Augmentation cystoplasty and simultaneous ureteral reimplantation reduce high-grade vesicoureteral reflux in children with neurogenic bladder

BACKGROUND

To compare the incidence of residual high-grade vesicoureteral reflux (HVUR) (≥Grade III) in neurogenic bladder patients receiving augmentation cystoplasty alone or with simultaneous ureteral reimplantation. Furthermore, we also tried to find the risk factors of residual VUR and febrile urinary tract infection.

METHODS

Between 1999 and 2009, urinary bladder augmentation was performed in 21 children with neurogenic bladder. Seventeen of these patients had VUR on preoperative voiding cystourethrography, of whom 11 patients (14 ureters) received augmentation alone (Group A) and 6 patients (8 ureters) received simultaneously ureteral reimplantation (Group B). Univariate logistic regression analysis and Fisher exact test were used for statistical analysis.

RESULTS

Six patients (8 ureters) had residual HVURs in Group A, but none in Group B. The incidences of residual HVUR were 57.14% and 0%, respectively. Seven patients had febrile UTIs after operation, 6 of them had residual HVURs. In risk factor analysis, postoperative follow-up duration less than 12 months and lack of anti-reflux operation were significant risk factors for residual HVUR; the residual HVUR was the significant risk factor for febrile urinary tract infection.

CONCLUSION

Simultaneous ureteral reimplantation reduces postop HVUR significantly. We recommend augmentation and simultaneous ureteral reimplantation in children with HVUR and neurogenic bladder if technically feasible.

An uncommon cause of abdominal pain and diarrhea-gastrinoma in an adolescent

Gastrinoma is a hormone-secreting tumor associated with the Zollinger-Ellison syndrome. It is quite rare among children, and it is also uncommon in locations other than the pancreas and the duodenum in the pediatric group. Here, we describe an adolescent male, presenting with recurrent secretory diarrhea and abdominal cramping pain, who had a solitary gastrinoma in the lesser sac, close to the stomach. The prognosis was good after complete resection.

Outcome and risk factors for mortality in pediatric peritoneal dialysis

BACKGROUND

The mortality rate among children requiring renal replacement therapy is higher than in children without end-stage renal disease (ESRD). Some factors, such as hypoalbuminemia, high peritoneal transport rate, age, malnutrition, cardiovascular disease, and recurrent peritonitis, appear to be associated with lower survival in adult peritoneal dialysis patients. Data regarding risk factors of mortality in children with continuous ambulatory peritoneal dialysis (CAPD) are limited. The aims of this study were to analyze the clinical characteristics of patients and investigate if routinely used laboratory and clinical variables are independent risk factors for mortality in children on CAPD.

METHODS

We performed a retrospective chart analysis of pediatric ESRD patients on CAPD between January 1997 and September 2008. 29 patients undergoing CAPD for more than 3 months were enrolled. An analysis was performed on clinical and biochemical variables for survivors and nonsurvivors to identify potential risk factors for mortality.

RESULTS

Mean age was 12.18 +/- 4.57 years. During the follow-up period, 8 patients transferred to hemodialysis and 13 patients received deceased donor renal transplantation. By the end of the study, 5 patients had died. Actuarial survival rate at 2 and 5 years was 96.55% and 91.19% respectively. The major complication during therapy was peritonitis (1 episode/57.79 patient-months). In the univariate analysis, younger age at initiation of dialysis, presence of comorbid disease, higher peritoneal transport rate, increased protein losses through peritoneal dialysis, high total daily protein loss, hypoalbuminemia, and hypophosphatemia were variables associated with mortality in pediatric CAPD patients. However, in the multivariate analysis, only low serum albumin (b = -2.089, p = 0.006; hazard ratio 8.06, 95% confidence interval 0.028 - 0.546) was independently associated with mortality.

CONCLUSION

Mortality was low in our pediatric patients receiving CAPD. Hypoalbuminemia showed a significant association with death in CAPD patients.

