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A dual-Wiimote 3D localization scheme has been developed for improving the spatial resolution and extending the sensing space of the original demonstrated single Wiimote 3D scheme. This scheme utilizes two pairs of Wiimotes to form a dual stereo vision and a kinematics relation is established to extract the 3D position of objects by using geometric transformation. The experimental results indicate that this scheme is effective in achieving the above mentioned goals. A demonstration by incorporating an omni-wheel robot and a quadcopter under a Wiimote sensing environment has been performed to examine the feasibility of the localization method. The demonstration indicates that with properly integration with this scheme, it is expected applications such as positioning of indoor mobile robots and human motion capture for animations could achieve a better performance.

The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT). Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33–35 fractions. In addition, 97 % of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months. The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1 %, respectively. A total of 27 patients had locoregional recurrence: 85.2 % in-field failures, 11.1 % marginal failures, and 3.7 % out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9 %) compared to those receiving conservative treatment (32.0 %, p = 0.051). In patients treated with 1 course of radiotherapy, grade ≥ 3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6 % of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation. IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.

Background: Single nucleotide polymorphisms (SNPs) identified from genome-wide association study (GWAS) have been found to be associated with breast cancer risk. We hypothesized that candidate genes and genes derived from GWAS involving in the Estrone/Estradiol (E2)/Tamoxifen biosynthesis may influence the adjuvant hormonal therapy effect and the survival. In this study, we sought to investigate whether these SNPs are associated with prognosis of hormone receptor (HR)-positive breast cancer patients, especially in HER2-negative patients. Patients and methods: We selected breast cancer susceptibility SNPs identified by GWAS, SNPs in tamoxifen metabolizing related genes, and SNPs in estrogen receptor genes and estrogen metabolism genes, and genotyped for variations of above genes, including ALDH3A1, CYP2C19, COMT, CYP19, MAP3K1, FGFR2, TNRC9, HCN1, ERCC4, CYP3A5, UGT1A1, ER, ABCG2, CYP2B6, CYP2D6, 5p12 in 171 hormone receptor-positive, and Her2-negative early breast cancer patients (127 with negative lymph node [LN], and 44 with 1–3 positive LN). All patients received adjuvant hormonal therapy. The associations were examined between SNPs and distance disease-free survival (DDFS), and overall survival (OS) by using the log-rank test and Cox's proportional hazard model. Furthermore, we combined clinicopathologic features and SNPs into the risk score analysis to further validate above identified genetic markers. Results: We found that SNPs of CYP2B6 (rs3211371), FGFR2 (rs2981582), and MAP3K1 (rs889312) were significantly associated with DDFS and OS. Furthermore, in lymph node-negative patients, CYP2B6 (rs3211371), FGFR2 (rs2981582), MAP3K1 (rs889312) and 5p12 (rs10941679 and rs4415084) were significantly associated with DDFS and OS, while CYP3A5 (rs776746) was significantly associated with OS but not DDFS. We further assessed the associations of disease prognosis with the number of high-risk genotypes in CYP3A5, FGFR2, and MAP3K1, and showed significant dose-response relationships between the number of high-risk alleles at these 3 loci and DDFS (P = 0.005 for trend) and OS (P = 0.0008 for trend). When combining the clinicopathologic features and SNPs into the risk score analysis, patients were divided into 3 subgroups (subgroup 1, risk score1.708, n=43 [LN-positive, n=11]). We found that around 20 % of subgroup 3 patients had early development of distant metastases (DM) in the upfront 3 years (the trend of DM appeared to persist at least 10 years), and subgroup 2 patients had higher risk of DM after 5 years, whereas subgroup 1 patients had no development of DM even after 12 years. Conclusion: Our results indicate that in addition to drug metabolic genes, genes related to cell proliferation, anti-apoptosis, and signaling transduction, for example, CYP3A5, CYP2B6, FGFR2, and MAP3K1 genes were associated with DDFS and OS in HR-positive/Her2-negative breast cancer patients. These findings provide additional insight that the genetic variants, or host factors, may affect the prognosis of breast cancer. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-02.

A convection-diffusion reaction scheme is applied to solve the transient transport equations for the prediction of steady electro-osmotic microchannel flow behavior. The governing equations for the total electric field include the Laplace equation for the effective electrical potential and the Poisson-Boltzmann equation for the electrical potential established in the electric double layer. The transport equations governing the hydrodynamic field variables comprise mass conservation equation for the electrolyte and equations of motion for the incompressible charged fluid flow subject to an electro-osmotic body force. The main aim of the study is to elucidate the effect of Joule heating, which can affect the electrohydrodynamic behavior. Investigation into the region near the negatively charged channel wall is made through the simulated velocity boundary layer, diffuse layer, and electric double layer.

