Zhonghua yi xue za zhi = Chinese medical journal; Free China ed

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Discontinued in 2002. Continued by Journal of the Chinese Medical Association (1726-4901).

Publications in this journal

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    ABSTRACT: Enucleation of pancreatic tumor has the potential risk for damage of the main pancreatic duct. Benign tumors located in the neck or body of the pancreas are usually removed by left (spleno-) pancreatectomy or pancreatoduodenectomy. Standard pancreatic resection may result in serious loss of normal pancreatic parenchyme and impairment of pancreatic function. The aim of this study is to evaluate the results of segmental pancreatectomy, a limited resection of the midportion of the pancreas, in patients with benign tumor of the pancreas. Four patients with benign tumor over pancreatic neck or body were treated with segmental pancreatectomy after pathological confirmation by frozen section. The proximal stump was closed and distal stump was anastomosed with a Roux-en-Y pancreaticojejunostomy. Clinical evaluation, routine blood sugar, stool fat examination and abdominal ultrasonography were performed for their follow up. Segmental pancreatectomy was satisfactory in these four patients. The pathologic examinations revealed serous cystadenoma. No mortality was noted. Minor pancreatic fistula was found in three of them and was treated conservatively. No obvious exocrine insufficiency was noticed. One patient had diabetes mellitus before operation, which was persisted postoperatively. Segmental pancreatectomy is a safe and effective alternative to major pancreatic resection in selected patients with benign tumor of the pancreas. This procedure has a surgical risk similar to that of the standard operation, but preserves more pancreatic tissues, which may prevent pancreatic function impairment.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 01/2003; 65(12):608-13.
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    ABSTRACT: We report a case of aggressive natural killer (NK) cell lymphoma/leukemia in a 70-year-old woman presenting with fever, hepatosplenomegaly, retroperitoneal lymphadenopathy, and elevated serum CA19-9. The patient died 4 days after diagnosis. Neoplastic NK cells were identified in the blood and retroperitoneal lymph node biopsy. Their phenotypes were confirmed by extensive flow cytometric and immunohistochemical studies. In situ hybridization for Epstein-Barr virus (EBV)-associated RNA (EBER) was positive. Various forms of NK cell neoplasm were reviewed and discussed.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 01/2003; 65(12):622-6.
  • Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 01/2003; 65(12):561-2.
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    ABSTRACT: We have previously shown that an increase in NO activity activated ATP-sensitive potassium channel (K(ATP)) and shortened action potential duration (APD) in an endotoxic shock model. Because the increase in NO production and the decrease of APD appear to be downstream late events in endotoxic shock, we hypothesized that a common signaling pathway might mediate these effects. Using a guinea pig model of endotoxic shock, we investigated the effect of genistein and tyrphostin AG 556 on the cardiac action potential. Adult Hartley guinea pigs (300 to 450 gm) were randomized into 2 treatment parts. In the chronic treatment part, guinea pigs were randomized to receive daily subcutaneous injection of one of the five agents: saline, genistein, tyrphostin AG 556, daidzein, and vehicle for 10 days. In the acute treatment part, these agents were administered by intraperitoneal injection 1 hour before endotoxic shock. The animals were then anesthetized and mechanically ventilated, and underwent 6-hour endotoxic shock or sham experiment. In the chronic treatment part, the plasma nitrate concentration, myocardial guanosine 3',5'-cyclic monophosphate (cGMP) content, and APD at 90% repolarization (APD90) of papillary muscle showed no difference in the five groups before endotoxic shock. After 6-hour endotoxic shock, the elevation of plasma nitrate concentration and myocardial cGMP content was found significant in the control, the daidzein, and the vehicle groups, but was blunted in the genistein and the tyrphostin groups. The shortening of APD90 of papillary muscle was also significant in the control, the daidzein, and the vehicle groups, but blunted in the genistein and tyrphostin groups. There were similar findings in the acute treatment part, except the weaker effect of genistein and tyrphostin. Genistein and tyrphostin AG 556, either administered chronically or acutely, significantly attenuate the cardiac APD shortening in endotoxic shock, presumably through the decrease in the plasma nitrate and the cardiac cGMP production. It is suggested that tyrosine kinase signaling plays an important role in the modulation of APD in endotoxic shock.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 01/2003; 65(12):570-9.
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    ABSTRACT: Colonic complications of severe acute pancreatitis are quite uncommon and always occur in the transverse colon and splenic flexure. Here we report the case of a 47-year-old male with mild acute pancreatitis (Ranson's score 1) who suffered from acute right lower quadrant pain during hospitalization. After conservative treatment failed, he underwent open appendectomy under the impression of acute appendicitis. However, the pathology revealed only periappendicitis. Small bowel ileus was noted on plain film of the abdomen and a high ascitic lipase level was found during operation suggesting that the periappendicitis resulted from the spreading of the pancreatic inflammatory exudate via the small bowel mesentery route. This report suggests that although rare, periappendiceal involvement mimicking acute appendicitis remains possible in even mild acute pancreatitis.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 01/2003; 65(12):619-21.
