Kaohsiung Municipal United Hospital

Kaohsiung, Taiwan

Kaohsiung Municipal United Hospital

Kaohsiung, Taiwan
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Chen S.-H.,Tzu Chi University | Lee C.-H.,Chang Gung Memorial Hospital | Wong T.,Kaohsiung Municipal United Hospital | Feng H.-S.,Ten Chen General Hospital
Foot and Ankle International | Year: 2013

Background: Although antituberculosis medication is the first step in the management of skeletal tuberculosis (TB), surgical debridement, biopsy, synovectomy, or arthrodesis may be needed for the definitive diagnosis and treatment of the symptomatic ankle. Methods: Twenty-nine patients with TB around the ankle joint were enrolled during a 23-year period and followed for 73.1 months (range, 30-260 months) after TB was controlled. Among 61 surgical procedures performed in 29 patients, complete resolution of ankle TB was seen in 28 patients. Results: According to Martini and Ouahes classification, radiographic findings of localized osteoporosis were stage I in 4 patients, one or more erosions were stage II in 9 patients, destruction of the whole joint was stage III in 8 patients, and anatomic disorganization and subluxation were stage IV in 8 patients. Functional results were excellent in 6 patients and good in 16 patients, but with talar bone collapse or hindfoot malalignment, a fair result was noted in 6 patients. The diagnostic accuracy rates were 28.5% with aspiration of synovial fluid, 66.7% in histological analysis, and 44.4% in bacteriological analysis. Mixed infection with bacterial flora was noted in 8 patients (27.6%). Conclusions: Ankle TB is easily misdiagnosed and may ultimately involve the peritalar neighboring joints with talar height loss or hindfoot deformity. Successful treatment depends on the extent of disease at presentation, accurate staging, duration of adequate chemotherapy, and optimal surgical intervention. Level of Evidence: Level IV, retrospective case series. © The Author(s) 2013.


Tseng H.-C.,Kaohsiung Medical University | Wang H.-H.,Kaohsiung Medical University | Weng W.-C.,Kaohsiung Municipal United Hospital
Kaohsiung Journal of Medical Sciences | Year: 2013

The purpose of this study was to explore senior nursing students' perceptions toward the nursing profession and their experiences in clinical practicum in Taiwan. This study used semistructured interview guides and unstructured face-to-face dialogue with the participants based on a qualitative method. A purposive sample with a snowball method from a baccalaureate nursing program in Southern Taiwan was used to recruit participants. A total of 30 senior nursing students participated in this study. Data were collected from February to May 2011. The interviews were transcribed verbatim, and data were analyzed based on the phenomenological approach of qualitative methodology. Data were categorized into three major themes: in-depth recognition of nursing, recognition of the meaning and value of life, and decision conflicts for being a nurse. The findings of the study not only help nursing educators further understand the educational effects of clinical practicum, but also provide information for managers of medical organizations to recruit and train newly graduated nurses. © 2013, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.


Wang C.-H.,Kaohsiung Medical University | Wang C.-H.,Tian Sheng Memorial Hospital | Leung M.,Kaohsiung Municipal United Hospital | Liang W.-C.,Kaohsiung Medical University | And 3 more authors.
Neuromuscular Disorders | Year: 2012

This study aimed to evaluate muscle involvement pattern and correlate the lesions on muscle imaging with clinical features and D4Z4 fragment size in 24 patients with facioscapulohumeral muscular dystrophy (FSHD). The grading of the muscle image detected by computed tomography (CT) was based on a four-point semi-quantitative visual scale. On muscle CT, the most affected muscle was trapezium, followed by hamstrings. CT image identified hamstrings involvement rather than shoulder-girdle in clinically asymptomatic subjects. CT image also showed that axial muscle was affected in one-third of patients which appeared even earlier than clinical manifestation. Strong correlations between CT findings, serum creatine kinase level and clinical severity scores were also found. Asymmetric involvement was more evident on CT image than it identified in manual muscle strength testing. Inverse correlation between CT grade and D4Z4 fragment size was clearly demonstrated. These findings suggest muscle CT will be helpful for the process of early intervention in FSHD, even in subjects in a preclinical status. © 2011 Elsevier B.V.


