Background: Revascularization within a 90-min door-to-balloon time is a strict policy enacted in Taiwan. Prompt diagnosis is critical to avoid an unnecessary procedure and catheterization laboratory activation. This study was aimed to investigate the clinical and prognostic characteristics of the patients with ST-elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI) and normal coronary arteries found following coronary angiography (CAG). Materials and Methods: From October 2009 to December 2012, 216 consecutive patients with STEMI referred for primary PCI were enrolled. The data of clinical history, physical examination, laboratory results, electrocardiography, echocardiography, CAG findings, diagnosis, and outcomes were collected and analyzed. Results: A total of 17 patients were proved normal coronaries angiographically. The incidence of the conditions mimicking as STEMI is 7.9%. Alternative diagnosis was coronary spasm (n = 7), peri-myocarditis (n = 6), apical ballooning syndrome (n = 3), anaphylactic shock (n = 1). Compared with STEMI group, patients in normal coronaries group were younger, with a less premature family history of coronary artery disease (CAD), and reported angina. The 30-day mortality rate in the normal coronaries group was 5.9%. Conclusions: Cautiously evaluating CAD risk factors and symptoms of angina and awareness of alternative diagnosis are important to make a prompt diagnosis without compromising accuracy in the patients presenting as suspected STEMI.

Background: Medical students who graduate after 2003 need to participate in the "Postgraduate Primary Care Medical Training Program," provided by the Taiwan Joint Commission on Hospital Accreditation. We wish to know how the education and assignment strategy influences National Defense Medical Center (NDMC) graduates. We examined whether the performance of postgraduate year (PGY) trainees would be affected by the assignment strategies. Materials and Methods: We consecutively collected 173 NDMC graduated trainees who participated in 6-months of PGY training and another 94 trainees who participated for 1-year. During the training period, all the trainees were evaluated by several assessment tools. Trainees were dichotomized according to the levels of dispatched hospitals and preassigned specialty, respectively, to evaluate those effects on the performance of the 6-month PGY training period. Results: We describe the assessment scores of NDMC graduate M.D. trainees engaged in the Tri-Service General Hospital (TSGH) PGY training program. PGY trainees who were preassigned to TSGH due to better overall averages in medical school had better scores in case-based discussion, mini-clinical evaluation exercise, and direct observation of procedural skills than those who were preassigned to the Regional Teaching Hospitals. There was no statistically significant difference in the overall scores. The preassigned specialties themselves did not affect the performance in PGY training. Incorporation of PGY scores in the assignment strategy significantly elevated the performance of PGY trainees who were dispatched to TSGH. Conclusion: The accumulated PGY training database provides educators a unique opportunity in reviewing the effects of education policies and strategies. Assignment strategy could affect the performance of PGY trainees during their training period.

Background: Injuries are the leading causes of death and contribute greatly to morbidity in children. Our study examined injuries' age and gender-specific variations over time among children 0-19, from 1989 to 2007. Materials and Methods: Numbers of deaths caused by injury are drawn from Taiwan's official Vital Statistics System. Mortality was age-adjusted to the US 2000 standard population. Temporal trends were analyzed by linear regression. Results: Both genders' annual mortality rates and proportional mortality ratios of unintentional injuries declined significantly during 1989-2007. Conversely, an increasing trend of intentional deaths occurred. In general, during 1992-2007, increasing the rates of suicide deaths in ages 10-19 and of homicide deaths in ages 0-9 occurred. Boys had more suicide deaths than did girls. Conclusions: Unlike unintentional injuries, intentional injuries increased over the 1989-2007 period. Deaths in the subgroups of ages 0-19 and categorized by genders were caused by varying injuries.

Background: Anesthesia technique may contribute to the improvement of operation room (OR) efficiency by reducing anesthesia-controlled time (ACT). We compared the difference between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia for gynecologic laparoscopic surgery undergoing general anesthesia. Materials and Methods: We performed a retrospective study using data collected in our hospital to compare the ACT of gynecologic laparoscopic surgery using either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia between January 2010 and December 2011. The various time intervals (waiting for anesthesia, operation time, anesthesia time, emergence time, exit from OR after extubation, total OR time and postanesthesia care unit stay time) and the incidence of prolonged extubation (≥15 min) were compared between the two anesthetic techniques. Results: We included data from 926 patients, with 377 patients receiving TIVA and 549 patients receiving DES. The only significant difference is emergence time, TIVA was faster than the DES group (7.3 ± 3.3 min vs. 8.3 ± 3.1 min; P < 0.001). The factors of prolonged extubation are DES anesthesia, body mass index, surgical time, and anesthesia time. Conclusion: In our hospital, propofol-based TIVA by TCI provide faster emergence compared with DES anesthesia in gynecologic laparoscopic surgery.

