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Tumor-node-metastasis (TNM) staging is the most commonly used model for evaluating therapeutic strategies for papillary thyroid cancer (PTC). Additionally, different histopathological patterns and variants of PTC have been reported to influence the prognosis of these patients. We reviewed the clinical presentation, cancer recurrence, and cancer-specific mortality of the most frequent histological patterns, including the follicular variant (FVPTC), insular pattern, tall cell pattern, diffuse sclerosing type, PTC with Hashimoto's thyroiditis, and multicentric PTC. The tall cell variant of PTC is a more aggressive variant than classical PTC and has a poor prognosis. The high expression of Muc 1 and type IV collagenase in these tumors may facilitate stromal degradation and increase the invasive potential. In contrast, approximately 18% of PTC patients have been identified as having FVPTC. FVPTC patients have a better survival rate than those with follicular thyroid cancer, and fewer instances of lymph node or soft tissue invasion than control patients with classical PTC. The diffuse sclerosing variant of PTC predominantly observed in young patients is a rare aggressive tumor that requires intensive treatment. Despite characteristic clinical and histological features that facilitate easy diagnosis, pre-operative fine needle aspiration cytological diagnosis of this variant is often challenging. Different histological variants of PTC with other histological patterns are important for predicting cancer recurrence. In addition to TNM staging, high-risk histological patterns of PTC require more aggressive follow-up examinations and postoperative adjuvant therapies.

Although diabetes mellitus is known as a major risk factor for Klebsiella pneumoniae infection, the differences in clinical characteristics between community-acquired and nosocomial K. pneumoniae bacteremia in diabetic patients have been rarely reported.This retrospective analysis enrolled 193 adult diabetic patients with K. pneumoniae bacteremia hospitalized between January 2005 and December 2006. The chi-squared test, analysis of variance (ANOVA), Student's t test, Fisher exact test, and Cox regression model were used for statistical analysis.Of the enrolled patients, 147 had community-acquired infections and 46 had nosocomial infections. Compared with the community group, the nosocomial group had higher rates of in-hospital mortality (41.3% vs. 18.4%, p=0.001), malignancy (50.0% vs. 19.0%, p0.001), and leukopenia (21.7% vs. 5.4%, p=0.001) but had lower levels of serum C-reactive protein (124.3 mg/L vs. 188.7 mg/L, p=0.018) and HbA1c (8.1% vs. 9.5%, p=0.025). The rate of infection with the extended-spectrum β-lactamase-producing strain (ESBL infection) in the nosocomial group was 11 times higher than that in the community group (45.7% vs. 4.1%, p0.001). ESBL infection accounted for 53% of mortality in the nosocomial group. Pneumonia was more common in the nosocomial group, while local abscess was more common in the community group. The risk factors for mortality were pneumonia, leukopenia, cirrhosis, and a high serum creatinine ratio (creatinine level at admission/baseline).The nosocomial group had more ESBL infections which might account for the higher mortality. The HbA1c level during the course of infection did not affect the outcome. Pneumonia, leukopenia, cirrhosis, and a high serum creatinine ratio at admission were the risk factors for poor outcome.

Many health indices have a relationship with anthropometric indices. This research attempts to provide a new measurement: a chronic disease risk factor score built into the regression model. This new model will help people visualize their health status and get multiple information during the process of the healthy examination.Data from 8,034 subjects were collected from the data bank of the Health Examination Center in Chang Gung Memorial Hospital. Related anthropometric indices and biochemical factors were selected and used to construct a regression model. The anthropometric indices used were body mass index, waist hip ratio, waist hip area ratio, health index, waist leg ratio and trunk leg ratio. Biochemical data included blood pressure, glucose, triglyceride, cholesterol and uric acid, combined to form an anthropometric chronic disease risk factor score.Subjects under 45 years of age had the highest chronic disease risk factor score, and were selected to construct a regression model. The R-square of this model is 0.355; its predictive error is near 12%. After verification with a testing group, the regression model could be used to predict health status.The purpose of this study was to develop a new anthropometric chronic disease risk factor score by combining anthropometric indices and biochemical data. A multiple regression model was used to illustrate health status via anthropometric chronic disease risk factor scores for the subjects participating in the health examination. The results show that the chronic disease risk factor score is useful for prescribing relevant medical treatment as well as for other research.

