Metabolic syndrome (MetS), cardiovascular diseases (CVD) and cancers such as colon cancer (CCa), prostate cancer (PCa) and breast cancer (BCa) have been recognized as obesity-initiated diseases. The development of obesity can cause changes in metabolic and hormonal conditions, which can result in the storage of excess energy in different forms in the human body. Existing anthropometric data are useful in the prognosis of these diseases. Although frequently studied, there is disagreement on the applicability, reliability and trends of weight, height, waist circumference (WC) and relevant indices. WC is generally accepted as a key marker in CVD and CCa risk assessment whereas more evidence of the usefulness of WC-CVD, WC-PCa and WC-BCa correlations is needed. The body mass index, which has been widely used as a determinant of obesity, has a strong connection with CCa risk in men and young women, but an inconsistent connection with BCa. Cross-referencing measurements, with indices such as the waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR), enhances the association with diseases, e.g. WHtR-CVD and WHR-CCa, and connections are strong. This idea is further applied to multiple referencing. For example, the WHtR/WHR has been studied and found highly correlated with the MetS risk in Asia. In addition, latent issues (such as tools or techniques for surface anthropometric measurement), which could affect the prognosis of diseases, have been discussed. To this end, three-dimensional technology is suggested as a reliable tool for various anthropometric data collection and analysis in preventive medicine.

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 Muc1 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.

Background: The balance of the Th1 and Th2 immune response plays an important role in the regulation of the immune system and in general health. Tumor bearing hosts are supposed to have a balance shifting to the Th2 pathway, while a favorable Th1 anti-tumor pathway is induced in tumor-resected hosts. The clinical impacts of a tumor-related Th2 environment have not been clearly studied. The present study was conducted to test the hypothesis that nonsmall cell lung cancer (NSCLC) has an impact on control of asthma, a wellknown Th2-predominant inflammatory disease. Method: Thirty-eight patients with the diagnoses of both asthma and lung cancer were retrospectively enrolled. Patients were divided into two groups according to their response to lung cancer treatment, the responder group (complete regression, partial regression and stable disease) and non-responder group (progression of disease). Asthma control test (ACT) scores were analyzed one year before diagnosis, at the time of diagnosis of lung cancer, and at the time of re-staging after cancer treatment. Results: All the asthmatics with lung cancer had worsening of their symptoms according to their ACT scores at the time of diagnosis of lung cancer compared to scores in the preceding year (21.6 ± 0.5 vs. 16.5 ± 0.8, n = 38, p < 0.001). The ACT scores in the responder group (17.3 ± 5.1) were significantly improved after effective lung cancer treatment (22.1 ± 1.8, n = 18, p < 0.01). However, the ACT scores in the non-responder group were even worse after disease progression (15.8 ± 5.0 vs. 11.6 ± 4.2, n = 18, p < 0.001). Conclusion: Our observations indicate that asthmatic patients with acquisition or progression of NSCLC may have worsening of their asthma control status. Those patients with good responses to cancer treatment had improved asthma control. These observations indicate that the Th2 pathway in lung cancer may be a contributing factor in asthma control, another Th2 predominant disorder. More sophisticated clinical and biological investigations are necessary to confirm the role of Th1/Th2 counterbalance in lung cancer in the clinical impact on related immune disorders.

Background: Itchy maceration of the toe webs is common in warm and humid weather. Some cases do not respond to treatment for tinea or eczema. Methods: Patients with foot intertrigo with a poor response to antifungal or antiinflammatory treatment from 2004 to 2009 were included in this study. Their general characteristics were recorded. Bacterial and fungal cultures as well as potassium hydroxide preparations were performed. Results: We recorded 32 episodes of foot bacterial intertrigo in 17 patients. The disease was more common in men (82%) and the mean age of the patients was 59 years. The main clinical finding was maceration of the toe webs. The majority of bacterial cultures grew mixed pathogens (93%). Pseudomonas aeruginosa, Enterococcus facealis and Staphylococcus aureus were the most common pathogens. Autoeczematization was present in 50% of the 32 disease episodes. Conclusion: Foot bacterial intertrigo is not a rare condition and can easily be confused with interdigital tinea or eczematous dermatitis. Proper identification of bacterial organisms is critical for early effective antibiotic therapy. Patients should be instructed about proper foot hygiene, which is important to prevent recurrent infections.

