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Wang JS, Lee HC, Sheu JC, Chang PY, Liang DC, Chen BF. Pancreatic tumors in children: report of three cases. ACTA PAEDIATRICA TAIWANICA = TAIWAN ER KE YI XUE HUI ZA ZHI 1999; 40:335-8. [PMID: 10910544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
From 1981 to 1996, we experienced 3 cases of pancreatic tumors in children--two pancreatoblastomas (PB) and one solid and cystic tumor (SCT). The ages were 1 month, 4 years, and 13 years of age respectively. The two cases of pancreatoblastoma initially presented as chronic diarrhea with failure to thrive, the other case presented with abdominal mass. All of them were studied by laboratory examination, ultrasonography, computed tomography and pathology. Increasing alpha- fetoprotein (AFP) levels were found in the 2 pancreatoblastoma cases, however, the level in the SCT case was normal. Abdominal sonography showed pancreatic masses with or without calcification, and the echogenicity may be solid and/or cystic. All patients underwent total excision of the tumors. We have reviewed the literature and find no pancreatoblastoma with chronic diarrhea was reported in young children, especially in neonate. Therefore, we suggest that young children presenting with an abdominal mass and/or weight loss should undergo imaging studies for the possibility of pancreatic tumors.
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Lin YH, Lee SC, Chang PY, Rajan PK, Sue SC, Wu WG. Heparin binding to cobra basic phospholipase A2 depends on heparin chain length and amino acid specificity. FEBS Lett 1999; 453:395-9. [PMID: 10405184 DOI: 10.1016/s0014-5793(99)00760-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Heparin is shown to bind specifically to the carboxy-terminal region of toxic type I phospholipase A2 from Naja nigricollis (N-PLA2) by competition assay using synthetic polypeptides and heparin affinity chromatography. The binding strength is seen to depend on heparin chain length and the presence of N-sulfate groups of heparin. It is observed that both electrostatic and non-electrostatic interactions are involved in the specific binding of heparin to the carboxy-terminus. When heparin's size is at least a decasaccharide, about two molecules of N-PLA2 bind to one molecule of heparin, as evidenced by the chemical estimate of protein to carbohydrate ratio in such N-PLA2/heparin complexes. Based on such a stoichiometric measurement and computer modeling of the N-PLA2/heparin complex, it is suggested that the binding sites of the two N-PLA2 molecules on one heparin molecule lie on the opposite sides of the heparin chain.
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Chu NF, Liou SH, Wu TN, Chang PY. Reappraisal of the relation between blood lead concentration and blood pressure among the general population in Taiwan. Occup Environ Med 1999; 56:30-3. [PMID: 10341743 PMCID: PMC1757651 DOI: 10.1136/oem.56.1.30] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The relation between blood lead concentration (PbB) and blood pressure was examined in a Taiwan nationwide population survey of PbB from July 1993 to June 1994. METHODS After multistage sampling procedures, 2800 subjects (1471 males and 1329 females) with a mean (range) age of 44 (15-85) years were enrolled in this study. Anthropometric, blood pressure, and lifestyle factors were measured during household visits. The PbB was measured with a flameless atomic absorption spectrophotometer and all specimens were analysed in triplicate. RESULTS The mean (range) PbB among all study subjects was 6.5 (0.1-69.1) micrograms/dl; among males it was 7.3 (0.1-69.1) micrograms/dl and among females 5.7 (0.1-40.1) micrograms/dl). The mean (range) systolic blood pressure among all subjects was 123 (80-210) mm Hg, among males it was 127 (80-200) mm Hg and among females 119 (80-210) mm Hg. The diastolic blood pressure among all subjects was 78 (40-150) mm Hg; among males it was 80 (40-130) mm Hg; and among females 75 (40-150) mm Hg. Age, body height, body weight, and body mass index (BMI) were significantly correlated with systolic blood pressure or diastolic blood pressure in both sexes. The PbB (or the natural logarithmic transformed PbB) was not significantly correlated with blood pressure among males or females. After adjustment for the potential confounders of age, age2, BMI, milk intake, alcohol consumption, and cigarette smoking, systolic blood pressure was significantly associated with PbB among males with a regression coefficient (beta) of 0.185 (p = 0.015). No significant association between PbB and blood pressure was found among females. CONCLUSIONS From this study, only a weak association between systolic blood pressure and PbB was found among males. There was no strong evidence that PbB was a good predictor of blood pressure. However, the possibility that long term high body lead burden could cause high blood pressure could not be ruled out on the basis of this survey.
