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   2020| September-October  | Volume 53 | Issue 5  
    Online since October 19, 2020

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Association between nonsteroidal anti-inflammatory drugs and lower incidence of surgical treatment of chronic subdural hematoma: A population-based study
Jui-Ming Sun, Cheng-Ta Hsieh, Yu-Hao Chen, Jin-Yin Chang, Chih-Shung Wong, Chih-Ta Huang
September-October 2020, 53(5):159-164
Background: Chronic subdural hematoma (CSDH) is a common neurosurgical disease and is considered an inflammatory angiogenic entity. An association between nonsteroidal anti-inflammatory drugs (NSAIDs) and surgical CSDH in patients following minor head injury without intracranial bleeding has not been reported. Therefore, we used a national population-based database to investigate the association between the use of NSAIDs and the incidence of surgical CSDH.To investigate the association between nonsteroidal anti-inflammatory drugs and the incidence of surgical chronic subdural hematoma. Materials and Methods: We extracted analytical data from the Longitudinal Health Insurance Database (2010), a subset of the National Health Insurance Research Database. Patients aged younger than 50 years, who had undergone neurosurgical procedures or who had a head injury with intracranial bleeding, were excluded from the study. Results: Of 67,296 patients with minor head injury without intracranial bleeding, 482 (0.72%) developed surgical CSDH. Patients who received NSAIDs were more likely to have comorbidities, including ischemic heart disease, stroke, diabetes mellitus, hypertension, hyperlipidemia, renal diseases, arrhythmia, heart failure, chronic liver disease, and valvular heart disease (P < 0.001). Surgical CSDH was more likely to develop in male patients who did not receive NSAIDs (adjusted odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.05–1.72, P < 0.05) and those aged >65 years (adjusted OR = 1.5, 95% CI = 1.15–1.92, P < 0.01). The adjusted OR of surgical CSDH in patients who did not receive NSAIDs was 1.37 (95% CI = 1.09–1.71, P < 0.01). Conclusion: Surgical CSDH may be more likely to develop in patients aged >65 years, male patients, and patients who did not receive NSAIDs. NSAID use may be associated with a low incidence of surgical CSDH in patients following minor head injury without intracranial bleeding.
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Role of mitochondrial DNA copy number alteration in non-small cell lung cancer
Chen-Sung Lin, Yi-Chen Yeh, Siao-Cian Pan, Shih-Yu Lu, Yann-Jang Chen, Wen-Yu Chueh, Yau-Huei Wei
September-October 2020, 53(5):165-176
Background: Mitochondrial dysfunction may involve in the progression of human non-small cell lung cancers (NSCLCs). We analyzed the mitochondrial DNA (mtDNA) copy number, the expression levels of mitochondrial biogenesis-related proteins including pyruvate dehydrogenase, mitochondrial transcription factor A (TFAM) and mtDNA-encoded peptide NADH dehydrogenase subunit 1 (ND1), and the expression level of hexokinase II (HK-II) in human NSCLCs both ex vivo and in vitro. Materials and Methods: Paired cancerous and non-cancerous pathological specimens from 20 resected NSCLCs and an NSCLC cell line, the H23, were used in this study. H23 was infected by lentiviral particles to knockdown (KD) the expression of TFAM. TFAM-Null and TFAM-KD represent the control and TFAM knocked-down H23 cells, respectively. The mtDNA copy number was measured by quantitative real-time polymerase chain reaction and the protein expression levels were measured by immunohistochemical staining and Western blotting, respectively. Results: Low TFAM expression (P = 0.066) and low mtDNA copy number of NSCLCs (P = 0.009) were poor prognostic variables in NSCLC patients. Advanced T4 NSCLCs had lower TFAM expression (P = 0.021), lower expression of mtDNA-encoded ND1 polypeptide (P = 0.049), and lower mtDNA copy number (P = 0.050) than did T1 or T2/T3 NSCLCs, respectively. TFAM-KD cells expressed lower levels of TFAM protein (P < 0.005), ND1 polypeptide (P < 0.005) and mtDNA copy number (P = 0.003), but higher level of vimentin protein (P = 0.045) and higher transwell migration activity (P = 0.003) than did TFAM-Null cells. Conclusion: Mitochondrial dysfunction caused by lower levels of TFAM, mtDNA copy number, and mtDNA-encoded ND1 polypeptide may play an important role in the progression of NSCLCs.
  2,057 205 1
Factors affecting mortality in trauma patients with more than three rib fractures
Po-Lun Tsai, Chun-Ying Huang, Jung-Fang Chuang, Sheng-En Chou, Wei-Ti Su, Shiun-Yuan Hsu, Ching-Hua Hsieh
September-October 2020, 53(5):184-190
Background: In patients with rib fractures, a higher number of rib fractures has been reported to increase the risk of mortality. This study aimed to explore the risk factors for mortality in patients with more than three rib fractures. Materials and Methods: This retrospective study involved a data review of 35,154 trauma patients registered in the Trauma Registry System of a single urban trauma center in Taiwan from January 1, 2009, to December 31, 2018. In total, 1,296 patients who had more than three rib fractures were identified and categorized into two groups: mortality (n = 42) and survival (n = 1,254). Univariate and multivariate logistic regression analyses were applied to identify the independent effects of predictive variables of mortality in patients with multiple rib fractures. Results: Patients who died had a significantly higher number of rib fractures (6.9 ± 3.0 vs. 5.5 ± 1.7, P < 0.001), lower Glasgow Coma Scale (GCS) score (median [interquartile range, Q1–Q3]; 12.5 [3–15] vs. 15.0 [15–15], P < 0.001), and higher injury severity score (ISS) (median [Q1–Q3]; 35.0 [26–41] vs. 16.0 [13–22], P < 0.001) than those who survived. The mortality group had a 10.4-, 3.8-, and 2.9-fold higher odds of sustaining a sternal fracture, pulmonary contusion, and hemopneumothorax, respectively. Multivariate logistic regression analysis revealed that age (odds ratio [OR], 1.1; 95% confidence interval [CI], 1.05–1.12; P < 0.001), number of rib fractures (OR, 1.2; 95% CI, 1.04–1.47; P = 0.016), GCS (OR, 0.8; 95% CI, 0.76–0.93; P = 0.001), ISS (OR, 1.2; 95% CI, 1.10–1.21; P < 0.001), blood transfusion (OR, 4.3; 95% CI, 1.37–13.40; P = 0.013), and hemopneumothorax (OR, 15.5; 95% CI, 2.769–86.62; P = 0.002) were the significant independent risk factors for mortality. Conclusion: This study revealed that age, number of rib fractures, GCS, ISS, blood transfusion, and hemopneumothorax were the significant independent risk factors for mortality of the patients with more than three rib fractures.
