Hao-Chung Ho

Taichung Veterans General Hospital, 臺中市, Taiwan, Taiwan

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Publications (40)34.45 Total impact

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    ABSTRACT: Sequential treatments using various targeted-therapies have been recommended for metastatic renal cell carcinoma. However, regimen selection remains difficult when adapting to various clinical situations.
    Anticancer research 10/2014; 34(10):5643-7. · 1.71 Impact Factor
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    ABSTRACT: The prognosis of renal cell carcinoma with brain metastasis is generally poor. Here we report a case of a 56-year-old man with metastatic renal cell carcinoma to the brain who underwent metastasectomy, cytoreductive nephrectomy, and whole brain radiotherapy. Thereafter, he received sunitinib, everolimus, and sorafenib sequentially for 11 months, 2 months, and 2 months, respectively. No tumor recurrence or progression of brain lesions has been reported in this patient for the past 16 months.
    Urological Science 04/2014;
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    ABSTRACT: Background The da Vinci robot system has become the mainstay of minimally invasive surgery and has been used in numerous complex reconstructive procedures. Due to the success of this innovative technology, we attempted to expand our practical model and application of the da Vinci robot system into other urologic surgeries, beginning with robotic-assisted laparoscopic radical prostatectomy (RALRP). Methods We retrospectively reviewed a total of 683 patients who underwent robotic-assisted urologic surgery between December 2005 and December 2012. We divided this 8-year course of device use into three periods, and analyzed the surgical capability of operations in 1 day over different periods through a retrospective analysis. Results In the first period (2005–2008), 159 cases of robotic-assisted urologic surgeries were performed. A total of 195 cases were performed in the second group (2009–2010), and 329 cases in the third (2011–2012). Starting with radical prostatectomy in December 2005, we performed various types of procedures such as partial nephrectomy, pyeloplasty, nephroureterectomy with cystoprostatectomy, nephroureterectomy with bladder cuff, radical cystoprostatectomy/cystectomy with ileal conduit reconstruction, partial cystectomy, adrenalectomy, nephropexy, simple prostatectomy, ureteral reconstruction, and pyelolithotomy/ureterolithotomy. The mean operation times of prostatectomy, partial nephrectomy, nephroureterectomy with radical cystectomy/cystectoprostatectomy, and nephroureterectomy were 154, 140, 295, and 129 minutes, respectively. Conclusion Based on our experience, a robotic system can be applied to many different types of urologic surgeries both safely and efficiently.
    Journal of the Chinese Medical Association 01/2014; · 0.75 Impact Factor
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    ABSTRACT: Renal transplant is the preferred treatment for patients with uremia. The renal transplant procedure is well established with a high success rate, but surgical complications are encountered occasionally. We report a case of sudden onset of anuria of the graft kidney owing to acute external iliac artery dissection diagnosed by Doppler sonography. Urgent endarterectomy with thrombus removal of false lumen prevented ischemia and occlusion of the right femoral artery. Without accurate diagnosis and management, this complication could have caused graft loss and death. We believe that renal transplant requires attentive teamwork to keep the graft functioning well.
    Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 06/2013; 11(3):274-7.