Outcome of foreign residents undergoing deceased donor liver transplantation in China: a single-center experience in Taiwan

Foreign residents seeking liver transplantation in China are not uncommon. The outcomes of these people have not been well reported, and the results remain unclear. A total of 64 adults [26 with end-stage liver disease (ESLD) and 38 with hepatocellular carcinoma (HCC)] who underwent donation after cardiac death (DCD) liver transplantation in China during a 5-year period were reviewed. The median follow-up period was 15.6 months. The estimated 3-month mortality rate was 4.7%. The overall survival (OS) rate of the entire patient group at 1 and 3 years was 80.3% and 63.6%, respectively. The 1- and 3-year graft survival rates were 78.5% and 64.4%, respectively. For ESLD, the 1- and 3-year OS rates were 82.5% and 82.5%, respectively. For HCC, the 1- and 3-year survival rates were 78.3% and 50.8%, respectively. The 1- and 3-year OS rates for the HCC patients who were beyond the Milan criteria (MC; n = 24) versus those who met the MC (n = 14) were 69.8% and 28.2% versus 92.9% and 92.9% (P = 0.0032). The 1- and 3-year disease-free survival rates for those beyond the MC versus those who met the MC were 56.8% and 39.0% versus 92.3% and 92.3% (P = 0.0089). The incidence of complications was 59.4%. Biliary complications (n = 24, 37.5%), vascular complications (n = 24, 37.5%), and infection (n = 16, 25%) were the 3 most frequent transplant-related complications. There were 10 patients with unsolved biliary complications, and a total of 5 patients died of posttransplant infections. In conclusion, patients with ESLD or HCC within the MC seeking DCD liver transplants in China obtained survival results comparable to those of other major cohorts from Western countries. However, a considerably high incidence of biliary complications, vascular complications, and infection substantially threatening the lives of patients is notable. Furthermore, the associated cost impact on medical resource utilization should not be overlooked.

Genetic evaluation and management of fetal chylothorax: review and insights from a case of Noonan syndrome

Fetal chylothorax is one of a very few syndromes that can be treated in utero with thoracoamniotic shunting or pleurodesis by OK-432 as two major therapeutic modalities. We report on a fetus with Noonan syndrome and a missense mutation c.182A > C (p.Asp61Ala) of PTPN11 who responded poorly to antenatal pleurodesis by OK-432. Based on our previous publication and this case study, we propose that fetal chylothorax of a distinct genetic origin may respond poorly to OK-432 pleurodesis.

Percutaneous transhepatic cholangiography and drainage is an effective rescue therapy for biliary complications in liver transplant recipients who fail endoscopic retrograde cholangiopancreatography

BACKGROUND

We attempted to evaluate both the factors that predispose a patient to biliary complications after liver transplantation and the results of percutaneous transhepatic cholangiography and drainage (PTCD) for the management of those complications.

METHODS

This study retrospectively reviewed the cases of 81 patients who received liver transplants at Taipei Veterans General Hospital between February 2003 and June 2008. Biliary complications were diagnosed on the basis of clinical findings, laboratory data, and the results of imaging studies.

RESULTS

A total of 18 patients (22.2%) developed biliary complications, and living donor liver transplantation (LDLT) was a significant risk factor (p = 0.035), compared to cadaveric liver transplantation. Eight patients with biliary complications received PTCD as the first treatment modality and 6 had successful results. An additional 10 patients received endoscopic retrograde cholangiopancreatography (ERCP) initially, but only 2 patients were effectively managed. One patient received conservative treatment after ERCP failure. One patient died from sepsis after ERCP. The remaining 6 patients with failed ERCP were successfully managed with PTCD. The overall mortality rate in these patients with biliary complications was 16.7%. No significant prognostic predictors were identified, including age, sex, biochemical data, and model for end-stage liver disease scores.

CONCLUSION

Biochemical markers cannot predict biliary complications preoperatively. LDLT increases the risk of biliary complications. PTCD is an effective rescue therapy when ERCP fails.

Progression from an immature teratoma with miliary gliomatosis peritonei to growing teratoma syndrome with nodular gliomatosis peritonei

A 4 1/2-year-old girl presented with an incompletely resected, huge, immature abdominal teratoma, elevated serum alpha-fetoprotein (AFP), and numerous miuiary gliomatosis peritonei (GP). Two courses of chemotherapy resulted in normalization of her AFP level and marked tumor shrinkage. Further chemotherapy was interrupted by complications. During treatment for these complications, ascites increased and the tumor enlarged, but serum AFP remained within the normal range. Second-took surgery revealed that the tumor had changed histologically to a mature teratoma, and GP had enlarged to nodular size, causing massive ascites. The still incompletely resected, growing mature teratoma was reduced with interferon. Nodular GP and ascites slowly regressed with interferon use, and finally disappeared after several months. One residual mass thought to be GP was reduced by gamma-knife surgery 3 years later.

