Tsang-Pai Liu

Mackay Memorial Hospital, T’ai-pei, Taipei, Taiwan

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Publications (47)68.89 Total impact

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    ABSTRACT: Background: Prophylactic dexamethasone has been shown to reduce postoperative pain, nausea, and vomiting in patients undergoing thyroidectomy. However, its effects on postoperative voice outcomes remain uncertain. Methods: A systematic review and meta-analysis of the literature was conducted. Cochrane database, MEDLINE, EMBASE, and CINAHL were thoroughly searched. Studies that compared intravenous dexamethasone administration with no dexamethasone in patients undergoing thyroidectomy were included. Main outcome measure was the difference in postoperative voice assessment between groups. Standardized mean difference (SMD) and 95 % confidence intervals (CIs) were estimated using fixed and random effects models. Results: Four studies with a total of 313 patients met inclusion criteria. Significant heterogeneity of study results was noted. Using random effects models, pooled data showed no difference in subjective voice quality between groups preoperatively (SMD, 0.29; 95 % CI -0.37 to 0.96; P = 0.39), 24 h after thyroidectomy (SMD, -1.02; 95 % CI -2.36 to 0.31; P = 0.13), or at 48 h (SMD, -0.05; 95 % CI -0.30 to 0.21; P = 0.72). A sensitivity analysis excluding one observational study yielded similar results. Conclusion: There are insufficient data for definite conclusions to be drawn regarding the effectiveness of a single perioperative administration of dexamethasone to reduce short-term voice disturbances after thyroidectomy. Further prospective trials using objective voice analysis are warranted to evaluate the efficacy of dexamethasone.
    Langenbeck s Archives of Surgery 11/2015; DOI:10.1007/s00423-015-1354-3 · 2.19 Impact Factor
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    ABSTRACT: Background: Tube thoracostomy is a common procedure. A chest bottle may be used to both collect fluids and monitor the recovery of the chest condition. The presence of the "tidaling phenomenon" in the bottle can be reflective of the extent of patient's recovery. Objectives: However, current practice essentially depends on gross observation of the bottle. The device used here is designed for a real-time monitoring of change in pleural pressure to allow clinicians to objectively determine when the lung has recovered, which is crucially important in order to judge when to remove the chest tube. Methods: The device is made of a pressure sensor with an operating range between -100 to +100 cmH2O and an amplifying using the "Wheatstone bridge" concept. Recording and analysis was performed with LABview software. The data can be shown in real-time on screen and also be checked retrospectively. The device was connected to the second part of a three-bottle drain system by a three-way connector. Results: The test animals were two 40-kg pigs. We used a thoracoscopic procedure to create an artificial lung laceration with endoscopic scissors. Active air leaks could result in vigorous tidaling phenomenon up to 20 cmH2O. In the absence of gross tidaling phenomenon, the pressure changes were around 0.25 cmH2O. Conclusions: This real-time pleural pressure monitoring device can help clinicians objectively judge the extent of recovery of the chest condition. It can be used as an effective adjunct with the current chest drain system.
    Journal of Thoracic Disease 09/2015; 7(7):1119-24. DOI:10.3978/j.issn.2072-1439.2015.07.09 · 1.78 Impact Factor
  • Kung-Chen Ho · Jie-Jen Lee · Tsang-Pai Liu · Po-Sheng Yang · Shih-Ping Cheng ·
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    ABSTRACT: Background/Introduction: Dialysis modalities may influence parathyroid hormone (PTH) levels and renal osteodystrophy patterns. To date, no study has compared the effects of dialysis modality on surgical patients with renal hyperparathyroidism. Purpose/Aim: This study evaluated the influence of different dialysis modalities on perioperative features among patients undergoing parathyroidectomy. Methods: Overall, 386 patients who underwent initial parathyroidectomy for renal hyperparathyroidism were recruited. Biochemical data and relevant symptoms were compared between hemodialysis and peritoneal dialysis patients. Results: Compared with the hemodialysis patients, the 40 (10%) peritoneal dialysis patients were younger (p = 0.002) and had a shorter duration of dialysis (p < 0.001). The peritoneal dialysis patients had lower hemoglobin (p = 0.006), albumin (p = 0.040), and intact PTH levels (p = 0.039) prior to surgery but had higher serum aluminum levels (p = 0.039). During follow-up, the peritoneal dialysis patients tended to have higher calcium-phosphorus product levels and more severe residual symptoms of bone pain (p = 0.080), mood swings (p = 0.053), and pruritus (p = 0.094). Conclusion: Patients on different dialysis modalities had similar decreases in intact PTH and alkaline phosphatase levels after surgery. However, the peritoneal dialysis patients had higher postoperative calcium-phosphorus product levels and more severe residual symptoms.