The present authors explored the relationship between asthma control status, measured using a derived Asthma Control TestTM (ACT) score, and utilisation of healthcare and its cost in eight Asia-Pacific areas. Patients were included if they were aged ≥12 yrs and had participated in a recent survey of asthma patients. Patient-reported frequency of healthcare resource use was used to estimate the cost of asthma care. The ACT score was derived from survey questions identical or similar to the items comprising the ACT. An ACT score was derived for 2,062 patients, of whom 59% (1,220) scored

The aim of this study was to investigate the possible additional diagnostic information provided by imprint cytology when performing ultrasound-guided transthoracic core biopsy and to evaluate whether it could optimise the biopsy procedure. A total of 155 transthoracic core biopsies with touch imprint smears were performed under ultrasound guidance, with 127 malignant and 28 benign lesions. The imprint smears were stained using Riu's method and interpreted by a cytopathologist. These were compared with the histopathology of core biopsy specimens and the final diagnosis of malignant versus benign disease. The overall diagnostic accuracy of imprint cytology was 94% (146 out of 155). Histopathological analysis showed an overall accuracy of 94% (146 out of 155), with a sensitivity of 94% (119 out of 127) and negative predictive value of 79% (27 out of 34). The combination of these two methodologies had an increased overall accuracy and negative predictive value of 98% (152 out of 155) and 90% (28 out of 31), respectively. The results of imprint cytology and histopathology were in agreement in 143 patients (92%). In conclusion, imprint cytology of ultrasound-guided transthoracic core biopsy is a sensitive procedure for diagnosing peripheral thoracic lesions, and it may increase the diagnostic accuracy and cancer negative prediction of biopsy alone. With an on-site approach, imprint cytology may help to assess the adequacy of biopsy specimens and optimise the biopsy procedure.

This retrospective study was conducted to assess Taiwanese emergency physicians for their preference in management and adherence to guidelines in treating patients with acute exacerbation of asthma. One hundred twenty patients from hospitals of three different levels were evaluated by reviewing their medical records. Our study revealed that physicians from medical centers and regional hospitals assessed patients more often with arterial blood gas or pulse oximetry; prescribed more doses of beta2-agonist nebulizers; administered more doses of beta2-agonist nebulizers before administering parenteral aminophylline; and prescribed ipratropium nebulizers more often as adjunctive therapy. On the other hand, physicians from district hospitals more frequently prescribed parenteral aminophylline as the first-line medication and more often prescribed only a single dose of beta2-agonist nebulizer. Most emergency physicians in Taiwan did not adhere to guidelines. Specifically, these included omission of peak expiratory flow as the means to assess the severity of asthma exacerbation and response to treatment; suboptimal use of inhaled bronchodilators, such as beta2-agonists and ipratropium; and inappropriate use of parenteral aminophylline as the first-line medication.

Sauropus androgymus (SA), a vegetable of the Euphorbiaceae family, is a common food source in Malaysia. In Taiwan, over 30 patients have developed progressive respiratory failure after consuming the extract from raw SA leaves as a means of losing weight. Symptoms consistent with a severe obstructive ventilatory defect progressed, despite cessation of SA intake and treatment with bronchodilators, corticosteroids, cytotoxic agents and plasmaphresis. Five patients with end-stage Sauropus androgynus-induced bronchiolitis obliterans (SABO) syndrome underwent lung transplantation. There was no early mortality. One patient died of post-transplant lymphoproliferative disorder and another patient died of bronchial stenosis with infection, 5 and 3.5 months, respectively, post-transplantation. The remaining 3 patients have been followed from 29 to 34 months, with improved general condition and pulmonary function. Perfusion/ventilation scans revealed that these improvements were exclusively attributed to the functional grafts. We believe that lung transplantation is the only effective modality of treatment for patients with end-stage SABO syndrome.

BACKGROUND--Carcinoid tumours of the thymus are rare. The clinical manifestations, radiographic findings, and cytological features of eight histopathologically verified thymic carcinoid tumours have been assessed. METHODS--One hundred and sixty two patients of mean age 52 (range 31-68) years with malignant mediastinal tumours were reviewed retrospectively and eight cases of thymic carcinoid were identified. Four of the eight patients were diagnosed by percutaneous ultrasound guided fine needle aspiration biopsy via a parasternal approach. RESULTS--Two patients had Cushing's syndrome at presentation and four had symptoms and signs secondary to mediastinal compression. Two were asymptomatic. Local extension of the tumour to pleura, pericardium, great vessels, phrenic nerve or regional lymph nodes, or both, were found in seven patients. Only one had the tumour confined to the thymus at diagnosis. Distant metastases were found in two patients, one to both lungs and the other in the iliac bone. Local recurrence or distant metastases developed 15-60 months after surgery in four of the five patients who underwent radical resection of the thymic tumour. Three patients died at 17 months, 34 months, and 10 years after diagnosis. The other five patients are alive at 9-51 months. CONCLUSION--Thymic carcinoid is a slow growing tumour with a poor prognosis because of its tendency to local and distant spread. Cytological examination of samples obtained by ultrasound guided fine needle aspiration may provide a useful method for diagnosis in selected patients.

BACKGROUND: Pulmonary tuberculosis can produce unusual radiographic appearances and negative results of sputum and bronchoscopic examinations are common. This study assessed the value of ultrasound guided aspiration biopsy in the diagnosis of pulmonary tuberculosis with unusual radiographic appearances. METHODS: Thirteen patients, ultimately diagnosed as having tuberculosis, underwent a chest ultrasonographic examination between June 1984 and August 1991. All had sputum available for examination and nine were also examined by bronchoscopy. Ten patients who had a negative sputum smear and negative bronchoscopic brushing smears underwent ultrasound guided aspiration or biopsy. Percutaneous aspiration was performed with a 22 gauge needle. If the smear did not reveal acid fast bacilli, a biopsy sample was taken with a 16 gauge Tru-cut needle to obtain a histological diagnosis. RESULTS: The ultrasonographic examination delineated the more complex nature of the lesions better than the chest radiograph. Ultrasound guided aspiration biopsy provided the diagnosis in nine of 10 patients, while the sputum smear and culture provided diagnosis in five of 13, and bronchoscopy in four of nine. In terms of rapid diagnosis, ultrasound guided aspiration biopsy gave the diagnosis in eight of 10 cases. No patient developed a major complication. CONCLUSION: Ultrasonography can direct the needle to the most suitable part of a lesion to obtain the relevant specimens. The diagnostic yield is high and the procedure is relatively safe. It is especially helpful in patients with negative results of sputum and bronchoscopic examinations.

