中毒疾病

有鑑於中毒病人的致病機轉與治療和其他疾病大不相同，為了讓這些病人得到更優質的照護，林杰樑教授於民國98年成立臨床毒物科。另外，為了提升中毒患者更優質的醫療品質，規劃執行醫療人員毒物知能訓練，並提供毒物諮詢及研究，林口長庚醫院於民國106年特成立功能性組織”臨床毒物中心”，目前中心主任為顏宗海教授。

林口長庚臨床毒物中心歷年了收治了許多中毒病患，其中毒原因五花八門，表現出的臨床症狀和致病機轉也因中毒的種類而有所差異，因此其治療方式和常見疾病也大不相同。臨床上常見的中毒疾病包含下列幾種。

>>林口長庚醫院臨床毒物中心

>>林口長庚醫院臨床毒物中心-臨床服務 

  1. 職業中毒: 金屬、有機溶劑、有毒化合物等
  2. 農藥中毒: 巴拉刈、有機磷、胺基甲酸、嘉磷賽(年年春)、除蟲菊精等
  3. 居家毒物: 甲醛、碘酒、漂白水、強酸、強鹼、樟腦丸、老鼠藥等
  4. 環境毒物: 環境賀爾蒙（多氯聯苯、戴奧辛、塑化劑、雙酚A等），金屬（鉛、鎘、砷、汞、銅、鎳、鉈、硒、銻、鉻、鋅、鉍、碲、鈷、銦等）
  5. 誤食或被有毒生物叮咬: 毒蛇、蜈蚣、虎頭蜂、河豚、蟾蜍、珊瑚礁魚、水母等
  6. 黑心食品或藥品: 有毒草藥、違法減肥產品、黑心食品等
  7. 處方藥中毒: 毛地黃、鈣離子阻斷流、抗心律不整藥物、環類抗憂鬱劑，抗精神病藥物、鋰鹽、單胺氧化脢抑制劑、止痛藥、抗生素等
  8. 酒精及其他濫用毒品: 假酒（甲醇）、乙醇、海洛英、大麻、鴉片類藥物、強力膠、安非他命、搖頭丸、K他命、迷幻藥等
  9. 有毒植物: 曼陀羅、八角蓮、夾竹桃、姑婆芋、烏頭、毛地黃等
  10. 其他: 任何懷疑中毒之個案

>>林口長庚醫院臨床毒物中心-成果介紹 

農藥中毒-以巴拉刈中毒為例

20%的巴拉刈只要15 mL就足以造成死亡，中毒病人會口腔潰爛、多重器官衰竭、肺部纖維化、並在二至三週時因缺氧而死亡。林杰樑教授率先提出了巴拉刈中毒的有效治療方法，他採用重覆類固醇及免疫抑制劑脈衝療法，再加上即時的活性碳血液灌流除汙，大幅度降低了病人的死亡率，存活率更高達50-60%。這種方法已為許多國家採用，也被列為巴拉刈中毒的標準治療方法，有多家權威實證醫學機構，認為這是目前為止唯一對巴拉刈中毒有效的療法。相關研究除撰寫過教科書外，亦發表了一系列論文於許多國際期刊如美國呼吸及重症照護、重症醫學、胸腔醫學等等。

以鉛中毒為例

林口長庚醫院臨床毒物團隊，於2008年在美國腎臟病雜誌（American Journal of Kidney Diseases）發表文章指出長期血液透析的病人，也會有鉛蓄積的問題，且其血鉛濃度和體內的發炎指數、營養不良指數及死亡率是息息相關的。另外2010年發表在腎臟透析移植期刊（Nephrology Dialysis Transplantation）指出，長期腹膜透析的病人，其血鉛濃度和透析病人的殘於腎功能、續發性副甲狀腺機能亢進和死亡率是正相關的。臨床上，一旦發現鉛中毒不必過度恐慌，只要避免持續暴露，症狀往往能改善，但當症狀無法緩解時則須考慮螯合劑[EDTA（ethylenediaminetetraacetate acid），DMSA（dimercaptosuccinic acid），DMPS（dimeracpto-1-propanesulfonic acid）治療。

