Tzu Chi Medical Journal

The Epidemiology of Parkinson's Disease

Shin-Yuan Chen, Sheng-Tzung Tsai — 2010-06-01

Abstract: Parkinson's disease (PD) is the second most common neurodegenerative disorder and manifests as bradykinesia, rigidity, resting tremor and posture instability. Although the disease symptomatology can be well controlled by levodopa, related medications and deep brain stimulation, the etiology of PD remains obscure. The epidemiological features have been discussed in depth in the literature, but the methodologies used to approach the issues have varied greatly, and the results cover a wide range of factors and are generally inconclusive. The crude prevalence rate of PD has been reported to range from 15 per 100,000 to 12,500 per 100,000, and the incidence of PD from 15 per 100,000 to 328 per 100,000, with the disease being less common in Asian countries. Risk factor studies have pinpointed cigarette smoking, coffee/tea consumption and alcohol drinking as being mostly related to a lower risk of PD. The relationship between a higher risk of PD and drinking well-water and being exposed to herbicides/pesticides is controversial. Systemic diseases including gout, hyperlipidemia and hypertension may be related to a reduced risk of PD. A family history of PD, tremor, depression and head injury are related to a higher risk of PD. Genetic studies of the glucocerebrosidase, parkin and LRRK2 genes have contributed to our understanding of familial PD but not of sporadic PD. The health-related quality of life of PD patients is related not only to their motor disability, but also to their non-motor symptoms of depression, sleep disturbance, bladder and sexual dysfunction. The economic burden of PD is enormous, and the annual cost of medical service per PD patient can reach €13,804 (NT$599,547).

Strong Correlation Between the Overactive Bladder Symptom Score and Urgency Severity Score in Assessment of Patients With Overactive Bladder Syndrome

Qian-Sheng Ke, Hann-Chorng Kuo — 2010-06-01

Abstract: Objective: To correlate between the overactive bladder symptom score (OABSS) and urgency severity score (USS) in a group of patients with over-active bladder (OAB) syndrome and evaluate the changes in these two measures after antimuscarinic treatment. Materials and Methods: A total of 170 patients with clinical symptoms of frequency urgency were prospectively enrolled in this study. The Chinese version of the OABSS questionnaire, which has been linguistically validated, and the USS based on a 3-day voiding diary were recorded at baseline. Patients with clinically diagnosed OAB were treated with solifenacin 5 mg daily for 1 month, and the OABSS and USS were repeated at 1 week and 1 month. The OABSS and USS were compared at baseline, 1 week and 1 month after treatment. Results: The patients enrolled included 98 men and 72 women with a mean age of 64.1 years. A high OABSS total score was significantly associated with a high grade of USS. There was a significant correlation between the two sores (R2=0.5520, p<0.0001). The main contributions to the OABSS in patients with a low USS were daytime frequency and nighttime frequency. The contribution of urgency and urgency urinary incontinence became significant in patients with high urgency grades. The changes in the USS and OABSS were significant at 1 month. The change in frequency was significant in the daytime as well as at nighttime. Conclusion: A strong correlation between the OABSS and USS based on a voiding diary was noted in patients with OAB. The changes in these two measures were similar after solifenacin treatment.

The Etiology of Short Stature in Children in Eastern Taiwan: A Retrospective Study

Chien-Wen Yang, Yu-Hsun Chang, Chia-Hsiang Chu, Shao-Yin Chu — 2010-06-01

Abstract: Objective: To study the etiology of short stature in children in eastern Taiwan. Materials and Methods: This retrospective study included patients referred to Hualien Buddhist Tzu Chi General Hospital for evaluation of short stature from 2002 to 2008. Data were collected from medical records, and included body height and weight by percentile, maternal history, birth history, past medical history, relevant hematological and biochemical investigations, urinalysis, levels of growth and thyroid hormones, bone age, and genetic study. Results: A total of 139 children were enrolled. Sixty (43.2%) were classified as having idiopathic short stature, 48 (34.5%) were attributed to underlying disease such as gastrointestinal disorder or chronic illness, 14 (10.1%) had been small for gestational age at birth and their growth had not caught up with that of their peers, 11 (7.9%) were diagnosed with familial short stature, and 6 (4.3%) were diagnosed with growth hormone deficiency. Conclusion: Idiopathic short stature was the most common etiology of short stature in children in eastern Taiwan. The incidence of short stature attributed to underlying disease seems to be higher than in other areas of Taiwan. The percentage of small-for-gestational-age children without catch-up growth was also higher in eastern Taiwan than in other areas.

