Chang-hua, Taiwan
Chang-hua, Taiwan

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Chou C.-T.,National Yang Ming University | Chou C.-T.,Chang Hua Christian Hospital | Chou J.-M.,Taipei Medical University Hospital | Chang T.-A.,Taipei Medical University Hospital | And 4 more authors.
World Journal of Gastroenterology | Year: 2013

AIM: To elucidate the variety of ways early-stage hepatocellular carcinoma (HCC) can appear on magnetic resonance (MR) imaging by analyzing T1-weighted, T2- weighted, and gadolinium-enhanced dynamic studies. METHODS: Seventy-three patients with well-differentiated HCC (wHCC) or dysplastic nodules were retrospectively identified from medical records, and new histological sections were prepared and reviewed. The tumor nodules were categorized into three groups: dysplastic nodule (DN), wHCC compatible with Edmondson-Steiner grade I HCC (w1-HCC), and wHCC compatible with Edmondson-Steiner grade II HCC (w2-HCC). The signal intensity on pre-contrast MR imaging and the enhancing pattern for each tumor were recorded and compared between the three tumor groups. RESULTS: Among the 73 patients, 14 were diagnosed as having DN, 40 were diagnosed as having w1-HCC, and 19 were diagnosed as having w2-HCC. Hyperintensity measurements on T2-weighted axial images (T2WI) were statistically significant between DNs and wHCC (P = 0.006) and between DN and w1-HCC (P = 0.02). The other imaging features revealed no significant differences between DN and wHCC or between DN and w1- HCC. Hyperintensity on both T1W out-phase imaging (P = 0.007) and arterial enhancement on dynamic study (P = 0.005) showed statistically significant differences between w1-HCC and w2-HCC. The other imaging features revealed no significant differences between w1- HCC and w2-HCC. CONCLUSION: In the follow-up for a cirrhotic nodule, increased signal intensity on T2WI may be a sign of malignant transformation. Furthermore, a noted loss of hyperintensity on T1WI and the detection of arterial enhancement might indicate further progression of the histological grade. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved.


Sy H.-N.,Chang Hua Christian Hospital | Wu S.-L.,Chang Hua Christian Hospital | Wu S.-L.,Da - Yeh University | Wang W.-F.,Chang Hua Christian Hospital | And 7 more authors.
Pharmacology Biochemistry and Behavior | Year: 2010

Emotional changes, impairment of object recognition, and neuroinflammation are seen in Parkinson's disease with dementia (PDD). Here, we show that bilateral infusion of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) into the rat substantia nigra pars compacta (SNc) of Wistar rats caused degeneration of nigrostriatal dopaminergic neurons, microglial activation in the SNc and hippocampus, and cell loss in the hippocampal CA1 area. With regard to behavior, an increase in anxiety-like behavior and impairment of object recognition were observed during the fourth week after MPTP lesioning. The behavioral changes were not caused by motor impairment, since the rats had already recovered from MPTP-induced catalepsy before the tests were performed. These findings show that MPTP-induced neuroinflammation and its consequences, for example, microglial activation and cell loss in the hippocampus, may be involved in dopaminergic degeneration-related behavioral deficits and suggest that, in addition to the dopaminergic system, the limbic system may also participate in the pathophysiology of PDD. MPTP-lesioned rats are therefore proposed as a useful tool for assessing the ability of pharmacological agents to prevent recognition deficits in PDD. © 2010 Elsevier Inc. All rights reserved.


