Changhua Christian Medical Center

Changhua, Taiwan

Changhua Christian Medical Center

Changhua, Taiwan
SEARCH FILTERS
Time filter
Source Type

Lin J.-T.,Chang Gung Memorial Hospital | Shih S.-C.,ChangHua Christian Medical Center | Chang T.-H.,ChangHua Christian Medical Center | Chang C.-S.,ChangHua Christian Medical Center
Gynecologic Oncology | Year: 2010

Objectives: This retrospective study evaluates the efficacy and safety of chemotherapy with docetaxel, carboplatin and 5-FU (TCF) in patients with metastatic cervical carcinoma. Methods: Between January 2006 and April 2007, 23 patients with metastatic cervical carcinoma were included in the study. Patients fulfilling the following criteria were enrolled: histologically confirmed metastatic cervical carcinoma; documented progressive disease (PD) after cisplatinum-based treatment if applicable; an Eastern Cooperative Oncology Group (ECOG) performance scale of 0-2; not candidates for local therapy; measurable metastatic lesions as assessed by the Response Evaluation Criteria in Solid Tumors (RECIST); and adequate hematologic, hepatic, and renal functions. Treatment consisted of intravenous docetaxel at 60 mg/m2 diluted in 500 ml 5% glucose administered over 1 h on day1, followed by carboplatin (AUC of 5 or 6) given as a 1-h intravenous infusion delivered on day 2, followed by 5-FU at 500 mg/m2 diluted in 500 ml normal saline continuously infusion for 24 h for 2 days on day 2. Chemotherapy was repeated every 21 days, and a total of 1-5 courses were performed. Results: There were 3 (13%) complete responses; 4(17%) partial responses; 6 (26%) with stable disease, and 10 (43%) with disease progression. The overall response rate was 56%. After a median follow-up of 16 months, the median overall survival was 12 months. Neutropenia was the most severe toxicity. Conclusions: The combination of docetaxel, carboplatin and 5-fluorouracil (TCF) appears to have activity in metastatic cervical carcinoma with acceptable toxicity profile. © 2009 Elsevier Inc. All rights reserved.


Wen Y.-K.,Changhua Christian Medical Center
International Urology and Nephrology | Year: 2011

Objectives Renal biopsy has been used extensively in systemic lupus erythematosus (SLE) with renal involvement. However, there is no complete agreement about the need for renal biopsy at presentation. The goal of this study is to define the role of renal biopsy as a therapeutic guide in new-onset SLE with renal involvement. Methods We retrospectively analyzed renal biopsy findings in 131 SLE patients who received renal biopsy within 3 months from the diagnosis of SLE. Results In patients presenting with acute renal failure, 91% of patients had proliferative lupus nephritis (LN) (class IV, mixed class V ? III) and 9% had non-proliferative lupus nephropathy (pure class V). In patients presenting with nephrotic range proteinuria, proliferative LN(class III, IV, mixed classV ? III) and non-proliferative lupus nephropathy (class II, pure class V) accounted for 55% and 36% of patients, respectively, whereas 9% had non-lupus nephropathy. With the exception of anti-double-stranded DNA, no clinical findings correlated with pathology. In patients presenting with sub-nephrotic proteinuria, 49% of patients had proliferative LN(class III, IV, mixed classV ? III) and 51% had non-proliferative lupus nephropathy (class II, pure class V). Decreased C4 levels were more common in patients with proliferative LN (P = 0.031). In patients presenting with isolated hematuria, all were not active form nephropathy. Conclusions Our data suggested that similar clinical features may be observed despite very different classes of LN. Therefore, in new-onset SLE patients with clinical renal disease, early renal biopsy may be helpful in planning the treatment. © Springer Science+Business Media, B.V. 2011.


