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   2015| January-February  | Volume 35 | Issue 1  
    Online since February 12, 2015

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Oncological emergencies for the internist
Umesh Das, KC Lakshmaiah, TM Suresh, K Govind Babu
January-February 2015, 35(1):1-10
An oncologic emergency is defined as any acute, potentially life-threatening event, either directly or indirectly related to a patient's cancer (ca) or its treatment. It requires rapid intervention to avoid death or severe permanent damage. Most oncologic emergencies can be classified as metabolic, hematologic, structural, or side effects from chemotherapy agents. Tumor lysis syndrome is a metabolic emergency that presents as severe electrolyte abnormalities. The condition is treated with aggressive hydration, allopurinol or urate oxidase to lower uric acid levels. Hypercalcemia of malignancy is treated with aggressive rehydration, furosemide, and intravenous (IV) bisphosphonates. Syndrome of inappropriate antidiuretic hormone should be suspected if a patient with ca presents with normovolemic hyponatremia. This metabolic condition usually is treated with fluid restriction and furosemide. Febrile neutropenia is a hematologic emergency that usually requires inpatient therapy with broad-spectrum antibiotics, although outpatient therapy may be appropriate for low-risk patients. Hyperviscosity syndrome usually is associated with Waldenstrφm's macroglobulinemia, which is treated with plasmapheresis and chemotherapy. Structural oncologic emergencies are caused by direct compression of surrounding structures or by metastatic disease. Superior vena cava syndrome is the most common structural oncological emergency. Treatment options include chemotherapy, radiation, and IV stenting. Epidural spinal cord compression can be treated with dexamethasone, radiation, or surgery. Malignant pericardial effusion, which often is undiagnosed in ca patients, can be treated with pericardiocentesis or a pericardial window procedure.
  7,035 547 -
Evaluation of stroke risk associated with the use of typical or atypical antipsychotics among patients with cardiovascular diseases
Meng-Ting Wang, Min-Fang Li, Che-Li Chu, Chin-Bin Yeh, Cheng-Liang Tsai, Jun-Ting Liou
January-February 2015, 35(1):11-18
Background: Concerns regarding stroke safety associated with the use of atypical antipsychotics among dementia patients have been raised. Although observational studies have found conflicting associations of stroke risk with the use of typical or atypical antipsychotics among the elderly with or without dementia, patients with cardiovascular diseases (CVDs), a high-risk for the stroke population, have not been examined. Little evidence has been provided regarding comparison of the stroke risk between the two antipsychotic classes. This study aimed to evaluate the comparative stroke risk with atypical versus typical antipsychotic use among CVD patients. Materials and Methods: We conducted a population-based nested case-control study analyzing the Taiwan National Health Insurance Research Database from January 1, 1996 to December 31, 2007. A total of 7,460 CVD patients was followed-up, among which 580 hospitalized cases with stroke were identified and matched to 5,398 randomly selected controls. Conditional logistic regressions were employed to quantify the difference in stroke risk associated with atypical versus typical antipsychotics. Results: Any use and current use of atypical antipsychotics were associated with a 1.67-fold (95% confidence interval [CI], 1.21-2.30) and a 2.30-fold (95% CI, 1.56-3.40) increased risk of stroke relative to any typical antipsychotic use, respectively. The stroke risk associated with current use of atypical antipsychotics persisted even compared with current use of typical antipsychotics (adjusted odds ratio, 1.53; 95% CI, 1.02-2.33). Conclusions: Use of atypical antipsychotics is associated with an increased risk of stroke requiring hospitalization compared to typical antipsychotic use among CVD patients. Healthcare professionals should take this risk into account when choosing between typical and atypical antipsychotic treatments among CVD patients.