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Chen KT, Chen CJ, Chang PY, Morse DL. A nosocomial outbreak of malaria associated with contaminated catheters and contrast medium of a computed tomographic scanner. Infect Control Hosp Epidemiol 1999; 20:22-5. [PMID: 9927261 DOI: 10.1086/501557] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To identify the risk factors associated with an unexpected outbreak of malaria that occurred among seven patients in a general teaching hospital in Taipei in October 1995. DESIGN A three-stage case-control study was conducted to identify risk factors. PATIENTS We identified all 7 patients who were diagnosed as malaria cases and 69 controls from those undergoing computed tomography (CT) examination. METHODS Malaria was diagnosed by demonstrating the presence of Plasmodium falciparum on either thick or thin blood smears. Clinical characteristics and exposure information were collected from medical records and patient interviews. RESULTS The index case was infected by malaria when he visited Nigeria in early September and was diagnosed when he was hospitalized in hospital A in October. Among 10 patients examined with the Imatron scanner after the index case, all 6 who were injected with contrast medium were infected, but none of 4 examined without contrast medium were infected (P=.005). CONCLUSIONS This nosocomial outbreak of malaria was most likely due to transmission via a contaminated catheter and contrast medium used for CT scanning. Use of disposable catheters may avoid such nosocomial outbreaks in the future.
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Chu NF, Liou SH, Wu TN, Ko KN, Chang PY. Risk factors for high blood lead levels among the general population in Taiwan. Eur J Epidemiol 1998; 14:775-81. [PMID: 9928872 DOI: 10.1023/a:1007544205378] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Environmental and occupational lead pollution is a common problem in both developing and industrialized countries. The purpose of this study is to evaluate the risk factors for high blood lead levels among the general population in Taiwan. METHODS After multi-stage sampling, we randomly selected 2803 subjects (1471 males and 1332 females) for this study. Univariate and multivariate logistic regression analyses were conducted to evaluate the risk of high blood lead. To control for differences in age and gender, all analyses were with age-adjusted and gender-stratified. RESULTS Among males, the mean age is 46 years (15 to 85 years), mean and median blood lead levels is 7.3 and 6.3 microg/dl, respectively. Among females, the mean age is 43 years (15 to 84 years), mean and median blood lead level is 5.7 and 4.8 microg/dl, respectively. Among males, the history of herbal drug use, drinking water from well or spring sources, and occupational lead exposure are significantly different between relatively high and normal blood lead level subjects. The history of occupational lead exposure, history of herbal drug use, and well or spring sources of drinking water are the major risk factors for high blood lead with odds ratio of 4.62 (95% CI: 2.82-7.55), 3.09 (95% CI: 1.60-5.97), 2.06 (95% CI: 1.13-3.76), and 2.37 (95% CI: 1.39-4.04), respectively. Among females, these characteristics remain important except the sources of drinking water. The history of herbal drug use and occupational lead exposure become the major risk factors for high blood lead with odds ratio of 2.94 (95% CI: 1.26-6.88) and 7.72 (95% CI: 3.51-16.99), respectively. In multivariate logistic regression analyses, we find that the risk factors for high blood lead in both genders include a history of herbal drug use and occupational lead exposure. Among males, the drinking water sources and factories in the neighboring areas are also significant factors for high blood lead. CONCLUSIONS For the goal of reducing prevalence of high blood lead by the year 2000, the improvement and monitoring of the working environment, the careful attention to herbal drug use and the lead-free drinking water sources should be executed as thoroughly as possible to reduce the probability of lead pollution.
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Abstract
From January 1990 to December 1995, a total of 22 patients with primary non-refluxing megaureter were treated in our hospital. The age distribution was 7 days to 8 years. The follow-up period was from 1 to 6 years. Nineteen of these 22 children underwent surgical intervention: 3 were operated upon at the time of diagnosis; the other 16 were initially treated conservatively, but underwent subsequent surgery due to impairment of renal function (13) or breakthrough infections (3). The failure rate for conservative management was about 84% (16/19): only 3 patients treated conservatively showed spontaneous resolution. The surgical success rate was 89.5% (17/19). The pathological change in the ureterovesical junction (UVJ) was adynamic in 13 cases and fibrotic in 6 (including 1 ectopic ureter). The postoperative complications were vesicoureteric reflux in 3 cases, with spontaneous resolution 6 months later, and UVJ stenosis in 1, which was resolved by reoperation. It is concluded that surgery is not necessary in every case, but still plays an important role in most cases. Early surgery can achieve good results and reduce renal damage.