Effect of Intravenous N-acetylcysteine on Plasma Total Homocysteine and Inflammatory Cytokines During High Flux Hemodialysis

2010-06-01

Abstract: Objective: Hyperhomocysteinemia and increased inflammatory cytokines are independent risk factors in patients with renal diseases. N-acetylcysteine (NAC) is an antioxidant that is known to decrease inflammatory cytokines and plasma total homocysteine (tHcy). Therefore, the aim of this study was to compare normal saline injection with and without intravenous NAC during hemodialysis (HD) in terms of changes in serum levels of tumor necrosis factor-α (TNF-α, interleukin-10 (IL-10), high-sensitivity C-reactive protein (hs-CRP) and plasma tHcy. Patients and Methods: In total, 43 high flux HD patients were enrolled at a 4-hour HD session and split into two groups, NAC (n = 22) and NS (n = 21) treatment groups, which received either a normal saline injection with intravenous NAC or without intravenous NAC, respectively. The NS group was divided into two subgroups, one with residual renal function (n = 5) and the other with anuria (n 16). The NAC group was also divided into two subgroups, one with residual renal function (n 6) and the other with anuria (n = 16). Serum TNF-α, IL-10, hs-CRP and tHcy were measured before and immediately after HD. Results: There were no significant differences in baseline characteristics, TNF-α, IL-10, hs-CRP, and tHcy levels in intra- and intergroup comparisons. Compared to pre-HD baseline values, plasma tHcy level was lower after HD in the NS group (p<0.001), NS with anuria subgroup (p=0.001), NS with residual renal function subgroup (p = 0.034), NAC group (p < 0.001), NAC with residual renal function subgroup (p < 0.001), and NAC with anuria subgroup (p = 0.003). There were no statistically significant differences in plasma tHcy level when the NS group was compared with the NAC group. Plasma tHcy level was significantly lower in the NAC with residual renal function subgroup compared with the NS group (p = 0.002), the NAC with residual renal function subgroup compared with the NS with anuria subgroup (p<0.001), and the NAC with residual renal function subgroup compared with the NAC with anuria subgroup (p = 0.001). Moreover, the reduction in plasma tHcy level during HD was greater in the NAC with residual renal function subgroup than in the NAC with anuria subgroup (p = 0.001). Conclusion: A normal saline injection is able to decrease plasma tHcy during high flux HD with or without NAC. However, a combination of the two further decreases plasma tHcy in high flux HD patients who still have residual renal function. NAC is only effective when there is residual renal function present to decrease plasma tHcy in high flux HD patients.

Treatment Results and Prognostic Factors for Locally Advanced Buccal Cancer

2010-06-01

Abstract: Objective: The aim of this study was to retrospectively analyze locally advanced buccal cancer in order to determine tumor characteristics and any other prognostic factors that may influence the survival of patients with the disease. Patients and Methods: The records of 54 patients with stage III to IV locally advanced buccal cancer (TNM system) who were seen from August 2000 to June 2008 at one institution were reviewed. The patients received radical surgery and then adjuvant treatment. The adjuvant treatment in cluded concurrent chemoradiotherapy or radiotherapy alone. The chemotherapy protocol consisted of two 4-weekly courses of concurrent cisplatin and 5-fluorouracil followed by another two 4-weekly courses after radiotherapy, with regimens of cisplatin (60–100 mg/m2/day) on day 1 and 5-fluorouracil (1000 mg/m2/day) on days 1–5. Results: The 3-year cumulative overall survival, disease-specific survival, disease-free survival, locoregional control, and distant metastasis-free survival rates were 66%, 69%, 58%, 65%, and 92%, respectively. Univariate analysis indicated that the pN classification, the surgical margin, and the presence of extracapsular spread were significantly associated with overall survival. On multivariate analysis, pN classification and surgical margin significantly affected disease-free survival. The pN classification (pN0 vs. pN1–3) and the surgical margin (< 1 vs.≥ 1 mm) were the two most significant factors affecting clinical outcome. Conclusion: The presence of lymph node involvement, the presence of extracapsular spread and a surgical margin < 1 mm were strong prognostic factors that were associated with tumor control. More aggressive postoperative therapy is suggested for patients with buccal mucosa carcinoma if these factors exist.

