Tzu Chi Medical Journal

C-reactive protein positively correlates with metabolic syndrome in coronary artery disease patients

Bang-Gee Hsu, Jen-Che Hsieh, Yu-Chih Chen, Ji-Hung Wang — 2011-11-30

Abstract: Objective: C-reactive protein (CRP) is an independent risk factor for coronary artery disease (CAD). Metabolic syndrome has been associated with an increased risk of CAD, as well as increased mortality from CAD. The aim of this study is to investigate the relationship between CRP and metabolic syndrome among CAD patients.Materials and Methods: Fasting blood samples were obtained from 112 CAD patients. Metabolic syndrome and its components were defined using the diagnostic criteria from the International Diabetes Federation.Results: Using Taiwanese individuals, a total of 56 CAD patients (50%) had metabolic syndrome. Fasting CRP levels positively correlated with metabolic syndrome (p = 0.014). Univariate linear regression analysis showed that body weight (p = 0.014), body mass index (p < 0.001), and body fat mass (p < 0.001) were positively correlated with serum CRP levels, while high-density lipoprotein cholesterol (HDL-C) (p = 0.049) was negatively correlated with fasting serum CRP levels in CAD patients. Multivariate forward stepwise linear regression analysis of the significant variables showed that body fat mass (β = 0.530, R square = 0.289, p < 0.001) and HDL-C (β = −0.171, R square = 0.029, p = 0.034) were independent predictors of serum CRP levels in CAD patients.Conclusion: CRP level positively correlated with metabolic syndrome among Taiwanese CAD patients. Body fat mass and HDL-C were independent predictors of serum CRP levels in CAD patients.

Analysis of pathogens and susceptibility in cancer patients with febrile neutropenia and bacteremia: Experience in a single institution in eastern Taiwan

Kuan-Po Huang, Tso-Fu Wang, Sung-Chao Chu, Yi-Feng Wu, Rou-Yun Wang, Ruey-Ho Kao — 2011-10-31

Abstract: Objective: Febrile neutropenia is a major complication in patients with malignancies receiving chemotherapy. The pathogens vary in different geographic areas, however, and also may vary in different institutions. This retrospective study analyzed the profile of bacteria in cases of febrile neutropenia at a single medical center in eastern Taiwan.Materials and Methods: From July 2006 to July 2007, we retrospectively evaluated 80 adult cancer patients who were admitted to the hematology and oncology ward in our hospital because of febrile neutropenia. The clinical characteristics of those who survived (survival group) and those who died (mortality group) were compared. The blood culture data and susceptibility to antibiotics during episodes of febrile neutropenia were obtained for interpretation.Results: Among a total of 110 episodes of febrile neutropenia, 31% had documented bacteremia. The most common malignancy among these patients was acute leukemia (31%), followed by non-Hodgkin’s lymphoma and breast cancer. The median time from the start of chemotherapy to febrile neutropenia was shorter in the mortality group than the survival group (8.5 days vs. 11 days; p=0.046). The rate of positive blood cultures was much higher in those who died compared to those who survived (75% vs. 23%, p=0.0001). Gram-negative bacilli were the predominant pathogens in these neutropenic patients, which is different from the trend in Western countries. Infection with Escherichia coli was more common in the survival group and Pseudomonas species were more common in the non-survival group. Gram-positive cocci occurred in similar proportions in both groups. E coli in patients with febrile neutropenia were still susceptible to all first-line antibiotics.Conclusions: Adult cancer patients with febrile neutropenia are at a high risk of mortality, especially those with documented bacteremia and short times between chemotherapy and neutropenia. Gram-negative bacilli are still the predominant pathogens in patients with febrile neutropenia and most are still susceptible to all first-line antibiotics. Further investigation into the relationship between the patterns of different pathogens and mortality in this population is needed.

Polymicrobial bloodstream infection involving Aeromonas species: Analysis of 62 cases

2011-11-07

Abstract: Objective: To better understand Aeromonas-involved polymicrobial bacteremia (AIPMB).Materials and Methods: We conducted a retrospective analysis of patients with AIPMB admitted to three large referral hospitals in Taiwan between 2001 and 2008.Results: Of a total of 62 patients with AIPMB, 22 had healthcare-associated infection and 40 had community-acquired infection. Enterobacteriaceae was the most common concurrent pathogen (82%). The leading underlying diseases/conditions in the affected patients were solid cancers (45%), recent gastric acid suppressant therapy (39%) and liver cirrhosis (26%). More than 95% of the Aeromonas isolates were susceptible to an aminoglycoside, a third- or fourth-generation cephalosporin, imipenem or ciprofloxacin. Antibiotic susceptibilities did not significantly differ between Aeromonas isolates in patients with healthcare-associated AIPMBs and those in patients with community-acquired AIPMBs. Coinfection with Enterobacteriaceae occurred more commonly in community-acquired AIPMB (93% vs. 64%; p=0.012).Conclusions: AIPMB occurred commonly in patients with liver cirrhosis, solid cancers or recent gastric acid suppressant therapy. Enterobacteriaceae were the most common concurrent pathogens. Similar antibiotic profiles were found in Aeromonas isolates of healthcare-associated and community-acquired AIPMBs.