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Lee MJ, Lee HC, Young W, Sheu JC, Chang PY, Wang NL. Conservative treatment of intra-abdominal abscess in children. ZHONGHUA MINGUO XIAO ER KE YI XUE HUI ZA ZHI [JOURNAL]. ZHONGHUA MINGUO XIAO ER KE YI XUE HUI 1998; 39:301-5. [PMID: 9823674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Fifty-three children under 18 years of age with sonogram-proved intra-abdominal abscess (IAA) were seen between July 1993 and June 1996 at the Department of Pediatrics of the Mackay Memorial Hospital, then were studied retrospectively. Following a course of conservative treatment and follow-up with serial sonographic studies, 42 (79.3%) patients responded favourably to antibiotics treatment without drainage procedure. The other 11 patients' condition deteriorated, and surgical intervention was performed. The gradual shrinkage and completely resolved periods of the abscesses averaged 27.9 days. The average duration of antibiotic treatment was 23.6 days, intravenously for average 12.2 days followed by oral treatment until the abscess was completely resolved (average 11.4 days). The intra-abdominal abscess recurred in 3 (5.7%) patients. The experience demonstrates that pediatric patients with an intra-abdominal abscess must be followed closely by sonography, and they can be managed successfully with appropriate antibiotics alone. Surgical intervention is still needed if symptoms and signs persist or deteriorate.
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Chen CP, Chern SR, Lin SP, Chang PY, Chang KM, Hsieh FJ. Concomitant chyloperitoneum and omental cysts presenting as fetal ascites with intra-abdominal cysts on prenatal ultrasound. Prenat Diagn 1998; 18:984-6. [PMID: 9793989 DOI: 10.1002/(sici)1097-0223(199809)18:9<984::aid-pd385>3.0.co;2-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chang PY, Kozono T, Chida K, Kuroki T, Huh N. Differential expression of Hox genes in multistage carcinogenesis of mouse skin. Biochem Biophys Res Commun 1998; 248:749-52. [PMID: 9703999 DOI: 10.1006/bbrc.1998.9076] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We surveyed expression of Hox genes in multiple carcinogenesis of mouse skin by RT-PCR cloning. According to the sequences of the amplified DNA fragments within the homeobox of Hox genes, 25 of the 39 known Hox genes were amplified in the normal dorsal skin of adult mice. In the papilloma and carcinoma, clones of Hox A7 and Hox B7 were preferentially isolated among others. The entire Hox D locus was silent in both papilloma and carcinoma. Our present results suggest that the majority of Hox gene family members are expressed in normal mouse skin, while the repertoire is substantially limited in the papilloma and carcinoma.
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Tzen CY, Chen BF, Chang PY, Wang NL. Mesenchymal hamartoma of the liver: a case report. ZHONGHUA YI XUE ZA ZHI = CHINESE MEDICAL JOURNAL; FREE CHINA ED 1998; 61:427-31. [PMID: 9699396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mesenchymal hamartoma of the liver (MHL) is a rare lesion occurring mainly in infants and children. It is often misdiagnosed clinically as a malignant tumor because of its rapid increase in size within a short period of time, or as a hepatic cyst or abscess because of its cystic appearance. Although a benign lesion, MHL may cause heart failure, due to arteriovenous shunts, or death if untreated, as a result of respiratory complications. A typical case of MHL was recently encountered in a 15-month-old boy. The patient presented with progressive abdominal distension; surgery revealed a large mass arising from the right lobe of the liver. The mass was predominantly solid, but collections of fluid were also present. Loose mesenchymal tissue and branched, tortuous bile ducts were the key diagnostic features. When predominantly cystic, MHL may mimic a lymphangioma both grossly and microscopically. Prudent examination of the cystic structures can establish a correct diagnosis.