Malakoplakia of Ipsilateral Kidney, Ureter and Bladder

Yung-Chih Chen, Hann-Chorng Kuo — 2010-06-01

Abstract: Malakoplakia is a rare chronic inflammatory disease of the urinary tract, usually caused by Escherichia coli infection. We report a 75-year-old woman who presented with hydronephrosis and pyuria associated with E. coli infection. Abdominal computed tomography revealed several renal stones and severe hydronephrosis of the right kidney. Biopsies of the urinary bladder and ureter revealed erosion and acute inflammation. According to a culture sensitivity test, antimicrobial treatment was prescribed with cephradine 500 mg every 6 hours and amoxicillin-clavulanic acid 100 mg twice daily for 1 month. Because of the advanced hydronephrosis with impaired renal function, a right nephroureterectomy was performed. Malakoplakia of the right kidney, ureter and urinary bladder was confirmed by pathology with Michaelis-Gutmann bodies present in the surgical specimen. The patient tolerated the operation well. She regained a good health status and was regularly followed-up in the urologic department.

Successful Treatment of Two Cases of Invasive Aspergillus Sinusitis With Voriconazole

2010-06-01

Abstract: Aspergillosis is a spectrum of diseases caused by Aspergillus spp., which is a widespread fungus that produces microscopic spores. Immunocompetent people may breathe in numerous Aspergillus every day, yet experience no symptoms. Invasive Aspergillus is relatively rare. There is limited information about the use of voriconazole for the treatment of invasive Aspergillus sinusitis. Here, we present two cases of invasive Aspergillus in elderly female patients with diabetes mellitus. Both patients fully recovered after treatment using surgical debridement and an antifungal regimen that included voriconazole.

Cystic Lung Changes in a Patient With Pulmonary Tuberculosis

2010-06-01

Abstract: A 32-year-old male had complained of a dry cough on and off for 1 year. Chest radiography revealed reticular infiltration of bilateral lungs. Chest computed tomography showed multiple thin-walled cystic lesions of bilateral lungs with a scattered tree-in-bud appearance. Histological diagnosis obtained via a video-assisted thoracoscopic lung biopsy indicated pulmonary tuberculosis. The cystic lesions regressed after antituberculous chemotherapy. Active pulmonary tuberculosis presenting as multiple cystic lung lesions on computed tomography is very rare. Here, we report the computed tomo-graphic findings for this patient and review the literature.

Cerebral Sparganosis

2010-06-01

Abstract: A 47-year-old woman presented with severe headache associated with nausea for 2 weeks. There was no fever, neck pain, dizziness, vertigo, unilateral limb weakness, blurred vision or trauma history. She had no history of systemic disease or medical problems. Brain computed tomography showed left side diffuse brain edema. Brain contrast magnetic resonance imaging revealed a mixed intensity mass lesion with heterogeneous abnormal enhancement in the left parietal lobe. The differential diagnosis included neoplasm and a lesion mimicking a neoplasm. An operative biopsy showed a grossly yellow, 3 cm, left occipital tumor. Pathological findings showed granulomatous inflammation in the brain tissue and a dead parasite body was noted. Calcareous bodies were evident inside the parasite. Cerebral sparganosis, which is an infection from Spirometra mansoni, was diagnosed. Two weeks later, she was discharged and had recovered completely. She may have been infected by eating raw meat and drinking unboiled water. Cerebral sparganosis is extremely rare and should be considered in the differential diagnosis of metastatic brain tumor, especially in endemic areas.

Coronary Artery Ectasia Presenting With Recurrent Inferior Wall Myocardial Infarction

Chi-Hsien Chen, Chih-Ta Lin, Tin-Kwang Lin — 2010-06-01

Abstract: Coronary ectasia presenting as a recurrent inferior myocardial infarction has rarely been reported in the literature. Herein, we report a 61-year-old man who presented with persistent chest pain accompanied by ST segment elevation in the inferior ECG leads. Coronary angiography showed ectasia of the right coronary artery (RCA) and total occlusion from the middle RCA. Two stents were implanted separately in the middle and distal RCA. The patient was readmitted due to recurrent inferior wall infarction 15 months after discharge. He underwent primary percutaneous coronary intervention again, and coronary angiography showed massive thrombosis and in-stent re-stenosis. The thrombosis and re-stenosis were successfully treated using balloon angioplasty. The patient was discharged under medical therapy with aspirin and clopidogrel. There were no anginal symptoms during the 3 years of follow up.

Hepatic Schistosomiasis

Yung-Hsiang Hsu — 2010-06-01

Retraction: Neurotoxin Versus Neuromodulation for the Treatment of Refractory Overactive Bladder Syndrome

Hann-Chorng Kuo — 2010-06-01