A very close margin of ≤1 mm predicts a poor outcome in resected buccal cancer patients with a pathological margin of ≤3 mm

2011-11-28

Abstract: Objectives: A close margin of ≤3 mm results in a high risk for locoregional recurrence, but still is not an independent factor that helps to guide the use of aggressive postoperative therapies in patients with resected buccal mucosa carcinoma. This suggests there is a diversity of clinical outcomes in this group of patients. The present study explores the predictors among this clinically debated group of patients.Materials and Methods: From 2000 to 2008, 30 resected buccal mucosa carcinoma patients with a close margin of ≤3 mm were retrospectively included in this study. All patients were treated with radical surgery together with postoperative radiotherapy (RT) or chemoradiotherapy (CCRT). Locoregional/local/regional control, disease-free status, disease-specific survival and overall survival were the study end points.Results: Two factors were observed that were able to predict 5-year locoregional control. These were a pathological N classification (pN0 vs. pN1-2, 71.5% vs. 30.0%, p = 0.044) and a very close margin (> 1 mm vs. ≤1 mm, 81.8% vs. 50.7%, p = 0.040). Remarkably, the predicting effect of a very close margin was well translated into disease-free status (81.8% vs. 47.1%, p = 0.024) and disease-specific survival (100% vs. 70.6%, p = 0.037). After multivariate analysis, a very close margin of ≤1 mm was found to independently predict a high risk of locoregional recurrence (HR, 9.528; 95% CI, 1.326–18.481; p = 0.025) and disease failure at any site (HR, 12.778; 95% CI, 1.934–25.217; p = 0.013).Conclusion: More aggressive postoperative treatments should be considered for resected buccal mucosa carcinoma patients with a very close margin of ≤1 mm.

Intranasal endoscopic surgery combined with adjuvant radiation therapy for olfactory neuroblastoma

Zong-Sin Wu, Hsu-Chueh Ho, Jeh-En Tzeng, Shih-Hsuan Hsiao — 2011-09-15

Abstract: Olfactory neuroblastoma, also known as esthesioneuroblastoma, is a rare malignant head and neck tumor. Olfactory neuroblastoma accounts for approximately 3–5% of all malignant nasal tumors. We present a case of olfactory neuroblastoma in a 61-year-old man who underwent endoscopic surgery followed by postoperative irradiation. Right neck metastasis was diagnosed about 6 months after endoscopic surgery. Supraomohyoid dissection of the right side of the neck was performed, but right parotid metastasis was identified about 3 months later. Boost radiotherapy was applied to the right metastatic parotid. There was no evidence of recurrence on head and neck magnetic resonance imaging and endoscopic examination during the 2-year follow-up.

Combined treatment of invasive giant prolactinoma with surgical excision, low-dose gamma knife radiosurgery, and a dopamine agonist—Report of two cases

2011-09-21

Abstract: Although most prolactinomas are benign, some are invasive or aggressive. The management of invasive giant prolactinomas (IGPs) has been an area of controversy. The present study reports the combined treatment of IGP with surgical excision, low-dose gamma knife radiosurgery (GKRS), and a dopamine agonist. An enhancing mass at the pituitary fossa with suprasellar extension and invasion of the cavernous sinus was identified in two patients. The blood prolactin level was more than 1000ng/mL in both patients before treatment. Trans-sphenoidal removal of the tumors was done to reduce tumor compression on the optic apparatus. Low-dose GKRS was then used to treat the residual tumor with invasion to the caversinous sinus. The marginal dose was set at 12 and 14Gy at the 50% and 42% isodose lines, respectively. A dopamine agonist, cabergoline, was used after GKRS. The tumors were markedly reduced and hard to be seen in magnetic resonance images. After a follow-up period of more than 3 years, the blood prolactin level returned to normal in one patient without the use of the dopamine agonist and was nearly normal in the other patient with continuing use of the dopamine agonist. Treatment combining surgical excision, GKRS, and a dopamine agonist may be a good treatment for IGPs. To make sure the remission of the disease, the longer follow-up is needed.