    Formosan Journal of Surgery 09/2015; 48(5). DOI:10.1016/j.fjs.2015.07.002
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    ABSTRACT: A number of studies have investigated the effects of surgery on symptoms and quality of life in patients with hyperparathyroidism. However, the results are inconsistent. We conducted this meta-analysis to quantitatively assess changes in quality of life among patients with asymptomatic primary hyperparathyroidism.Different databases were searched for randomized controlled trials comparing surgery with surveillance. Quality of life was measured by the Short Form-36 general health survey. The pooled random-effects estimates of standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated.Three trials involving 294 participants were included. At 1 year, patients undergoing parathyroidectomy had significantly better physical role functioning (SMD, 0.31; 95% CI 0.04-0.57; P = 0.02) and emotional role functioning (SMD, 0.29; 95% CI 0.02-0.55; P = 0.03). At 2 years, the surgery group had significantly better emotional role functioning (SMD, 0.35; 95% CI 0.02-0.67; P = 0.04) than the surveillance group. Furthermore, compared with baseline, emotional role functioning improved after surgery (SMD, 0.31; 95% CI 0.02-0.60; P = 0.04), whereas emotional role functioning tended to get worse in patients assigned to medical surveillance (SMD, -0.27; 95% CI -0.55 to 0.02; P = 0.07).Although Short Form-36 is a generic instrument, our results suggest that parathyroidectomy may be associated with better quality of life, especially in the emotional aspects of well-being.
    Medicine 06/2015; 94(23):e931. DOI:10.1097/MD.0000000000000931 · 5.72 Impact Factor
  • Chih-Hao Chen · Ho Chang · Tsang-Pai Liu · Tun-Sung Huang · Chao-Hung Chen ·
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    ABSTRACT: Conventional rigid endoscope requires a bundle of optic fibers for illumination and a set of camera for viewing body cavity. The design is bulky in the hand-held part and the laterally positioned optic fibers may hinder manipulation of instruments, especially in single port surgery. We designed a simplified unit to replace conventional endoscope. We used an independent front image sensor along with six light emitting diode crystals. A wireless module working in 2.4 GHz and its antenna were integrated into the hand-help part. Two 800 mA batteries were used for power supply. The study was tested in two 35 kg pigs. Some simple thoracoscopic and laparoscopic operations were simulated to test the reliability and surgeon's acceptability. Signal Noise ratio can be controlled well in the setting of the operative room. Signal transmission was influenced significantly when covered by damped gauze or drape. The best quality of wireless transmission is through line-of-sight. Dropping frame is less than 1 frame per second in 99% time period during the test. Wireless modules in the design of rigid endoscope may be a plausible option with good acceptability. Copyright © 2015. Published by Elsevier Ltd.