Hsieh L.-C.,Kaohsiung Municipal United Hospital | Chow C.-J.,National Kaohsiung Marine University | Chang W.-C.,Kaohsiung Municipal United Hospital | Liu T.-H.,Taipei Physical Education College | Chang C.-K.,Sport Science Research Center
Asia Pacific Journal of Clinical Nutrition | Year: 2010

Malnutrition and muscle loss are common in bed-ridden elderly nursing home residents. Supplementation of β-hydroxy-β-methylbutyrate (HMB) has been shown to prevent muscle loss in several catabolic conditions. The aim of this study was to investigate the effect of HMB supplementation on body composition and protein metabolism in bed-ridden elderly nursing home residents receiving tube feeding. The subjects were randomly assigned to HMB (n=39, 2 g/d) or control group (n=40). Anthropometry measurements, blood sampling, and 24-hr urine collection were performed on the day before and 14 days after the start of the study. A subgroup of subjects (HMB: n=19, control: n=20) continued the study for another 14 days. Changes in body weight and BMI were not significantly different between the groups after 14 or 28 days after controlling for baseline BMI. Blood urea nitrogen significantly decreased in the HMB group, while it remained unchanged in the control group after 14 days. Urinary urea nitrogen excretion significantly decreased in the HMB group, while it showed a trend of increase in the control group after 14 and 28 days, respectively. Changes in blood urea nitrogen and urinary urea nitrogen excretion were significantly different between the groups after controlling for baseline BMI. This study suggested that HMB supplementation for 2-4 weeks could reduce muscle breakdown in bed-ridden elderly nursing home residents receiving tube feeding.


Wong T.,Kaohsiung Municipal United Hospital | Wang C.-J.,Chang Gung University | Wang J.-W.,Chang Gung University | Ko J.-Y.,Chang Gung University
Biomedical Journal | Year: 2014

Background: Uni-knee arthroplasty (UKA) has shown better knee kinematics and motion that may better suit the activities of daily living in Eastern countries. The purpose of this study was to evaluate the functional outcomes of UKA for medial compartment knee arthropathy in Asian patients.Methods: The study cohort consisted of 48 patients with 51 UK A knees. Only one type of prosthesis was used and all components were cemented. Postoperative management included ambulation with weight bearing, range of motion, and muscle strengthening exercises as tolerated until full recovery. The average follow-up was 52.0 ± 24.0 (range 12-92) months. The evaluation included functional assessment, the Knee Society knee and functional scores, the International Knee Document Committee (IKDC) subjective and objective scores, and radiographs of the knee.Results: The overall clinical outcomes of the knee showed the functional outcome of the knee to be normal in 51%, nearly normal in 37%, abnormal in 8%, and severely abnormal in 4%. The functional activities included stair climbing in 96%, squatting in 76%, jogging in 71% and kneeling in 47%. Three-quarters of the patients were able to kneel for daily activities. Approximately 98% of the patients were satisfied with the operation. The survivorship of the prosthesis was 98% with one revision pending. Radiographic evaluations revealed the components were centered in 82% and off-centered in 18%. Osteoarthritis was 22% preoperative and 27% postoperative for the patellofemoral compartment, and 0% before and 4% after surgery for the lateral compartment. The functional outcomes showed no difference between patients with and without patellofemoral arthritis. The complications included one component malposition and one knee pain of undetermined origin.Conclusions: UKA provides excellent pain relief and restoration of knee function including kneeling, squatting, and sit-to-stand activities that perfectly fit the oriental lifestyle and high patient satisfaction in Asian patients at medium-term follow-up. The complications were rare and the survival rate was 98% at medium-term follow-up. © 2014, Biomedical Journal. All Rights Reserved.


Wang C.-J.,Chang Gung University | Huang C.-C.,Chang Gung University | Wong T.,Kaohsiung Municipal United Hospital | Yang Y.-J.,Chang Gung University
Biomedical Journal | Year: 2012

Background: This study analyzed the long-term outcomes of extracorporeal shockwave therapy (ESWT) and core decompression for early osteonecrosis of the femoral head (ONFH) with 8- to 9-year follow-up. Methods: The study cohort consisted of 48 patients with 57 hips including 23 patients with 29 hips in the ESWT group and 25 patients with 28 hips in the surgical group. Patients in ESWT group received shockwave therapy to the affected hip. Patients in surgical group underwent core decompression and autogenous cancellous bone and allogenous fibular graft. The average length of follow-up was 103.5 ± 3.4 (ranged 93-106) months and 104.5 ± 4.3 (ranged 95-108) months for the ESWT and the surgical group, respectively. The evaluations included clinical assessment for pain and function, X-ray and MRI of the affected hips. Results: The overall clinical results were 76% good or fair and 24% poor for the ESWT group; and 21% good or fair and 79% poor for the surgical group. THA was performed in 3% and 21% at one year, 10% and 32% at 2 years and 24% and 64% at 8-9 years for ESWT and the surgical group respectively. Significant differences in pain and Harris hip scores were observed at different time intervals favoring the ESWT group. There was a trend of decrease in the size of the lesion in the ESWT group when compared with the surgical group. Conclusion: ESWT appears to be more effective than core decompression and bone grafting for early ONFH with 8- to 9-year long-term follow-up.