Photodegradation of polycyclic aromatic hydrocarbon pyrene by iron oxide in solid phase

To better understand the photodegradation of polycyclic aromatic hydrocarbons (PAH) in solid phase in natural environment, laboratory experiments were conducted to study the influencing factors, kinetics and intermediate compound of pyrene photodegradation by iron oxides. The results showed that the pyrene photodegradation rate followed the order of alpha-FeOOH>alpha-Fe(2)O(3)>gamma-Fe(2)O(3)>gamma-FeOOH at the same reaction conditions. Lower dosage of alpha-FeOOH and higher light intensity increased the photodegradation rate of pyrene. Iron oxides and oxalic acid can set up a photo-Fenton-like system without additional H(2)O(2) in solid phase to enhance the photodegradation of pyrene under UV irradiation. All reaction followed the first-order reaction kinetics. The half-life (t(1/2)) of pyrene in the system showed the higher efficiencies of using iron oxide as photocatalyst to degrade pyrene. Intermediate compound pyreno was found during photodegradation reactions by gas chromatography-mass spectrometry (GC-MS). The photodegradation efficiency for PAHs in this photo-Fenton-like system was also confirmed by using the contaminated soil samples. This work provides some useful information to understand the remediation of PAHs contaminated soils by photochemical techniques under practical condition.

Effect of Celecoxib on Ca2+Fluxes and Proliferation in MDCK Renal Tubular Cells

The effect of celecoxib on renal tubular cells is largely unexplored. In Madin Darby canine kidney (MDCK) cells, the effect of celecoxib on intracellular CaCa2+ concentration ([Ca2+]i) and proliferation was examined by using the Ca(2 +)-sensitive fluorescent dye fura-2 and the viability detecting fluorescent dye tetrazolium, respectively. Celecoxib (> or =1 micro M) caused an increase of [CaCa2+]i in a concentration-dependent manner. Celecoxib-induced [CaCa2+]i increase was partly reduced by removal of extracellular CaCa2+. Celecoxib-induced CaCa2+ influx was independently suggested by MnCa2+ influx-induced fura-2 fluorescence quench. In Ca(2 +)-free medium, thapsigargin, an inhibitor of the endoplasmic reticulum Ca(2 +)-ATPase, caused a monophasic [CaCa2+]i increase, after which celecoxib only induced a tiny [CaCa2+]i increase; conversely, pretreatment with celecoxib completely inhibited thapsigargin-induced [CaCa2+]i increases. U73122, an inhibitor of phospholipase C, abolished ATP (but not celecoxib)-induced [CaCa2+]i increases. Overnight incubation with 1 or 10 micro M celecoxib decreased cell viability by 80% and 100%, respectively. These data indicate that celecoxib evokes a [CaCa2+]i increase in renal tubular cells by stimulating both extracellular CaCa2+ influx and intracellular CaCa2+ release and is highly toxic to renal tubular cells in vitro.

Chitosan/Cellulose Acetate Microspheres Preparation and Ranitidine Release In Vitro

New microspheres containing hydrophilic core and hydrophobic coating as a controlled-release system with no toxic reagents were proposed. Water in oil in water (W/O/W) emulsion and solvent evaporation methods were used to make chitosan/ cellulose acetate (CCA) microspheres sized 200 - 400 microm. Ranitidine hydrochloride, as a model drug, was investigated for its release properties in vitro. The loading efficiency and release rate of ranitidine were affected by chitosan concentration and molecular weight. Higher loadings were obtained at lower concentrations in the interval of 1% to 2%. With chitosan at a 2% concentration microspheres could be obtained with more spherical appearance, smaller size, and higher ranitidine loading efficiency microspheres than at other concentrations. Among the different molecular weight chitosan (47, 145, 308, 499, and 1130 KD) microspheres, the high molecular weight chitosan (1130 KD) microspheres had relatively high loading efficiency (10%). Molecular weight and concentration of chitosan as well as the size of microspheres affected the release of ranitidine. Microspheres smaller than 280 microm released the drug faster than did the bigger by about 10%. The optimal condition for the preparation of the microspheres was chitosan concentration 2%, molecular weight 1130 KD. The ranitidine release from the microspheres was 30% during 48 h in phosphate-buffer saline medium.

