National Yang-Ming University School Research Articles

Paraclinoid Aneurysms: Part III—Lateral Aneurysms

Dr. Krisht is Professor and Director, Arkansas Neuroscience Institute, St. Vincent Hospital, #5 St. Vincent Circle, Suite 503, Little Rock, AR 72205; E-mail: [email protected]; and Dr. Hsu is Neurosurgeon, Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and Professor, National Yang-Ming University School of Medicine, Taipei, Taiwan. The authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this CME activity.This article is reprinted from a classic Contemporary Neurosurgery article published in 2008.Category: CerebrovasularLippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on November 29, 2021.

Paraclinoid Aneurysms: Part I—Superior (True Ophthalmic) Aneurysms

Dr. Krisht is Professor and Director, Arkansas Neuroscience Institute, St. Vincent Hospital, #5 St. Vincent Circle, Suite 503, Little Rock, AR 72205; E-mail: [email protected]; and Dr. Hsu is Neurosurgeon, Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and Professor, National Yang-Ming University School of Medicine, Taipei, Taiwan. The authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this CME activity.This article is reprinted from a classic Contemporary Neurosurgery article published in 2008.Category: CerebrovasularLippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on October 29, 2021.

Adding Volume for Reduction of Thick Lips in the Asian Patient

P-Skin Professional Clinic, Kaohsiung, Taiwan National Yang-Ming University School of Medicine, Taipei, Taiwan P.H.L. Peng is a speaker and/or consultant for Allergan, Galderma, and Merz. The remaining author has indicated no significant interest with commercial supporters.

Degenerative leiomyoma of the cervix: Atypical clinical presentation and an unusual finding

a Department of Obstetrics and Gynecology, Cardinal Tien Hospital-Hsintien, New Taipei City, Taiwan b Department of Obstetrics and Gynecology, Fu Jen Catholic University, New Taipei City, Taiwan c Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan d Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan e Department of Medical Research, China Medical University Hospital, Taichung, Taiwan

Predictability effect reflects different contributions from each hemisphere: data from left and right hemisphere damage patients

Predictability effect reflects different contributions from each hemisphere: data from left and right hemisphere damage patients

Rebleeding prophylaxis improved outcomes in patients with hepatocellular carcinoma: Is it feasible in all patients?

We read with great interest the recent article by Ripoll et al.1 In this multicenter case-control study, the authors emphasize the survival benefit of second prophylaxis in patients with hepatocellular carcinoma (HCC) and variceal bleeding (VB) regardless of Barcelona Clinic Liver Cancer (BCLC) stage. However, these results should be interpreted with caution. In this study the median survival was only 0.9 months and 0.7 months in patients without second prophylaxis stratified by BCLC A/B and C/D, respectively. Because of the retrospective nature, it is highly probable that patients who were too ill to start or died before the second prophylaxis were inevitably stratified to the group without second prophylaxis; therefore, selection bias of poor survivor in the nonprophylaxis group should be a concern. These phenomena were shown in Supporting Table 1, in which patients without prophylaxis in BCLC C/D had a higher Model for Endstage Liver Disease (MELD) score and poor liver reserve.1 Moreover, we don't think the patients in BCLC D should be analyzed together with BCLC C because the patients in BCLC D usually had the poorest hepatic reserve and survival, and also were very unlikely to tolerate second prophylaxis. Actually, our previous randomized controlled trial (RCT) showed that 44.4% (24/54) of patients with unresectable HCC and VB cannot receive a second scheduled ligation after endoscopic hemostasis of acute bleeding; more than 90%(22/24) of these patients were Child-Pugh C.2 We are very interested to see if the patients in BCLC D can receive second prophylaxis and their outcomes in the current study because the proof of no harm to introduce invasive treatment to terminal and fragile patients is very important. In an earlier study in Japan, neither prophylactic nor emergency endoscopic injection sclerotherapy prolonged the survival of patients with HCC and Child-Pugh C.3 In another recent retrospective study, Dr. Han found that hepatic reserve instead of endoscopic therapy is associated with in-hospital mortality in patients with HCC and Child-Pugh C.4 On the other hand, the use of a beta-blocker in patients with poor hepatic reserve should be done very cautiously because a study showed that beta-blocker is associated with poor survival in patients with refractory ascites.5 In conclusion, the benefit of second prophylaxis of VB in patients with HCC and poor hepatic reserve is still unclear and further prospective study is needed. Ping-Hsien Chen, M.D.1,2 Ming-Chih Hou, M.D.1,2 1Endoscopy Center for Diagnosis and Treatment Taipei Veterans General Hospital Taipei, Taiwan 2School of Medicine National Yang-Ming University School Taipei, Taiwan