2003年，林口長庚醫院林杰樑教授觀察到慢性腎病惡化的其中一個原因是和鉛污染有關，當病人的腎功能惡化是鉛污染造成時，適時給予螯合劑治療，可以降低血液中鉛濃度，也能有效減緩腎功能惡化。過去20多年來，林口長庚醫院臨床毒物團隊陸續發表了一系列關於長期暴露於低劑量鉛對慢性腎病惡化的論文於國際期刊，包括新英格蘭醫學雜誌、內科醫學年鑑雜誌、內科醫學檔案雜誌、美國醫學雜誌、美國腎臟醫學會雜誌、國際腎病雜誌、腎臟透析移植期刊等等。

>>林口長庚醫院臨床毒物中心-醫療團隊 

由臨床醫療團隊和毒物實驗室團隊組成:包括腎臟系臨床毒物科團隊及毒物實驗室團隊。

腎臟系臨床毒物團隊:

主要由長庚醫院腎臟科醫師組成，包括顏宗海醫師、許景瑋醫師、陳冠興醫師、黃文宏醫師、翁正昊醫師、劉守璿醫師。

毒物實驗團隊:

主要由毒物實驗室所屬的人員組成，包括譚敦慈護理師、林中英副研究員及研究助理。

>>林口長庚醫院臨床毒物中心-成果介紹

(cgmh.org.tw)

一、農藥中毒治療成果

以巴拉刈中毒為例

接受重覆類固醇及免疫抑制劑脈衝療法的巴拉刈中毒病人，存活率會較沒有接受螯合劑治療的高。（Intensive Care Med. 2011 Jun;37(6):1006-13）

二、重金屬中毒治療成果

以鉛中毒為例

接受螯合劑治療的鉛中毒病人，腎絲球過濾率會較沒有接受螯合劑治療有改善。（N Engl J Med. 2003 Jan 23;348(4):277-86）

案例1汞中毒:

高雄一名50多歲婦人，平日即愛吃魚，又額外補充朋友自製的鯊魚軟骨膠囊，日前她出現手抖、無力等症狀就醫，被發現血汞濃度是常人近四倍，醫師建議她停止服用鯊魚軟骨膠囊與少吃遠洋大型魚類，症狀即改善。醫師表示，海魚富含Omega-3等營養素，有助降低心血管疾病風險，但遠洋大型魚類易含甲基汞，食用需適量，以50公斤婦女為例，每周攝取的遠洋大型魚量，應小於80公克、約半個巴掌大。

案例2甲醇中毒:

誤喝甲醇假酒死亡率近3成！長庚醫院毒物團隊統計14年來接獲50位甲醇中毒患者的就醫紀錄，發現中毒來源逾半是喝到含甲醇酒精飲料，由於甲醇進入人體會代謝成甲醛、甲酸，毒性是甲醇的6至33倍，就算就醫治療，死亡率仍高達28%，幸運救回也恐有失明、腎衰竭等後遺症，呼籲民眾不要飲用來路不明的酒，酒後發生視力模糊等異狀，要趕快就醫檢查。

案例3巴拉刈中毒:

農藥巴拉刈已於去年2月1日被農委會宣布禁用，但部分鄰近亞洲國家仍廣泛將其用於農作，國內某些場所也仍有巴拉刈儲存，為改善巴拉刈中毒可達7成的高致死率，長庚醫院、台北榮總與清華大學聯手開發出全球首款巴拉刈尿液檢測試劑，10分鐘即可知檢驗結果，比傳統檢驗法省下近3倍時間，有助搶救更多人命，也是台灣之光。

案例4河豚中毒:

一對六旬夫婦乘船到基隆外海海釣，釣到整桶河豚，當晚就大啖美味的鮮魚湯，不料，太太先感到眩暈、嘴唇、舌頭發麻，被緊急送醫後，隔天先生也出現眩暈症狀，覺得天花板在轉，經送驗確診是河豚中毒。所幸住院4天後，身體漸進代謝掉毒素，康復出院。醫師提醒，河豚毒素屬於神經毒，食用有可能造成心臟與呼吸衰竭，勸民眾不認識的魚都不要吃。

案例5鉛中毒:

一名40多歲台商赴非洲投資從事煉鉛工作，近期返台準備過農曆春節，年前健檢卻赫然發現，血鉛濃度飆高到71.7 ug/dl，比一般成人高出6倍，尿鉛濃度也比常人高1倍；醫師提醒，焊接工、油漆工也是高危險群，甚至生活中常見的汽機車廢氣、蠟燭、鮮豔食器，甚至大骨湯等，也可能有鉛毒害。?

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>>林口長庚醫院臨床毒物中心-衛教園地

一、懷疑重金屬中毒，該選擇哪一種檢查？

12項有毒金屬及元素的尿液檢測，包含了銅(Copper，Cu)、鋅(Zinc, Zn)、錳(Manganese, Mn)、鎳(Nickel, Ni)、鉛(Lead, Pb)、鎘(cadmium, Cd)、砷(Arsenic, As)、汞(Mercury, Hg)、銻(Antimony, Sb) 、鍗(Tellurium, Te)、鉍(Bismuth, Bi) 、鉈(Thallium, Tl) 。若遇到有中毒狀況之病人，醫師將會立即安排適當的醫療處置。

二、餐廳裡的和牛是天然的還是加工的？

毒物專家教分辨注脂肉與重組肉，這些疾病患者要少吃 :

顏宗海指出，注脂肉會額外加工處理，把一些脂肪組織打進肉品，因此建議有三高的病人應少吃注脂肉，吃多了可能膽固醇、三酸甘油脂都會飆高，長期下來會增加罹患心血管疾病的風險。另外，重組肉最大的問題，是磷酸鹽的含量非常高」，磷是經由腎臟代謝，像洗腎患者若是一整天一滴尿都沒有，磷根本就無法排掉，因此，洗腎病人雖然要多吃肉，但建議重組肉就不要吃了。Read more 

三、三高、長者留意4大熱傷害！醫：異常症狀盡速就醫不要拖 :

熱痙攣、熱衰竭、中暑。任何人都有可能發生熱傷害，但三高、心臟病、腎臟病等慢性病患者因散熱機制較不易出汗，調節能力較差。調節系統發育尚未完全的嬰幼童、65歲以上調節能力不足的年長者、體脂肪較多阻饒散熱BMI≧24的肥胖者也都需注意。另外，部分藥物(如利尿劑、抗憂鬱劑及抗精神疾病藥劑等)也會增加熱傷害的機率，而需長期在戶外曝曬、高溫、密閉空間等悶熱場所活動的工作者，也是風險族群之一。若真的遇到熱傷害，顏宗海醫師建議，除了當下應盡快至蔭涼處休息，也應盡可能將衣物寬鬆透氣，並尋找冰塊、冷水協助降溫，以白開水、電解液、運動飲料補充水分及電解質。也觀察相關症狀，必要時盡速就醫，以免危及生命安全。Read more

四、福島食品解禁！是核食？有何風險？ 醫詳解要注意什麼 :

福島食品和核食是兩種不同的存在，應分成兩件事情看待，開放「福食」不代表開放「核食」，最重要的關鍵就在政府需作好完善的風險管理。對於福食解禁，顏宗海醫師也呼籲政府應落實所公布的三原則、三配套管制，執行機關也需加強食品安全的把關，產品包裝建議要明確標示產地，讓民眾有自由選擇的權利。而民眾採買食品時，也建議以台灣在地的農、漁、牧產品為優先考慮，購買食品時，應注意產品標示，減少相關疑慮。Read more

