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  • The Kaohsiung journal of medical sciences 07/2014; 30(7):376–377. DOI:10.1016/j.kjms.2013.04.009

  • Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 10/2009; 15(6):321. DOI:10.1097/RHU.0b013e3181b848d3
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    ABSTRACT: To study the characteristics of clinical findings and CT imaging of perforated appendicitis for predicting the outcome of patients who received immediate appendectomy for perforated appendicitis. Thirty-eight patients with perforated appendicitis who received immediate appendectomy were retrospectively reviewed. During a median follow-up period of 1091 days, 13 patients had to be re-hospitalized owing to occurrence of complications relating to the immediate appendectomy. Accordingly, the patients were divided into two groups as either complication or non-complication group. The clinical characteristics and CT imaging of these two groups were compared. Those patients who delayed seeking medical advice were more prone to develop surgical complications after immediate appendectomy. CT imaging showing either fat stranding with remarkable fluid content or abscess indicates the presence of severe inflammation and is related to adverse surgical outcomes. Moreover, extraluminal appendicolith was more frequently found in the CT imaging of complication group. Patients with perforated appendicitis differ in their severity. Patients who seek medical advice late or have signs of severe inflammation or extraluminal appendicolith on their CT imaging are associated with more severe diseases and are prone to develop complications of surgery at this time and should be better treated conservatively.
    Hepato-gastroenterology 01/2008; 55(81):127-32.
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    ABSTRACT: The purpose of this study was to study the clinical symptoms, laboratory data, and the characteristics of computed tomography (CT) imaging of nonoperated perforated appendicitis for predicting the recurrence of appendicitis. Thirty-five patients with nonoperated perforated appendicitis were retrospectively reviewed for this study. During a median follow-up period of 1155 days, 7 patients had to receive an appendectomy owing to recurrent appendicitis. Accordingly, the patients were divided into 2 groups: the recurrence and the nonrecurrence group. The clinical characteristics between these 2 groups were compared. Both of the 2 patients who had a past history of appendicitis suffered recurrent appendicitis (the recurrence versus the nonrecurrence group, P<.05). The only CT imaging relating to the recurrence of appendicitis is the presence of calcified appendicolith (the recurrence versus the nonrecurrence group, P<.001). It is most likely that appendicitis will recur if a calcified appendicolith on CT imaging or a past history of appendicitis is presented. Interval appendectomy may be reserved only for those patients who possess one of these risk factors of recurrent appendicitis.
    The American Journal of Surgery 10/2006; 192(3):311-6. DOI:10.1016/j.amjsurg.2005.08.037
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    ABSTRACT: To understand the injury mechanism of the intervertebral disc at different loading rates and to explore the anatomic and histological changes of intervertebral discs. Fresh porcine lumbar spines were used for fatigue testing to study the morphological changes of the intervertebral disc. Intervertebral disc problem is one of the most common causes that lead to low back pain. Slow repetitive loading was considered to be the critical factor of spine and disc injuries. Twenty-four lumbar functional units were subjected to cyclic loading at three different loading rates. The geometric measurements and magnetic resonance image observations were conducted for the comprehension of morphological changes. The detail observation was taken through a stereomicroscope. There was no significance in geometric changes between different loading rates. For magnetic resonance imagings, morphological changes included the changes of nucleus pulposus shape, bulge of anterior and posterior longitudinal ligaments, and dehydration in annulus fibrosus. The morphological changes of intervertebral disc were revealed in certain kinds of lesions. The results imply that fatigue failure and degeneration or instability are strongly linked. The correlation of magnetic resonance imaging and anatomic observation showed a high correspondence in the comparison of shape and position of the nucleus pulpasus. The changes of geometric measurements and relationship between anatomic observation and magnetic resonance imaging finding had been analyzed. It could help in understanding the mechanism of triggering cause in the early stage of disc degeneration.