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Liu HC, Liang DC, Chen SH, Liu FL, Chang PY, Sheu JC, Wang NL. The stage I yolk sac tumor of testis in children younger than 2 years, chemotherapy or not? Pediatr Hematol Oncol 1998; 15:223-8. [PMID: 9615319 DOI: 10.3109/08880019809028788] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Yolk sac tumor is the most frequent germ cell tumor of testis in children. For stage I yolk sac tumor of testis in children younger than 2 years, high inguinal orchiectomy alone has been the standard treatment, with a cure rate of at least 75%. Here, we compare the treatment results of receiving chemotherapy or no chemotherapy after orchiectomy, to analyze the role of chemotherapy. From February 1987 to January 1997, 22 children younger than 2 years, with stage I yolk sac tumor of testis, were included in the study. All patients had high inguinal orchiectomy without retroperitoneal lymphadenectomy. Initial diagnostic imaging studies included computed tomographic scan of abdomen, chest radiography, and long bone survey. Clinical stage I was defined as a tumor completely resected with no evidence of local regional lymph node involvement or distant metastases. Serum alpha-fetoprotein (AFP) was assessed at diagnosis. After orchiectomy, diagnosis, and staging, patients were stratified into two treatment groups, with or without chemotherapy, according to the decision of the parents. Ten children received chemotherapy consisting of cisplatin, vinblastine, and bleomycin (PVB, modified "Einhorn regimen") for 12 weeks. The remaining 12 patients were followed up according to a "wait and see" policy. Determination of AFP was performed monthly during the first postoperative year, every other month during the second year, every 3 months during the third year, every 6 months during the fourth year, and yearly until the fifth postoperative year at least. The duration of follow-up ranged from 3 months to 119 months (median, 53 months). The Kaplan-Meier plot estimated an overall survival rate of 91.6% at 7 years after diagnosis. Among the 12 patients without chemotherapy, 2 children had relapses at 4 and 6 months after diagnosis, respectively. One was cured with PVB chemotherapy. The other patient died with refractory lung metastasis, in spite of intensive multimodality salvage therapy. The Kaplan-Meier plot showed a survival rate of 80% at 7 years and a relapse-free survival rate of 81.8% at 5 years after diagnosis. All children receiving chemotherapy were alive and free from relapse. There was no significant treatment-related toxicity. Our results may suggest that PVB chemotherapy after orchiectomy is an affective and safe regimen for stage I yolk sac tumor of testis in children younger than 2 years. Instead of four courses of PVB as used here, two or three courses could be enough. To elucidate the necessity for chemotherapy and to determine the number of courses of PVB needed (if chemotherapy is given), a randomized study of more cases is warranted.
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Wang NL, Yeh ML, Chang PY, Sheu JC, Chen CC, Lee HC, Hung HY, Hsu CH. Prenatal and neonatal intussusception. Pediatr Surg Int 1998; 13:232-6. [PMID: 9553178 DOI: 10.1007/s003830050305] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intussusception found in the 1st month of life is rare and usually discussed as one entity, neonatal intussusception, but in fact, includes the intussusceptions occurring both prenatally and neonatally, of which the clinical presentations and results are different. Four full-term babies with prenatal intussusception presenting as intestinal atresia (IA) and three premature babies with neonatal intussusception mimicking necrotizing enterocolitis (NEC) are presented. Prenatal intussusception, as one of the causes of IA produces prominent signs of intestinal obstruction immediately after birth. Preoperative evaluation usually fails to yield a definitive diagnosis, but surgery is usually performed in time and is successful. In neonatal intussusception, full-term infants usually have a pathological lead point and the colon is almost always involved. A barium enema is thus useful in diagnosis. Premature babies, on the other hand, rarely have a colonic component, and the clinical features are insidious and similar to NEC. This results in diagnostic confusion that may lead to a dangerous delay in appropriate surgical correction. A high level of suspicion about this condition in cases diagnosed presumptively with NEC is important. Serial abdominal sonograms may be helpful in the early diagnosis of neonatal intussusception.
