without stringent criteria.
Adalimumab
;
Crohn Disease*
;
Humans
;
Immunologic Factors
;
Inflammatory Bowel Diseases*
;
Japan
;
Korea
;
National Health Programs
;
Retrospective Studies
;
Taiwan*
8.Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023
Hsu-Heng YEN ; Jia-Feng WU ; Horng-Yuan WANG ; Ting-An CHANG ; Chung-Hsin CHANG ; Chen-Wang CHANG ; Te-Hsin CHAO ; Jen-Wei CHOU ; Yenn-Hwei CHOU ; Chiao-Hsiung CHUANG ; Wen-Hung HSU ; Tzu-Chi HSU ; Tien-Yu HUANG ; Tsung-I HUNG ; Puo-Hsien LE ; Chun-Che LIN ; Chun-Chi LIN ; Ching-Pin LIN ; Jen-Kou LIN ; Wei-Chen LIN ; Yen-Hsuan NI ; Ming-Jium SHIEH ; I-Lun SHIH ; Chia-Tung SHUN ; Tzung-Jiun TSAI ; Cheng-Yi WANG ; Meng-Tzu WENG ; Jau-Min WONG ; Deng-Chyang WU ; Shu-Chen WEI
Intestinal Research 2024;22(3):213-249
Ulcerative colitis (UC) is a chronic inflammation of the gastrointestinal tract and is characterized by alternating periods of inflammation and remission. Although UC incidence is lower in Taiwan than in Western countries, its impact remains considerable, demanding updated guidelines for addressing local healthcare challenges and patient needs. The revised guidelines employ international standards and recent research, emphasizing practical implementation within the Taiwanese healthcare system. Since the inception of the guidelines in 2017, the Taiwan Society of Inflammatory Bowel Disease has acknowledged the need for ongoing revisions to incorporate emerging therapeutic options and evolving disease management practices. This updated guideline aims to align UC management with local contexts, ensuring comprehensive and context-specific recommendations, thereby raising the standard of care for UC patients in Taiwan. By adapting and optimizing international protocols for local relevance, these efforts seek to enhance health outcomes for patients with UC.
9.Management of Crohn’s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023
Jia-Feng WU ; Hsu-Heng YEN ; Horng-Yuan WANG ; Ting-An CHANG ; Chung-Hsin CHANG ; Chen-Wang CHANG ; Te-Hsin CHAO ; Jen-Wei CHOU ; Yenn-Hwei CHOU ; Chiao-Hsiung CHUANG ; Wen-Hung HSU ; Tzu-Chi HSU ; Tien-Yu HUANG ; Tsung-I HUNG ; Puo-Hsien LE ; Chun-Che LIN ; Chun-Chi LIN ; Ching-Pin LIN ; Jen-Kou LIN ; Wei-Chen LIN ; Yen-Hsuan NI ; Ming-Jium SHIEH ; I-Lun SHIH ; Chia-Tung SHUN ; Tzung-Jiun TSAI ; Cheng-Yi WANG ; Meng-Tzu WENG ; Jau-Min WONG ; Deng-Chyang WU ; Shu-Chen WEI
Intestinal Research 2024;22(3):250-285
Crohn’s disease (CD) is a chronic, fluctuating inflammatory condition that primarily affects the gastrointestinal tract. Although the incidence of CD in Taiwan is lower than that in Western countries, the severity of CD presentation appears to be similar between Asia and the West. This observation indicates the urgency for devising revised guidelines tailored to the unique reimbursement system, and patient requirements in Taiwan. The core objectives of these updated guidelines include the updated treatment choices and the integration of the treat-to-target strategy into CD management, promoting the achievement of deep remission to mitigate complications and enhance the overall quality of life. Given the diversity in disease prevalence, severity, insurance policies, and access to medical treatments in Taiwan, a customized approach is imperative for formulating these guidelines. Such tailored strategies ensure that international standards are not only adapted but also optimized to local contexts. Since the inception of its initial guidelines in 2017, the Taiwan Society of Inflammatory Bowel Disease (TSIBD) has acknowledged the importance of continuous revisions for incorporating new therapeutic options and evolving disease management practices. The latest update leverages international standards and recent research findings focused on practical implementation within the Taiwanese healthcare system.
10.Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.
Shu Chen WEI ; Ting An CHANG ; Te Hsin CHAO ; Jinn Shiun CHEN ; Jen Wei CHOU ; Yenn Hwei CHOU ; Chiao Hsiung CHUANG ; Wen Hung HSU ; Tien Yu HUANG ; Tzu Chi HSU ; Chun Chi LIN ; Hung Hsin LIN ; Jen Kou LIN ; Wei Chen LIN ; Yen Hsuan NI ; Ming Jium SHIEH ; I Lun SHIH ; Chia Tung SHUN ; Yuk Ming TSANG ; Cheng Yi WANG ; Horng Yuan WANG ; Meng Tzu WENG ; Deng Chyang WU ; Wen Chieh WU ; Hsu Heng YEN ; Jau Min WONG
Intestinal Research 2017;15(3):285-310
Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.
Adrenal Cortex Hormones
;
Asian Continental Ancestry Group
;
Biological Therapy
;
Consensus*
;
Crohn Disease*
;
Diagnosis
;
Disease Management
;
Expert Testimony
;
Gastrointestinal Tract
;
Hepatitis B virus
;
Humans
;
Incidence
;
Inflammatory Bowel Diseases*
;
Magnetic Resonance Imaging
;
Prevalence
;
Quality of Life
;
Taiwan*
;
Tuberculosis