Analysis of the RET gene in subjects with sporadic Hirschsprung's disease

BACKGROUND

Hirschsprung's disease (HSCR), or aganglionic megacolon, is a hereditable disease of the enteric nervous system. It is an embryonic developmental disorder characterized by the absence of ganglion cells in the lower enteric plexus. Gut motility is compromised in HSCR, with consequent risk of intestinal obstruction.

METHODS

We sequenced the RET gene and characterized the clinical manifestations in 15 unrelated Chinese patients (9 males, 6 females; age range, 2-21 years) with sporadic HSCR. Genomic DNA extraction, PCR and DNA sequence analysis were performed according to standard procedures.

RESULTS

We identified heterozygous RET gene mutations in 2 patients. The mutations included a missense mutation in exon 2 (CGC --> CAC) resulting in a substitution of arginine by histidine at codon 67 (patient 1), and a missense mutation in exon 3 (TAC --> AAC) resulting in a substitution of tyrosine by asparagine at codon 146 (patient 2). The pathological findings disclosed short-segment HSCR in patient 1 and long-segment HSCR in patient 2, respectively.

CONCLUSION

We identified RET gene mutations in 2 of 15 patients with HSCR in Taiwan. The Y146N mutation we identified was novel.

Characterization of reflection intermittency in a composite granular chain

The physical factors controlling the power-law behavior of impact energy in a composite granular chain remain elusive. Based on event-driven simulations and the on-off intermittency of wave reflections, we obtain the probability distribution functions of the waiting time tau and the energy leakage DeltaE . They exhibit lognormal distributions, which together with the relationship between DeltaE and tau allow one to explain directly the power-law behavior of the confined energy. This work may be extended to higher dimensions and help us understand the complex dynamics in granular materials.

Severe necrotizing fasciitis of the abdominal wall secondary to colon perforation in a child

We discuss the successful saving of an 18-month-old boy with necrotizing fasciitis of the abdominal wall secondary to colon perforation and peritonitis. The patient underwent emergency surgery with exploratory laparotomy, repeated procedures of debridement, and reconstructive abdominal wall surgery with skin graft. He recovered 6 months after admission. We also address the issue of the closure of large abdominal wall defect and the importance of alimentation in this patient group. We discuss the need to recognize necrotizing fasciitis as a potential complication of intra-abdominal disease, as once necrotizing fasciitis occurs, mortality is more likely. We conclude that recognition and aggressive surgical debridement is mandatory.

Liver transplantation at a small-volume procedure center--preliminary results from Taipei Veterans General Hospital

BACKGROUND

Liver transplantation is a challenging procedure that is associated with perioperative morbidity and mortality, so it is justifiable to perform such a procedure in high-volume procedure centers. Organ shortage remains a major issue in Taiwan. Due to the difficulty in establishing a high-volume procedure center, it is important to review the overall outcome of patients undergoing liver transplantation at a small-volume procedure center to determine if performing such a procedure is justified.

METHODS

Between April 2001 and May 2005, 26 adults underwent deceased donor liver transplantation at Taipei Veterans General Hospital. The overall outcomes were reviewed in terms of 90-day mortality, 1-year and 3-year survival rates. In addition, the patients were divided into a hepatocellular carcinoma (HCC) group (n = 12) and a benign end-stage liver disease (ESLD) group (n = 14). The clinical demographics, 90-day mortality, 1-year and 3-year survival rates were reviewed and compared between the 2 groups.

RESULTS

The 90-day mortality was 15.3% in the whole series, 8.3% in the HCC group and 18.7% in the ESLD group. The overall 1-year and 3-year survival rates were 76.9% and 63.5%, respectively, for the whole series. For the 2 groups, the respective 1-year and 3-year survival rates were 83.3% and 71.4% in the HCC group, and 71.4% and 57.1% in the ESLD group. The survival difference was not significant (p = 0.319) between the 2 groups. In the HCC group, the 1-year and 3-year disease-free survival rates were 88.9% and 71.1%, respectively.