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Sheu JC, Huang YH, Chang PY, Wang NL, Tsai TC, Huang FY. Results of surgery for vesicoureteral reflux in children: 6 years' experience in an Asian country. Pediatr Surg Int 1998; 13:138-40. [PMID: 9563026 DOI: 10.1007/s003830050267] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
From January 1990 to December 1995, a total of 181 patients underwent reimplantation of 318 ureters for primary vesicoureteral reflux (VUR); 87.8% received bilateral reimplantation. Surgical indications included breakthrough infection (35%), high-grade (> or = IV) reflux (33%), or both (29%). The operative success rate was 99.4% at 3 months postoperatively and 100% ultimately. The complications included: contralateral sequential reflux in 3.9%, postoperative bladder diverticula in 1.1%, postoperative urinary infection in 1.1%, residual reflux in 0.3%, postoperative vesicoureteral stenosis in 0.3%, and slippage of the drainage tube in 0.3% of cases. Two patients had renal failure due to VUR that was proven by renal biopsy (one 4-year-old and one 8-year-old). The incidence of associated anomalies was higher than in the normal population. The average number of hospital admission days was 7.9 (3-63). After 1992, no ureteral stent was left in postoperatively. All patients received prophylactic antibiotics for 3 months postoperatively until the VUR disappeared. The surgical results were satisfactory in this series.
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Wu TN, Liou SH, Shen CY, Hsu CC, Chao SL, Wang JH, Chang SF, Ko KN, Chiang HC, Chang PY. Surveillance of noise-induced hearing loss in Taiwan, ROC: a report of the PRESS-NHL results. Prev Med 1998; 27:65-9. [PMID: 9465355 DOI: 10.1006/pmed.1997.0238] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND To understand the extent of noise-induced hearing loss (NIHL) among noise-exposed workers, an ongoing public health surveillance system (Program to Reduce Exposure by Surveillance System or PRESS-NIHL) was established in Taiwan in 1995 to monitor the prevalence of NIHL. METHODS A total of 9,535 noise-exposed (> 85 dBA) workers were recruited into PRESS-NIHL from January to June 1995. Each received a periodic annual audiometric examination at 1 of 73 well-qualified audiometric examination rooms in accredited hospitals. Among those examined, 9,463 audiograms were acceptable for evaluation to determine the severity of NIHL at 4K Hz. RESULTS The mean hearing threshold at 4K Hz was 36.8 dB among male workers and 29.7 dB among female workers. The mean hearing loss at 4K Hz of male workers was higher than that of female workers. Among both men and women, hearing ability was found to decrease with increasing age. A total of 3,216 (34.0%) workers were found to have NIHL, with a hearing threshold higher than 40 dB (NIHL) in either one or both ears. Among these workers, 1,886 (19.9%) had mild NIHL (hearing threshold between 40 and 55 dB) and 1,330 (14.1%) had severe NIHL (hearing threshold above 55 dB) in either one or both ears. The proportion of severe NIHL was higher in certain industries, including construction (38.6%), ship building/repairing (19.2%), and weapon manufacturing (13.6%). CONCLUSION This surveillance system for NIHL is on of the first surveillance systems in the world established to monitor and control NIHL in the setting of industrial hygiene and occupational disease prevention. Our finding of a high prevalence of NIHL in certain industries will trigger immediate actions to control noise hazard, which in turn will provide better protection for noise-exposed workers.
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Wu TN, Shen CY, Liou SH, Chao SL, Hsu CC, Lin FT, Ko KN, Chang PY. Reducing lead exposure by surveillance system: the Taiwan experience. ARCHIVES OF ENVIRONMENTAL HEALTH 1998; 53:75-8. [PMID: 9570312 DOI: 10.1080/00039899809605692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To evaluate the performance of a lead-surveillance program in reducing blood lead levels of workers in Taiwan, the authors conducted prospective and cross-sectional studies. A total of 6 905 workers, whose job titles indicated a direct exposure to lead in 1995, were included in this surveillance system. In this study, the authors compared the mean blood lead levels in 1994 (i.e., year of onset of surveillance) with that in 1995 in workers of major industries. Lead-exposed workers had a statistically significant decrease (i.e., average of 1.8 microg/dl) in blood lead levels during this 1-y period. The decrease was particularly obvious in individuals who worked in chemical products manufacturing, ship building/repairing, and plastic products manufacturing. The significant decreases in blood lead levels in these workers indicated that this surveillance system was effective. Surveillance, combined with control measures, might be an important means by which occupational lead exposure can be reduced.