The aim of this study was to compare the clinical manifestations and outcomes of patients with diabetic ketoacidosis (DKA) today and 20 years ago.A retrospective review was conducted of patients with DKA treated at our hospital from January 2001 through June 2002. The medical records were analyzed to identify clinical presentations, contributory factors, laboratory data, and outcomes. Additionally, data were compared with the records of patients with DKA in 1981 and 1982 at the same hospital.Data on 132 patients with 148 DKA episodes were included in the present study. When compared with the data from 20 years ago, clinical presentations, precipitating factors and laboratory data were similar. However, the mortality rate markedly decreased from 7.96% to 0.67%. Among patients with documented bacterial infections, a significantly high prevalence (70%) of Klebsiella pneumoniae infection was discovered. In patients with recurrent DKA, young women with type 1 diabetes accounted for most of the cases (67%) due to the omission of insulin. Eleven of 49 patients (22%) with newly diagnosed diabetes presenting with DKA were not insulin dependent during the 1.5-year follow up.After 20 years, the clinical presentations and precipitating factors of DKA were similar. However, the mortality rate was significantly reduced. Klebsiella pneumoniae was the leading cause of bacterial infections precipitating DKA in our hospital. Young women with type 1 diabetes were at high risk of repeat DKA.

Insufficient information exists on the prognostic factors of papillary thyroid cancer (PTC) with chest metastases, which is detected only using a radioactive iodide (131I) whole body scan (WBS) but could not be detected using radiographic findings. The aim of this study was to analyze the clinical features and treatment results of patients with PTC.This retrospective study includes 17 patients diagnosed from 1985 through 2002. The clinical features and responses to treatment were compared between patients with diffuse lung metastases and those with focal lung or mediastinal metastases, and at the end of follow up the results were also compared between disease-free patients and those with persistent chest metastases.The mean age of the 17 patients was 32.2 +/- 19.1 years. After a mean follow up of 89.6 +/- 51.3 months, all 17 patients survived except for one who died of a non-thyroid-related disease. Six of the 17 patients were disease-free at the end of follow up, and eight of the 17 patients became free of chest metastases. The dose of 131I required to cure chest metastases was higher in the patients with diffuse lung uptake than those with focal chest uptake. The primary tumor size and serum thyroglobulin (Tg) level on the first finding of chest metastases differed markedly between disease-free patients and patients with persistent chest metastases.131I scans can effectively demonstrate early chest metastases, which are difficult to detect from chest X-ray or computed tomography (CT). The prognosis for patients with papillary thyroid carcinoma with chest metastases detectable only using 131I is favorable. Additionally, the low serum Tg level on the first finding of chest metastases and the small size of the primary tumor may have favorable therapeutic outcomes.

The endocrine adrenal gland has 3 zones comprised of the cortex and medulla. The character of multi-hormonal expression results in multiple clinical manifestations. To define the clinical characteristics of adrenal tumors in Taiwan, we reviewed 336 pathologically proven adrenal tumors at Chang Gung Memorial Hospital in Linkou.We retrospectively analyzed 258 pathologically proven adrenal tumors with sufficient data treated from 1983 to 2000. Among them, 174 (67%) were functional and 84 (33%) were nonfunctional. The diagnosis was based on clinical features, hormonal status, imaging studies, and pathology.Of the 258 patients, 161 were women (mean age, 38.5 +/- 15.4; range, 1-75 years) and 97 men (mean age, 41.6 +/- 17.8; range, 1-81 years). The prevalence of cortical tumors was much higher in females than in males. Fifty-two percent of patients with an adrenal tumor were diagnosed at an age between 30 and 50 years. Incidentalomas (N = 84) accounted for about 1/3 of total tumor cases. Of the 46 cases proven to be malignant, 40 (87%) were found incidentally. All malignant tumors had a diameter of greater than 3 cm. Postoperative adrenal insufficiency was present in 18% of cases, and overall mortality in this study was 0.4%.In our series, adrenal incidentalomas corresponded to about 1/3 of adrenal tumors and accounted for 87% of malignancies. It is mandatory to increase medical attention for incidentally found adrenal masses in Taiwan. Those incidentalomas with a diameter of more than 3 cm should undergo a pathological examination.

The Chang Gung University School of Medicine adopted problem-based learning (PBL) education 3 years ago. A questionnaire was designed to evaluate the effectiveness of this teaching method, and the results were analyzed to determine statistical significance.In June 2001, all the interns in the Medical and Surgical departments of the Chang Gung Memorial Hospital were compulsorily assessed using a newly developed questionnaire, which was provided to the residents, chief resident, and attending doctors. The questions involved the interns' ability to perform 10 essential skills, namely (1) problem searching, (2) problem solving, (3) initiative learning, (4) thinking process, (5) establishing the patient-doctor relationship, (6) establishing the doctor-nurse relationship, (7) interaction with peers, (8) professional knowledge, (9) clinical techniques, and (10) medical notes writing. Forty-three completed questionnaires, evaluating 25 interns, were returned. Of these 25 individuals, 14 had participated in PBL education and 11 had been taught using the conventional variant.No statistically significant differences were demonstrated for gender or average school records between the interns who had been taught using the PBL and conventional methods. Statistically significant superiority was demonstrated for interns educated using PBL in three of 10 areas including, thinking process, professional knowledge, and clinical techniques.Analysis of the questionnaire results clearly demonstrated that the introduction of the PBL method of teaching at the university was efficacious in terms of the competence demonstrated by the interns when entering clinical practice.