CONCLUSION

The survival rates between ESLD and HCC patients undergoing liver transplantation at a small-volume procedure center were comparable. The results of the whole series were not satisfactory, but the results for the HCC group were acceptable.

Effect of alumina on photocatalytic activity of iron oxides for bisphenol A degradation

To study the photodegradation of organic pollutants at the interface of minerals and water in natural environment, three series of alumina-coupled iron oxides (Al(2)O(3)-Fe(2)O(3)-300, Al(2)O(3)-Fe(2)O(3)-420, and Al(2)O(3)-Fe(2)O(3)-550) with different alumina fraction were prepared and characterized by X-ray diffraction (XRD), Brunauer-Emmett-Teller (BET) and Barret-Joyner-Halender (BJH), and Fourier transform infrared spectra (FTIR). The XRD results showed that existence of alumina in iron oxides could hinder the formation of maghemite and hematite, and also the crystal transformation from maghemite to hematite during sintering. It has been confirmed that the BET surface area and micropore surface area of Al(2)O(3)-Fe(2)O(3) catalysts increased with an increased dosage of alumina and with decreased sintering temperature. The pore size distribution also depended on the fraction of alumina. Furthermore, all Al(2)O(3)-Fe(2)O(3) catalysts had a mixed pore structure of micropore, mesopore and macropore. FTIR results showed that FTIR peaks attributable to Fe-O vibrations of maghemite or hematite were also affected by alumina content and sintering temperature. It was confirmed that the crystal structure and crystalline, the surface area and pore size distribution of Al(2)O(3)-Fe(2)O(3) catalysts depend strongly on the content of alumina and also sintering temperature. Bisphenol A (BPA) was selected as a model endocrine disruptor in aquatic environment. The effects of alumina on the photocatalytic activity of iron oxides for BPA degradation were investigated in aqueous suspension. The experimental results showed that the dependence of BPA degradation on the alumina content was attributable to the crystal structure, crystalline and also the properties of their surface structures. It was confirmed that the mixed crystal structure of maghemite and hematite could achieve the higher photocatalytic activity than maghemite or hematite alone.

Crossover in the power-law behavior of confined energy in a composite granular chain

We present a numerical study of the impact energy decay in a composite granular chain containing two heavy and one light sections. We observe a marked crossover in the power-law behavior of the impact-energy decay. The average reflection frequency first increases with a decreasing acceleration, and arrives at its maximum at "crossing" time then decays almost exponentially. The analysis demonstrates that this phenomenon is related to the structural transition from compression to dilation state in both heavy-particle sections. The further calculations suggest the dependence relation of the power-law exponent (gammacb) in compression state on the mass ratio (m2/m1) and the Hertz law exponent (n) of the composite granular chain gammacb approximately (m2/m1)1/(n+1).

B-group vitamins, MTHFR C677T polymorphism and carotid intima-media thickness in clinically healthy subjects

OBJECTIVE

Plasma B-group vitamins and age may affect the carotid intima-media thickness (IMT) in subjects with different 677TT genotype of the methylenetetrahydrofolate reductase (MTHFR) gene.

DESIGN

A hospital-based cross-study.

SETTING

Genomic and Vascular Center, Changhua Christian Hospital, Changhua, Taiwan.

SUBJECTS

Five hundred and forty-one clinically healthy subjects.

INTERVENTION

Fasting plasma, homocysteine (Hcy), vitamin B(6), vitamin B(12), folate and B-mode carotid ultrasound.

RESULTS

MTHFR genotype, plasma concentrations of folate, vitamin B(6) and vitamin B(12) and age were significantly correlated to the plasma Hcy concentration. MTHFR 677TT carriers had higher concentrations of Hcy than did subjects with the CC and CT genotypes. Age, sex, body mass index and plasma Hcy were independent contributors to increase carotid IMT. However, with stratification by mean value of age and B-group vitamins concentrations, we found that at advanced age, lower plasma folate and vitamin B(12) were three risk factors involved in the enhancing effect of the MTHFR 677TT genotype on the increase of plasma Hcy and carotid IMT.