In a previous paper, we addressed the problem of choosing constant values of altitude, speed, and angle of attack such that the orbital plane change during hypersonic flight is maximized for a fixed amount of propellant consumption. In the present paper, the restrictions of constant speed and angle of attack are removed. Necessary conditions for solutions to the resulting optimal control problem are derived. Numerical solutions are obtained for several specific cases under the assumption that the constant altitude trajectory that maximizes the plane change is primarily a singular arc. We find that, under the condition of constant altitude flight, it is not, in general, optimum to fly at constant angle of attack. The reduction in plane change capability resulting from a constant angle-of-attack program increases as the range over which the flight takes place increases. On the other hand, the optimum speed is nearly constant.

Eleven patients who had lung tumors associated with obstructive pneumonitis and who failed to yield diagnostic material at conventional bronchoscopic biopsy underwent real-time ultrasonographic (US) studies and US-guided aspiration biopsy. Sonography of the consolidated lung showed a wedge-shaped hypoechoic lesion containing a fluid bronchogram. The presumed obstructing tumor was seen as a hypoechoic nodule near the hilum or as a well-defined hyperechoic mass inside the partially consolidated lung. Computed tomography (CT) was superior to US in demonstrating the bronchial obstruction (P less than .05). However, there were no significant differences between CT and US in demonstrating the obstructing tumor (P greater than .10). In all 11 patients the diagnosis was made by means of US-guided transthoracic aspiration biopsy and in eight patients also by means of Trucut biopsy. No complications were observed in the studies. It is concluded that US and US-guided aspiration biopsy are useful adjunct diagnostic techniques for lung tumor patients with obstructive pneumonitis.

Nodular amyloidosis of the breast and lung is a rare condition of unknown aetiology. The disease runs a benign course, but offers a diagnostic problem due to nonspecific histological features. We describe the case of a 56 year old woman with a 5 year history of multiple nodules of both lungs and left breast, clinically mimicking breast carcinoma with pulmonary metastasis. To our knowledge, this is the first case of cytologically proven amyloidosis diagnosed by ultrasound-guided percutaneous transthoracic fine-needle aspiration of pulmonary nodules.

National Taiwan University Hospital, Taipei, Taiwan.To study the variations in the NRAMP1 gene using five genotypes (274C/T, 577-18G/A, A318V, D543N and 3' untranslated region [UTR]), and the susceptibility of tuberculosis and HIV infection in Taiwanese.The study sample included 49 patients with tuberculosis, 48 healthy control subjects and 60 HIV-infected patients. The polymerase chain reaction (PCR) products amplified from their genomic DNA were subjected to restriction enzyme digestion and were analysed using agarose gel electrophoresis.A318V was not polymorphic in the studied population. Only D543N and 3'UTR were more heterozygous. In 274 C/T and 577-18G/A, the allele frequencies showed the predominant type to be the homozygous patterns C/C (94%) and G/G (94%), respectively. There were no statistically significant differences between the tuberculosis patients and the healthy control subjects. Despite the high susceptibility to Mycobacterium tuberculosis in HIV-infected patients, genotypic frequencies in the HIV-positive patients were not significantly different between tuberculous (n = 29) and non-tuberculous patients (n = 31). In comparison with previous studies, there were significant differences between different ethnic groups in allele frequencies for 274C/T, D543N and 3'UTR.The allele and genotype of NRAMPI polymorphism among Taiwanese differed from those of Caucasians, Africans and Hispanics. No allelic associations were identified between the NRAMP1 alleles and tuberculosis susceptibility.

Methamphetamine, heroin, and cannabis are three of the most commonly misused drugs in Asia. In Taiwan, cases of misuse of methamphetamine have been increasing. In this paper, we report the case of a 23-year-old woman who had a 10-year history of smoking methamphetamine and intermittent use of heroin for 3 to 4 years. She developed pulmonary toxic effects associated with misuse of heroin and methamphetamine. She was brought to the emergency room because of consciousness disturbance and acute respiratory failure. Her symptoms of rapid progression of refractory hypoxemia, ill-defined densities over both lung fields, and normal pulmonary artery wedge pressure were consistent with acute respiratory distress syndrome. Rapid resolution of infiltrations and improvement of oxygenation were observed after mechanical ventilation with positive end-expiratory pressure support and oxygen therapy. She was discharged on the fifteenth hospital day without any sequela except for mild exertional dyspnea.