    International Journal of Surgery (London, England) 05/2015; 19. DOI:10.1016/j.ijsu.2015.05.003 · 1.53 Impact Factor
  • Fang Lee · Jie-Jen Lee · Tsang-Pai Liu · Shih-Ping Cheng ·

    The American surgeon 01/2015; 81(1):36-7. · 0.82 Impact Factor
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    ABSTRACT: Perchlorate, nitrate, and thiocyanate are well-known inhibitors of the sodium-iodide symporter and may disrupt thyroid function. This exploratory study investigated the association among urinary perchlorate, nitrate, and thiocyanate concentrations and parathyroid hormone (PTH) levels in the general U.S. population. We analyzed data on 4265 adults (aged 20 years and older) from the National Health and Nutrition Examination Survey in 2005 through 2006 to evaluate the relationship among urinary perchlorate, nitrate, and thiocyanate concentration and PTH levels and the presence of hyperparathyroidism cross-sectionally. The geometric means and 95% confidence interval (95% CI) concentrations of urinary perchlorate, nitrate, and thiocyanate were 3.38 (3.15-3.62), 40363 (37512-43431), and 1129 (1029-1239) ng/mL, respectively. After adjusting for confounding variables and sample weights, creatinine-corrected urinary perchlorate was negatively associated with serum PTH levels in women (P = 0.001), and creatinine-corrected urinary nitrate and thiocyanate were negatively associated with serum PTH levels in both sex groups (P = 0.001 and P<0.001 for men, P = 0.018 and P<0.001 for women, respectively). Similar results were obtained from sensitivity analyses performed for exposure variables unadjusted for creatinine with urinary creatinine added as a separate covariate. There was a negative relationship between hyperparathyroidism and urinary nitrate and thiocyanate [odds ratio (95% CI) = 0.77 (0.60-0.98) and 0.69 (0.61-0.79), respectively]. A higher urinary concentration of perchlorate, nitrate, and thiocyanate is associated with lower serum PTH levels. Future studies are needed to determine the pathophysiological background of the observation.
    PLoS ONE 12/2014; 9(12):e115245. DOI:10.1371/journal.pone.0115245 · 3.23 Impact Factor
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    ABSTRACT: Objective Phyllodes tumors are composed of a benign epithelial component and a cellular spindle cell stroma that form a leaf-like structure. The purpose of this study was to define changes in patient characteristics, histopathologic parameters, and the outcome during two periods: before and after the introduction of core needle biopsy for preoperative diagnosis. Methods Records were reviewed of 170 patients with phyllodes tumors who were managed surgically. Patients treated from 1997 to 2004 (n = 101) were compared with patients treated from 2006 to 2013 (n = 69). Results The analysis of the two treatment periods revealed that the tumor size at diagnosis increased from 4.6 cm during the earlier period to 7.0 cm during the recent period (p < 0.05). The number of patients undergoing wide excision significantly increased during the recent period. Multivariate analysis revealed that a positive surgical margin was the only independent predictor of recurrence with an increased hazard of 4.8. Conclusion Wide excision with a clear margin is the first choice of current treatment for phyllodes tumors, even for malignant phyllodes tumors. However, this strategy does not further reduce local recurrence effectively, and core needle biopsy cannot be overstated in avoiding inappropriate initial surgery.
    Journal of Experimental and Clinical Medicine 10/2014; 6(5). DOI:10.1016/j.jecm.2014.08.002
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    ABSTRACT: Background: Aluminum overload and accumulation in tissues may lead to skeletal, hematological, and neurological toxicity. The aim of this study was to assess the effects of serum aluminum levels on presentations, postoperative recovery, and symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism. Methods: From 2008 to 2013, all patients with end-stage renal disease undergoing initial parathyroidectomy were included in the study. Serum aluminum level was measured preoperatively and/or within 1 week after surgery. Preoperative and postoperative biochemical profile and symptoms were compared between the low and high aluminum groups. Results: A total of 176 patients were included in the study. Of these, 38 (22 %) patients had serum aluminum levels higher than 20 μg/L. A higher percentage of patients in the high aluminum group were on peritoneal dialysis than in the low aluminum group (24 vs. 4 %, p = 0.001). Both groups had similar bone mineral density and changes in biochemical profiles. The preoperative parathyroidectomy assessment of symptoms (PAS) score was not associated with serum aluminum levels (p = 0.349), whereas the postoperative PAS score showed positive association (p = 0.005). There was a negative association between serum aluminum levels and the improvement of total PAS scores (p = 0.001). The high aluminum group had more residual symptoms in three aspects: bone pain (p = 0.038), difficulty getting out of a chair or car (p = 0.045), and pruritus (p = 0.041). Conclusions: A high serum aluminum level was associated with reduced symptom improvement in patients undergoing parathyroidectomy for secondary hyperparathyroidism.