Wang C.-J.,Chang Gung University | Sun Y.-C.,Chang Gung University | Wong T.,Kaohsiung Municipal United Hospital | Hsu S.-L.,Chang Gung University | And 2 more authors.
Journal of Surgical Research | Year: 2012

Background: Recent studies reported that extracorporeal shockwave therapy (ESWT) has a chondroprotective effect on the initiation and regression of osteoarthritis of the knee in rats. However, the time course effects of ESWT in the osteoarthritic knee are not fully understood. The purpose of this study was to evaluate the effects of ESWT over time on osteoarthritis of the knee in rats. Methods: We used 72 8-week-old male Sprague-Dawley rats with body weights ranging from 245 to 265 g. We randomly divided the rats into three groups, with 24 rats in each group. The control group received neither surgery nor ESWT. The anterior cruciate ligament transected (ACLT) group underwent anterior cruciate ligament transection but received no ESWT. The ACLT plus ESWT group underwent ACL transection and received ESWT at 1 wk after surgery. The animals were killed at 2, 4, 8, and 12 wk, 6 rats from each group at each time course. Evaluation parameters included Mankin score, Safranin O stain, and collagen II for the articular cartilage; and vascular endothelial growth factor (VEGF), bone morphogenetic-2 (BMP-2), and osteocalcin for the subchondral bone using histopathological examination and immunohistochemical analysis. Results: The ACLT group showed significant increases in Mankin score and Safranin O stain, and a decrease in collagen II in the articular cartilage, and significant decreases in VEGF, BMP-2, and osteocalcin in the subchondral bone compared with the control (P <.05). The ACLT + ESWT group showed significant decreases in Mankin score and Safranin O stain and an increase in collagen II in the articular cartilage, and significant increases in VEGF, BMP-2, and osteocalcin in the subchondral bone compared with the control group. The changes in the ACLT + ESWT group appeared to correlate with the time courses of treatment; the most beneficial effects were noticed 4 weeks after ESWT. Conclusion: Extracorporeal shockwave therapy is effective in preventing osteoarthritis of the knee in rats. The beneficial effects of ESWT appear to be time-dependent beginning at 4 weeks after treatment. © 2012 Elsevier Inc. All rights reserved.


Wang C.-J.,Chang Gung University | Wong T.,Kaohsiung Municipal United Hospital | Ko J.-Y.,Chang Gung University | Siu K.-K.,Chang Gung University
Knee | Year: 2014

Background and purpose: Patellofemoral disorders are often associated with patellofemoral malalignment. Tibial tubercle transfer is an effective method to correct the patellofemoral malalignment. This study evaluated the long-term results of triple positioning of tibial tubercle osteotomy for refractory patellofemoral disorders with 10-year follow-up. Patients and Methods: Fifty-six patients with 62 knees underwent triple positioning of tibial tubercle osteotomy for refractory patellofemoral disorders. All patients received standard rehabilitation protocol postoperatively. The average length of follow-up was 128.5. ±. 9.8. months (range 116 to 149). The evaluations included pain score, Kujala patellofemoral score, Lysholm score and radiograph of the knee. Results: The overall clinical results were excellent in 41.9%, good in 37%, fair in 12.9% and poor in 5% at 1. year; and 29% excellent, 41% good, 18.3% fair and 9.3% poor at 10. years. Satisfactory results were 78.9% and 70.9%, and unsatisfactory results 21.1% and 29.1% at 1. year and 10. years respectively. There was no correlation of clinical outcomes with age, sex, body weight and height and preoperative pain score. However, there was a positive correlation of clinical outcomes with the improvement of the congruence angle on postoperative X-rays of the knee, and a negative correlation of clinical outcome with the severity of articular cartilage damage assessed in arthroscopy. The complications included 1 non-union and 1 infection with non-union. Conclusion: Triple positioning of tibial tubercle osteotomy is effective and long lasting in patients with patellofemoral disorders with 70.9% satisfactory results at 10-year follow-up. Level of evidence: IV (refer to instructions for detailed description on the level of evidence). © 2012 Elsevier B.V.


