Background: Duodenal contents reflux through the pylorus into the stomach can cause chronic gastritis and gastric cancer. This study aims to propose a new classification of endoscopic findings of duodenogastric reflux (DGR) in symptomatic patients. Patients and Methods: Eighty-eight patients with symptoms of DGR were included. Endoscopic findings, Helicobacter pylori, and mucosa pathological were recorded. Hepatobiliary scintigraphy was performed to quantify the DGR. Results: Among the 88 patients, 41 patients had normal mucosa (control group), 36 patients had bile lake (BL) (Group A), and 11 patients had bile stain (BS) (Group B). Group A significantly increases in postprandial DGR at 50 and 60 min. Group B significantly increases in fasting DGR at 50 and 60 min and postprandial DGR at 30, 40, 50, and 60 min. Group A and Group B had significant high intestine metaplasia and mucosal inflammation score than those in control group. Group B had a significantly higher incidence of gastric polyp than those patients in Group A and control group. Conclusions: Endoscopic findings of BS increased both fasting and postprandial DGR. BL had significant increased postprandial DGR. DGR increased the intestine metaplasia, mucosal inflammation, and gastric polyp in the stomach.

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Background: Imaging-guided surgery provides intraoperative realtime navigation for spinal surgery to prevent neurovascular injury. However, the initial experience of O-arm three-dimensional (3D) navigation is less clarified. The study aims to evaluate the accuracy of O-arm 3D navigation-assisted spinal implantation. Materials and Methods: Total 118 transpedicle/lateral mass screws in 17 consecutive patients performed through O-arm 3D computed tomography (CT) imaging navigation. Screws accuracy, Visual analogue scale (VAS), and operation time were assessed. O-arm 3D navigation included 96 pedicle screws and 22 lateral mass screws. Results: There accuracy rate of screw implantation was 96.6% (114/118) without breach (Grade 0), whereas 3.4% (4/118) breach between 2 and 4 mm (Grade 2). In the cervical spinal, 12 pedicle screws were placed in 4 patients; 16.7% (2/12) exhibited a Grade 2 breach in one patient, who developed a new neurological deficit and required revision. In the lumbosacral spine, 2.78% (2/72) exhibited a Grade 2 breach in 2 patients. The mean ± standard deviation VAS of the patients in postoperative and preoperative status was 1.47 ± 0.50 and 3.58 ± 1.00, respectively. The operation time was significantly longer in O-arm navigation than in C-arm guidance (426.5 ± 180.4 vs. 317.9 ± 133.6 min, P < 0.05). Conclusion: O-arm 3D navigation achieves a relatively high accuracy of pedicle and lateral mass screws implantation. The accumulation of experience for O-arm 3D CT during initial learning curve is still warranted to promote the accuracy of screws position and shorten operation time.

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Objective: The present study aimed to investigate the relationship among neurocognitive variables, depressive symptoms, functional activities, and the quality of life (QoL) in patients with mild dementia and single-domain amnestic mild cognitive impairment (a-MCI). Materials and Methods: Thirty-seven mild dementia patients and thirty a-MCI participants were recruited. All subjects participated in a series of neuropsychological measures (Cognitive Abilities Screening Instrument, family pictures, and digit span), geriatric depression scale-15 (GDS-15), activities of daily living (ADL), The Lawton instrumental ADL scale (IADL) and QoL-Alzheimer's disease. Results: Multiple regression analysis revealed that only depressive symptoms was a predictor for the QoL in mild dementia (β = −0.56, P < 0.001). In contrast, all variables were not associated with the QoL in a-MCI. Mildly demented people scored significantly lower on most aspects of cognitive functioning and reported poorer performances on IADL than a-MCI. There were no significant differences on GDS, ADL, and QoL between the two groups. Conclusion: Findings indicated that depressive symptoms contributed to the QoL in mild dementia. Interventions targeting depressive symptoms in mild dementia may improve their QoL during their early stages of dementia.

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Reexpansion pulmonary edema (RPE) is an important cause of unilateral pulmonary edema that rarely occurs following drainage of pleural effusion or pneumothorax. Most patients develop symptoms within an hour of lung expansion. The presentation is usually rapid and dramatic and may be fatal at times. The duration of lung collapse more than 3 days, large-size pneumothorax, rapidity of lung expansion, and application of negative pleural suction are well-known risk factors for the development of RPE. We present here an elderly male with diabetes mellitus who presented with a large pneumothorax and developed RPE shortly after insertion of a chest tube.

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Profunda femoris artery (PFA) injury is a rare complication following fracture of the femoral neck. Here, we present a case of a patient with an injured branch of the PFA following internal fixation with cannulated hip screws for a femoral neck fracture. Computed tomography angiography revealed active bleeding from the ascending and descending branches of lateral femoral circumflex artery. We suspected that the cause of the vessel laceration was the sharp tip of the guidewire used during surgery or the closed reduction performed during surgery. The patient was successfully treated with coil embolization. With early recognition and prompt radiological intervention, this rare complication following fracture fixation surgery can be treated without the need for additional surgery.

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We present a case of port-site metastasis in a 60-year-old Taiwanese woman who underwent laparoscopic gastrectomy. Seventeen months after surgery, the patient presented with a firm mass (4 cm × 4 cm in size) over the site of the umbilical surgical wound. Wide excision of the umbilicus was performed. Histological examination of the excised mass showed umbilical adenocarcinoma with no evidence of peritoneal nodules, and the patient was discharged to receive further chemotherapy treatment. After 15 months of follow-up, there was no indication of tumor metastasis.

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Conscious change following head injury needs a scrutiny of the "nontraumatic" cause to avoid inappropriate management and catastrophic complication. We described an 81-year-old diabetic woman with advanced chronic kidney disease (CKD) (estimated glomerular filtration rate: 6 ml/min/1.73 m ² ) re-presented to Emergency Department with altered mentality and generalized muscular hypotonia 2 days after falling with a head injury. Her initial mentality was alert, and computed tomography of the brain was negative for organic lesions; she has been given oral baclofen 10 mg daily to control her associated spastic back pain. The repeated laboratory and imaging studies were still unrevealing. Her serum baclofen concentration was markedly elevated (1437 ng/ml). With emergent hemodialysis for two sessions, complete elimination of serum baclofen concentration was accompanied by full recovery of her consciousness. Nontraumatic causes, especially drug-induced neurotoxicity, must be kept in mind in traumatic patients with CKD and unexplained neurological feature.

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Background: The purpose of this study was to analyze the characteristics of the children with developmental delays (DDs) in Kinmen. The methods of evaluation for the children with DDs were also discussed as references for other rural areas in Taiwan. Materials and Methods: There were 73 children recruited into our study in 2003 while starting the project of early evaluation for children with DDs in Kinmen. All the children were classified into 6 functional delay groups: Cognitive, speech, motor, social/emotional, pervasive, and nonspecific DDs. Results: Speech DD (46.7%) was the most frequently seen in all types of DDs. The second was the motor DD type (34.7%). Both the cognitive and pervasive types were the third frequent types of DDs (25.3%). It was shown that the speech DD types were the most frequently seen both in Taiwan and Kinmen, but the motor DD type was more frequent in Kinmen than in Taiwan. Conclusions: Our findings suggested that there are various factors related to the types of DDs. This result of our study could provide the future directions of the early evaluation program for the children with DD in rural areas.

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