The aim of this study was to investigate the value of chest sonography in the diagnosis and management of patients with chest radiograph opacities in an emergency department.Seventy-eight patients with acute chest complaints whose chest radiographs showed opacities underwent chest sonography. The initial diagnosis (based on clinical manifestations and the chest radiograph), the sonographic diagnosis (before any invasive procedures), and the final diagnosis were compared. The impact of chest sonography on the management of patients with chest opacities was also analyzed.The initial diagnosis was in concordance with the final diagnosis in 60 (77%) of the 78 patients, while the sonographic diagnosis was in concordance with the final diagnosis in 75 (96%) of the patients. Chest sonography therefore significantly increased the rate of correct diagnoses from 77% (95% confidence interval, 67-87%) to 96% (95% confidence interval, 92-100%; p0.0001). Sonography provided new information in 52 patients (67%): a different diagnosis from the initial diagnosis in 18 patients and additional diagnostic information in 34 patients. New information gained from sonography affected the management of 35 patients. Sonography also provided help in guiding 42 (70%) of 60 invasive diagnostic procedures and 22 (73%) of 30 invasive therapeutic procedures for which chest radiography and physical examination had failed to or were unsuitable to provide guidance. Overall, sonography assisted in the management of 64 (82%) of 78 patients. Sonography was of no benefit in 14 patients (18%).We conclude that chest sonography can complement chest radiography and is of value in the diagnosis and management of emergency department patients with acute chest diseases presenting as opacities on chest radiographs.

We have quantified the expression of all 4 isoforms of vascular endothelial growth factor (VEGF) mRNA in non-small-cell lung cancer (NSCLC) using a new kinetic quantitative PCR method, real-time quantitative (RTQ) RT-PCR, and investigated the association between VEGF expression at the mRNA and protein levels and the clinicopathologic variables, tumor angiogenesis, patient survival and timing of relapse. Surgical tumor specimens from 72 NCSLC patients (37 squamous-cell carcinomas, 35 adenocarcinomas) were examined. Twenty-eight patients had stage I, 10 stage II and 34 stage IIIA or IIIB disease. Total VEGF mRNA (all 4 isoforms) was quantified by RTQ RT-PCR, while VEGF protein expression and microvessel number in tumors were assessed immunohistochemically. VEGF mRNA was detected in all 72 tumor samples at significantly higher levels than in adjacent normal tissue. Tumoral VEGF mRNA levels correlated strongly with the VEGF protein staining score and microvessel count. Adenocarcinomas showed significantly higher VEGF mRNA expression and a higher protein staining score than squamous-cell carcinomas. High tumoral VEGF mRNA expression was associated with advanced (IIIA or IIIB) tumor stage, lymph node metastasis, high tumoral microvessel counts, short patient survival (24 months) and early relapse (12 months), while a high VEGF protein staining score was associated with high tumoral microvessel counts, short patient survival and early relapse. Patients with high tumoral levels of both VEGF mRNA and protein had significantly shorter survival and earlier relapse. In multivariate analysis, the VEGF protein staining score and nodal status were the most important independent predictors of survival and recurrence. We conclude that RTQ RT-PCR is a sensitive method for detecting and quantifying VEGF mRNA expression in NSCLC and that the expression levels of total VEGF mRNA and protein in NSCLC are strongly associated with histologic type, tumor angiogenesis, survival and timing of relapse. High VEGF expression in adenocarcinomas may contribute to their greater metastatic potential.

To analyze the clinical data of four patients with a diagnosis of tracheobronchial endometriosis, and to reappraise the diagnostic value of bronchoscopy and bronchial brush cytology in these patients.We conducted a retrospective study of four patients with documented tracheobronchial endometriosis treated at National Taiwan University Hospital from 1994 to 1998. The complete histories, diagnostic time interval, results of physical examinations, laboratory data, bronchoscopic findings, cytologic results, chest radiographs, and chest CT of these patients were analyzed.These patients tend to be younger and nonmultiparous as compared to other patients with thoracic endometriosis. Bronchoscopic examination performed within 1 day or 2 days of menses disclosed multiple purplish-red submucosal patches bilaterally that bled easily when touched. Cytologic evaluation of the brushing specimens demonstrated clusters of small cuboid cells consistent with an endometrial origin. Follow-up bronchoscopic examination in the middle of the menstrual cycle showed disappearance of the previous tracheobronchial lesions. The mean diagnostic interval was 3.25 months. All four patients were successfully treated with danazol therapy.Tracheobronchial endometriosis consists of a special subgroup of patients with thoracic endometriosis. Proper timing of bronchoscopic examination plays an important diagnostic role in these patients. Cytologic features as well as cyclic changes in bronchoscopic findings are sufficient to warrant the diagnosis. The results of treatment with danazol in these patients seemed favorable.