  5,459 453 2
Valproic acid exerts an anti-tumor effect on tongue cancer sas cells in vitro and in vivo
Gu-Jiun Lin, Shu-Sheng Kao Chen, Shing-Hwa Huang, I-Hsun Li, Li-Chen Yen, Jang-Yi Chen, Huey-Kang Sytwu, Yuan-Wu Chen
January-February 2015, 35(1):28-36
Background: Valproic acid (VPA) is a drug approved by the Food and Drug Administration for epilepsy and bipolar disorders. It is also a known histone deacetylase inhibitor and has been evaluated as an anti-cancer agent. However, the in vitro and in vivo anti-tumor effect of VPA on human tongue cancer has not been evaluated. Materials and Methods: We tested VPA for its anti-tumor activity on the human tongue cancer (SAS) cell line in vitro and in vivo in a tumor xenograft model in mice. The effect of VPA on the cell cycle and apoptosis was examined. Results: Growth inhibition was noted when SAS, squamous cell carcinoma 25 and OECM-1 cells were treated with various doses of VPA for 24-72 h, and it was found that VPA treatment caused G1 arrest and apoptosis in SAS cells. VPA also inhibited the phosphorylation of Akt and ERK in SAS cells in vitro. Tumor growth inhibition was observed in NOD/SCID mice bearing xenografts of human tongue cancer that were treated with a VPA dose of 400 mg/kg/day. Conclusions: This study demonstrates that VPA can inhibit the growth of human tongue cancer cells in vitro and in vivo without causing any significant adverse effects.
  4,497 276 1
Effect of kidsolone on isolated rat's tracheal smooth muscle
Shao-Cheng Liu, Chi-Chung Wu, Hsing-Won Wang
January-February 2015, 35(1):22-27
Purpose: Prednisolone (Kidsolone) is an anti-inflammatory drug that is mainly used for patients with chronic obstructive airway diseases (COAD), such as asthma and chronic obstructive pulmonary diseases (COPD). The objective of this study was to determine the effects of Kidsolone on the trachea of rats in vitro. Materials and Methods: We tested the effectiveness of Kidsolone on isolated rat trachea submersed in Krebs solution in a muscle bath. Changes in tracheal contractility in response to the application of parasympathetic mimetic agents were measured. The following assessments of Kidsolone were performed: (1) Effect on tracheal smooth muscle resting tension; (2) effect on contraction caused by 10-6 M methacholine; (3) effect of the drug on electrically-induced tracheal smooth muscle contractions. Result: Our results demonstrated that no significant effects were induced by the addition of 10-8-10-5 M Kidsolone on tracheal tension after methacholine treatment, indicating that Kidsolone had no anti-cholinergic effect. It alone had a minimal effect on the basal tension of the trachea as the concentration increased. Furthermore, Kidsolone did not affect electrical field stimulation-induced spike contraction, which represent the Kidsolone could not antagonize the parasympathetic innervation responsible for trachea smooth muscle contraction. Conclusion: The immediate effect of Kidsolone on COAD may be indirectly. Therefore, sorely use of inhalation Kidsolone without β2-agonist in treating acute asthma or COPD attack may be more suboptimal than co-administration of them.
  2,677 153 1
Kartagener syndrome with pulmonary tuberculosis in a fertile male: A rare co-existence
Manoj Kumar Panigrahi, King Herald Kisku
January-February 2015, 35(1):43-46
Kartagener syndrome (KS), a subset of primary ciliary dyskinesia, is an autosomal recessive disorder with variable phenotypic expressions. Males with this syndrome are usually infertile. Its association with pulmonary tuberculosis (PTB) is exceedingly rare. We report this case in view of the simultaneous coexistence of KS with male fertility and PTB.
  2,277 135 -
Systemic sclerosis presenting with severe digital ischemia: A rare case report
Sourya Acharya, Samarth Shukla, SN Mahajan
January-February 2015, 35(1):37-39
Digital ischemic loss is a cause of significant morbidity in patients with systemic sclerosis (SSc). Both small and large digital arteries are involved causing perfusion defects leading to ischemia. Microvascular disease causes intimal proliferation and luminal narrowing of small digital arteries, macrovascular disease causes narrowing or occlusion of larger digital arteries. Immediate clinical evaluation and treatment are mandatory at the onset of critical digital ischemia to prevent digital loss. We present a case of 38-year-old female suffering from SSc who presented with acute onset severe digital ischemia of all four limbs.