五、享受烤肉避免致癌物上身 顏宗海：留意６原則烤肉也能很健康 :

長庚醫院顏宗海醫師表示，若想避開致癌地雷，最基本的觀念就是「避免過度加熱、避免食物烤焦」。像是油炸、油煎、大火快炒等方式溫度通常都相當高，這些高溫的烹調方式都容易使得食物產生有致癌疑慮的物質。另外建議避免大魚大肉，在烤肉的同時可以用2:1蔬菜包肉的方式進行，不僅增加口感、解膩、蔬菜的纖維也可以避免過量飲食造成身體負擔。飲料則建議可以無糖綠茶取代啤酒、汽水等。Read more

六、腰痛是腎臟病嗎？醫：不可大意 4種人最容易洗腎 :

顏宗海醫師表示，腰痛可分成三大類型，包括和骨骼、肌肉、神經有關的結構性疼痛；與發炎、疾病、免疫疾病有關的發炎性疼痛，例如僵直性脊椎炎、乾癬性關節炎等；以及臟器性疼痛，包括了民眾常聽說、常會擔心的腎臟問題。當中以結構性和發炎性最為常見，臟器性雖然較為少見，但一樣不可大意。腎臟疾病繁多，與腰痛有關的較常見包括了急性腎盂腎炎、腎結石、腎臟腫瘤等，目前僅有嚴重的腎結石所造成的雙側腎水腫才有可能進入到洗腎這個階段。Read more

七、避免洗腎吃清淡一點就好？醫：日常8風險都要留意

顏宗海醫師說，飲食習慣偏鹹，確實會增加洗腎的風險，但並不是直接的影響，最主要的因素在於，這般飲食習慣容易引起高血壓及糖尿病。高血壓、高血糖及糖尿病、高血脂，三高彼此環環相扣，得一者也會容易得另外兩者，這些疾病的常見的共同風險，除了家族遺傳和飲食偏鹹，也包括了鮮少運動、不常喝水、身材肥胖、不吃蔬果等。若是引起高血壓及糖尿病等疾病，又不控制或未妥善治療，接下來就可能引起腎臟病變及其他併發症，換言之，若要防範洗腎，這些都是需要注意的問題，而不單只著重在飲食口味。Read more

八、尿量變少留意4情況！腎臟科醫師提醒：嚴重恐高血納、腎衰竭:  

民眾若發現到自己尿量變少，可先初步檢視自己是否飲水過少、出汗過多，也觀察尿液顏色是否較深、出現口乾舌燥等情況，並盡快補充水分。若是觀察到自己的排尿量明顯大幅減少，甚至少於400c.c，甚至開始意識模糊，此時多半有身體異常或疾病的情況，為避免高血納、腎衰竭而有生命危險，應盡快就醫檢查，而若檢查無虞，也可透過點滴等方式加速水分補充。顏宗海醫師也叮嚀水分來源應避免酒、咖啡、茶等，具有利尿作用的飲品，以及糖分較高容易影響血管健康的手搖飲、汽水、飲料等，飲水以白開水為佳，並分散時間避免一次過量，或只有在某個時段飲水，否則這也代表著身體只有該時間水分充足，一樣不利健康。Read more

九、瘦肉精吃了會怎樣？可以用高溫「煮掉」嗎？顏宗海詳解 :

長庚醫院顏宗海醫師表示，所謂「瘦肉精」其實種類繁多，此次因美豬進口備受關注的「萊克多巴胺」為其中一種，且在眾多的瘦肉精種類中，萊克多巴胺算是毒性最低的一種，目前各國進口家禽前都有相關風險評估、標準訂定、嚴格控管等配套措施。然而，顏宗海指出，就現有研究來看，大量攝取萊克多巴胺，對敏感族群如心血管疾病、嬰幼兒或孕婦有可能引發頭暈、噁心、血壓上升、心悸、胸悶，同時也會增加心血管合併症等風險。此外醫師提醒，內臟器官的瘦肉精殘留量是最高的，若肝腎功能不佳者也應該少吃。瘦肉精的耐熱度相當高，目前尚未有確切指出高溫能去除掉瘦肉精的研究證據。因此，還是呼籲民眾應注意自己是否為敏感族群，購買豬肉產品時應留意產地及來源，建議以國產豬為主。Read more