The use of lung grafts from non-heart-beating donors (NHBD) is one way of solving the donor organ shortage problem. In this experiment, we studied the effect of retrograde flush (RF) from the left atrium before harvest, inhaled nitric oxide (NO), and gabexate mesilate (FOY), a protease inhibitor, in the lung grafts from NHBD.Forty-eight Lee-Sung, small-ear, miniature pigs (15-20 kg) were divided into 24 pairs (donor and recipient) and four groups. The donor lungs were flushed and harvested 90 min after cardiac arrest. No i.v. heparin was administered until the time before flush and harvest. Left single lung transplantation was undertaken, and the recipients were observed for 18 hr. The grafts warm and cold ischemia times were 90 (controlled) and 183+/-23.4 min. Group 1 (untreated control, UC, n=6) had core perfusion through a Swan-Ganz catheter followed by a single, antegrade flush with modified Euro-Collin's solution containing heparin, urokinase, and PGE1. Group 2 (RF group, n=6) had the same as group 1, except that one additive retrograde flush through the left atrium was administered. Group 3 (NO group, n=6) had the same as group 1, except that 20 parts per million (ppm) inhaled NO was administered for the cadaver donors before the graft harvest, and for the recipients after the grafts reperfusion. Group 4 (FOY group, n=6) had the same as group 1, except that the recipients received FOY i.v. infusion from the beginning of the recipient's operation and continuously throughout the experiments.Compared with the group 1 (control), group 2 (RF) had significantly (P0.05) lower mean pulmonary artery pressure, pulmonary vascular resistance (PVR), lung wet/dry ratio, histological lung injury score, and higher PaO2/FiO2 and pulmonary dynamic compliance. Group 3 (NO) had significantly lower mean pulmonary arterial pressure, PVR, lung injury score, degree of tissue neutrophils infiltration (histological and myeloperoxidase assay), bronchoalveolar lavage fluid protein content and neutrophils (PMNs) percentage, and higher PaO2/FiO2 and pulmonary dynamic compliance. Group 4 (FOY) had significantly lower PMNs infiltration, lung injury score, wet/dry ratio, bronchoalveolar lavage fluid protein and PMNs percentage, and higher PaO2/FiO2. Group 2 (RF) revealed better gas exchange (PaO2/FiO2) than the control (group 1) at earlier reperfusion periods (1st and 5th hr). On the contrary, group 4 (FOY) had higher PaO2/FiO2 than group 1 only at later period (18th hr). Pathologically, retrograde flush (group 2, RF) inhibited the intravascular thrombi formation more effectively than the NO or FOY treatment. However, the NO or FOY treatment inhibited the neutrophil infiltration more effectively than did the retrograde flush.The retrograde flush, inhaled NO and FOY infusion are beneficial to the protection of the NHBD lung grafts at an early reperfusion period, through different mechanisms. The use of these treatments in combination might help us to find a better way to protect the NHBD grafts against the preservation and reperfusion injury.

To illustrate the cytologic features of hepatocellular carcinoma (HCC) after percutaneous acetic acid injection (PAI) and to correlate the cytologic findings with helical computed tomography (CT) findings.The study included 30 patients with 37 HCC who had undergone PAI. Baseline cytomorphology of HCC was evaluated by needle aspiration in all cases. PAI under ultrasound guidance was done every three to seven days. Upon completion of PAI, fine needle aspiration cytology was performed and followed by helical CT within two weeks. The degeneration of HCC after PAI was classified into two grades. Grade 1 showed incomplete degeneration (99% of nuclear area); grade 2 showed complete degeneration or severe degeneration with cell debris or amorphous material only. The specimens were stained with Riu's method (Romanowsky system).The cytologic changes after PAI included decreased cell number, reduced cellular aggregation, degeneration of cytoplasm and nucleus, and eosinophilic or basophilic background in all tumors. In all the 37 tumors without enhancement on helical CT, grade 2 degeneration was detected.Our results reveal that grade 2 degeneration alone, demonstrated cytologically, could indicate almost complete necrosis of HCC after PAI, probably implying no need for booster PAI.

Sauropus androgymus (SA), a vegetable of the Euphorbiaceae family, is a common food source in Malaysia. In Taiwan, over 30 patients have developed progressive respiratory failure after consuming the extract from raw SA leaves as a means of losing weight. Symptoms consistent with a severe obstructive ventilatory defect progressed, despite cessation of SA intake and treatment with bronchodilators, corticosteroids, cytotoxic agents and plasmaphresis. Five patients with end-stage Sauropus androgynus-induced bronchiolitis obliterans (SABO) syndrome underwent lung transplantation. There was no early mortality. One patient died of post-transplant lymphoproliferative disorder and another patient died of bronchial stenosis with infection, 5 and 3.5 months, respectively, post-transplantation. The remaining 3 patients have been followed from 29 to 34 months, with improved general condition and pulmonary function. Perfusion/ventilation scans revealed that these improvements were exclusively attributed to the functional grafts. We believe that lung transplantation is the only effective modality of treatment for patients with end-stage SABO syndrome.

To assess the clinical features of Taiwanese patients with tuberculous pleurisy and their response to treatment, we analyzed the records of patients treated for this condition from December 1990 through November 1995, at a regional 100-bed referral center for tuberculosis care. Diagnosis of tuberculous pleurisy was based on histologic evidence of caseating granulomatous inflammation in the pleural biopsy specimen, or evidence of mycobacteria in pleural fluid. Patients were also stratified on the basis of parenchymal involvement. Ninety-seven patients (79 men, 18 women) with a mean age of 47.5 (range, 15-90) years were included in the analysis. The two major symptoms were cough (69%) and shortness of breath (57%). Chest roentgenographs showed that the pleural effusion was unilateral in 88 (91%) patients, and small to moderate in amount in 74 (76%). Laboratory analysis of the pleural fluid showed moderate levels of glucose (4.6 mmol/L), with no significant difference between patients with and without parenchymal involvement. The levels of lactate dehydrogenase and triglycerides were significantly higher in patients with parenchymal involvement (172 vs 240.5 IU and 0.36 vs 0.45 mmol/L, respectively). In 85 of 93 patients (91%) with available data, lymphocytes were predominant in the differential count. All patients had received short-course chemotherapy for at least 6 months. After excluding the defaulters and patients receiving subsequent management in other hospitals, the overall rate of successful treatment was 97% (72/74). There was no significant difference in the treatment outcome between patients with parenchymal involvement and those without. None of the successfully treated patients had a relapse within a mean follow-up period of 31.7 +/- 18.4 months. We conclude that current patients with tuberculous pleurisy in Taiwan are not young, and short-course chemotherapy with isoniazid, ethambutol, rifampicin, and pyrazinamide is an effective treatment. The presence of parenchymal tuberculous lesions does not appear to influence the treatment outcome.