A Female Patient With Persistent Epigastric Pain for 1 Week

Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; College of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan

Clinical significance of novel cloud-based telemetry ECG in detecting arrhythmias, reducing hospitalizations and medical cost

arrhythmias, reducing hospitalizations and medical cost Yen-Chang Huang , Shih-Lin Chang ⁎, Yenn-Jiang Lin , Li-Wei Lo , Yu-Feng Hu , Tze-Fan Chao , Wen-Ling Sheen , Hui-Lun Chuang , Mei-Ling Chen , Huan-Chung Li , Fei-Lung Lin , Chih-Hsiang Liu , Shih-Ann Chen a,b a Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC b Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC c Department of Medicine, Taipei City Hospital, Taipei, Taiwan, ROC d Advanced Research Institute, Institute for Information Industry, Taipei, Taiwan, ROC

Exaggerated placenta site in placenta previa: an imaging differential diagnosis of placenta accreta, placental site trophoblastic tumor and molar pregnancy

Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Chung Shan Medical University, Faculty of Clinical Medicine, National Yang-Ming University School of Medicine, Taichung, Taiwan Department of Obstetrics and Gynecology, International Islamic University, Kuantan, Malaysia Department of Pathology, Taichung Veterans General Hospital, Chung Shan Medical University, Faculty of Clinical Medicine, National Yang-Ming University School of Medicine, Taichung, Taiwan

Stage III malignant mixed Müllerian tumor of the fallopian tube: A case of 5-year survival after optimal debulking and adjuvant chemotherapy with paclitaxel plus carboplatin

Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan c Institute of Biomedical Nutrition, Hung Kuang University, Taichung, Taiwan d Institute of Biomedical Sciences, National Chung-Hsing University, Taichung, Taiwan Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan

Stimulus-induced rhythmic, periodic, or ictal discharges – A case report

Department of Neurology, Taipei General Hospital, Department of Health, Executive Yuan, Taiwan, ROC Institute of Brain Science, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC Pediatric Epilepsy Surgery Group, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC Section of Neurology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taiwan, ROC

Umbilical Hernia Due to Enlarged Paraumbilical Vein

*Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan; College of Medicine, Tzu Chi University, Hualien, § aiwan; Department of Medical Image, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan

Successful application of haemoclips plus argon plasma coagulation for angioectasia bleeding with underlying arteriovenous malformation in the colon

Colorectal DiseaseVolume 12, Issue 7Online p. e180-e181 Successful application of haemoclips plus argon plasma coagulation for angioectasia bleeding with underlying arteriovenous malformation in the colon T.-Y. Lee, T.-Y. Lee Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital Department of Medicine, Chung Shan Medical UniversitySearch for more papers by this authorH.-Z. Yeh, H.-Z. Yeh Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital National Yang-Ming University School of Medicine, TaipeiSearch for more papers by this authorS.-S. Yang, S.-S. Yang Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General HospitalSearch for more papers by this authorC.-S. Chang, C.-S. Chang Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ChinaSearch for more papers by this author T.-Y. Lee, T.-Y. Lee Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital Department of Medicine, Chung Shan Medical UniversitySearch for more papers by this authorH.-Z. Yeh, H.-Z. Yeh Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital National Yang-Ming University School of Medicine, TaipeiSearch for more papers by this authorS.-S. Yang, S.-S. Yang Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General HospitalSearch for more papers by this authorC.-S. Chang, C.-S. Chang Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ChinaSearch for more papers by this author First published: 18 June 2010 https://doi.org/10.1111/j.1463-1318.2009.02059.xCitations: 1 Chi-Sen Chang, Section of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 160, Section 3, Taichung Harbor Road, Taichung 407, Taiwan, China.E-mail: tylee@vghtc.gov.tw Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume12, Issue7OnlineJuly 2010Pages e180-e181 RelatedInformation