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  228. Lee YC, Lin JL, Lee SY, Hsu CW, CH, Chen YH, Yang CW, Yen TH*. Outcome of patients with lithium poisoning at a far east poison center. Hum Exp Toxicol 2011;30:528-34
  229. Wang TY, Hu CJ, Kuo CW, Chen Y, Lin JL, Yang CW, Yen TH*. High incidence and recurrence of transitional cell carcinoma in Taiwanese patients with end-stage renal disease. Nephrology 2011;16:225-31
  230. Chen KH, Lin JL*, Lin-Tan DT, Hsu CW, Huang WH, Yen TH, Weng SM, Hung CC. Glycated Hemoglobin Predicts Mortality in Nondiabetic Patients Receiving Chronic Peritoneal Dialysis. Am J Nephrol 2010;32:567-74
  231. Tseng JR, Lee MJ, Lin JL, Yen TH*. Definite and probable septic pericarditis in hemodialysis. Ren Fail 2010;32:1177-82
  232. Lee CC, Lin JL, Hsieh HH, Yen TH*. Pseudoporphyria in a haemodialysis patient. NDT Plus 2010;3:592-93
  233. Chen KS*, Wang CH, Yen TH, Chen JR, Hung MJ, Lin CY. Potential role of bone marrow-derived cells in the turnover of mesothelium. Ren Fail 2010;32:1081-7
  234. Liang CC, Lin HH, Wang IK, Kuo HL, Liu JH, Yeh HC, Chang CT, Yen TH, Hung CC, Huang CC*. Influence of predialysis comorbidity and damage accrual on mortality in lupus patients treated with peritoneal dialysis. Lupus 2010;19:1210-8
  235. Hsu CW, Lin JL*, Lin-Tan DT, Yen TH, Chen KH. White blood cell count predicts all-cause, cardiovascular disease-cause and infection-cause one-year mortality of maintenance hemodialysis patients. Ther Apher Dial 2010;14:552-9
  236. Yen TH*, Lin JL, Weng CH, Tang CC. Colic induced by lead. CMAJ 2010;182:E381
  237. Yen TH*, Chen Y, Fu JF, Weng CH, Tian YC, Hung CC, Lin JL, Yang CW. Proliferation of myofibroblasts in the stroma of renal oncocytoma. Cell Prolif 2010;43:287-96
  238. Yen TH*, Lin JL, Lin-Tan DT, Hsu CW. Association between body mass and mortality in maintenance hemodialysis patients. Ther Apher Dial 2010;14:400-8
  239. Hsu CW, Lin JL*, Lin-Tan DT, Yen TH, Chen KH, Huang WH, Ho TC, Huang YL. High-calcium dialysate - a factor associated with inflammation, malnutrition and mortality in non-diabetic maintenance haemodialysis patients. Nephrology 2010:15;313-20
  240. Yen TH*, Lin JL, Lin-Tan DT, Hsu CW, Weng CH, Chen YH. Spectrum of corrosive esophageal injury after intentional paraquat ingestion. Am J Emerg Med 2010: 28;728-33
  241. Liang CC, Huang CC, Wang IK, Chang CT, Chen KH, Weng CH, Lin JL, Hung CC, Yang CW, Yen TH*. Impact of renal survival on the course and outcome of systemic lupus erythematosus patients treated with chronic peritoneal dialysis. Ther Apher Dial 2010;14:35-42
  242. Lin JL*, Lin-Tan DT, Chen KH, Hsu CW, Yen TH, Huang WH, Huang YL. Blood lead levels association with 18-month all-cause mortality in patients with chronic peritoneal dialysis. Nephrol Dial Transplant 2010: 25:1627-33
  243. Weng CH, Hsu CW, Yu CC, Yen TH, Yang CW, Hung CC*. Peritoneal dialysis and hemodialysis in systemic lupus erythematosus patients: comparison of clinical outcomes. Kidney Blood Press Res 2009;32:451-6