To examine the clinical manifestations, treatment, and outcome of pulmonary cryptococcosis, we reviewed the medical records of all patients treated for Cryptococcus neoformans infection at our hospital from January 1988 through September 1998. Sixty-three patients were included in the analysis, 10 (16%) of whom had acquired immunodeficiency syndrome (AIDS). Thirty-four of the 53 non-AIDS patients, including 19 men and 15 women had pulmonary cryptococcosis, including 31 with isolated pulmonary cryptococcosis and three with disseminated disease. Of the 10 AIDS patients, seven presented with disseminated cryptococcosis (including one patient with lung involvement) and one had isolated cryptococcal lung disease. The age (mean +/- SD) of the 34 non-AIDS patients with pulmonary cryptococcosis was 52.1 +/- 15.2 years (range, 19-75 yr). Cough was the most common symptom (58%). Diabetes mellitus (12%) and malignancy (12%) were two major underlying diseases. Nodules and masses were the predominant manifestations of pulmonary cryptococcosis in non-AIDS patients (79%). The most frequently used diagnostic modality for pulmonary cryptococcosis was biopsy with/without aspiration under ultrasound guidance (56%). Antifungal therapy (20/34) was the most common treatment for non-AIDS patients, followed by surgical resections with antifungal therapy (9), surgical resections alone (3), and no treatment (2). Antifungal therapy and/or resection yielded excellent outcomes (total recovery, 27; improvement, 4). Of the 18 patients who underwent lumbar puncture, only two had positive cerebrospinal fluid (CSF) cultures for C. neoformans, both had symptoms and signs of increased intracranial pressure. There was no clinical evidence of meningitis in the other 32 patients. Our findings indicate that pulmonary cryptococcosis in non-AIDS patients tends to be a more localized and benign process than in AIDS patients. Ultrasound-guided lung biopsy or aspiration is an effective tool for diagnosis. CSF examination may not be mandatory as an initial routine procedure for pulmonary cryptococcosis in non-AIDS patients.

Pulmonary arteriovenous malformation (PAVM) is an uncommon but not rare disease. It is very often associated with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease, OWRD). Both conditions may be readily diagnosed at the bedside when careful attention is given to clues from history taking and physical examination. Sometimes the clinical features may be neglected, delaying the diagnosis. The natural history of this disease is still incompletely understood because of the paucity of cases. This retrospective study was undertaken to evaluate the clinical manifestations and treatment options in patients with documented PAVM at the National Taiwan University Hospital between 1985 and 1997. Ten patients (4 men, 6 women) of documented PAVM were evaluated. Mean age at diagnosis was 37.8 years (range 22-63). Presenting symptoms included dyspnea on exertion, characteristics of OWRD, and major neurologic events. Six episodes of brain abscess occurred in three patients. The predominant location of PAVMs was the lower lobe. Solitary PAVM was more frequent in our patients (5/6) with OWRD than in other reports. The therapeutic options were: surgical resection (3 patients), embolotherapy (4), and no treatment (4). One patient, who refused treatment at first, developed a brain abscess later. There was no documented recurrence or growth of new PAVMs in patients who underwent surgical resection. Embolotherapy failed in one patient; no recanalization was found in the remaining patients. In conclusion, the diagnosis of PAVM may be subtle, but careful attention to historic clues and physical findings may lead to early diagnosis. Appropriate treatment is mandatory and may prevent the severe complications of PAVM. The debate about the preferred treatment seems likely to continue until more is known about the natural history of this disease.

The incidence of diseases caused by nontuberculous mycobacteria (NTM) is increasing worldwide. There has been no previous report regarding the clinical significance and disease spectrum of these bacteria in Taiwan. From January 1992 to June 1996, 201 isolates of NTM were recovered from clinical specimens from 143 patients at National Taiwan University Hospital. We retrospectively studied the clinical records and radiographs of these patients. A total of 86 isolates of NTM were considered clinically significant; they were cultured from 39 patients with soft-tissue infections and/or osteomyelitis (16 patients), isolated pulmonary infections (10), keratitis (6), disseminated infections (4), peritonitis, enteritis, and conjunctivitis. The most common organisms involved in these patients were Mycobacterium fortuitum complex, followed by Mycobacterium avium-intracellulare. Positive cultures of NTM were derived from respiratory sources (sputum, bronchial washing, and pleural effusion) from 111 patients; in 11 the isolates were associated with clinically significant disease, in two they were persistent colonizers, in 79 the isolates were considered to be contaminants, and for the remainder there were insufficient cultures to classify. The organisms involved in pulmonary diseases were M. avium-intracellular (4 patients), Mycobacterium chelonae (1), Mycobacterium abscessus (1), M. fortuitum (2), Mycobacterium gordonae (1), and unidentified scotochromogens (2), M. fortuitum complex (55%) was the most common pathogen of keratitis and soft-tissue infection. Three of the four cases of disseminated disease were caused by M. avium-intracellulare. The only isolate of Mycobacterium kansasii found in this study was a contaminant. The strains of clinically significant NTM isolates found in our hospital and their disease spectrum differ from those reported in other regions of the world.