Digoxin intoxication–induced encephalopathy in a patient with chronic kidney disease

Hui-Ying Shih, Yi-Chun Chen, Mei-Hua Chuang — 2011-08-24

Abstract: Digoxin is a drug with a narrow therapeutic range. We present an 88-year-old woman with chronic kidney failure who was suspected of having digoxin intoxication when she developed nausea, vomiting, loss of appetite, lethargy, and unconsciousness after taking digoxin 0.25mg daily for 1 week. A blood test revealed a high digoxin concentration of 5.42ng/mL. The patient experienced bradycardia, hypotension, acute renal failure, and hyperkalemia. Electroencephalography revealed global brain dysfunction. She was given a temporary pacemaker and several rounds of dialysis. The digoxin concentration in the patient’s blood was monitored every 2 days, and she gradually regained consciousness as the level of digoxin decreased to the normal range within 2 weeks. Patients with chronic renal failure should be monitored and tested before the administration of digoxin to titrate the dose. The drug plasma concentration should be carefully monitored for 5–7 days after drug administration. Patients’ renal function, associated electrolyte concentrations, and drug levels should be tested regularly to ensure drug safety.

Monoplegia and paresthesia as rare presentations of type B aortic dissection

Cheng-Ta Hsieh, Tzu-Tsao Chung, Ming-Ying Liu — 2011-08-19

Abstract: Aortic dissection is a cardiovascular emergency, and the management remains a challenge for physicians because of the abrupt symptoms and rapid process. Acute neurological complications caused by descending aortic dissection, especially monoplegia, are rarely manifested. Herein, we present a 24-year-old man with Type B aortic dissection with acute onset of abdominal pain, accompanied by weakness and numbness only in the right lower extremity. After injection of contrast medium, computed tomography of the thorax and abdomen confirmed a diagnosis of Type B aortic dissection with the false lumen from the suprarenal descending aorta to the right common iliac artery. The monoplegia and paresthesia in the right lower extremity may have resulted from occlusion of the right common iliac artery because of the intimal flap. The detailed physical examination with absent pulsation of the right dorsalis pedis artery and right femoral artery, isolated low blood pressure and low motor neuron dysfunction of the right lower extremity, and abdominal/chest computed tomography were the key points for the correct diagnosis in our patient.

Three cases of successful treatment of granulomatous tenosynovitis

2011-11-09

Abstract: Granulomatous tenosynovitis is a rare disease with an indolent, relapsing process, which can be caused by various pathogens. Here, we describe three immunocompetent patients with right wrist granulomatous tenosynovitis. Two cases were attributed to nontuberculous mycobacteria (NTM) infection. In the third case, no definite etiology was found. However, the symptoms and patient history were similar to the other two cases. All three patients were cured by surgical debridement and clarithromycin-based anti-NTM antibiotics.

Genetic counseling on amniocyte level II mosaicism

Chun-Ying Weng, Shao-Yin Chu, Tzu-Ying Li, Jye-Siung Fang, Ming-Liang Lee — 2011-11-28

A 36-year-old woman who was a junior college graduate and a housewife received amniocentesis because of her advanced maternal age. Giemsa banding revealed the karyotype of the amniocytes was 46, XY. More than two cells with 46, XY, t (1; 2) (p21; q22) in one colony, however, were found among the 15 colonies analyzed (). Mosaicism level II was diagnosed.

Clear cell carcinoma of the thymus

Yung-Hsiang Hsu — 2011-05-16

A 52-year-old man visited our hospital after suffering from chest pain for a half year. Chest computed tomography (CT) showed a huge anterior mediastinum mass. CT-guided biopsy showed tumor nests with clear cytoplasm consistent with clear cell carcinoma of the thymus (). Immunohistochemistry stain was strongly positive for CD5 in the cell membrane (). He also complained of a severe headache for several months. Brain CT showed a metastatic mass in the frontal lobe. A craniotomy and excisional biopsy were performed. Histopathology confirmed metastatic cancer same as the thymic picture.

Re: Methanol intoxication with bilateral putaminal and occipital necrosis. Tzu Chi Med J 2010;22:160–163

Hossein Sanaei-Zadeh — 2011-11-28

I enjoyed reading the manuscript titled “Methanol intoxication with bilateral putaminal and occipital necrosis” that was published in your journal . After presentation of the computed tomography (CT) and magnetic resonance imaging findings in the brain in a case of methanol poisoning, the authors stated that their case was a unique presentation of bilateral occipital and putaminal necrosis with no previous reports in the literature.

Reply

Syuan-Huei Lin, Guo-Fang Tseng, Chung-Chao Liang, Yu-Chou Hung — 2011-11-28

In response to the comment by Associate Professor Hossein Sanaei-Zadeh, we would like to point out that we started writing our case report in October 2008, based on the PubMed research at that time. This could have led to our failure to notice the article by Taheri and colleagues, which became available online in December 2008 . We are not surprised to see that Taheri et al also reported similar results in some of their cases, namely occipital necrosis due to methanol intoxication.