  1,355 140 -
Solid-predominant ground-glass opacity has a higher recurrence rate
Hsin-Ju Han, Han-Shui Hsu, Yi-Han Lin
September-October 2020, 53(5):177-183
Background: Although it is generally considered that ground-glass opacity (GGO) is less invasive and sublobar resection is adopted, recurrence still occurs in these patients. The risk factors that affect GGO recurrence need to be re-evaluated.Materials and Methods: We collect retrospectively the data of GGO patients and study the risk factors of tumor recurrence. Patients with T1N0M0 lung adenocarcinoma who underwent lung resection from 2011 to 2016 were enrolled in the study. The collected variables included GGO size, solid part size, consolidation/tumor ratio (CTR), clinical T stage, surgical procedure, and pathology report, from which the risk factors affecting tumor recurrence were analyzed.Results: A total of 28 recurred in 694 patients. Risk factors include age, tumor size, solid part size, CTR ≧50%, and surgical procedures. After multivariate analysis, the only risk factor was CTR ≧50% that will affect tumor recurrence (hazard ratio: 6.789, P < 0.001).Conclusion: CTR ≧50% is a risk factor affecting GGO recurrence. Clinicians should be more careful with such tumors.
  1,301 137 -
Scalp cirsoid aneurysm
Kuo-Chang Huang, Yu-Hao Chen, Cheng-Ta Hsieh, Jui-Ming Sun
September-October 2020, 53(5):202-204
Scalp cirsoid aneurysm, also known as arteriovenous fistula, is a rare condition that commonly presents with a pulsatile cutaneous mass. Angiography is the gold standard for diagnosing this rare lesion. Here, we report the case of a 21-year-old woman who presented with a 7-year subcutaneous pulsatile mass over the suboccipital region. Computed tomographic angiography and conventional angiography confirmed the diagnosis of scalp cirsoid aneurysm. No residual or recurrent fistulas were observed after treatment with only endovascular embolization.
  1,196 115 -
Surgical treatment of Stanford type A dissection for a patient with situs inversus
Xiao Chun Ling, Kuei-Ton Tsai
September-October 2020, 53(5):191-194
Situs inversus totalis represents a positional anomaly of fetal development, in which the heart is right sided with inverted atria, along with mirror-imaged malposition of other visceral organs. Situs inversus totalis is frequently associated with concurrent cardiac anomaly of the patient. Therefore, in the event of life-threatening conditions such as acute aortic dissection, effective surgical planning, and optimal management are crucial to survival. We report the rare case of a 66-year-old male with situs inversus totalis and type A aortic dissection who, sustaining abdominal visceral ischemia and paraplegia at the initial presentation, had then undergone successful aortic graft reconstruction. Besides, a brief review of literature is presented with regard to situs inversus and aortic dissection.
  1,103 136 -
Sump syndrome following choledochoduodenostomy
Dhaivat Vaishnav, Mahendra Narwaria
September-October 2020, 53(5):195-197
Sump syndrome is a rare long-term complication of side-to-side choledochoduodenostomy (CDD), a common surgical procedure in patients with biliary tract disease in the era before endoscopic retrograde cholangiopancreatography (ERCP). In the setting of a side-to-side CDD, the bile does not drain through the distal common bile duct (CBD) anymore. Therefore, the part of the CBD distal from the CDD anastomosis consequently transforms into a poorly drained reservoir, making this so-called “sump” prone to accumulation of debris. These patients are prone to cholangitis. We present a case of a 56-year-old woman with a history of side-to-side CDD 8 years ago who presented with cholangitis and ruptured liver abscess. Sump syndrome was diagnosed by magnetic resonance cholangiopancreatography. Laparoscopic peritoneal lavage was done for the ruptured liver abscess. After endoscopic debris removal and antibiotic treatment, the patient recovered well. In the ERCP era, little is known about CDD and its long-term complications. Therefore, this report provides an opportunity to refresh the knowledge and raise awareness of this syndrome.
  1,071 135 -
Borderline malignancy solitary fibrous tumor of abdominal wall
Wang Lung-Jui
September-October 2020, 53(5):198-201
Solitary fibrous tumor (SFT) is a rare mesenchymal tumor originating in the pleura or at virtually any site in the soft tissue. Although they are commonly thought of as intrathoracic tumors, 50% to 70% of SFTs arise outside the thorax. Approximately 78% to 88% of SFT are benign and 12% to 22% are malignant. The most common sign/symptom of intraabdominal SFT is a palpable abdominal mass with pain and weight loss. Compression symptoms, including dysuria, urinary retention, hydronephrosis, constipation, incontinence, or vomiting have also been reported. However, an intraabdominal SFT located abdominal wall was asymptomatic in this case presentation.
  1,034 122 -