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    ABSTRACT: BACKGROUND: The risk of developing chronic kidney disease (CKD) among living kidney donors (LKDs) is seldom included in evaluations of patients' outcomes. Potential risk factors and new criteria for estimating the glomerular filtration rate (eGFR) indexed for body surface area (BSA) were investigated with a view to prevent the development of CKD in LKDs. METHODS: We conducted a retrospective study of LKDs from May 1983 to March 2011. The Mann-Whitney U test and χ(2) test were used to analyze the male versus female groups. Survival analysis was plotted as CKD-free survival and analyzed separately by different eGFR index classifications. The Cox regression model was used to identify potential risk factors for development of CKD. RESULTS: A total of 105 LKDs with a mean age of 46.3 ± 12.5 years had a mean eGFR indexed for BSA of 88.9 ± 21.5 ml/min per 1.73 m(2). After a mean duration of 5.4 ± 4.9 years' follow-up, eGFR dropped to 61.4 ± 16.4 ml/min per 1.73 m(2) (p = 0.002). Median CKD-free survival was only 5.7 years. The difference between eGFR ≥ 80 ml/min per 1.73 m(2) and <80 ml/min per 1.73 m(2) was not statistically significant (p = 0.980). Multivariate Cox regression analysis showed that higher eGFR at donation (HR = 0.952, p = 0.0199) could be a protective factor. The receiver operating characteristic (ROC) curve for initial eGFR with best sensitivity of 52.78 % and specificity of 81.40 % was obtained with a cutoff value of 90.2 ml/min per 1.73 m(2) for preoperative eGFR. An eGFR of 90 ml/min per 1.73 m(2) yielded a significant survival curve (p = 0.0199) after 21 years of follow-up. Further classifications of eGFR >90 ml/min per 1.73 m(2) into 90-99 ml/min per 1.73 m(2), 100-109 ml/min per 1.73 m(2), and ≥110 ml/min per 1.73 m(2) were examined, but this survival curve was not statistically significant (p = 0.1247). CONCLUSIONS: Living kidney donors will develop CKD after a long duration of follow-up if there is insufficiently high eGFR at donation. An eGFR above 90 ml/min per 1.73 m(2) before donation is the only factor that predicts prevention of CKD. Larger studies with longer duration of follow-up are necessary to clarify the clinical outcome of this postoperative CKD group, especially for patients with eGFR between 80 and 90 ml/min per 1.73 m(2).
    World Journal of Surgery 01/2013; · 2.23 Impact Factor
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    ABSTRACT: Background Doubling of serum creatinine (DSC) in transplantation has been seen as the end-point of renal function without pathological evidence. We conducted this study to elucidate the relationship between DSC and pathological findings. Material and Methods We conducted a retrospective cohort study to illustrate pathologic changes in patients receiving a kidney biopsy in the previous 5 years with clinicopathological correlations to DSC and proteinuria. Results Of a total of 99 kidney recipients (146 biopsies), results of graft biopsy were as follows: calcineurin inhibitor toxicity (CNI) (38.7%) and rejection (36.9%). Compared to males, females had higher proportions of class I (p=0.003) and class II PRA (p<0.001), and a higher rejection rate (p=0.042), but had the same clinical outcomes as males, like eGFR at follow-up (p=0.882), DSC (p=0.703), and proteinuria (p=0.745). Pathological diagnoses and findings were related to proteinuria: glomerulopathy (HR=4.9, p=0.01), AMR (HR=2.5, p=0.025), especially acute AMR (HR=2.9, p=0.008), chronic glomerular change (HR=10.2, p=0.002), arteriolar hyaline (HR=2.3, p=0.026), and mesangial matrix change (HR=6.3, p=0.002). BK nephropathy and rejection were the only 2 risk factors. Pathological findings favoring AMR (PTC infiltration and glomerulitis) showed a greater risk of DSC compared with those favoring CMR (interstitial inflammation, intimal arteritis, and tubulitis). DSC was correlated with clinical manifestation (rejection) and provided strong pathological evidence. Conclusions There was more acute rejection and chronic pathological change in women, but outcomes were the same due to less activity of renin-angiotensin-aldosterone and hyperfiltration in females. DSC as an end-point of graft function can be used to identify recipients, especially AMR or mixed AMR and CMR. 1. All forms of support received by each author: None of the authors received support. 2. Any potential conflict of interest for each author: No conflict of interest for any of the authors.
    Annals of transplantation : quarterly of the Polish Transplantation Society. 01/2013; 18:471-81.
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    ABSTRACT: Suprapubic cystostomy is commonly performed in patients with neurogenic bladder or bladder outlet obstruction. The most serious complication is bowel injury, which usually occurs during catheter insertion. Bowel perforation during suprapubic catheter exchange is rare. We herein report an extremely rare case of terminal ileal perforation resulting from a change of suprapubic catheter. After insertion of the suprapubic catheter, a feculent material was noted in the terminal ileum. A cystography revealed that the contrast medium passed directly into the terminal ileum and colon. A computed tomographic scan confirmed the presence of a balloon tip in the terminal ileum. Terminal ileum perforation was diagnosed. Emergent laparotomy and loop ileostomy were performed. The patient's recovery was uneventful.
