The Age Distribution among Children Seeking Medical Treatment for Precocious Puberty in Taiwan.

OBJECTIVE: Children with precocious puberty (PP) may have increased physiological and psychological problems. In this study, we aimed to explore the trend of parents seeking medical care for their children with precocious puberty. METHODS: The Taiwan National Health Insurance Research Dataset (NHIRD) was used to estimate the prevalence (2000-2013) and incidence (2002-2013) of PP (ICD-9 code: 259.1) among boys aged 0-11 years and girls aged 0-10 years. The proportions of PP management within 1 year from the date of first diagnosis were also compared between two periods (2002-2007 and 2008-2012). The trends of PP prevalence or incidence were determined by join-point regression. RESULTS: In 2000, 309 boys and 2706 girls had at least one visit for PP, the crude prevalence rates (per 10,000 persons) were 0.99 (95% confidence interval, 95% CI 0.87-1.14) and 13.56 (95% CI 13.01-14.13) in boys and girls, respectively. In 2013, the crude prevalence rates increased to 7.01 (95% CI 6.56-7.84) and 110.95 (95% CI 108.97-112.96) in boys and girls, respectively. A total of 2584 girls and 207 boys with incident PP cases were identified in 2002, and 7498 girls and 739 boys were identified in 2013. For girls, the incidence rates (per 10,000 person-years) were 16.17 (95% CI 15.55-16.80) and 70.23 (95% CI 68.65-71.83) in 2002 and 2013, respectively. For boys, the incidence rates were 1.09 (95% CI 0.95-1.24) and 5.72 (95% CI 5.32-6.15) in 2002 and 2013, respectively. The sex ratio (F:M) of the incidence of PP cases was 14.89 in 2002 and 12.28 in 2013. CONCLUSION: In this study, from 2000 to 2013, the frequency of visiting pediatric endocrinology outpatient clinics for precocious puberty increased in both genders. We advocate that it is important to pay increased attention to children's health, environmental hormones, and diet. Researchers should consider how to survey precocious puberty and offer parents more education to avoid the waste of medical resources or delays in seeking medical care.

Insights Into Microcirculation Underlying Critical Limb Ischemia by Single-Photon Emission Computed Tomography.

Perfusion difference is used as a parameter to evaluate microcirculation. This study aims to differentiate lower-limb perfusion insufficiency from neuropathy to prevent possible occurrence of failed back surgery syndrome (FBSS).Patients were retrospectively gathered from 134 FBSS cases diagnosed in the past 7 years. Up to 82 cases that were excluded from neuralgia by radiologic imaging, electrodiagnostic electromyography, and nerve conduction velocity were enrolled in this study. Perfusion difference was evaluated by single-photon emission computed tomography, and pain intensities were recorded via visual analog scale (VAS) score.Lower perfusion at the left leg comprises 51.2% (42 of 82) of the patients. The mean perfusion difference of the 82 patients was 0.86 ±â€Š0.05 (range: 0.75-0.93). Patients with systemic vascular diseases exhibited significantly higher perfusion difference than that of patients without these related diseases (P < 0.05), except for renal insufficiency (P = 0.134). Significant correlation was observed between perfusion difference and VAS score (r = -0.78; P < 0.0001; n = 82).In this study, we presented perfusion difference as a parameter for evaluating microcirculation, which cannot be detected by ultrasonography or angiography.

Long-term follow-up study of osteoporotic vertebral compression fracture treated using balloon kyphoplasty and vertebroplasty.

OBJECT: Long-term follow-up study is required for verifying whether the clinical outcomes of kyphoplasty and vertebroplasty are altered. The authors' findings showed only subtle differences between these operations within a 5-year period. However, they still suggest the use of vertebroplasty over kyphoplasty in view of the treatment costs. In their previous study, the authors performed a short-term prospective comparison between vertebroplasty and kyphoplasty. Vertebroplasty was recommended instead of kyphoplasty for the treatment of vertebral compression fractures (VCFs) because of the subtle differences between this procedure and kyphoplasty and the treatment costs. To determine whether these clinical outcomes persist in the long term, they continued to observe the patients from their short-term study over a longer-term period. METHODS :One hundred cases of VCF were assigned randomly to either the kyphoplasty or the vertebroplasty group. In cement augmentation, the authors used polymethylmethacrylate as bone filler. Pain was assessed by using a visual analog scale (VAS). For each patient, vertebral body height and wedge angle were measured from reconstructed CT images. RESULTS: The duration of the follow-up period was 5 years. Vertebral body height, kyphotic wedge angle, and VAS score were not evidently altered. Eight patients in the kyphoplasty group had an adjacent fracture after the procedure, whereas 7 patients in the vertebroplasty group had an adjacent fracture after the procedure. These adjacent fractures occurred within 1 year of surgery in both treatment groups except in 1 kyphoplasty-treated patient in whom the adjacent fracture was noted 16 months after treatment. Three patients in the vertebroplasty group had a nonadjacent fracture, and 4 patients in the kyphoplasty group had a nonadjacent fracture. The link between angular correction and the occurrence of adjacent fracture was statistically significant in the vertebroplasty group. CONCLUSIONS: Excessive angular correction is a critical concern in the risk of adjacent fracture after vertebroplasty. Given the subtle differences between vertebroplasty and kyphoplasty observed over the course of 5 years, vertebroplasty remains the preferred option in view of the costs.