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Chen CP, Chen SH, Chuang CY, Lee HC, Hwu YM, Chang PY, Chen ML, Chen BF. Clinical and perinatal sonographic features of congenital adrenal cystic neuroblastoma: a case report with review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 1997; 10:68-73. [PMID: 9263428 DOI: 10.1046/j.1469-0705.1997.10010068.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Cystic formation in association with adrenal neuroblastoma may be related to hemorrhage and necrosis of the tumor. We present an unusual case of congenital cystic fetal neuroblastoma of the right adrenal gland detected at 37 weeks' gestation which evolved into a complex echogenic mass 6 weeks after birth. Surgical exploration revealed a 3.5 x 3 x 3 cm right complex adrenal tumor which was resected. The infant did well 10 weeks after tumor resection. Typically adrenal hemorrhage may appear sonographically to be entirely echogenic, of mixed echogenicity, or anechoic when first imaged. Gradually, the texture of the hematoma will evolve and become more cystic and echolucent on follow-up ultrasound examinations. In contrast, our case of congenital adrenal cystic neuroblastoma became more complex after resolution of the hemorrhagic cyst. This case suggests that adrenal hemorrhagic and adrenal cystic neuroblastoma with a hemorrhagic cyst have different sonographic appearances. We suggest that additional imaging and surgical intervention should be considered whenever a cystic suprarenal mass becomes more complex after resolution and demonstrates no significant decrease in size in postnatal examinations.
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Wu TN, Liou SH, Hsu CC, Chao SL, Liou SF, Ko KN, Yeh WY, Chang PY. Epidemiologic study of occupational injuries among foreign and native workers in Taiwan. Am J Ind Med 1997; 31:623-30. [PMID: 9099366 DOI: 10.1002/(sici)1097-0274(199705)31:5<623::aid-ajim18>3.0.co;2-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study was designed to compare the risk of occupational injuries in foreign workers compared to native workers in Taiwan. The cohort of foreign workers under study was constructed by records of legally registered workers migrated from foreign countries to Taiwan from July 1, 1991 to December 31, 1993. The native Taiwanese workers for comparison were labor-insured workers working in the same industries as foreign workers in 1992. The number of occupational injuries in the first year of employment were obtained by matching the cohort of foreign workers with the labor insurance payment records by name, birth date and passport number. The 1-year incidence rate of occupational injuries in the first year of employment was calculated and a standardized morbidity ratio (SMR) was used for comparison with adjustment for age distribution and to accommodate the small sample size of foreign workers. The risk to occupational injuries among total (SMR = 0.86) and male (SMR = 0.58) foreign workers was not higher; indeed, it was even lower, than that among native workers in Taiwan. However, the risk to female migrant workers, especially in the construction industry, was significantly higher than that of female Taiwanese workers (SMR = 1.60). Stratified by industry, the incidence was high in the fabricated metal products manufacturing industry and in machinery and equipment manufacturing industry for male foreign workers, while a high incidence for the female foreign workers occurred in construction industry and rubber products manufacturing industry. The risk of occupational injuries was greater for foreign workers who had been in Taiwan for only a short time. Most of the injuries occurred within the first 6 months of employment. Eighty-four out of the 394 occupational injuries among foreign workers resulted in disabilities. None of the accidents was fatal, but most of the disabilities were severe. The most common disabling injuries were cut or crushed fingers. The finding of a similar distribution of occupational injuries among foreign and native workers indicates that control measures are needed to reduce occupational injuries for all foreign and native workers in Taiwan.
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Wu TN, Liou SH, Shen CY, Lai JS, Chang PY. Program to Reduce Exposure by Surveillance System (PRESS) in Taiwan: experiences of closing the surveillance gap. Am J Ind Med 1997; 31:479-80. [PMID: 9093665 DOI: 10.1002/(sici)1097-0274(199704)31:4<479::aid-ajim16>3.0.co;2-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ko YC, Lee CH, Chen MJ, Huang CC, Chang WY, Lin HJ, Wang HZ, Chang PY. Risk factors for primary lung cancer among non-smoking women in Taiwan. Int J Epidemiol 1997; 26:24-31. [PMID: 9126500 DOI: 10.1093/ije/26.1.24] [Citation(s) in RCA: 235] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although cigarette smoking is considered to be the most important cause of lung cancer, smoking behaviour cannot fully explain the epidemiological characteristics of lung cancer in Taiwanese women, who rarely smoke but contract lung cancer relatively often. There are other causes of lung cancer that have produced variability in lung cancer incidence. METHODS A case-control study involving interviews with 117 female patients (including 106 non-smoking) suffering from lung cancer and the same number of individually matched hospital controls was conducted in Kaohsiung, Taiwan between 1992 and 1993. The questionnaire administered to cases and controls collected information on cigarette smoking and suspected risk factors for lung cancer. Multivariate logistic regression analysis was applied to assess smoking for all women and suspected risk factors for non-smoking women. RESULTS The relationship between cigarette smoking and lung cancer was statistically significant although only a small proportion (9.4%) of female patients had smoked. However, the risk of contracting cancer for non-smoking women appears to be associated with certain cooking practices, especially preparing meals in kitchens not equipped with a fume extractor at cooking age of 20-40 years (odds ratio [OR] = 8.3; 95% confidence interval [CI]: 3.1-22.7. These factors and a history of pulmonary tuberculosis plus low consumption of fresh vegetables explained 78% of the summary attributable risks for non-smoking women in a multivariate logistic regression model. CONCLUSIONS Exposure to fumes from cooking oils, when not reduced by an extractor, may be an important factor in causing lung cancer in non-smoking Taiwanese women.