    Urological Science 01/2013;
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    ABSTRACT: PURPOSE: The purpose of this study is to evaluate the efficacy of a protocol including topical heparin therapy for hand-foot skin reactions (HFSR) during multikinase (MKI) treatment. METHODS: We prospectively collected 26 patients who had HFSRs during treatment with the MKIs, sunitinib, sorafenib, or axitinib. The age distribution ranged from 46 to 87 years, with a mean of 66 years. The distribution of HFSR severity was 12 patients with grade 1, 12 with grade 2, and 2 with grade 3. A heparin-containing topical ointment treatment, combined with hand-foot shock absorbers and skin moisturizers, was used at the lesion sites. Changes in the grade of HFSR, MKI dosage, and interruptions of MKI therapy were recorded. RESULTS: The results showed that 66.7 % of grade 1 patients were cured of disease, 83.3 % of grade 2 patients had improved symptoms, and both grade 3 patients (100 %) had improved symptoms and were downgraded to grade 2. Four (15.4 %) patients required reduction of MKI dosage, but there were no treatment interruptions or dropouts. CONCLUSION: Our protocol is beneficial in promoting resolution of HFSRs induced by MKIs. Further validation in large control studies should be investigated.
    Supportive Care in Cancer 12/2012; · 2.09 Impact Factor
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    ABSTRACT: BACKGROUND: Catheter malfunction is a common and significant complication during peritoneal dialysis (PD). We developed a minilaparotomy procedure to rescue malfunctioning catheters and to prevent recurrence of malfunction. ♢ METHODS: From 2006 to 2011, 11 patients receiving PD had a malfunctioning catheter. In all patients, a 2-cm incision, 5 cm caudally to the previous peritoneal entry site was used to correct the malfunctioning catheter, with concomitant fixation of the catheter to the peritoneum. ♢ RESULTS: Catheter tip migration occurred in 7 patients, omental wrapping in 3, and blood clot obstruction in 1. The mean onset time to catheter malfunction was 197.5 days (range: 4 - 1270 days), and the mean operating time was 41 minutes (range: 35 - 56 minutes). There was no recurrence of catheter malfunction and no surgery-related peritonitis. ♢ CONCLUSIONS: Our minilaparotomy procedure is safe and feasible for the salvage of malfunctioning PD catheters.
    Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 09/2012;
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    ABSTRACT: Peritoneal dialysis (PD) is a widely used renal replacement therapy for end-stage renal disease (ESRD) patients. Using laparoscopic guidance for PD catheter placement, we have designed a safe method that resulted in a reduction in catheter migration. We retrospectively reviewed 250 consecutive patients who underwent PD catheter placement from January 2005 to December 2009. The patients were divided into two groups: the conventional open surgery group and the laparoscopic group. All patients received Tenckhoff straight catheters. In the laparoscopic group, the catheter was additionally fixed to the ventral abdominal wall. Data were collected and a statistical analysis was performed to compare patient characteristics, surgical complications and catheter removal between the groups. Overall surgical complications in the laparoscopic group were lower than those in the conventional group (3.8% vs. 19.4%, p < 0.001), and the majority of catheter migrations and omental wraps occurred in the conventional group. Patients in the conventional group had higher American Society of Anesthesiologists scores than those in the laparoscopic group. There was no difference in the incidence of previous abdominal operation or follow-up periods in the groups. Our laparoscopy-assisted PD catheter insertion method using an intraperitoneal fixation loop is safeand can be a valuable tool in prevention of catheter migration and omental wraps.
    Journal of the Chinese Medical Association 07/2012; 75(7):309-13. · 0.75 Impact Factor
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    ABSTRACT: Induction therapy with interleukin-2 receptor antagonist (IL2RA) is widely used for renal transplant recipients and this study aimed to examine the impact of IL2RA among Chinese renal transplant recipients. Two hundred and thirty-eight Chinese renal transplant recipients aged 18-65 years at the Taichung Veterans General Hospital from January 2004 to July 2009 were retrospectively studied to assess the influence of IL2RA on biopsy-proven acute rejection (BPAR) within 1 year. Secondary outcomes included acute rejection rate in the first 3 months, delayed graft function, post-transplant diabetes mellitus, and malignancy. Cox proportional hazard analysis was used for multivariate analysis. Of all the patients, 116 received IL2RA (basiliximab, n = 44; daclizumab, n = 72) and 122 had no induction therapy. The mean follow-up duration was 43.3 months (range, 1-79 months). Overall, 227 (95.4%) patients completed the 12-month follow-up period with a functioning graft. No difference of BPAR was observed between the two groups and the secondary outcomes were also similar. After adjusting potential covariates with Cox regression, IL2RA use still provided no benefit on BPAR. In conclusion, there is no benefit of IL2RA in decreasing BPAR was observed in our study. Routine use of IL2RA for adult Chinese kidney transplant recipients may not be as effective as we thought before. More research is still needed to elucidate the effect of IL2RA among Chinese kidney transplant recipients.