    Clinical Biomechanics 08/2003; 18(6):S3-9. DOI:10.1016/S0268-0033(03)00078-0
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    ABSTRACT: We conducted this study to correlate computed tomography (CT) images with the complications induced by CT-guided percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC). Twenty-two patients with ultrasonographically unreachable HCC were treated with CT-guided transthoracic PEI. The procedures and the CT findings were recorded to correlate with the various complications of PEI. After the ethanol injection, 3 patterns of CT images were identified according to the distribution of ethanol (ie, intratumoral, extrahepatic, and intrahepatic patterns). The intrahepatic pattern was further classified as the branch, tubular, and infiltrative types. During the follow-up period, 3 patients developed biliary stricture, portal vein thrombosis, or tumor seeding. The tubular type was associated with the development of biliary stricture, whereas the branch type was related to the occurrence of portal vein thrombosis. These complications were considered to be caused by a greater amount of ethanol leakage into bile ducts or portal veins than in cases without complications (median = 17 mL vs. 0 mL, P = 0.002). Ethanol leakage is not uncommon when performing PEI; however, it seems to be safe when the leakage is less than 15 mL. Injection of a small amount of ethanol or monitoring by CT may be helpful in preventing the development of these complications.
    Journal of Computer Assisted Tomography 07/2003; 27(4):590-6. DOI:10.1097/00004728-200307000-00025
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    ABSTRACT: To study the portal flow patterns from CTAP (computed tomography of arterial portography), then to predict the existence of esophageal varices bleeding clinically. 192 patients who underwent CTAP from superior mesenteric artery infusion were recruited in this study. The obtained images were classified according to our proposed criteria. Stage 0: hepatopetal flow, when all the contrast medium from the superior mesenteric vein entered the portal vein. Stage 1: when the contrast medium opacified the splenic vein or the other collateral vessels. Stage II: when the contrast medium opacified the paraesophageal vessels without entering the inner wall of the esophagus. Stage III: when the contrast medium opacified the collaterals up to the inner wall of the esophagus. The incidence of bleeding esophageal varices was correlated to the different stages of collateral flows pattern obtained. The esophageal varices bleeding rates were 0/137, 1/16, 1/14, 16/25 for stage 0, I, II and III, respectively. The incidence of bleeding esophageal varices was significantly higher in stage III group than in the other groups (P < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of stage III patients in regard to the occurrence of bleeding esophageal varices were estimated as 80.0%, 98.8%, 88.9%, 94.8%, and 94.3%, respectively. Our results show that CTAP demonstrates the portal flow patterns and collateral veins clearly, which can serve as an excellent imaging modality to predict the risk of esophageal varices bleeding.
    Hepato-gastroenterology 01/2000; 47(36):1615-8.
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    ABSTRACT: OBJECTIVE: To compare the strength of two types of fixation method for calcaneal fractures. DESIGN: A biomechanical testing examined the stability of 12 fractured calcaneal specimens fixed with two different methods. BACKGROUND: Though anatomic reduction and internal fixation for the treatment of intra-articular fractures of the calcaneus has become popular, biomechanical data on the fixation strength is lacking. METHODS: Twenty fresh frozen specimens of amputated human legs were impacted by a 20 kg weight dropped from a 155 cm height to create calcaneal fractures. Twelve specimens which demonstrated a longitudinal and a transverse primary fracture lines were selected for open reduction and internal fixation. Group 1: a lateral buttress plate and parallel screws placed in the latero-medial direction were used. Group 2: a longitudinal screw was added in addition to the fixation used in group 1. Biomechanical testing was performed by applying a tibial shank load until the internal fixation failed. RESULTS: All mechanical failures of the reconstructed calcaneus occurred through the transverse primary fracture line. The average failure load was 805+/-356 N in group 1 and 2905+/-910 N in group 2 (Wilcoxon p<0.05). CONCLUSIONS: A longitudinal transfixing screw could significantly improve the stability of the transverse primary fracture line in calcaneal fractures.
    Clinical biomechanics (Bristol, Avon) 04/1998; 13(3):230-233. DOI:10.1016/S0268-0033(97)00042-9
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