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Ho HF, Liaw SB, Chang PY. Delayed manifestation of congenital diaphragmatic hernia with intrathoracic kidney: report of one case. ZHONGHUA MINGUO XIAO ER KE YI XUE HUI ZA ZHI [JOURNAL]. ZHONGHUA MINGUO XIAO ER KE YI XUE HUI 1997; 38:61-64. [PMID: 9066193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Intrathoracic kidney is a very rare congenital anomaly with only about 50 cases reported in the world literature. Incidence of intrathoracic kidney with Bochdalek hernias was reported to be less than 0.25 percent. The relationship between them remains uncertain. We report a case in which the patient had a normal chest x-ray at birth, but at the age of 5 months an isolated left sided intrathoracic kidney with incomplete duplication was discovered. This was followed by ipsilateral diaphragmatic hernia at the age of nine months. Other coexisting malformations included hydrocephalus and an imperforate anus with perineal fistula. A primary repair of the diaphragmatic defect and a minimal posterior sagittal anorectoplasty were carried out at the age of nine months. Since then, the patient has had repeated admissions due to viral infection. Eventually she succumbed to pneumonia at the age of one year. This case raised the question "Does the ascent of metanephron continue postnatally and affect development of the diaphragm?"
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Chen C, Shih SL, Liu FF, Jan SW, Tsai TC, Chang PY, Lan CC, Chen CP. In utero urinary bladder perforation, urinary ascites, and bilateral contained urinomas secondary to posterior urethral valves: clinical and imaging findings. Pediatr Radiol 1997; 27:3-5. [PMID: 8995156 DOI: 10.1007/s002470050050] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report on a rare in utero appearance of urinary bladder perforation, urinary ascites, and bilateral contained urinomas secondary to posterior urethral valves. The findings on prenatal sonography, postnatal voiding cystourethrography, and magnetic resonance imaging are described.
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Wu TN, Shen CY, Liou SH, Yang GY, Ko KN, Chao SL, Hsu CC, Chang PY. The epidemiology and surveillance of blood lead in Taiwan (ROC): a report on the PRESS-BLL project. Int Arch Occup Environ Health 1997; 69:386-91. [PMID: 9215924 DOI: 10.1007/s004200050165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To monitor the lead hazards in industries and to investigate the prevalence of elevated blood lead levels (BLLs) in lead-exposed workers, a lead surveillance system (PRESS-BLLs) has been established and operated in Taiwan, Republic of China, since July 1993. A cohort of lead-exposed workers who received a periodic annual health examination at 55 accredited hospital laboratories was constructed. A total of 9807 separate BLL measurements were reported to the system in 1994. The mean BLL was 15.8 micrograms/dl in male workers and 11.6 micrograms/dl in female workers. The mean BLL of lead-exposed workers was significantly (P < 0.05, z-test) higher than that of the general Taiwanese population (8.6 micrograms/dl for males and 6.7 micrograms/dl for females). In addition, the BLLs of 983 (10.0%) workers exceeded the regulatory action level (40 micrograms/dl for males; 30 micrograms/dl for females). The workplaces and homes of 57% of the workers with elevated BLLs were thoroughly investigated to determine the sources of lead contamination. These actions identified the causes of elevated BLLs and set up strategies to reduce workers' lead exposure. The establishment of this occupational lead surveillance system represents a method for monitoring of lead hazards from occupational and environmental settings to prevent lead poisoning. The information acquired from the system can help in the setting up of a priority of prevention and the development of control measures. It is also useful for further monitoring of changes in the BLLs of the lead-exposed cohort. The Health Department of Taiwan can use this information to evaluate the effectiveness of current industrial hygiene practice. Subjects with elevated BLLs have been medically treated and placed on long-term follow-up for sequelae.