    Renal Failure 05/2012; 34(7):856-61. · 0.94 Impact Factor
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    ABSTRACT: A 54-year-old female had a 9-cm left renal mass with a 12-cm aorto-caval mass lesion mimicking an enlarged lymph node. Retroperitoneal dissection and left radical nephrectomy were performed, and pathology revealed a left renal mucinous tubular and spindle cell carcinoma combined with a retroperitoneal ganglioneuroma. The patient has had no local recurrence or distant metastasis after 3 years' follow-up. A misdiagnosis of metastatic renal cell carcinoma may be upheld by the primary imaging studies. Even in the targeted therapy era, cytoreductive nephrectomy is still an important step in the diagnosis and treatment of suspicious metastatic renal cell carcinomas.
    Journal of the Chinese Medical Association 05/2012; 75(5):240-2. · 0.75 Impact Factor
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    ABSTRACT: To analyze the incidence of malfunction of the da Vinci robotic system in a single center and to provide potential solutions. A total of 400 patients underwent da Vinci robotic urological surgery at Taichung Veterans General Hospital in Taichung, Taiwan, from December 2005 to April 2011. Episodes of malfunction of the robotic system were analyzed by period of operation, type of procedure, type of malfunction and management of the event. Overall, 14 cases of malfunction occurred (3.5% of the entire series). Among them, five (1.25%) occurred before the surgery and nine (2.25%) intraoperatively. Operative procedures included radical prostatectomy, bilateral pelvic lymph node dissection, dismembered pyeloplasty, partial nephrectomy, nephroureterectomy, and radical and partial cystectomies. Areas of malfunctions included the robotic arm system and joint (11/14), optical system (1/14), power system and connector (1/14), endoscopic instrument (1/14), and software (1/14). In 10 cases, the failure was recoverable, whereas in four cases there was a critical failure, requiring a conversion to standard laparoscopy in three of them, and the rescheduling of the surgery in one case. The da Vinci robotic system is extremely reliable for use in urology. Malfunction is rare and the risk of critical failure is very low. Managing mechanical failure before or during the surgery is the key to maintaining the safety of patients undergoing robotic surgical procedures.
    International Journal of Urology 04/2012; 19(8):736-40. · 1.73 Impact Factor
  • Wen-Ming Chen, Chen-Li Cheng, Hao-Chung Ho
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    ABSTRACT: Aim We describe the use of Fogarty balloon catheter, during laparoscopic nephroureterectomy for upper-tract urothelial carcinoma, to facilitate countertraction and hemostasis during cystoscopic en bloc excision of the distal ureter and bladder cuff. Methods Between November 2005 and January 2010, the above-mentioned technique was used in 28 patients. The diseased kidney and ureter were dissected adequately by laparoscopy. The patient was placed in the dorsal lithotomy position. A 4 French Fogarty balloon catheter was introduced into the targeted distal ureter by cystoscopy and was inflated to occlude the ureteral lumen. Under countertraction of the inflated Fogarty balloon catheter, transurethral resection with a 1-cm safety margin around the ureteral orifice by a Collins knife was performed, and the distal ureter and bladder cuff were detached en bloc from the urinary bladder. Results The mean surgical time was 253 minutes (range: 170–275 minutes). The mean estimated blood loss was 120 mL (range: 70–350 mL). The mean hospital stay was 6.3 days (range: 3–10 days). Acute urinary retention developed in one patient, who had an enlarged prostate. The catheter was reinserted and removed 7 days later. One uremic patient treated by hemodialysis developed a symptomatic lymphocele 2 months postoperatively, which improved with temporary percutaneous drainage. At a mean follow-up of 15.4 months (range: 6–26 months), no local recurrence was noted. Conclusions The use of Fogarty balloon catheter for countertraction during transurethral en bloc excision of the distal ureter and bladder cuff is a useful and safe technique to achieve excellent surgical results.
