輔仁醫學期刊/Fu-Jen Journal of Medicine
輔仁大學醫學院,正常發行
選擇卷期
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Objective: This retrospective study was conducted to examine the relationship between diabetes mellitus (DM) and lung cancer by using Taiwan's nationwide, population-based database. Methods: The National Health Insurance (NHI) is a mandatory universal health insurance program, offering comprehensive medical care coverage to all Taiwanese residents. A multistage stratified systematic sampling design was used. We searched the Longitudinal Health Insurance Database 2005 (LHID2005) for the source population during 2000-2004 to identify the patients with diabetes or lung cancer. Results: A total of 44,893 cases of type 2 diabetes were defined as study group, and a total of 898,602 subjects were identified as the control group. The cumulative incidence markedly increased with age in either the diabetic or non-diabetic patients. Risk ratio analysis showed that diabetic patients had a higher risk than non-diabetic patients in each age group, and both genders. The highest age-specific risk ratio was observed in diabetic male with age ＜ 40 years (RR=6.8). Adjusted hazard ratio (HR) for the 4-year follow-up period on the likelihood of developing lung cancer is 1.312 (95%CI=1.20-1.44). Conclusions: This study demonstrates the incidence of lung cancer is increasing with age in Taiwan, and a positive association between diabetes and subsequent lung cancer, which is much more remarkable in the age of ＜ 40 years.
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Background and Purpose. Cancer metastasis to bone marrow (BM) is universally a poor prognostic feature. Awareness of BM metastasis by simple blood test and confirmed by BM examination is crucial to improve treatment outcome. The aim of this study was to investigate the hematologic manifestation of adult patients with cancer BM metastases diagnosed by BM aspiration. Methods. Retrospective review of 1330 BM aspirations carried out in Cathay General Hospital between March 2007 and December 2014. Patients with presence of cancer BM metastasis were the study group. Patients with normal appearance of BM were the control group. Basic clinical characteristics, complete blood counts and survival of patients were obtained from the hospital records. Results. Twenty-nine patients (2.2%) had evidence of cancer BM metastasis. Breast cancer (34.5%) and colorectal cancer (17.2%) were the most common cancers associated with BM metastasis. As compare with the control group, BM metastasis patients had more cases of anemia (100% vs. 74.9%), thrombocytopenia (82.8% vs. 24.6%), leukoerythroblastosis (69% vs. 2.2%) and high lactate dehydrogenase (LDH) (90% vs. 38.2%). The most common site of metastasis other than BM was bone (n=25, 86.2%). Median survival after BM metastasis was 1.9 months and 6-month survival rate was 21.4%. Patients who received chemotherapy after BM metastasis had significant better survival with medium survival of 5.4 months vs. 0.7 months. Conclusion. BM metastasis by cancer carries a poor prognosis. Anemia, thrombocytopenia, leukoerythroblastosis and high LDH suggest of possible BM metastasis. BM examination provides a quick way to detect metastasis. Patients who received chemotherapy had better survival.
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Gangliocytic paraganglioma (GP) is a rare tumor. It is diagnosed according to its pathological characteristics. GP consists of three cell types: neuroendocrine cells, spindle-shaped cells with Schwannian differentiation, and ganglion cells. The clinical presentations vary among patients. In general, GP is a benign disease. We report a 75-year-old man with a common bile duct tumor and duodenal tumor; the clinical presentations were abdominal fullness and general malaise. The patient underwent the Whipple procedure and common bile duct adenocarcinoma and GP were diagnosed. There is no evidence of recurrence after 3-year follow- up.
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Prostatic abscess, a rare infection, is predominantly caused by Escherichia coli and other gram-negative bacteria among middle-aged men. Prostatic abscess caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is extremely rare. We report two patients with prostatic abscesses caused by community-acquired MRSA. On the basis of a detailed history, physical examination, and essential imaging studies, we were able to establish a correct diagnosis. Both of our patients recovered following surgical abscess drainage with only 2 weeks of vancomycin therapy. We discuss our patients and review the community-acquired MRSA cases in the literature regarding characteristics, management, and outcomes.
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Rib fractures are common injuries seen in the emergency department, and occur most often following blunt thoracic trauma. However, violent or sustained coughing can also cause complications such as pneumothorax and rib fracture. We report a 50-year-old man who presented to the emergency department with an intermittent nonproductive cough for 8 days and sudden onset of right side chest pain after an episode of violent paroxysmal coughing. The initial chest radiograph did not reveal a rib fracture. Subsequent chest computed tomography demonstrated a linear nondisplaced fracture at the lateral aspect of the right 8th rib. The patient gradually improved after medical treatment and was discharged the next day.
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Andrographis paniculata (Burm. f) Nees, commonly recognized as 'king of bitters', is an herbaceous plant of the Family of Acanthaceae used extensively in Southeast Asia, India, Thailand and Malaysia for the treatment of sore throat, flu and upper respiratory tract infections. This plant contains the pharmacologically important chemical constituent andrographolide. Andrographolide has been offered wide variety of pharmacological activities such as anti-inflammatory, antibacterial, antitumor, antidiabetic, anti-HIV, anti-feedant, and antivirus. Cardiovascular diseases are still the leading cause of death worldwide. Impaired endothelial function followed by inflammation of the vessel wall leads to atherosclerotic lesion formation that causes myocardial infarction and stroke. Due to the rising age of the population, the incidence of heart failure is further increasing. Thus, the increase in risk factor burden by age and metabolic diseases expands the incidence for vascular and cardiac diseases and provides a challenge for developing efficient treatments. Therefore, this review aimed to provide the evidence-based information from the existing literature about the plant Andrographis paniculata and its compound andrographolide for the treatment of cardiovascular diseases.
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Platonin (4,4',4＂-Trimethyl-3,3',3＂-Trihepthyl-7-(2＂-thiazolyl)-2,2',-Trimethine Thiazolocyanine- 3,3＂-Diiodide), is a cyanine photosensitizing dye and has potent antioxidant scavenging ability for reactive oxygen (ROS) and reactive nitrogen species (RNS). It also has potent immunomodulating effect and is being developed for the treatment of immune diseases, especially rheumatoid arthritis. In addition, platonin shows anti-inflammatory activity, improves circulatory insufficiency, and reduces mortality in septic rats. Previous data also showed that platonin inhibited endotoxin-induced up-regulation of inflammatory molecules (e.g. interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), and inducible nitric oxide synthase (iNOS)). Our previous studies demonstrated that platonin has inhibitory effects on pyrogen release, tissue damage, and ischemic during heatstroke in rats. Platonin also suppresses ischemia reperfusion injury in lungs and improves the survival of skin allografts in rats. However, there is no organized and precise review about the cardiovascular pharmacology of platonin. Therefore, we here summarize some interesting and unique cardiovascular pharmacological actions of platonin. Furthermore, this review discusses the signaling cascades targeted by platonin which include those mediated by nuclear factor-kB (NF-kB) and mitogen-activated protein kinases (MAPKs), and NO/NOS. NF-kB and MAPKs are considered promising molecular targets for the treatment of cardiovascular diseases.