    World Journal of Surgery 07/2014; 38(11). DOI:10.1007/s00268-014-2695-8 · 2.64 Impact Factor
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    ABSTRACT: Somatic BRAF mutation is frequently observed in papillary thyroid carcinoma (PTC). Recent evidence suggests that PTCs are heterogeneous tumors containing a subclonal or oligoclonal occurrence of BRAF mutation. Conflicting results have been reported concerning the prognostic significance of the mutant allele frequency. Our present aim was to investigate the association between the percentage of BRAF c.1799T > A (p.Val600Glu) alleles and clinicopathological parameters in PTC. Genomic DNA was extracted from fresh-frozen specimens obtained from 50 PTC patients undergoing total thyroidectomy. The BRAF mutation status was determined by Sanger sequencing. The percentage of mutant BRAF alleles was quantified by mass spectrometric genotyping, pyrosequencing, and competitive allele-specific TaqMan PCR (castPCR). Positive rate of BRAF mutation was 72 % by Sanger sequencing, 82 % by mass spectrometric genotying, and 84 % by pyrosequencing or castPCR. The average percentage of mutant BRAF alleles was 22.5, 31, and 30.7 %, respectively. There was a good correlation among three quantification methods (Spearman's rho = 0.87-0.97; p < 0.0001). The mutant allele frequency was significantly correlated with tumor size (rho = 0.47-0.52; p < 0.01) and extrathyroidal invasion. The frequency showed no difference in pathological lymph node metastasis. The percentage of mutant BRAF alleles is positively associated with tumor burden and extrathyroidal invasion in PTC. Relatively good correlations exist among mass spectrometric genotyping, pyrosequencing, and castPCR in quantification of mutant BRAF allele frequency.
    Annals of Surgical Oncology 04/2014; 21(4). DOI:10.1245/s10434-014-3723-5 · 3.93 Impact Factor
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    ABSTRACT: Background and aims: High levels of parathyroid hormone (PTH) appear to be associated with an increased mortality. Previous studies concerning the relationship of inflammatory markers with hyperparathyroidism have yielded inconsistent results. This study investigated whether serum PTH concentrations were independently associated with several inflammatory markers among the US adults. Materials and methods: Using data from the National Health and Nutrition Examination Survey, we examined the relation between serum PTH and C-reactive protein (CRP), red cell distribution width (RDW), and platelet-to-lymphocyte ratio (PLR) levels with weighted linear regression. Additionally, we examined the relation with increased modified Glasgow Prognostic Score (mGPS) by using weighted logistic regression. Results: CRP, RDW, and PLR values increased with increasing serum PTH concentration. After extensively adjusting for covariates, CRP and RDW increased linearly and across PTH categories (all P < 0.001), while PLR marginally increased (P = 0.190 and P = 0.095 using PTH as a categorical and continuous variable, resp.). The odds ratio of increased mGPS was 1.11 and 1.31 across PTH categories and with increasing PTH levels continuously. Conclusion: These nationally representative data indicate that serum PTH levels are independently associated with several inflammatory markers in the US population. The casual relationship between PTH levels and inflammation remains to be elucidated.
    Mediators of Inflammation 03/2014; 2014:709024. DOI:10.1155/2014/709024 · 3.24 Impact Factor
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    ABSTRACT: Postoperative ileus is among the most common complications after surgery. Aging is associated with an increased colonic transit time, and anesthetic disturbance to colonic motility is often aggravated in the elderly. Postoperative ileus increases morbidity, prolongs the length of hospital stay, and constitutes a significant economic burden on the healthcare system. Multimodal enhanced recovery protocols, or fast-track surgeries, have been developed to improve postoperative recovery. Patient education, avoidance of perioperative fluid overload, selective use of nasogastric decompression, early ambulation, adopting a minimally invasive approach, early initiation of clear fluids, and gum chewing are all possible measures to reduce postoperative ileus. Thoracic epidural anesthesia is a well-established technique to hasten recovery, whereas insufficient data are available to ascertain the safety and efficacy of opioid-sparing analgesia in the elderly. The evidence is clear that traditional prokinetic medications are not helpful in the treatment or prevention of postoperative ileus. Early results suggest that alvimopan is a promising agent to reverse opioid-induced ileus. Since postoperative ileus is a multifactorial condition, a concerted effort is therefore necessary to prevent or decrease the duration of postoperative ileus using multimodal strategies.