Chou C.-T.,National Yang Ming University | Chou C.-T.,Chang Hua Christian Hospital | Chen Y.-L.,Chang Hua Christian Hospital | Wu H.-K.,Chang Hua Christian Hospital | And 2 more authors.
Journal of Magnetic Resonance Imaging | Year: 2011

Purpose: To evaluate the utility of gadoxetic acid-enhanced hepatocyte-phase magnetic resonance imaging (MRI) in characterization of T1-weighted hyperintense nodules within cirrhotic liver. Materials and Methods: This retrospective study was approved by our Institutional Review Board. Thirty-four nodules hyperintense in unenhanced T1-weighted MRI with histopathological confirmation from a collection of 19 patients were included. Tumor size, signal intensity on T1-weighted, and T2-weighted imaging as well as enhancement patterns on contrast-enhanced dynamic/hepatocyte-phase imaging were recorded. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of hepatocyte-phase imaging. Results: Evaluation of the nodules with standard of reference revealed 15 dysplastic nodules (DN), seven well-differentiated hepatocellular carcinomas (wHCC), and 12 moderately differentiated HCCs (mHCC). The mean size of dysplastic nodules was smaller than that of HCCs (P < 0.001). Using the HCC criteria (T2W or arterial enhancement followed with portal venous washout), 11/19 HCC were correctly characterized. Using solely hypointensity (compared to the surrounding liver parenchyma) during the hepatocyte phase as the criterion, 18/19 HCC were correctly characterized. There were seven additional HCCs diagnosed with hepatocyte-phase imaging (P = 0.02). Conclusion: Gadoxetic acid-enhanced MRI with hepatocyte-phase imaging is superior to gadoxetic acid-enhanced MRI with conventional criteria alone in characterization of T1W hyperintense nodules. © 2011 Wiley-Liss, Inc.


Chou C.-T.,Chang Hua Christian Hospital | Chou C.-T.,National Yang Ming University | Chen R.-C.,National Yang Ming University | Chen R.-C.,Taipei Medical University Hospital | And 4 more authors.
British Journal of Radiology | Year: 2012

Objective: The aim of this study was to diagnose microvascular invasion in patients with solitary hepatocellular carcinoma (HCC) from pre-operative CT imaging. Methods: 102 patients with solitary HCC who underwent curative hepatectomy were retrospectively included in our study. The pre-operative 3-phase CT imaging and laboratory data for the 102 patients were reviewed. Tumour size, tumour margin, peritumoral enhancement and α-fetoprotein level were assessed. Surgical pathology was reviewed; tumour differentiation, liver fibrosis score and microvascular invasion were recorded. Results: The histopathological results revealed that 50 HCCs were positive and the other 52 were negative for microvascular invasion. Univariate analysis revealed that tumour size (p=0.036), higher Edmondson-Steiner grade (p=0.047) and non-smooth tumour margin (p<0.001) showed statistically significant associations with microvascular invasion. Multivariate logistic regression analysis showed that non-smooth tumour margin had a statistically significant association with microvascular invasion only (p<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the non-smooth tumour margin in the prediction of microvascular invasion were 66%, 86.5%, 82.5% and 72.6%, respectively. Conclusion: Non-smooth tumour margin in pre-operative CT had a statistically significant association with microvascular invasion. More aggressive treatment should be considered in HCC patients with suspected positive microvascular invasion. © 2012 The British Institute of Radiology.


Lin W.Y.,China Medical University at Taichung | Wu B.T.,China Medical University at Taichung | Lee C.C.,China Medical University at Taichung | Sheu J.J.,China Medical University at Taichung | And 6 more authors.
Journal of Biological Regulators and Homeostatic Agents | Year: 2012

Defects in dopaminergic transmission play important roles in the disturbance of synaptic plasticity and even in advanced cognitive behavior. However, the relationship between genes involved in the regulation of dopamine levels and predisposition for Alzheimer's disease (AD) remains unclear. The potential association of dopamine-modulating gene polymorphisms with AD was evaluated. We performed a case-control study with 120 patients and 86 healthy controls. Two catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms (SNPs) (rs2020917 and rs4646312), two dopamine D4 receptor (DRD4) SNPs (rs3758653 and rs916455), and four dopamine transporter (DAT1) SNPs (rs2937639, rs6347, rsl2516948 and rs11133762) were investigated. The T allele at the DRD4 SNP (rs3758653) was found to be significantly associated with AD. Our results also showed that haplotype frequencies, observed from the analyzed SNPs, were distributed significantly differently in AD patients vs control subjects. Moreover, a strong association was observed between the A allele at rs6347 of DAT1 and moderate stage of dementia. These observations suggest that genetic variations in the dopamine-modulating genes, COMT, DRD4 and DAT1, may contribute to AD pathogenesis in the Taiwanese population. Copyright © by BIOLIFE, s.a.s.