CONCLUSION

MTHFR 677TT-related carotid atherosclerosis was only identified in healthy elderly subjects with lower level of plasma folate and vitamin B(12).

SPONSORSHIP

Changhua Christian Hospital.

Development of a degradable cement of calcium phosphate and calcium sulfate composite for bone reconstruction

A new type of composite bone cement was prepared and investigated by adding calcium sulfate (CS) to calcium phosphate cement (CPC). This composite cement can be handled as a paste and easily shaped into any contour, which can set within 5-20 min, the setting time largely depending on the liquid-solid (L/S) ratio; adding CS to CPC had little effect on the setting time of the composite cements. No obvious temperature increase and pH change were observed during setting and immersion in simulated body fluid (SBF). The compressive strength of the cement decreased with an increase in the content of CS. The degradation rate of the composite cements increased with time when the CS content was more than 20 wt%. Calcium deficient apatite could form on the surface of the composite cement because the release of calcium into SBF from the dissolution of CS and the apatite of the cement induced the new apatite formation; increasing the content of CS in the composite could improve the bioactivity of the composite cements. The results suggested that composite cement has a reasonable setting time, excellent degradability and suitable mechanical strength and bioactivity, which shows promising prospects for development as a clinical cement.

Renal cell carcinoma in children and young adults

Renal cell carcinoma (RCC) is a relatively uncommon tumor in childhood. Its biologic behavior and prognostic factors have rarely been documented. We report treatment and survival of 4 children (aged 8, 9, 11, and 14 years) who had RCC, along with a review of the literature to analyze the frequency of major symptoms, clinical stage, and prognostic factors based on 130 published cases of RCC in individuals younger than 20 years of age. Two of our cases had renal tumors detected by ultrasound screening, and all 4 cases were followed for a considerable length of time and were alive and free of disease after treatment. An analysis of these 130 published cases of pediatric RCC showed tumor staging and cell type to be the factors that affected patient survival. Tumors composed of granular cells or mixed cells, or at advanced stages, had a poor prognosis. Age, sex, tumor size, symptom duration, and cellular pattern were not related to patient prognosis. Children older than 10 years of age, who have an abdominal mass, flank pain, and/or hematuria should alert clinicians to consider the possibility of RCC. The importance of early diagnosis of renal tumors, using ultrasound as a tool of screening, is emphasized, since surgical treatment leads to a favorable prognosis only in the early stage of RCC.

Calculations of cellular microdosimetry parameters for alpha particles and electrons

The cellular microdosimetry parameters including the cellular S-value and the single-event specific energy distribution for alpha particles and electrons are important in radiation dosimetry and biology. These parameters may be used to determine the relative biological effectiveness of radiations in the boron neutron capture therapy. In the present work, such parameters were calculated for different source to target region combinations, i.e. cell surface, cytoplasm, nucleus and cell. Calculations were made using a semi-analytical model that simulated the emission of alpha particles or electrons by the Monte Carlo method and calculated the energy imparted to the target volume by the analytical method. Delta particle equilibrium and partial delta particle equilibrium were applied to alpha particles and electrons, respectively. Range-energy relations were employed to determine the incident and emerging energies of the primary particles. For electrons, the fraction in the energy loss resulting from the generation of bremsstrahlung and high-energy secondary electrons was estimated. The energy loss straggling of electrons entering and leaving a target volume was also estimated. Calculated cellular S-values were compared to corresponding data of the MIRD Committee. Calculated single-event specific energy distributions were also compared to results calculated using the Penelope code.

Surgical treatment of chylothorax caused by cardiothoracic surgery in children

Four pediatric cases of chylothorax after cardiothoracic surgery, which were managed surgically, are reviewed retrospectively. All patients underwent right thoracotomy and mass ligation of the right thoracic duct without detecting the true site of leakage. Although 1 patient died from heart failure the day after operation, the other 3 recovered quickly without sequelae. Based on our limited experience, we suggest that right thoracotomy with mass ligation of the right thoracic duct can successfully cure chylothorax on either side, particularly if identification of the site of leakage is considered too risky because of severe adhesion from previous cardiothoracic surgery.