  2,211 149 -
Spinal spontaneous epidural hematoma
Yi-Syue Tsou, Yung-Hsiao Chiang, Jiann-Her Lin
January-February 2015, 35(1):40-42
Spontaneous spinal epidural hematoma is a rare but significant condition of spinal cord compression. Urgent decompressive surgery is generally indicated to prevent serious permanent neurological deficits and improve outcome. We encountered a case of an 83-year-old woman who sustained sudden onset of severe back pain, followed by progressive weakness and numbness over bilateral lower limbs. Magnetic resonance imaging of thoracic and lumbar spine demonstrated an epidural mass extending from T9 through L4, causing spinal cord and thecal sac compression. Emergent decompressive surgery was performed, and epidural hematoma was diagnosed postoperatively; the patient had significant improvement of neurologic deficits. The relevant literature is also reviewed.
  2,026 142 -
Ruptured infective intracranial aneurysm with intracerebral hemorrhage in an infant
Kin Sang Iao, Abel Po Hao Huang, Kuo Chuan Wang, Shih-Hung Yang
January-February 2015, 35(1):47-49
Intracranial aneurysms are rare in children. Less than 10% of pediatric intracranial aneurysms are infective aneurysms, and few cases of such aneurysms in infants have been reported in the literature. In this study, we report the case of a 1-month-old preterm infant presenting with recurrent intracerebral hemorrhage due to a ruptured intracranial infective aneurysm. Blood culture yielded Candida species. Brain computed tomography and cerebral angiography revealed a large intracerebral hematoma in the left frontal lobe and a 2.7-mm sized aneurysm in a distal branch of the middle cerebral artery. The patient underwent craniotomy for hematoma evacuation and aneurysm excision. After the surgical intervention, antifungal therapy, and rehabilitation treatment, the patient recovered with mild neurological sequelae. This case demonstrated that the aggressive treatment for infective intracranial aneurysm is key to a favorable outcome, even in a young infant.
  1,936 137 -
The efficiency of adjusted-da-chai-ling-tang in radiation-induced brain edema in patients with brain tumors
Da-Tong Ju, Hsing-Lung Chao, Chen-Yu Lee, Shin-Fang Chung, Cheng-Ta Hsieh
January-February 2015, 35(1):19-21
Background: Brain edema induced by radiotherapy is a common complication in patients with brain tumors, for which medical treatment is the treatment of choice. Adjusted-Da-Chai-Ling-Tang, a Chinese herbal formulation, has been confirmed to be protective against the radiation-induced edema. In this study, we investigated the efficiency of adjusted-Da-Chai-Ling-Tang in radiation-induced brain edema in patients with brain tumors. Materials and Methods: A total of 46 patients with brain tumors treated with radiotherapy alone or combined with surgery were enrolled. These patients were divided into two groups: The experimental group with adjusted-Da-Chai-Ling-Tang and the control group with conventional medical treatment. Clinical data including symptoms and serologic results were collected pretreatment and on the 4 th , 7 th and 10 th day posttreatment. Magnetic resonance imaging of the brain was performed to investigate changes in brain edema. Results: Clinical symptoms including headache, dizziness, nausea/vomiting and fatigue significantly improved in the experimental group (P < 0.05). No difference in serological results was observed. Brain edema was significantly reduced in the experimental group in magnetic resonance imaging (P < 0.05). Conclusion: Adjusted-Da-Chai-Ling-Tang is effective in the treatment of radiation-induced brain edema in patients with brain tumors. No obvious side effects were observed.
  1,750 160 -