Chen Y.-H.,Chang Gung University | Chen Y.-H.,Chung Shan Medical University | Chen Y.-H.,Chang Hua Christian Hospital
Eye (London, England) | Year: 2014

PURPOSE: To evaluate the refractive outcomes in children treated after intravitreal injection of bevacizumab (IVB) for retinopathy of prematurity (ROP).METHODS: A retrospective, bi-centre study of 34 patients (64 eyes) was conducted. The patients were divided into three groups, patients received intravitreal IVB (IVB group), patients received combined IVB and laser treatment (IVB + Laser group), or patients received lens-sparing vitrectomy (IVB + LSV group). Cycloplegic refraction and axial length (AXL) were evaluated at 2 years old.RESULTS: The prevalences of myopia and high myopia were 47.5 and 10.0% in the IVB group, respectively, which were lower than those in the IVB + Laser (82.4 and 29.4%) and IVB + LSV (all 100%) groups (P = 0.001 and P < 0.001). The prevalences of emmetropia in the IVB group, IVB + Laser group, and IVB + LSV group were 50, 5.9, and 0% (P = 0.001). The AXL were similar among all groups.CONCLUSIONS: At the 2-year follow-up, severe ROP patients treated with IVB alone were more likely to remain emmetropic and had lower prevalences of myopia and high myopia. The development of high myopia in severe ROP patients could not be explained by AXL changes but may be associated with abnormalities in the anterior segment.


PubMed | Chang Hua Christian Hospital and National Yang Ming University
Type: Comparative Study | Journal: Journal of the Chinese Medical Association : JCMA | Year: 2015

Gadoxetic acid is one of the hepatobiliary-specific agents and so can be used for contrast-enhanced magnetic resonance cholangiography (CE-MRC). The aim of our study was to compare the performance of CE-MRC with that of T2-weighted magnetic resonance cholangiography (T2W-MRC), and also to ascertain the effectiveness of both modalities combined for visualizing anatomic structures of the biliary tree in patients with liver cirrhosis.Fifty-six patients underwent CE-MRC and T2W-MRC imaging. In the CE-MRC studies, hepatobiliary phase images were acquired 20 minutes after contrast injection. Two radiologists first evaluated the T2W-MRC and CE-MRC images separately in random order, and then they reviewed both images together 8 weeks later. The readers graded the quality of visualization of each biliary duct and the entire biliary tree (overall rating) using a five-point scale. Images with a grade of 3 or 4 were considered to provide sufficient visualization for clinical application, and those with a grade of 2 or less were considered to provide insufficient visualization. Laboratory data, Child-Pugh classification, and model for end-stage liver disease score were also recorded.The overall rating of T2W-MRC was significantly higher than that of CE-MRC (p<0.001), although combined T2W/CE-MRC provided better visualization of biliary segments than T2W-MRC alone (p=0.025). There were no significant differences between liver function and the overall rating of CE-MRC.CE-MRC is not superior to conventional T2W-MRC with respect to biliary visualization in patients with liver cirrhosis. However, a combination of T2W-MRC and CE-MRC provides significantly better visualization of biliary structures than T2W-MRC alone.