Background: This study determines the pain-reducing effect of CyberKnife radiosurgery in the treatment of spinal lesions. Materials and Methods: We evaluated the clinical outcomes of patients treated with CyberKnife radiosurgery for spinal lesions in 65 patients with 76 spinal lesions at Tri-Service General Hospital, Taipei, Taiwan, from July 2007 to May 2013. Pre- and post-treatment visual analog scale (VAS) scores for pain were obtained. Results: In the benign cases, 12 patients had a pretreatment VAS score of 7 (46.2%); 12 patients, 8 (46.2%); and 2 patients, 9 (7.7%). For the posttreatment VAS scores, 10 patients had a score of 1 (38.4%); 15 patients, 2 (57.7%); and 1 patient, 4 (3.8%). In the malignant cases, 2 patients had a pretreatment VAS score of 8 (28.6%); 3 patients, 9 (42.9%); and 2 patients, 10 (28.6%). For the posttreatment VAS scores, 1 patient had a score of 2 (14.3%) and 6 patients had a score of 3 (85.7%). In the metastatic cases, 15 patients had a pretreatment VAS score of 8 (46.9%); 7 patients, 9 (21.9%); and 10 patients, 10 (31.3%). For the posttreatment VAS scores, 3 patients had a score of 1 (9.4%); 11 patients, 2 (34.4%); 16 patients, 3 (50%); and 2 patients, 4 (6.3%). Wilcoxon signed-rank tests to compare the pre- and post-treatment VAS scores in each patient group showed significant decreases in all groups (P < 0.05 for all comparisons). Conclusions: Collectively, these results show that significant pain relief without obvious adverse effects can be achieved when treating spinal lesions using stereotactic radiosurgery.

Background: Hemangiopericytoma is a vascular tumor arises from pericyte of Zimmermann. Hemangiopericytoma arises from varies the location, but most commonly reported in extremities, retroperitoneum, head and neck, spine and cranium. However, intra-abdominal hemangiopericytoma is very rare. There are varies case report of intra-abdominal hemangiopericytoma including liver, spleen, pelvic cavity, and omentum; but primary hemangiopericytoma of the liver is very rare. Case Report: This is a case report of 49-year-old male presenting with abdominal pain for 2 months duration. No other positive history. During evaluation of the patient found to be having a mass lesion in the liver adjacent to caudate lobe, which compresses inferior vena cava. It found to be a primary hepatic hemangiopericytoma of the liver.

A 32-year-old male presented to us with the history of purulent discharge from scrotum since 5 months ago, with increased amount of discharge during sexual intercourse. Magnetic resonance imaging showed a fistula tract ending at the root of the penis. However, intraoperatively it was found to be communicating with the anal canal. Fistula in ano rarely presents with an external opening in the scrotum. We could not find any published literature in this regard. Complex fistula in ano therefore should be considered in cases of scrotal discharging sinus.

Cough caused by scapular osteochondroma has never been reported. This study reports a case of long-term coughing caused by osteochondroma growing over the right scapula. A 44-year-old Asian female presented complaining a persistent cough for 2 months. Physical examination revealed no specific abnormality and clear and symmetrical breathing. A lesion revealed on X-rays, and computer tomography was diagnosed as an osteochondroma of the medial border of the scapula and the tumor caused the rib cage deformity. Following a preoperative examination, the patient underwent open surgery for lesion removal. Histological examination confirmed the clinical diagnosis of osteochondroma. Clinical examination 3 months later demonstrated a healed wound without cough and no recurrence was noted. Cough caused by the mass effect of osteochondroma is rare. The pathophysiology of nonproductive cough might cause by enlarging tumor in the lung field and caused a small part of alveoli atelectasis. Despite its rarity, osteochondroma should be considered in the differential diagnosis of any adult presenting with chronic coughing.

The incidence of aneurysmal subarachnoid hemorrhage (SAH) associated with intraventricular hemorrhage (IVH) varies. In general, the anterior communicating artery and posterior circulation aneurysms cause such IVHs. A 48-year-old man visited the Neurosurgical Department for the evaluation of a severe thunderclap headache that had awakened him from sleep. Brain computed tomography revealed diffuse, but asymmetric, SAH. Digital subtraction cerebral angiography (DSA) showed multiple vascular lesions, including an obvious saccular aneurysm on the left anterior choroidal artery. After surgical clipping, rebleeding was noted, and repeat DSA demonstrated that the bleeding site was on the right posterior cerebral artery. The distribution of SAH associated with the preserved Liliequist membrane may suggest the origin of the bleeding. Treatment of the correct bleeding site is effective for preventing rebleeding.