  244. Yang PY, Lin JL*, Lin-Tan DT, Hsu CW, Yen TH, Chen KH, Ho TC. Residual daily urine volume association with inflammation and nutrition status in maintenance hemodialysis patients. Ren Fail 2009;31:423-30
  245. Lu CY, Yen TH, Hsieh ML, Chen Y*. Spontaneous rupture of adrenocartical carcinoma: a coincidence or a tendency? Clin Nephrol 2009;72:147-50
  246. Yen TH*, Lin JL, Lin-Tan DT, Hsu KH. Cardiothoracic ratio, inflammation, malnutrition and mortality in diabetes patients on maintenance hemodialysis. Am J Med Sci 2009;337:421-8
  247. Tseng JR, Lee MJ, Yen KC, Weng CH, Liang CC, Wang IK, Chang CT, Lin-Tan DT, Lin JL, Yen TH*. Course and outcome of dialysis pericarditis in diabetic patients treated with maintenance hemodialysis. Kidney Blood Press Res 2009;32:17-23
  248. Hsu CW, Lin JL*, Lin-Tan DT, Yen TH, Huang WH, Ho TC, Huang YL, Yeh LM, Huang LM. Association of environmental cadmium exposure with inflammation and malnutrition in maintenance haemodialysis patients. Nephrol Dial Transplant 2009;24:1282-8 
  249. Weng CH, Chang CT, Lin JL, Hung CC, Yang CW, Yen TH*. Candida cholecystitis in a diabetic patient on chronic peritoneal dialysis. Dial Transplant 2008;37:458-9
  250. Yen TH*, Chang CT, Lin-Tan DT, Lin JL. The case: a woman with postpartum fever. Kidney Int 2008;73:1327-8
  251. Lin HH, Yen TH, Huang CC, Chiang YJ, Kuo HL*. Blood eosinophilia, corticoadrenal insufficiency and eosinophilic cystitis. Urol Int 2008;80:219-21
  252. Weng CH, Yen TH, Chen KH, Hung CC, Wu JH, Yang CW, Chang CT*. The quality of hemodialysis in patients with mental retardation. Ren Fail 2008;30:63-5
  253. Yen TH*, Chang CT. The case: a young woman with abdominal discomfort and a mass. Kidney Int 2008;73:367-8
  254. Lin JL*, Lin-Tan DT, Yen TH, Hsu CW, Jenq CC, Chen KH, Hsu KH, Huang YL. Blood lead levels, malnutrition, inflammation, and mortality in patients with diabetes treated by long-term hemodialysis. Am J Kidney Dis 2008;51:107-15
  255. Chang CT, Hung CC, Chen YC, Yen TH, Wu MS, Yang CW, Phillips A, Tian YC*. Transforming growth factor-1 decreases epithelial sodium channel functionality in renal collecting duct cells via a smad4-dependent pathway. Nephrol Dial Transplant 2008;23:1126-34
  256. Lin-Tan DT, Lin JL*, Yen TH, Chen KH, Huang YL. Long-term outcome of repeated lead chelation therapy in progressive non-diabetic chronic kidney diseases. Nephrol Dial Transplant 2007;22:2924-31
  257. Yen TH, Alison MR, Cook HT, Jeffery R, Otto WR, Wright NA, Poulsom R*. The cellular origin and proliferative status of regenerating renal parenchyma after mercuric chloride damage and erythropoietin treatment. Cell Prolif 2007;40:143-56
  258. Yen TH*, Wright NA. The gastrointestinal tract stem cell niche. Stem Cell Rev 2006;2:203-12
  259. Yen TH, Chen Y, Lin JL*, Ng KF. Renal oncocytoma in Taiwan. Ren Fail 2006;28:141-7