    International Journal of Gerontology 03/2014; 8(1). DOI:10.1016/j.ijge.2013.08.002 · 0.53 Impact Factor

  • International Journal of Gerontology 12/2013; 7(4). DOI:10.1016/j.ijge.2013.01.017 · 0.53 Impact Factor
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    ABSTRACT: Background: Peritoneal dialysis (PD)-related peritonitis is the most common complication and the leading cause of technique failure for patients on PD therapy. The aim of this study was to review the episodes and outcomes of PD-related peritonitis, with special reference to the effects of age and diabetes status. Methods: The study comprised 204 consecutive peritonitis episodes between January 2001 and June 2011 from our registry database. Factors associated with treatment failure and mortality were analyzed with multi-variable logistic regression modeling. Results: The overall peritonitis rate was one episode per 65 patient-months or 0.187 episodes/patient-year. Older patients had lower probability of remaining free of peritonitis (log rank, p<0.001). Elderly patients and diabetic subjects had a higher risk of peritonitis-related dropout. Age (odds ratio [OR], 1.37; p=0.041), diabetes mellitus (OR, 3.64; p=0.005), and gram-negative peritonitis (OR, 3.55; p=0.011) were independent determinants of catheter removal. Age (OR, 1.93; p=0.026) and diabetes (OR, 5.98; p=0.015) were the only predictors of death from peritonitis. Conclusions: Old age and diabetes mellitus are two major risk factors for adverse outcomes of PD-related peritonitis. Although they are not contraindications to PD, our results suggest that these patients need meticulous care when peritonitis occurs.
    Surgical Infections 10/2013; 14(6). DOI:10.1089/sur.2012.195 · 1.45 Impact Factor
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    ABSTRACT: The parathyroidectomy assessment of symptoms (PAS) score was designed initially for primary hyperparathyroidism to provide a specific symptom assessment and was validated later in secondary and tertiary hyperparathyroidism. The aim of our study was to evaluate changes in the PAS scores and quality of life before and after parathyroidectomy for secondary hyperparathyroidism. This prospective study included 49 consecutive patients who underwent parathyroidectomy for secondary hyperparathyroidism. The PAS and Short Form (SF)-36 questionnaires were completed before parathyroidectomy and at 12 months postoperatively. All 13 symptoms included in the PAS score improved significantly. The mean ± standard deviation PAS score decreased from 545 ± 263 to 284 ± 201 (P < .0001) after parathyroidectomy. Quality of life was enhanced in both physical (40.3 ± 17.1 to 59.0 ± 14.9; P < .0001) and mental (47.6 ± 17.1 to 63.7 ± 13.0; P < .0001) components. The PAS score was inversely correlated with the SF-36 global score preoperatively and postoperatively (r(2) = 0.48 and 0.25; P < .001). The change in PAS score also correlated with the change in SF-36 global score (r(2) = 0.29; P < .001). Multiple linear regression analysis showed that preoperative PAS score and bone mineral density T-score were predictors of the decrease in PAS score. Preoperative SF-36 global score and intact parathyroid hormone levels were predictors of the increment in SF-36 score. The symptom burden of secondary hyperparathyroidism has a negative impact on a patient's quality of life. Parathyroidectomy is associated with a marked improvement in symptoms and quality of life.
    Surgery 09/2013; 155(2). DOI:10.1016/j.surg.2013.08.013 · 3.38 Impact Factor
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    ABSTRACT: Background and objectives: Inflammation has been implicated in the initiation and progression of thyroid cancer. Neutrophil-to-lymphocyte ratio (NLR) is a simple index of systemic inflammatory response, and has been shown to be a prognostic indicator in some types of cancer. The aim of this study was to examine the relationship between NLR and clinicopathological features in patients with differentiated thyroid cancer. Methods: Total white blood cell and differential counts of 159 patients with differentiated thyroid cancer were compared to those of 318 age- and sex-matched controls undergoing thyroidectomy for benign thyroid nodules. Clinicopathological variables, stratified by NLR tertiles, were analyzed. Results: There was no difference in NLR between patients having benign and malignant thyroid nodules (P = 0.293). Cancer patients in the higher NLR tertile had significantly larger tumor size (P = 0.004). Higher NLR was observed in patients with high American Thyroid Association (ATA) risk of recurrence. Conclusions: High preoperative NLR was associated with increased tumor size and high ATA risk of recurrence in patients with differentiated thyroid cancer.