Hsu T.-C.,Taipei Mackay Memorial Hospital | Hsu T.-C.,Taipei Medical University | Huang T.-M.,Chang Hua Christian Hospital | Yang Y.-C.,Taipei Mackay Memorial Hospital
Taiwanese Journal of Obstetrics and Gynecology | Year: 2012

Objective: Colorectal surgeons are frequently on call to provide help to gynecologists who are managing bowel problems that occur either during or following gynecological surgery. This is a retrospective analysis of a single surgeon's experiences associated with such instances. The analysis focuses on whether there have been any changes in referral patterns, surgical techniques and/or results. Materials and Methods: From July 1984 to June 2008, 282 patients were operated on by a single colorectal surgeon, for problems that were related to gynecology. These consisted of 137 patients operated on during the first 12-year period, from July 1984 to June 1996. During this first period, 85 patients were operated on for cervical cancer related problems, 39 patients were operated on for problems related to other gynecological malignancies and nine patients were operated on for iatrogenic bowel injury during surgery. During the second 12-year period, from July 1996 to June 2008, 145 patients were operated on. Of these, 85 patients were operated on for cervical cancer related problems, 44 patients were operated on for problems related to other gynecological malignancies and eight patients were operated on for iatrogenic bowel injury during surgery. Results: During the first 12-year period, six operations were pelvic exenterations for primary gynecological malignancies or recurrences. One hundred and one patients received stomas during their first operation. Twenty-five patients encountered various complications. Postoperative death occurred in five patients. During the second 12-year period, 12 operations were pelvic exenterations for primary gynecological malignancies or recurrences. Eighty-seven patients received stomas during their first operation. Thirty-seven patients encountered various complications. Postoperative death occurred in six patients. Conclusion: Gynecological problems frequently involve the colon or rectum. Cervical cancer related problems remain the most common type necessitating help from a colorectal surgeon. In spite of advances in surgical management, stomas are still frequently unavoidable in order to cure a patient or improve the patient's quality of life. Appropriate management of problems by a colorectal surgeon in relation to gynecology is important and in the best interests of the patient. © 2012.


Lee K.-W.,Taipei Medical University | Lee K.-W.,Chang Hua Christian Hospital | Tsai F.Y.,Taipei Medical University | Cheng C.-Y.,Chang Hua Christian Hospital
Neuroradiology Journal | Year: 2013

This report describes cerebral aneurysmal rupture with asymmetry of ipsilateral dural sinus hypoplasia using quantitative color-coded l-Flow cerebral venography to identify the venous pressure gradient. We suggest the pressure gradient may be a potential factor in cerebral aneurysmal rupture. We used I-Flow quantitative cerebral venography to measure the venous pressure gradient during acute cerebral aneurysmal rupture and post embolization in a 67-year-old woman who presented with clinical symptoms of left third nerve palsy for several days with mild headache initially without subarachnoid hemorrhage. We encountered a high venous pressure gradient of severe ipsilateral dural sinus hypoplasia during acute rupture of a posterior communicating aneurysm. Venous dural sinus asymmetry has been considered a congenital benign and non-pathological condition. However, this case may present severe hypoplasia of the dural sinus with potential pressure gradient in some unusual condition. A high venous pressure gradient may be another factor in cerebral aneurysmal rupture.


Chen C.-B.,Chang Hua Christian Hospital | Chou C.-T.,Chang Hua Christian Hospital | Hsueh C.,Chang Hua Christian Hospital | Lee K.-W.,Chang Hua Christian Hospital | Chen Y.-L.,Chang Hua Christian Hospital
Journal of the Chinese Medical Association | Year: 2013

Inflammatory pseudotumor of the liver is a rare tumor. It has variable clinical presentations and image findings. It can mimic benign or malignant hepatic tumors, and may be difficult to diagnose. We present a case in which a hepatic inflammatory pseudotumor was misdiagnosed as hepatocellular carcinoma because the tumor presented a typical enhancing profile and morphology of hepatocellular carcinoma on computed tomography, and the patient had liver cirrhosis. However, a thicker tumor capsule than that of typical hepatocellular carcinoma was noted while reviewing the computed tomography images. A capsule of inflammatory pseudotumor thicker than that of hepatocellular carcinoma has never been reported in the literature before, and could be an important diagnostic clue to differentiate inflammatory pseudotumor from hepatocellular carcinoma. © 2013 .

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