  260. Yen TH, Huang CC*, Lin HH, Huang JY, Tian YC, Yang CW, Wu MS, Fang JT, Yu CC, Chiang YJ, Chu SH. Does hepatitis C virus affect the reactivation of hepatitis B virus following renal transplantation? Nephrol Dial Transplant 2006;21:1046-52
  261. Wu HH, Chang CT, Yen TH, Hung CC*. A case of adrenal aldosteronoma with horseshoe kidney and duplicated inferior vena cava. Nephrol Dial Transplant 2005;20:2858-60 
  262. Lee SY, Wang LJ, Yen TH, Chang CT*. Transarterial embolization of ruptured angiomyolipoma associated with tuberous sclerosis. Nephrol Dial Transplant 2005;20:1762-3 
  263. Chen SW, Lin HH, Lee KF, Chang CT, Yen TH*. Sinus aspergillosis in a hemodialysis patient. Dial Transplant 2005;34:172-4
  264. Yen TH*, Lai PC, Chen CC, Hsueh S, Huang JY. Renal involvement in patients with polymyositis and dermatomyositis. Int J Clin Pract 2005;59:188-93
  265. Chang CT, Hung CC, Ng KK, Yen TH*. Nutcracker syndrome and left unilateral haematuria. Nephrol Dial Transplant 2005;20:460-1
  266. Chen Y*, Chu SH, Wei TY, Yen TH, Chiang YJ, Wu CT, Chen HW. Does mycophenolate mofetil increase the incidence of infections in stable renal transplant recipients initially treated with a two-drug regimen? Transplant Proc 2004;36:2122-3
  267. Chen Y*, Yen TH, Liu KL, Chiang YJ, Wu CT, Chen HW, Chu SH. Outcome of renal transplantation in children with pericardiopleural effusion. Transplant Proc 2004;36:2032-3
  268. Yen TH, Lin JL*. Acute poisoning with emamectin benzoate. J Toxicol Clin Toxicol 2004;42:657-61
  269. Yen TH, Chang CT*, Huang CC, Ng KK, Tsai SY. Bifurcated abdominal aorta, with a coarctation over the right branch of the bifurcated abdominal aorta and aberrant renal arteries originating from the left branch of the bifurcated abdominal aorta. Ren Fail 2004;26:83-7
  270. Yen TH*, Lai PC, Huang CC, Chen Y. Single kidney eliciting a search for associated genital tract anomaly. Nephrol Dial Transplant 2004;19:731-2
  271. Yen TH, Chang CT, Ng KK, Wu MS*. Bilateral renal infarction in chronic myelomonocytic leukemia on blast crisis. Ren Fail 2003;25:1029-35
  272. Yen TH, Chang CT, Lin JL*, Jiang JR, Lee KF. Scrub typhus: a frequently overlooked cause of acute renal failure. Ren Fail 2003;25:397-410
  273. Yen TH, Huang JY*, Chen CY. Unexpected IgA nephropathy during the treatment of a young woman with idiopathic dermatomyositis: case report and review of the literature. J Nephrol 2003;16:148-53
  274. Yen TH, Chang CT*, Wu MS, Huang CC. Acute rhabdomyolysis after gemfibrozil therapy in a pregnant patient complicated with acute pancreatitis and hypertriglycerdemia while receiving continuous veno-venous hemofiltration therapy. Ren Fail 2003;25:139-43
  275. Lin WR, Chang CT*, Yen TH, Lin JL. Diarrhea associated acute renal failure in a patient with Salmonella enteritidis sepsis. Ren Fail 2002;24:535-8
  276. Yen TH, Huang JY*, Wu CH, Lee KF, Huang CC. Severe hypercalcaemia with normal serum calcitriol in a diabetic patient with chronic renal failure, autoimmune hepatitis and disseminated tuberculosis. Nephrol Dial Transplant 2000;15:2046-9