Background: Benzodiazepines cause a high proportion of adverse effects while non-benzodiazepine compounds have demonstrated high efficacy and less adverse effects in patients with insomnia. The objective of this study was to compare the effectiveness and safety of non-BZ zaleplon and zolpidem in primary insomnia. Methods: This was a randomized, double-blind, active-controlled, double-dummy, comparative study. A total of 48 patients were enrolled, of which 45 patients completed the study. Patients who entered the study were required to take the study drug orally once daily at bedtime for two weeks. Each patient kept a sleep diary and answered a questionnaire. We used these documents to measure and evaluate changes from baseline to Week 2 in sleep latency, duration and quality of sleep, the number of awakenings and incidence of rebound insomnia. Results: The data revealed a significant decrease in sleep latency from baseline to Week 2 for patients receiving zaleplon 10 mg and zolpidem 10 mg. Patients receiving zaleplon exhibited a marginally greater, but not statistically significant, reduction in sleep latency than those who received zolpidem. There was no significant difference in the frequency of adverse effects between the zaleplon and zolpidem groups; however, during this clinical trial there was one lethal event caused by a traffic accident in the zaleplon group. Conclusion: There was no significant difference between zaleplon and zolpidem in the efficacy of reducing sleep latency or adverse effects. A large pharmacovigilance study is needed before concluding that either zolpidem or zaleplon is free from next-day residual effects.

Background: The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. Method: A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. Results: One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). Conclusion: The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.

Background: Cytomegalovirus (CMV) infection is uncommon in hematology patients. The clinical pictures and outcomes of this virus are not entirely clear. Method: Consecutive cases of CMV infection (17 patients with 20 episodes) were compiled for study over a six year period. Results: CMV infection occurred in patients of various ages and with a number of underlying hematological diseases, including non-Hodgkin's lymphoma, multiple myeloma (MM), acute myeloid leukemia (AML) and myeloproliferative neoplasm, No single laboratory assay was sensitive enough to serve as a screening test in the diagnosis of CMV infection. A combination of laboratory assays, clinical features and radiographic findings were required for diagnosis. All patients with AML or MM had received various chemotherapies before CMV infection. All but one lymphoma patient had received steroids and rituximab treatment prior to CMV infection. CMV infection episodes were accompanied by various co-infections in 60% (12/20) of cases. Bacterial lobar pneumonia was the most common form of co-infection. We used ganciclovir as the sole antiviral treatment in most of the infection episodes (18/20). Anti-CMV immunoglobulin (cytotect) was also provided to one patient because of persistent fever and dyspnea. Treatment was successful in all but one of the cases, which occurred when ganciclovir was initiated after respiratory failure. This patient died of CMV pneumonia. The other patients had good initial responses to antiviral treatment, but their longterm outcome was poor. Only five patients survived after a short follow-up duration. Conclusions: In an era of intensive immuno-chemotherapy, CMV infection may become a serious threat for hematology patients. Physicians dealing with hematological malignancies should be aware of CMV infection, especially for patients receiving rituximab and steroids.

Background: The aim of this study was to assess the diagnostic performance of stereotactic core needle breast biopsy using spring-loaded or vacuum-assisted techniques for impalpable microcalcification lesions in Taiwanese women. Methods: We retrospectively reviewed the data of patients who received stereotactic core needle breast biopsy for impalpable mammographic microcalcification lesions from January 1999 to February 2009. The accuracy, false negative rate, ductal carcinoma in situ (DCIS) upgrade rate and rate of concordance with biopsy procedures were determined. We also compared the diagnostic performance between the vacuum-assisted and spring-loaded techniques. Results: A total of 335 breast stereotactic core needle biopsy procedures (218 by spring-loaded and 117 by vacuum-assisted technique) were enrolled for analysis. The overall accuracy, false negative rate, DCIS upgrade rate and concordance rate with stereotactic core needle biopsy were 88.5%, 17.3%, 23.1% and 83.8% respectively. The vacuum-assisted technique yielded better results than the spring-loaded technique in accuracy (100% vs. 84%), and the false negative (7.1% vs. 21%), DCIS upgrade (0% vs. 37.5%), and concordance rates (95% vs. 79.6%). Conclusion: Stereotactic core needle biopsy is a feasible technique in diagnosing impalpable microcalcification lesions of the breast in Taiwanese women. The diagnostic performance of the vacuum-assisted technique was better than that of the spring-loaded technique.

Background: Reports of the efficacy of Salter's osteotomy have often been based on groups of patients with complex disease conditions and treatment. The purposes of this study were to document the results of patients with well-defined conditions, focusing on the onset and sequelae of osteonecrosis. Methods: The study participants consisted of 63 patients with unilateral hip dislocation who had undergone one-stage open reduction and Salter's innominate osteotomy between the ages of 1 and 3 years. The results were evaluated clinically by McKay's classification and radiologically by the modified Severin's classification. Early signs of osteonecrosis were identified by neck widening, epiphysis fragmentation, and presence of a metaphyseal growth disturbance line in the first year after the operation. Results: After a follow-up of 10 years on average, good clinical and radiographic results were noted in 89% and 92% of the patients, respectively. Osteonecrosis occurred in 30 hips, of which 14 subsequently developed femoral head deformity. Residual dysplasia was noted in 5 hips, mostly resulting from late-onset coxa valga. Eighty-five percent of the hips without osteonecrosis and 53% of the hips with osteonecrosis (p < 0.05) were classified as Severin class 1. No pre-operative factors were found to be associated with the occurrence of osteonecrosis. Conclusion: One-stage open reduction and Salter's osteotomy was an effective treatment for developmental dysplasia of the hip after walking age. However, parents must be informed of the two major complications, osteonecrosis and residual dysplasia, that can lead to long-term morbidity.