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Lai JS, Wu TN, Liou SH, Shen CY, Guu CF, Ko KN, Chi HY, Chang PY. A study of the relationship between ambient lead and blood lead among lead battery workers. Int Arch Occup Environ Health 1997; 69:295-300. [PMID: 9138005 DOI: 10.1007/s004200050150] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the relationship between ambient lead levels and blood lead levels and to explore the modifiers of the relationship between ambient lead and blood lead. METHOD A cross-sectional study was conducted in two lead battery factories. Blood lead level and ambient lead concentration were measured for each participant concurrently. A structured questionnaire was administered to collect sociodemographic characteristics and occupational history. DESIGN Biological and personal environmental measurements of 219 lead-exposed workers were analyzed by both simple and multiple linear regression. A regression model was selected for interpretation. RESULTS A high correlation (r = 0.62) between ambient lead (PbA) and blood lead (PbB) was observed. In addition, numerous factors, including age, sex, alcohol consumption, personal hygiene practice and type of lead exposure, were also found to influence blood lead levels. Although PbB was highly correlated with PbA, blood lead level may not be effectively lowered by reducing ambient lead level. Based on the regression coefficients, improvement of hygienic practice was more effective at lowering PbB than reducing ambient lead level. Good hygienic practice may be the preferential way to reduce lead exposure in current conditions. CONCLUSION Education of correct work practice may be more important than engineering control in the developing countries to lower blood lead levels in lead battery factories.
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Wu TN, Liou SH, Wang JD, Shen CY, Ko KN, Yang GY, Lai JS, Ho CK, Chao SL, Hsu CC, Guo YL, Lai MS, Chang PY. Establishment of a work-related diseases surveillance system in Taiwan, Republic of China. Prev Med 1996; 25:725-9. [PMID: 8936575 DOI: 10.1006/pmed.1996.0112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The occurrence of occupational illness and injury has been seriously underestimated in Taiwan, which subsequently contributes to difficulties in performing effective control of occupational hazards and implementing intervention programs for protecting workers. METHODS Based on the successful experience of the nationwide blood lead level surveillance program, the Department of Health, the Executive Yuan, Taiwan, Republic of China, has established a work-related diseases surveillance system. This government-administered system requests practicing physicians to report the suspected cases suffering from six categories of work-related disorders. RESULTS An occupational illness and injury surveillance program in Taiwan has been in operation since June of 1995. CONCLUSION Background information of work-related diseases obtained from this surveillance system will be useful for providing better management of available resources for occupational medicine, for preventing hazards, and for enforcing occupational diseases prevention programs. Our experience in establishing this surveillance system will be used in other countries and settings.
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Lai JY, Sheu JC, Chang PY, Yeh ML, Chang CY, Chen CC. Experience with distal circular myotomy for long-gap esophageal atresia. J Pediatr Surg 1996; 31:1503-8. [PMID: 8943110 DOI: 10.1016/s0022-3468(96)90165-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
From 1980 to 1994, the authors treated 65 cases of esophageal atresia (with or without tracheoesophageal fistula). Among these patients, 15 (23%) underwent pure proximal circular myotomies and five (8%) underwent both proximal and distal circular myotomies. Of the latter five cases, three were Gross type C and two were Gross type A. The gap ranged from 4.5 cm to 6.5 cm (mean, 5 cm). Surgical complications in these five patients included two anastomotic leaks (40%), one anastomotic stricture (20%), and four gastroesophageal refluxes (80%). Three patients eventually underwent fundoplication as an antireflux procedure. Mucosal outpouching was noted in all cases. The myotomy did not adversely affect the esophageal peristalsis and motility on the esophagogram. Esophageal function was similar to that of other children who had esophageal atresia without myotomy. All patients could eat food typical for their age. This limited experience suggests that distal circular myotomy might be a safe adjuvant procedure to achieve primary anastomosis in long-gap esophageal atresia.
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