    Journal of Surgical Oncology 04/2013; 107(5). DOI:10.1002/jso.23270 · 3.24 Impact Factor
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    ABSTRACT: Surgical management of gastric outlet obstruction may associate with significant morbidity and mortality. Few studies have documented surgical outcomes in elderly patients. The aim of this study was to review recent operative results of benign gastric outlet obstruction in elderly patients compared with younger patients. Forty- seven consecutive patients from January 2000 through September 2008 were included. Preoperative, intraoperative data and early postoperative complications were analyzed. Fifteen operations were performed in elderly patients and 32 in younger patients. More patients in the elderly group were assigned as ASA class 3 (p=0.037), but Charlson comorbidity index was similar. Procedure types included Finney or Jaboulay pyloroplasty (n=26), antrectomy (n=13) and gastrojejunostomy (n=8). The mean postoperative hospital stay was 14.9 days. A modest correlation between the length of stay and the patient's age (p=0.044; r=0.294) was observed. There were two in hospital mortalities and four patients had complications. Surgery for benign gastric outlet obstruction is safe in the elderly population and is not associated with any increase in morbidity or mortality.
    Hepato-gastroenterology 07/2012; 59(117):1643-6. DOI:10.5754/hge10495 · 0.93 Impact Factor
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    ABSTRACT: Preoperative detection of vocal cord palsy is important in thyroid and parathyroid surgery. However, routine fiberoptic laryngoscopy may bring patients unnecessary discomfort. The aim of this study was to determine the feasibility of using surgeon-performed ultrasonography (US) as a screening tool for preoperative assessment of vocal cord movement. In the first phase, patients had both laryngoscopic and US examination before surgery. In the second phase, patients had US evaluation first. Those with abnormal vocal cord movement on US, with invisible cord movement, or presenting with significant vocal symptoms underwent laryngeal examination. In all, 93 (82 %) of 114 patients had successful US evaluation of vocal cord movement during the first phase. Two of them had vocal cord paralysis. In the second phase, vocal cord movement could be evaluated by US in 349 (84 %) of 415 patients. Four patients with abnormal movement were confirmed to have vocal cord palsy by laryngoscopy. None of 46 symptomatic patients with normal movement on US had vocal cord palsy. One other patient whose cord movement could not be seen by US had vocal cord palsy on laryngoscopic examination. Surgeon-performed US appears to be a relatively accurate method for assessing vocal cord movement in the preoperative setting. It can be used to select patients to undergo laryngoscopic examination before thyroidectomy and parathyroidectomy.
    World Journal of Surgery 06/2012; 36(10):2509-15. DOI:10.1007/s00268-012-1674-1 · 2.64 Impact Factor
  • Tung-Sun Huang · Chung-Hsin Tsai · Chia-Chi Tsai · Tsang-Pai Liu ·

    ANZ Journal of Surgery 05/2011; 81(5):391-2. DOI:10.1111/j.1445-2197.2011.05716.x · 1.12 Impact Factor
  • Wen-Teng Yao · Chih-Hao Chen · Jie-Jen Lee · Be-Fong Chen · Tsang-Pai Liu ·
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    ABSTRACT: Thymic carcinoma is a rare tumor arising from the thymus, which is most commonly located in the anterior mediastinum. We report a 24-year-old woman who presented with a neck tumor. The patient underwent complete resection and the pathology sections showed thymic carcinoma. The patient received adjuvant chemotherapy and radiotherapy. After a 6-month follow-up, the patient is well without any evidence of recurrence.
    The Annals of thoracic surgery 08/2010; 90(2):666-8. DOI:10.1016/j.athoracsur.2009.12.078 · 3.85 Impact Factor

Publication Stats

449 Citations
68.89 Total Impact Points


  • 2000-2015
    • Mackay Memorial Hospital
      • Department of Internal Medicine
      T’ai-pei, Taipei, Taiwan
  • 2014
    • Mackay Medical College
      T’ai-pei, Taipei, Taiwan
  • 2009
    • National Yang Ming University
      • Department and Institute of Pharmacology
      T’ai-pei, Taipei, Taiwan
  • 2005
    • Mackay Medicine, Nursing and Management College
      T’ai-pei, Taipei, Taiwan