Background: To determine whether magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) are able to distinguish between adenocarcinoma originating from the uterine cervix and endometrium. Methods: Institutional review board approval and informed consent were obtained. From May 2006 to June 2008, 29 women 25-73 years old (mean age, 50.3 years) with a cervical biopsy yielding adenocarcinoma were enrolled for 3-T MR study with the imaging pulse-sequence protocol of T2-weighted imaging (T2WI) and dynamic contrast-enhanced (DCE) MRI and diffusion-weighted MRI (DWI, b = 0, 1000 sec/mm2). The extent and shapes of the tumor and ADC values were evaluated by two radiologists retrospectively. Surgical histopathology served as the reference standard of the tumor origin from the cervix (n = 22) or endometrium (n = 7). The Mann-Whitney U test was used for statistical comparison and receiver operating characteristic (ROC) analysis was used to obtain optimal ADC cut off values. Results: A longitudinal shape occurred significantly more frequently in endometrial cancer, and an oval shape was more frequently found in cervical cancer (p = 0.011). Mean ADC values were significantly lower in endometrial cancer (76.6 x 10– 5 mm2/sec) than in cervical cancer (96.9 x 10– 5 mm2/sec). Receiver operating characteristic analysis yielded an optimal ADC cutoff value of 70 x 10– 5 mm2/sec to distinguish cervical cancer from endometrial cancer. Conclusion: MRI may distinguish between most uterine adenocarcinoma originating from the cervix and endometrium using distinctive characteristics found on T2WI and DCE. When tumors show an ambiguous morphology, the ADC value of the tumor may be helpful for further differentiation.

Background: Primary synovial chondromatosis commonly involves large joints such as the knee and hip. The optimal approaches for successful surgical management of symptomatic primary synovial chondromatosis of the hip joint are controversial. Methods: The current study reviewed 9 patients with primary synovial chondromatosis of the hip who underwent surgical treatment between 2000 and 2005. By identification of the surgical indications, we chose the optimal surgical approach, open arthrotomy or arthroscopic surgery, for a definite treatment. Results: Of the 9 patients, 4 underwent open arthrotomy and 5 underwent hip arthroscopic surgery. The mean follow-up duration was 24.9 months (range, 12– 50). There were no perioperative or postoperative complications. There was 1 recurrence 2 years after the first arthroscopic surgery. All hips remained in stationary condition on radiological follow-up except for 1 hip, the recurrence case. The mean Harris Hip Score at the 12-month follow-up was 93.7 (range, 90– 99). Conclusions: Surgical treatment for primary synovial chondromatosis of the hip proved beneficial for these patients. By means of identified indications, selecting an appropriate surgical approach provides a rapid recovery and low incidence of recurrence.

An implant periapical lesion (IPL) is an infectious-inflammatory alteration surrounding an implant apex. In the English literature, the treatments for IPL have all been surgical methods. We present a case of successful treatment of an IPL with medical methods. A 36-yearold man underwent placement of two implants in the molar region of the right mandible. About one month later, the patient had pain at the surgical site and radiolucencies at the apical portion of the two implants on radiographs. Systemic antibiotic treatment with amoxicillin and acetaminophen was instituted, but the symptoms did not improve. The medications were changed to prednisolone, augmentin and mefenamic acid and the patient's symptoms completely subsided. This case was successfully treated using medical methods. The IPL disappeared on radiography and there were no symptoms or signs of recurrence at the 2-year follow up. We report a successful case of an IPL using medical methods. However, additional data are certainly necessary for a more comprehensive understanding of the etiopathologic and clinical problems related to an IPL.

We present a case of sclerosing syringoid carcinoma of the finger, a type of eccrine sweat duct malignancy that is rare and mimics the appearance of a benign lesion, but is locally aggressive and has a tendency to recur. It has seldom been reported in the literature. It has a predilection for the head and neck region but is rare in the extremities. We believe this is the second reported case of sclerosing syringoid carcinoma in the finger, after the diagnosis was determined from a histological and immunohistochemical study. The disease presentation and the difficulties encountered during establishment of the diagnosis and planning of the treatment are discussed.