The remarkably variable expressivity of CADASIL: report of a minimally symptomatic man at an advanced age

Sir, Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an adult-onset, dominantly inherited disorder caused by NOTCH3 mutations. It is characterized by recurrent subcortical infarctions, dementia, and less frequently, migraine and psychiatric symptoms. NOTCH3 has 33 exons, and most CADASIL-associated NOTCH3 mutations result in a gain or loss of one cysteine residue within a given extracellular epidermal growth factor (EGF)-like repeat domain and, in Caucasians, with a strong cluster in exon 3–6 encoding the first five EGF-like repeats [1]. The typical MRI features in CADASIL include multi-focal lacunar infarcts and diffuse T2-weighted hyperintensity of cerebral white matter with involvement of the anterior temporal lobes [1]. The presence of granular osmiophilic material (GOM), which is seen in close vicinity to the basement membrane of the smooth muscle cells of the arterioles on electron microscopy (EM), is pathognomonic for CADASIL [1]. Although the penetrance of MRI changes has been reported to be complete by 40 years of age [2], the spectrum of clinical phenotypes has remained elusive. Herein, we report the case of an 86-year-old minimally symptomatic male with CADASIL mutation, representing one extreme of the remarkably variable expressivity of CADASIL. The 86-year-old man had been doing very well before. His past history is only remarkable for heavy cigarette smoking without migraine or psychiatric symptoms. He came to our attention because of a mild numbness in the left hand following two falls 2 months earlier. The neurological examinations revealed only subtly increased deep tendon reflexes in the right biceps and brachioradialis. The brain MRI with gadolinium-enhanced magnetic resonance angiography (MRA) revealed a diffuse leukoencephalopathy without anterior temporal lobe involvement, one single and small lacunar infarct in the left putamen (Fig. 1a), and patent cerebral vessels. Subsequent mutational analysis of NOTCH3 uncovered a missense mutation, c. 1708C [ T, in exon 11, which putatively may result in a substitution of cysteine for arginine at amino acid 544 (R544C). The EM exam of a skin biopsy demonstrated the presence of characteristic GOM (Fig. 1b, c). His family history was unclear because of his early separation, at teenage, from the family and he has no children. He had received 7 years of education. His score of Mini-Mental State Examination (MMSE) was 27 out of 30 and the Cognitive Abilities Screening Instruments (CASI) was 81 out of 100. The cutoff scores of CASI in our population for the diagnosis of dementia in those who received 6 or more years of education is 79/80 [3]. NOTCH3 R544C has previously been reported manifesting typical CADASIL features [4, 5]. In the literature, the clinical manifestations of NOTCH3 mutations are enormously variable [6], with another report of a 14-yearold boy presenting with recurrent hemiplegia [7]. The observation in this patient highlights that, because the clinical manifestations may be extremely subtle, NOTCH3 Y.-C. Lee B.-W. Soong (&) Department of Neurology, National Yang-Ming University School of Medicine and Taipei Veterans General Hospital, #155, Sec.2, Li-Nung Street, Peitou District, Taipei 11217, Taiwan, ROC e-mail: bwsoong@vghtpe.gov.tw