Fu J.-C.,Kaohsiung Municipal United Hospital | Xirasagar S.,University of South Carolina | Liu J.,University of South Carolina | Probst J.C.,University of South Carolina
BMC Public Health | Year: 2010

Background. Cultural and ethnic roots impact women's fertility and delivery preferences This study investigated whether the likelihood of cesarean delivery, primary cesarean, and vaginal delivery after cesarean (VBAC) varies by maternal national origin. Methods. We conducted a nation-wide, population-based, observational study using secondary data from Taiwan. De-identified data were obtained on all 392,246 singleton live births (500 g; 20 weeks) born to native-born Taiwanese, Vietnamese and mainland Chinese-born mothers between January 1 2006 and December 31 2007 from Taiwan's nation-wide birth certificate data. Our analytic samples consisted of the following: for overall cesarean likelihood 392,246 births, primary cesarean 336,766 (excluding repeat cesarean and VBAC), and VBAC 55,480 births (excluding primary cesarean and vaginal births without previous cesarean). Our main outcome measures were the odds of cesarean delivery, primary cesarean delivery and VBAC for Vietnamese and Chinese immigrant mothers relative to Taiwanese mothers, using multiple regression analyses to adjust for maternal and neonatal characteristics, paternal age, institutional setting, and major obstetric complications. Results. Unadjusted overall cesarean, primary cesarean, and VBAC rates were 33.9%, 23.0% and 4.0% for Taiwanese, 27.6%, 20.1% and 5.0% for mainland Chinese, and 19.3%, 13.9 and 6.1% for Vietnamese respectively. Adjusted for confounders, Vietnamese mothers were less likely than native-born Taiwanese to have overall and primary cesarean delivery (OR = 0.59 and 0.58 respectively), followed by Chinese mothers (both ORs = 0.90 relative to native-born Taiwanese). Vietnamese mothers were most likely to have successful VBAC (OR = 1.58), followed by Chinese mothers (OR = 1.25). Conclusion. Immigrant Vietnamese and Chinese mothers have lower odds of cesarean and higher VBAC odds than native-born Taiwanese, consistent with lower cesarean rates prevailing in their home countries (Vietnam 10.1%; mainland China 20% - 50% rural and urban respectively). © 2010 Fu et al; licensee BioMed Central Ltd.


Xirasagar S.,University of South Carolina | Fu J.-C.,Kaohsiung Municipal United Hospital | Liu J.,University of South Carolina | Probst J.C.,University of South Carolina | Lin D.-P.,Kaohsiung Municipal United Hospital
Maternal and Child Health Journal | Year: 2011

In Taiwan, immigrant women by marriage face social discrimination due to widespread impressions that they give birth to low birth weight, high-risk, high cost babies due to their lower socioeconomic status, shorter stature, and lower pre-pregnant weight than native-born Taiwanese women. This study compared crude and adjusted birth outcomes of immigrant mothers (Chinese and Vietnamese) relative to native-born Taiwanese, and tested for the phenomenon of an epidemiological paradox of favorable neonatal outcomes among immigrants. Data from patient charts of all singleton live births during 2002-2007, weighing ≥500 and <4,000 g, and ≥20 weeks gestational age at a regional hospital in Kaohsiung, Taiwan, were used. Multiple regression analysis was used to test the hypothesis controlling for maternal characteristics (demographics, national origin, obstetric and prenatal factors) and neonatal characteristics (birth weight, gestational age). Of 3,267 births satisfying the inclusion criteria, 19.0% were to Chinese and Vietnamese mothers. Crude birth weight was lowest for Taiwanese mothers, who also had the highest rate of preterm delivery (<37 weeks). The adjusted birth weight for Chinese and Vietnamese mothers was 87.7 and 74.7 g higher, respectively than native-born Taiwanese (both P < 0.001). Chinese and Vietnamese mothers also had lower odds of preterm birth (ORs 0.46 and 0.47, respectively). Findings support paradoxically better neonatal outcomes among Chinese and Vietnamese immigrant mothers in Taiwan. Findings can be used to initiate public education to reverse the widespread negative perceptions and attitudes towards immigrant spouses in Taiwan. © 2010 Springer Science+Business Media, LLC.

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