Wen Y.-K.,Changhua Christian Medical Center | Chen M.-L.,Changhua Christian Medical Center
Renal Failure | Year: 2010

Background: Glomerular "full-house" immunofluorescence staining commonly indicates lupus nephritis. However, some non-lupus nephropathy also can present with a "full-house" immunofluorescence pattern mimicking lupus nephritis. The goal of this study is to define the clinicopathological spectrum of originally non-lupus "full-house" nephropathy. Methods: Records of 24 patients with "full-house" nephropathy in the absence of clinical or serological evidence of systemic lupus erythematosus (SLE) at the time of renal biopsy were abstracted for demographics, clinical presentation, laboratory data, renal biopsy findings, and clinical follow-up. Results: The clinicopathological diagnoses included membranous glomerulonephritis (GN) (46%), IgA nephropathy (21%), membranoproliferative GN (12.5%), postinfectious GN (12.5%), C1q nephropathy (4%), and unclassified mesangial GN (4%). No one had endothelial tubuloreticular inclusions. One patient originally diagnosed as IgA nephropathy developed anti-DNA antibody and another one patient with membranous GN developed hypocomplementemia 8 months and 10 months after renal biopsy, respectively. The two patients also developed clinical symptoms of lupus subsequently. Conclusions: There was a broad spectrum of glomerular histological findings in non-lupus "full-house" nephropathy. The possibility of "full-house" nephropathy preceding the emergence of overt systemic lupus erythematosus remained to be elucidated. © 2010 Informa UK Ltd.


Wen Y.-K.,Changhua Christian Medical Center | Chen M.-L.,Changhua Christian Medical Center
Renal Failure | Year: 2010

Background: Acute renal failure rarely complicates the course of IgA nephropathy. In this study, we have tried to define the mode of presentation, the spectrum of morphology, and the prognostic factors for renal outcome. Methods: Twenty patients with biopsy-proven IgA nephropathy who developed acute renal failure were identified from 2000 to 2009 at a medical center in Taiwan. The patients' records were retrospectively reviewed with respect to clinical presentation, morphology of renal biopsy, and outcomes. Results: On histology, glomerular crescents were present in 11 patients (55%), acute tubular necrosis was identified in 11 patients (55%), acute interstitial nephritis was seen in 4 patients (20%), and extensive tubular red blood cell casts were present in 4 patients (20%). At the end of follow-up, 2 patients (10%) had died, 11 patients (55%) were in remission, and 7 patients (35%) developed end-stage renal disease. The prognostic factors for renal outcome were peak serum creatinine, dialysis support requirement, morphology (prominent glomerulartubular injury), percentage of glomeruli affected by crescents, and interstitial infiltration (p = 0.04, <0.001, 0.013, 0.05, 0.02, respectively). Conclusions: Our findings suggested that there were four pathogenic mechanisms involved in IgA nephropathy with acute renal failure including (1) crescentic IgA nephropathy; (2) acute tubular necrosis associated with microhematuria and red blood cell casts occluding tubules; (3) acute tubular necrosis not related to microhematuria; and (4) acute interstitial nephritis, apparently induced by drugs. In general, patients with prominent tubular injury had a much higher remission rate than patients with prominent glomerular injury. © 2010 Informa UK Ltd.


Wen Y.-K.,Changhua Christian Medical Center | Chen M.-L.,Changhua Christian Medical Center
Renal Failure | Year: 2010

Background: The goal of this study was to define the clinical and histological differences in new-onset IgA nephropathy between young adults and the elderly. Methods: We retrospectively examined renal biopsy findings, clinical features at presentation and outcomes in 82 young adults (mean age 30.3 ± 10.2 years) and 17 elderly patients (mean age 71.9 ± 4.5 years) with IgA nephropathy whose renal biopsies were taken within 1 year from the onset of renal manifestations. Results: The elderly group more frequently had hypertension (p < 0.001), acute renal failure (p < 0.001), and nephrotic range proteinuria (p = 0.001) at presentation than the young adults group. On histology, a higher percentage of globally sclerotic glomeruli (p < 0.001) was present in the elderly group. In patients presenting with acute renal failure, the elderly group more frequently had an intercurrent disease (p 0.02), mostly infection, and a higher mortality rate (p 0.033). On histology, the young adults group had a higher percentage of glomeruli affected by crescents (p = 0.027); in contrast, the elderly group more commonly had acute tubular injury (p = 0.02). Conclusions: The elderly patients affected by IgA nephropathy had more severe renal manifestations at presentation (acute renal failure in 52.9 and nephrotic syndrome in 41.2 of patients). In cases of acute renal failure, the elderly patients had more predominant tubular rather than glomerular injury. Moreover, the considerable mortality rate (44.4) might be associated with the intercurrent disease, mostly infection, which was more commonly present in the elderly patients. © 2010 Informa UK, Ltd.