Ipsilateral crural monoparesis in lateral medullary infarction due to vertebral artery dissection

European Journal of NeurologyVolume 13, Issue 7 p. e8-e9 Ipsilateral crural monoparesis in lateral medullary infarction due to vertebral artery dissection C.-Y. Liu, C.-Y. Liu The Neurological Institute, Taipei Veterans General Hospital, Taipei National Yang-Ming University School of Medicine, TaipeiSearch for more papers by this authorF.-C. Chang, F.-C. Chang National Yang-Ming University School of Medicine, Taipei Department of Radiology, Taipei Veterans General Hospital, Taipei, TaiwanSearch for more papers by this authorH.-H. Hu, H.-H. Hu The Neurological Institute, Taipei Veterans General Hospital, Taipei National Yang-Ming University School of Medicine, TaipeiSearch for more papers by this authorL.-C. Hsu, L.-C. Hsu The Neurological Institute, Taipei Veterans General Hospital, Taipei National Yang-Ming University School of Medicine, TaipeiSearch for more papers by this author C.-Y. Liu, C.-Y. Liu The Neurological Institute, Taipei Veterans General Hospital, Taipei National Yang-Ming University School of Medicine, TaipeiSearch for more papers by this authorF.-C. Chang, F.-C. Chang National Yang-Ming University School of Medicine, Taipei Department of Radiology, Taipei Veterans General Hospital, Taipei, TaiwanSearch for more papers by this authorH.-H. Hu, H.-H. Hu The Neurological Institute, Taipei Veterans General Hospital, Taipei National Yang-Ming University School of Medicine, TaipeiSearch for more papers by this authorL.-C. Hsu, L.-C. Hsu The Neurological Institute, Taipei Veterans General Hospital, Taipei National Yang-Ming University School of Medicine, TaipeiSearch for more papers by this author First published: 23 June 2006 https://doi.org/10.1111/j.1468-1331.2006.01290.xCitations: 10 Li-Chi Hsu, MD, The Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih- Pai Rd, Beitou District, Taipei, Taiwan 11217 (tel.: +886 2 2875 7578; fax: +886 2 2875 7579; e-mail: [email protected]). Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume13, Issue7July 2006Pages e8-e9 RelatedInformation

Case of the month

Each month, we will present a challenging Case of the Month for The Green Journal readers, who must use their clinical acumen to arrive at the correct answer. We will also post the case each month on the Journal’s web site (http://www.elsevier.com/locate/ajmselect). Several possible answers may be consistent with the case presentation; use your best judgment. Please send your answer (one per respondent) and indicate the case to which you are responding to The Green Journal at editors@amjmed.org or via FAX to (415) 447-2799. Only those answers with a complete mailing address will be considered. The correct answer will appear in the July issue of the Journal. The first five persons who submit correct answers will receive a free one-year subscription to the Journal. Colleagues of Drs. Tarng and Hung at the National Yang-Ming University School of Medicine in Taiwan are not eligible for this month’s case. If you would like to contribute a case, please submit a brief synopsis (<250 words) to the editorial office. An individual may win only once per calendar year.

Peripheral endotoxemia and hyperdynamic circulation of rats with extrahepatic or intrahepatic portal hypertension: [formula omitted] Div. of Gastroenterology, Dept. of Medicine, and ∗Dept. of Medical Education and Research, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Peripheral endotoxemia and hyperdynamic circulation of rats with extrahepatic or intrahepatic portal hypertension: [formula omitted] Div. of Gastroenterology, Dept. of Medicine, and ∗Dept. of Medical Education and Research, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Circulating tumorf necrosis factor-α and interleukin-6 concentrations and hyperdynamic circulation in cirrhosis: [formula omitted] Div. of Gastroenterology, Dept. of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Circulating tumorf necrosis factor-α and interleukin-6 concentrations and hyperdynamic circulation in cirrhosis: [formula omitted] Div. of Gastroenterology, Dept. of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.