    Formosan Journal of Surgery. 02/2012; 45(1):8–11.
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    ABSTRACT: This study was conducted to delineate the frequency of recurrent lupus nephritis in a Chinese kidney transplant cohort and to estimate its impact on long-term transplant outcomes. A total of 32 lupus transplant patients were enrolled in this study, and the medical records were retrospectively reviewed. Patients with unexplained graft abnormalities were subjected to allograft biopsy. Recurrent lupus nephritis was diagnosed by light microscopy, immunofluorescence, and electron microscopy. In addition, to determine the clinical manifestations of recurrent lupus GN in these patients, serum original systemic lupus erythematosus disease activity index (SLEDAI) scores while undergoing allograft biopsy were evaluated. In total, six out of 32 patients (18.8%; mean age, 40.5 ± 9.1 years) were diagnosed as having recurrent lupus nephritis and the mean time at diagnosis was 5.1 ± 4.9 years post-transplantation. According to the International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 criteria, three of the six cases (50%) were defined as class I, one was class II, one was class IV, and one was class III + V. The graft and patient survival rates of recurrent lupus nephritis (n = 6) were not different from those of patients with other diagnostic entities. Although recurrent lupus nephritis was not uncommon, it did not appear to have a strong negative impact on long-term outcome in Chinese kidney transplant patients. The recurrence was potentially treatable and should not be precluded for receiving transplantation.
    Clinical Rheumatology 01/2012; 31(4):705-10. · 2.04 Impact Factor
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    ABSTRACT: The aim of our study was to identify the optimal predictor of prostate cancer among several prostate-specific antigen (PSA) derivatives in repeat prostate biopsy. We retrospectively assessed the repeat prostate biopsy specimens, obtained between 1999 and 2008, of 212 patients with a total PSA (tPSA) of 4-10 ng/ml and normal digital rectal examination. Using a receiver operating characteristic (ROC) analysis, we assessed the predictive power of tPSA, percent free PSA (f/t PSA), PSA density (PSAD), and PSA velocity (PSAV) for the detection of prostate cancer. Repeat prostate biopsy specimens were positive for prostate cancer in the case of 26 patients and negative in the case of 186 patients. The areas under the receiver operating characteristic (ROC) curves for tPSA, f/tPSA, PSAD, and PSAV were 72.7%, 57.9%, 74.4%, and 64.8%, respectively. The ROC curve analysis revealed that PSAD was a better predictor of prostate cancer than f/t PSA. Moreover, when PSAD at an optimal cutoff of 0.18 ng/ml/cc was considered as the predictor, the detection of prostate cancer was found to have a high sensitivity and specificity (77% and 69%, respectively). In a repeat prostate biopsy, PSAD is superior to f/t PSA as a predictor of prostate cancer. And, by assessing this predictor, an unnecessary repeat biopsy of patients with tPSA of 4-10 ng/ml can be avoided.
    Journal of the Chinese Medical Association 12/2011; 74(12):552-5. · 0.75 Impact Factor
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    ABSTRACT: The Resonance(®) metallic stent has been reported to be sufficient for the management of malignant extrinsic ureteral obstructions within a 12-month time period. To determine the effectiveness in each specific patient group, we report our experience using the Resonance(®) stent in the treatment of ureteral obstructions. We retrospectively reviewed 20 patients (23 stents) who successfully received the Resonance(®) metallic stents and divided them into a patent group (n = 19) and an obstructive group (n = 4) according to the treatment results. Twenty-one stents were inserted via cystoscopy or ureteroscopy in a retrograde fashion. The remaining two were inserted via percutaneous nephrostomy in an antegrade manner. Follow-up serum creatinine measurements and sonography were performed. The overall ureteral patency rate and the risk of stent failure were evaluated. The overall ureteral patency rate was 82.6% (19/23). Patients with previous radiotherapy had a 50% (4/8) patency rate which was significantly lower than non-radiotherapy patients (100%, 15/15, p = 0.028). Malignant obstructions in those other than radiotherapy patients had a 100% patency rate (5/5). Benign obstructions in those other than radiotherapy patients had a 100% patency rate (10/10). In the radiotherapy patients, the mode of therapy did not dominate the stent outcome. Patients with ureteral obstructions can be treated sufficiently with the Resonance(®) metallic stent. Patients who had gynecological malignancies and received radiotherapy had a higher failure rate after Resonance(®) metallic stent insertion.