Wen Y.-K.,Changhua Christian Medical Center | Chen M.-L.,Changhua Christian Medical Center
Renal Failure | Year: 2010

Background: A unique form of postinfectious glomerulonephritis (PIGN) with IgA-dominant deposition mimicking IgA nephropathy has been increasingly reported. Methods: We compared the clinical and histological features of 12 patients with postinfectious IgA-dominant glomerulonephritis to 134 patients with idiopathic IgA nephropathy. Results: In addition to hypocomplementemia and subepithelial hump-shaped deposits characteristic of PIGN, patients with postinfectious IgA-dominant glomerulonephritis had older age (62.3 ± 16.9 vs. 37.9 ± 16.3 years; p < 0.001) and more frequently presented with acute renal failure (83.3 vs. 10.4; p < 0.001) than patients with idiopathic IgA nephropathy. Moreover, glomerular changes including endocapillary proliferation, neutrophil infiltration, and capillary loops deposits by immunofluorescence were more commonly present in postinfectious IgA-dominant glomerulonephritis group (p < 0.001). Conclusions: PIGN could be characterized by glomerular IgA-dominant deposition resembling idiopathic IgA nephropathy. It is essential to differentiate postinfectious IgA-dominant glomerulonephritis from idiopathic IgA nephropathy because of the different treatments and prognosis of the two diseases. © Informa UK, Ltd.


Chiu C.-C.,Changhua Christian Medical Center | Chiu C.-W.,Changhua Christian Medical Center | Chen Y.-C.,Changhua Christian Medical Center | Siao F.-Y.,Changhua Christian Medical Center
American Journal of Emergency Medicine | Year: 2013

Extracorporeal membrane oxygenation (ECMO) is a form of a mechanical cardiopulmonary life-support system and an adjunct to prolonged cardiac resuscitation. The ECMO results in good outcomes for patients with in-hospital cardiac arrest. We present a case of a 52-year-old man with out-of-hospital cardiac arrest caused by refractory ventricular fibrillation. The patient was referred to our emergency department with suspected acute coronary syndrome. Cardiac arrest with ventricular fibrillation was refractory to conventional cardiopulmonary resuscitation. In this case, the ECMOcardiopulmonary resuscitation provided cardiopulmonary life support for out-of-hospital cardiac arrest, achieving a sustained return of spontaneous circulation that allowed prompt percutaneous coronary intervention and a good recovery. © 2013 Elsevier Inc. All rights reserved.


Wen Y.K.,Changhua Christian Medical Center | Chen M.L.,Changhua Christian Medical Center
Clinical Nephrology | Year: 2010

Background: The characteristics of post infectious glomerulonephritis (PIGN) now differ from what were described decades ago. After encountering several patients of PIGN with atypical morphology, we conducted this retrospective study to determine the significance in the changes of clinicopathological spectrum of the disease. Methods: Between July 2000 and February 2009, 21 cases of PIGN were identified at a medical center in Taiwan. The patients' records were reviewed with respect to clinical presentation, microbiology, serology, morphology of renal biopsy, and clinical course. Results: The mean age was 60.4 years. All patients developed acute renal failure and the majority (66.7%) required dialysis support. Hypocomplementemia was present in 61.9% of patients. The most frequently identified infectious agent was Staphylococcus (57.1%). Histological characteristics showed two distinct patterns of PIGN. One was diffuse endocapillary proliferation typical of PIGN (61.9%) and the other was atypical pattern of focal mesangial proliferation (38.1%). In comparison, glomerular neutrophil infiltration was more commonly present in typical pattern (p = 0.018). Glomerular IgAdominant or co-dominant deposition was more frequently seen in atypical pattern (p = 0.032). However, there were no statistically significant differences in the clinical presentation and outcome between the two groups. Our data also showed that the percentage of patients with atypical morphology PIGN significantly increased over time. Conclusions: Atypical pattern of focal mesangial proliferative glomerulonephritis may represent a resolution stage of PIGN. The nature of subclinical infection with a more protracted course may contribute to the increasing recognition of this resolving PIGN at the time of renal biopsy. Another possible explanation is that the atypical morphology may be a peculiar pattern of poststaphylococcal glomerulonephritis which was increasingly identified in PIGN over the past 10 years. ©2010 Dustri-Verlag Dr. K. Feistle.