Selective retromastoid vestibular neurectomy for intractable Ménière's disease: a technical note.

BACKGROUND: Retrosigmoid vestibular neurectomy is considered to be the most effective and safe procedure to control intractable vertigo associated with Ménière's disease while preserving hearing. The surgical procedure of retrosigmoid vestibular neurectomy at the cerebellopontine angle has been well established. Here, we provide for otologic surgeons additional details about the procedure, with special attention to the anatomic features to emphasize our technique, which enables an adequate sectioning of the vestibular fibers on the cochlear nerve close to the overlapping zone containing large-caliber vestibular fibers and small-caliber cochlear fibers. METHODS: We used the lateral decubitus position to enter the cerebellopontine angle. The cerebellum was gently retracted to expose the cerebellomedullary cistern, which was then opened to drain the cerebrospinal fluid for slacking of the cerebellum. The underlying lower cranial nerves IX, X, and XI were identified. The retractor was then moved upward to locate the internal acoustic meatus and the complexes VIII-VII. Adjacent to the internal auditory canal, a longitudinal incision, about 3 mm long and 0.5 mm away from the landmarks of arteriole or cochleovestibular cleavage plane, was made on the cochlear nerve. A surgical separation plane was bluntly created using a microdissector between the two components, and the vestibular nerve was sharply sectioned with microscissors. RESULTS: We re-examined the patients' hearing status, word recognition (speech discrimination) skill, functional levels, and frequency of vertiginous episodes 1 month and at all 6-month intervals after the surgery. At 2 years after surgery, vertigo was completely controlled, indicating a 100% cure rate. CONCLUSION: Sectioning of vestibular fibers was performed along the cochleovestibular cleavage landmark on the cochlear nerve where the overlapping zone was located, allowing for a safe and adequate vestibular neurectomy, while most of the cochlear fibers were spared.

Brainstem hemorrhage caused by direct carotid-cavernous fistula. A case report and literature review.

A 34-year-old woman presented with a history of persisting headache for years, and a newly developed dizziness, left facial palsy and right hemiparesis two days prior to this admission. Initial computed tomographic angiography of the head demonstrated an area of increased density in the left middle and posterior fossae. Multiple aneurysmally dilated venous ectasias with contrast enhancement at the left pre-pontine cistern causing a massive mass effect to the brainstem were also noted, suggesting a huge vascular abnormality. Digital subtraction angiography revealed an abnormal vascular lesion surrounding the brainstem, which indicated a left direct carotid-cavernous fistula with posterior drainage. As her consciousness deteriorated the next day, a follow-up computed tomography scan was done which revealed a pontine hemorrhage. Subsequently, endovascular closure of the fistula with sacrifice of the left ICA was performed, which successfully eliminated the imaging abnormalities.

En bloc resection concept for endoscopic endonasal nasopharyngectomy: surgical anatomy and outcome.

BACKGROUND: Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy. For those recurrent NPC (rNPC) patients, re-irradiation may cause some complications. In recent years, endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients. Here we introduce the concept of en bloc excision (EBE) technique for EEN, including the surgical technique and clinical outcomes. METHODS: A retrospective study was conducted covering September 2009 to May 2013, involving the collection of locoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore). These patients failed prior therapy and then underwent EEN. We reported the 2-year overall survival rate, the 2-year disease-free survival rate, and related complications. RESULTS: Nine patients (five from KTGH and four from NUHS) completed this study, with five, two, and two patients of recurrence tumors (rT1), rT2, and rT3, respectively. The mean age was 46.4 years (range 32-63); the mean follow-up period was 24.9 months (range 10-45). The 2-year survival rate and the 2-year disease-free rate were 100% and 80%, respectively, in five patients. No significant complications or cases of mortality occurred. CONCLUSIONS: The EBE concept of EEN is suitable for early rT1 and has relatively encouraging short-term outcomes. In selected rT2, careful EBE can be performed by expanding the surgical field. A clear view of the internal carotid artery-related anatomy is indispensable. In the future, more series may be needed to determine the role of EEN in rNPC patients.