Hepatoblastoma and hepatocellular carcinoma in children

BACKGROUND

After nation-wide hepatitis B vaccination in Taiwan, the authors reviewed retrospectively their experience to investigate how the histopathology type of pediatric malignant hepatic tumors changed and whether the survival rate was improved with current surgical technique and adjuvant chemotherapy.

METHODS

Cases of hepatoblastoma and hepatocellular carcinoma were retrospectively analyzed and divided into 2 groups by time of diagnosis. Group I was those who received treatments during 1978 to 1990. Group II was those treated during 1991 to 2001.

RESULTS

There were 20 cases of hepatoblastoma and 15 cases of hepatocellular carcinoma. Male predominance was noted in both groups (male:female, 12:8 and 9:6, respectively). The patients with hepatoblastoma were younger than those with hepatocellular carcinoma (mean/range, 9/2-36 months and 10/0.7-15 years, respectively). Cases of hepatocellular carcinoma were all hepatitis B carriers. The ratio of hepatoblastoma:hepatocellular carcinoma increased from 11:12 in group I to 9:3 in group II. Three-year survival rate of hepatoblastoma was zero in group I and 55% (5/9) in group II. Three-year survival rate of hepatocellular carcinoma was zero in both groups. Operative mortality was 9% (2/23) in group I and zero in group II.

CONCLUSIONS

Since the institution of national program of universal hepatitis B vaccination, the incidence of hepatocellular carcinoma in children have declined in Taiwan. The improved survival of hepatoblastoma resulted from better surgical technique and chemotherapy.

Epidemiological and genetic studies of myotonic dystrophy type 1 in Taiwan

To investigate the prevalence and genetic characteristics of myotonic dystrophy type 1 (DM1) in Taiwan, DM-suspected patients and their families identified during the period of 1990-2001 had their clinical records reevaluated and the CTG repeat sizes at the DM1 locus examined. A total of 96 subjects belonging to 26 families were identified as DM1 patients, which gave a minimal disease prevalence of 0.46/100,000 inhabitants. Clinical anticipation was frequently observed in affected families, even in some parent-child pairs with transmission contraction of the CTG repeat size. The inverse correlation between age at onset and CTG repeat length was significant only in patients with small expansions. In addition, a DM1 carrier with a childhood-onset son was found to have CTG length heterogeneity in the range of 40-50, indicating that premutation alleles could be unstable during gametogenesis as well as in somatic tissues. Our data demonstrated that DM1 is a rare disease in Taiwan and showed that transmission contraction of repeat size is more likely to occur in alleles with large repeats.

Electron- or hole-assisted reactions of H defects in hydrogen-bonded KDP

We present an ab initio study of the stability and defect reactions of neutral and charged H interstitial (H(i)) and H vacancy (H(v)) in KH2PO4 (KDP). We find that while there is no interaction between the neutral H(i) and the host, the addition of an electron leads to the ejection of a H host atom and the subsequent formation of an interstitial H2 molecule and a H(v). In sharp contrast, the addition of a hole results in the formation of a hydroxyl bond. Thus, H(i) in both charged states severs the H-bonded network. For the H(v), the addition of a hole leads to the formation of a peroxyl bridge. The neutral H(i) and the positively charged H(v) induce states in the gap. The results elucidate the underlying atomic mechanism for the defect reactions suggested by experiment.

Hepatopulmonary syndrome in a child

We report a case of congenital biliary atresia and liver cirrhosis who developed hepatopulmonary syndrome thirteen years after Kasai operation. This 15-yea-old girl suffered from hyperbilirubinemia and acholic stool since birth. Congenital biliary atresia was diagnosed at 6 weeks of age and she received Kasai operation when liver cirrhosis was also found during the surgery. Dyspnea and cyanosis insidiously occurred since the age of 13 and she had been admitted to our hospital due to episodes of esophageal varices bleeding where esophageal varices ligation was performed. Serial examinations showed PaO2: 71 mmHg despite of 100% oxygen supplement. Pulmonary catheterization showed multiple arteriovenous shunts and macroaggregated albumin test revealed significant shunting. Contrast-enhanced echocardiogram showed microbubbles in the left heart. Thus, hepatopulmonary syndrome type II was diagnosed. Treatment is a dilemma although liver transplantation with concomitant lung transplantation is a possible choice.