Mucin glycoprotein can promote tumor-cell invasion metastasis and modulate the immune recognition of cancer. This study aimed to elucidate the clinical significance of mucin gene overexpression in lung cancer. We collected 60 lung cancer samples and paired non-tumorous lung portions of varying types and stages. Slot-blot analysis with specific anti-sense oligonucleotide probes derived from tandem repeat sequence of MUC1, -2, -3, -4, 5B and 5AC were utilized to compare the amount of mucin gene mRNA in tumor samples with that of the non-tumorous counterparts. A ratio higher than 1.5 for each specific mucin mRNA amount was considered to indicate mucin gene overexpression in tumors. Immunohistochemical staining of monoclonal antibodies against mature airway mucin (17Q2) and MUC1 mucin protein (HMFG2) were also used to analyze mucin protein. The study showed that overexpression of mucin genes frequently occurred in lung cancer (25 out of 60, 41.7%), but that there was no preferential expression of a particular mucin gene or a combination of mucin genes in these tumors. The overexpression of mucin genes and mucin protein had no correlation with tumor stage, nodal stage, histology or pathological differentiation grade. Tumors of smokers had higher MUC5B and MUC5AC mRNA expression ratios than those of non-smokers. Tumors with increased expression of mucin genes tended to be associated with post-operative relapse, especially when MUC5B and MUC5AC genes were overexpressed (p = 0.015 and 0.025, respectively). The study suggests that overexpression of novel tracheobronchial mucin genes may result in an increased likelihood of post-operative lung-cancer recurrence or metastases.

Systolic heart failure because of hyperthyroidism in patients without preexisting heart disease is not common. Thyrotoxic systolic heart failure is rarely diagnosed during life. Reports about thyrotoxicosis-related systolic heart failure have been diagnosed postmortem. However, antemortem diagnosis of this fatal disease has important clinical implications because if detected early, thyrotoxicosis-related systolic heart failure is reversible. Here is a report a patient with Graves' disease, systolic heart failure, and deep jaundice, which resolved after the treatment of antithyroid drugs.

The prognostic value of the number of nucleolar organizer regions (NORs) (DNA loops in the nucleus) in tumor cells from various kinds of malignancies has been widely studied in recent years. During the period 1989 to 1992, a total of 73 primary lung tumors was examined for the number of NORs by silver staining AgNOR proteins on the stump smear of resected specimens in this hospital. The relations of the mean number of AgNOR per cell with other factors such as sex, age, habit of smoking, performance status, tumor location, tumor size, pathological stage, histological type, degree of differentiation, and whether histologically vascular or lymphatic invasion were analysed. It was found that the mean number of AgNOR was significantly different between positives and negatives of histologically vascular or lymphatic invasion (6.4 +/- 0.4 vs 5.5 +/- 0.2) (p0.05). Both single and multiple-variate analysis of patient survival revealed that the mean number of AgNOR was a significant prognostic factor, as were pathological stage, histological type, and performance status of the patient. Patients with a higher mean number of AgNOR (7) had a significantly worse prognosis compared with those with less AgNOR (or = 7) (median survival 28 versus 43 months) (p0.05). It was concluded that the mean number of AgNOR of tumor cells is a significant prognostic factor in surgically treated lung cancer patients.

Systemic lupus erythematosus (SLE) presenting as a pleural effusion in a young male is not common. This paper describes a 20-year-old man who was admitted to hospital with a spiking fever, chills and cough. A chest x-ray showed alveolar infiltration and a moderate right-sided pleural effusion. The patient was treated for parapneumonic effusion. Thoracentesis was performed and cytology of the aspirated fluid was initially interpreted as showing only numerous polymorphonuclear (PMN) leukocytes. However, in spite of antibiotic treatment the symptoms persisted. A careful review of the cytology specimen showed classic lupus erythematosus (LE) cells in addition to PMN cells. Subsequent investigation, including antinuclear antibodies titer, confirmed the diagnosis of LE pleurisy. Therapy with antibiotics was discontinued and treatment with prednisolone 20 mg daily was begun. There was a rapid clinical response including resolution of the fever and pleural effusion.

Routine urine cytology is not particularly useful as a screening test for urinary tract malignancy in the general population, due to its low detection rate. Bladder, ureteral, and pelvic lavage and flow cytometry increased the test sensitivity but could be applied only to a limited number of patients. A simple, sensitive screening test is needed.Two hundred eighty-two urine samples from 146 patients from the Urology Tumor Clinic patients during their initial visits were subject to cytologic evaluation and measurement of the activity of endogenous beta-glucuronidase, followed by confirmation procedures, including cystoscopy with biopsy, ultrasonography, radiography and/or computed tomography.Among 146 patients, 32 had confirmed transitional cell carcinoma and 14 renal cell carcinoma. The urinary beta-glucuronidase activity was higher in patients with cancer than in those without cancer in the Urology Service and in 80 normal healthy control subjects. The accuracy of the urine enzyme diagnostic system measured by the receiver-operating characteristic (ROC) plot was 98% or higher based on the number of patients. The upper threshold value determined by ROC analysis was 1.7 nmol/min/mumol creatinine. At this threshold value, the sensitivities of the enzyme assay for transitional cell carcinoma, renal cell carcinoma, and all cancers were, respectively, 94%, 98%, and 95%. These values were much higher than the corresponding sensitivities of urine cytology: 41%, 0%, and 22%.Urinary beta-glucuronidase is a much more sensitive test to screen for urinary tract malignancy than routine urine cytology in high risk patients, provided that a positive test is followed by diagnostic procedures for confirmation.