    Journal of the Chinese Medical Association 10/2011; 74(10):460-3. · 0.75 Impact Factor
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    ABSTRACT: Radical retropubic prostatectomy remains the gold standard treatment for localized prostate cancer. However, new minimally invasive techniques have emerged, providing a less invasive approach. Robotic-assisted laparoscopic radical prostatectomy is the ideal technique, providing good oncologic and functional outcomes. We analyzed the impact of robotic surgical systems on practice patterns among urologists to explain changes in the value of radical retropubic prostatectomy, laparoscopic radical prostatectomy and robotic-assisted laparoscopic radical prostatectomy in a single institution in Taiwan. We retrospectively reviewed the records of patients who received prostatectomy by one of the above procedures between January 2004 and November 2009. Decisions to perform these procedures were made by patient preference. Patients who received prostate biopsies at other hospitals were transferred to our hospital specifically for robotic-assisted prostatectomy. A total of 434 radical prostatectomies were performed, of which 141 (32.49%) were radical retropubic prostatectomies, 59 (13.59%) were laparoscopic radical prostatectomies and 234 (53.92%) were robotic-assisted laparoscopic prostatectomies. The overall number of prostatectomies has increased over time because of an increase in robotic-assisted procedures. No decreases were seen in the number of radical retropubic prostatectomies during the evaluation period. Changes in the ratio of robotic-assisted prostatectomies compared to radical retropubic and laparoscopic radical prostatectomies demonstrated a trend toward robotic-assisted procedures. The percentage of cases transferred from other hospitals also increased over time from 28.57% to 68.60%. Our experience emphasizes the potential of robotic-assisted prostatectomy to become the mainstream treatment for localized prostate cancer in Taiwan.
    Journal of the Chinese Medical Association 04/2011; 74(4):155-8. · 0.75 Impact Factor
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    ABSTRACT: Peritoneal dialysis (PD) is a widely used renal replacement therapy for end-stage renal disease patients. We compared our novel laparoscopic-assisted method with conventional procedures in the catheter survival and complications. Seventy-three patients who underwent PD catheter placement were enrolled in this study. Our laparoscopic methods were characterized with smaller incision and additional fixation in the lower abdomen. Catheter migration developed in 4 patients in the conventional group compared with none in the laparoscopic group. The catheter dysfunction-free survival was significantly longer among the patients in the laparoscopic group than that in the conventional group (P=0.001). There were no significant differences between the 2 groups in peritonitis, exit-site hematoma, or exit-site infection. Laparoscopy-assisted PD catheter insertion with an intraperitoneal loop fixation is safe and provides good maintenance of catheter function (See the video, Supplemental Digital Content 1, http://links.lww.com/SLE/A28).
    Surgical laparoscopy, endoscopy & percutaneous techniques 04/2011; 21(2):106-10. · 0.88 Impact Factor
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    ABSTRACT: A 61-year-old woman with type 2 diabetes mellitus was admitted for living donor renal transplantation. Sudden onset of acute pulmonary edema developed one day post-transplant and was proved to be due to acute myocardial infarction. Urgent coronary arterial bypass grafting was performed immediately due to failure of percutaneous coronary intervention and cardiogenic shock. This was followed by a prolonged period of delayed graft function (53 days). Fortunately, she had full recovery of graft function with a discharged serum creatinine of 0.8 mg/dL.
    Journal of Internal Medicine of Taiwan 01/2011; 22(4):283-286.

Publication Stats

125 Citations
34.45 Total Impact Points

Institutions

  • 2003–2014
    • Taichung Veterans General Hospital
      • Department of Internal Medicine
      臺中市, Taiwan, Taiwan
  • 2012
    • China Medical University Hospital
      臺中市, Taiwan, Taiwan
  • 2011
    • Chi-Mei Medical Center
      臺南市, Taiwan, Taiwan
  • 2009–2010
    • National Chung Hsing University
      臺中市, Taiwan, Taiwan