Wen Y.-K.,Changhua Christian Medical Center
International Urology and Nephrology | Year: 2010

Objectives: The goal of this study was to define the differences between prominent glomerular injury and prominent tubular injury in immunoglobulin (Ig) A nephropathy patients presenting with acute renal failure. Methods: In our experience of 236 patients with biopsy-proven IgA nephropathy from 2000 to 2009 at a medical center in Taiwan, 20 cases of acute renal failure were identified. The patients' records were retrospectively reviewed with respect to clinical presentation, morphology of renal biopsy, and outcomes. Results: We subdivided the 20 patients into two groups: group 1 included 9 patients with prominent glomerular injury (≥30% of glomeruli affected by crescents) and group 2 included 11 patients with prominent tubular injury (tubules filled with red blood cell casts/acute tubular necrosis/or acute interstitial nephritis). Regarding clinical parameters, the glomerular injury group had a greater urinary protein excretion (P = 0.014), a higher level of peak serum creatinine (P = 0.025), and more frequently had requirement for dialysis support (P = 0.022). Concerning histological parameters, the glomerular injury group had a higher degree of mesangial hypercellularity (P = 0.009). Regarding renal outcome, the tubular injury group had a higher remission rate than the glomerular injury group (P = 0.022). Conclusions: Histological characteristics showed two distinct mechanisms of acute kidney injury associated with IgA nephropathy, including prominent glomerular injury and prominent tubular injury. The clinical presentation and prognosis largely depended on the histological presentation. © 2009 Springer Science+Business Media, B.V.


Chen Y.-Y.,China Medical University at Taichung | Yen H.-H.,Changhua Christian Medical Center | Chou K.-C.,Changhua Christian Medical Center | Wu S.-S.,Changhua Christian Medical Center
World Journal of Gastroenterology | Year: 2012

AIM: To evaluate the efficacy of thalidomide in combination with other therapies to treat patients with advanced hepatocellular carcinoma (HCC). METHODS: We performed a retrospective analysis of all patients with HCC who were treated with thalidomide for at least two months. The medical records of patients with HCC who were treated at our institution between April 2003 and March 2008 were reviewed. Image studies performed before and after treatment, tumor response, overall survival, and the decrease in α-fetoprotein (AFP) levels were evaluated. RESULTS: A total of 53 patients with HCC received either 100 or 200 mg/d of thalidomide. The patient population consisted of 9 women and 44 men with a median age of 61 years. Thirty patients (56.6%) were classified as Child-Pugh A, and 12 patients (22.6%) were classified as Child-Pugh B. Twenty-six patients had portal vein thrombosis (49.1%), and 25 patients had extrahepatic metastasis (47.1%). The median duration of thalidomide treatment was 6.0 mo. Six of the 53 patients achieved a confirmed response (11.3%), one achieved a complete response (1.9%) and 5 achieved a partial response (9.4%). The disease control rate (CR + PR + SD) was 28.3% (95% CI: 17.8-42.4), and the median overall survival rate was 10.5 mo. The 1- and 2-year survival rates were 45% and 20%, respectively. Only one complete response patient showed an improved overall survival rate of 66.8 mo. Sixteen patients (30.2%) showed more than a 50% decrease in their serum AFP levels from baseline, indicating a better response rate (31.3%), disease control rate (43.8%), and overall survival time (20.7 mo). The therapy was well tolerated, and no significant toxicities were observed. CONCLUSION: Thalidomide was found to be safe for advanced HCC patients, demonstrating anti-tumor activity including response, survival, and AFP decreases of greater than 50% from baseline. © 2012 Baishideng. All rights reserved.

Loading Changhua Christian Medical Center collaborators
Loading Changhua Christian Medical Center collaborators