Carcinoid tumors of the thymus are very rare, and their cytologic findings have not been reported previously in English. Retrospective study of fine needle aspiration (FNA) cytologic features in four histopathologically verified thymic carcinoid tumors are described here in detail. The FNA cytology of thymic carcinoids is characterized by predominantly single and some loose clusters of small, round to oval cells with scanty cytoplasm, interspersed with some larger cells with moderate to abundant, granular cytoplasm. The differential diagnosis of the cytologic features between carcinoid tumor and other mediastinal tumors is also discussed.

Urinalysis yields a great deal of information quickly and economically for detection of renal diseases. The inter-technician variation and time consuming are major problems while processing large amount of specimens. The purpose of this study is to evaluate the benefit of an automated urine analyzer, Yellow IRIS/model 450, and the feasibility of replacing the currently-used manual KOVA method.A total of 1,000 random urine specimens were analyzed with Yellow IRIS and KOVA method. Precision, correlation, and detection rate of abnormality were compared between these two methods.The results revealed that Yellow IRIS had high precision with little between-run and within-run variation, while the obtained values were notably highly correlated with the expected values (r = 0.99). In addition, detection rate of blood cell abnormalities for the Yellow IRIS was twice better than for the manual KOVA method.The high precision of the machine, the simple procedure of performing, and the quickness of obtaining data, can minimize variability caused by the manual method and save processing time for mass screening. It is feasible to replace the manual urinalysis by the automated urine analyzer Yellow IRIS. Nevertheless, to minimize the extent of manual manipulation, including pouring the urine into the pour cup, and placement of the urine strip, will assist in a wider acceptance for the Yellow IRIS/Model 450.

The nuclear area and DNA content between tumor and nontumor portions of hepatocellular carcinoma (HCC) were compared. Thirty pairs of imprint smears were made from surgical specimens and stained with a modified Feulgen reaction. Two hundred nuclei were scanned with a microdensitometer at a wavelength of 550 nm. DNA histograms were plotted with lymphocytes as the internal control. Nuclear areas of 200 cells in each case were measured with Minimagiscan image analyzer. Hyperploidy (DNA index1.1) was 76.7% and 53.3% in tumor and nontumor portions, respectively. The S-phase fraction value was 7.9 +/- 3.5% (+/- SD) and 4.1 +/- 2.4% in tumor and nontumor portions of HCC (P.001). The mean nuclear area of the tumor portion was significantly larger than that of its corresponding nontumor portion (232.9 +/- 68.1 vs. 137.6 +/- 15.5 microns2, P.001). Marked anisonucleosis was found in both the tumor and nontumor portions of HCC. The mean coefficient of variation of mean nuclear areas was 27.8 +/- 10.4% and 22.9 +/- 4.9% in the tumor and nontumor portions, respectively (P.05). DNA ploidy correlated well with mean nuclear area in the tumor portions (r = .730) but not in the nontumor ones. The results indicate that the three most important cytologic criteria of malignant cells--hyperchromatism, nuclear enlargement and anisonucleosis--are evident in both the tumor and nontumor portions of HCC.

The DNA histograms of 29 histologically verified primary lung cancers were analyzed with flow cytometry and microdensitometry. Fresh tumor tissues were imprinted on the slide and air dried for modified Feulgen staining. Then the smears were scanned with a scanning microdensitometer at a wavelength of 550 nm. The S-phase fraction value was estimated from the DNA histogram with a cumulated probability scale. The remaining parts of the tumors were minced and prepared for dispersal as a single cell suspension for propidium iodide staining. The tumor cells were then analyzed with a flow cytometer at 488 nm. The correlation between the analyses measured with these two methods showed r = .75 for the DNA index, r = .71 for the S-phase fraction and r = .61 for the G0G1 population; P.001. The DNA indices, S-phase fraction values and G0G1 populations obtained with flow cytometry and microdensitometry correlated well.

To elucidate the diagnostic value of fine needle aspiration (FNA) cytology of ultrasonically suspected parathyroid lesions, we reviewed a series of 17 cases seen over the past two years. Patients with biochemically proven primary or secondary hyperparathyroidism were examined by ultrasonography using a 7.5-MHz linear transducer. Ultrasound-guided FNA cytologic examinations with Riu's stain were performed on 13 patients who had questionable ultrasonographic patterns. The aspirates were considered adequate in nine out of 13 cases (69%). The cytologic patterns, characterized by tight cohesion of naked nuclei with indistinct cell border showing hypermonomorphism and overlapping of nuclei, were noted in adenomatous and hyperplastic lesions. There were several different findings noted in the case of parathyroid carcinoma, including loose cohesion of nuclei, larger nuclear size, and prominent anisokaryosis. One patient with secondary hyperparathyroidism who previously had a neck exploration, received an ultrasonically-guided percutaneous alcohol injection to the parathyroid lesion after cytologic verification. The result was remarkable both in volume reduction and in clinical improvement. The results suggest that ultrasound-guided FNA cytologic examination with Riu's stain is safe, simple and helpful in the localization of parathyroid lesions prior to surgery or percutaneous alcohol ablation therapy.