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    ABSTRACT: To assess the feasibility of analyzing fetal cells from maternal circulation by using magnetic activated cell sorting (MACS) and polymerase chain reaction (PCR) for prenatal diagnosis. Thirty-one high-risk (either advanced maternal age or abnormal serum Down screening) pregnant women (14-22 weeks) were enrolled. Twenty ml of venous blood from each woman after amniocentesis were pretreated with density gradient centrifugation and sorted by MACS with monoclonal antibodies: anti-CD71 (n = 26) or anti-GPA (n = 5). Nested PCR with Y-specific probes--Y1.5-Y1.8 (n = 10) and Amelogenin (n = 21) were then applied to the sorted nucleated red blood cells (NRBCs) for fetal sex determination. These results were compared with cytogenetic data. To assess the sensitivity of PCR, different proportions of known male and female cultured amniocytes were mixed and amplified for gender identification. Karyotypes were normal in all fetuses (18 females and 13 males). The proportions of NRBCs (in total cells) sorted by MACS--anti-GPA or anti-CD71 were 50% (2000 +/- 1500) and 85% (350 +/- 280), respectively. Accuracies of sex determination by PCR-Amelogenin or Y1.5-Y1.8 were 76.2% (16/21) and 50% (5/10), respectively. Three cases resulted in PCR failure. Assay of nested PCR inferred that after cell sorting, existence of at least 20% of male fetal cells mixed in maternal blood circulation was required for prenatal diagnosis under current methodology. We confirmed the existence of fetal NRBCs in maternal blood during pregnancy. The low accuracy of sex determination (76.2%) may be attributed to contamination of either maternal NRBCs or non-NRBCs. No conclusive data, however, so far demonstrates the ideal marker to identify the origin of NRBCs. Without specific fetal cell marker and more sophisticated fetal cell analysis methodologies, in our experience, the feasibility of routinely analyzing fetal cells from maternal blood for prenatal diagnosis is limited.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 01/2003; 65(12):594-9.
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    ABSTRACT: Solitary plasmacytomas include extramedullary plasmacytomas and those found in the bone. Seventy percent of patients are male and the median age is 50-55 years, younger than that for plasma cell myeloma. Most solitary plasmacytomas of bone eventually evolve to plasma cell myeloma within 2-10 years, while the extramedullary ones do so infrequently. We present an unusual case of intra-abdominal plasmacytoma in a young woman which was misdiagnosed and treated as T cell lymphoma initially. Typical manifestations of plasma cell myeloma appeared one year later. High dose chemotherapy followed by allogeneic peripheral stem cell blood transplantation (allo-PBSCT) was given. Relapse in skin occurred one year after allo-PBSCT, and was treated with wide excision and local irradiation. The patient was well and alive without evidence of disease 4 years after wide excision of the recurrence of chest wall solitary plasmacytoma and local radiotherapy.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):557-60.
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    ABSTRACT: Zafirlukast, a competitive cysteinyl leukotriene receptor antagonist, is a new class of asthma medications. It has shown an adverse event profile similar to that of placebo. Herein, we present a 69-year-old female patient who suffered from general malaise, poor appetite, nausea and jaundice after 3 months of zafirlukast therapy for asthma. She had no past history of liver disease, nor history of alcoholism, herb medication, blood transfusion, acupuncture, tattoo or recent traveling history. Liver biochemistries revealed elevated serum alanine aminotransferase and aspartase aminotransferase levels up to 481 U/L and 212 U/L, respectively. Moreover, peak serum total bilirubin level was elevated to 34.8 mg/dL during admission. Serum viral hepatitis marker, antinuclear antibody, anti-mitochondrial antibody and anti-smooth muscle antibody were all negative. Her general condition and liver biochemistries improved gradually after zafirlukast was discontinued. Roussel Uclaf causality assessment for adverse drug reaction confirmed the diagnosis of drug-induced liver injury. This case reminds us that zafirlukast is a potentially hepato-toxic drug. If clinical manifestations of hepatitis develop, patients should be managed cautiously and closely monitored for liver biochemistries. If drug-induced hepatitis is suspected, medication should be discontinued immediately to prevent further liver injury.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):553-6.
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    ABSTRACT: Unlike in Western countries, autoimmune hepatitis (AIH) is an infrequent diagnosis in Taiwan. The clinical characteristics of AIH in this area are unclear. The aim of this study was to elucidate the clinical features of AIH in Taiwan. All the medical records of in-patients with the diagnosis of chronic hepatitis in our hospital from 1990 to 2001 were reviewed for the possibility of AIH. The clinical features, biochemical data, immunological presentations, treatments and survival of the patients were evaluated. Twenty-two patients (15 females and 7 males) were diagnosed as having AIH within 11 years. The median age at onset was 64 years (range: 17-77 years). Compared with female patients, male patients had older age (p = 0.001), shorter duration from initial presentation of symptoms to diagnosis (p = 0.015), lower serum levels of alkaline phosphatase (ALK-P, p = 0.022) and albumin (p = 0.043). Five (23%) patients presented with cirrhosis upon diagnosis. Compared with non-cirrhotic patients, cirrhotic patients had lower serum levels of alanine aminotransferase (p = 0.002), aspartate aminotransferase (p = 0.015), gamma-glutamyl transferase (G-GT, p = 0.002), albumin (p = 0.14), white cell counts (p = 0.009) and platelet counts (p = 0.002). Thirteen (59%) patients had concomitant clinico-pathological features of cholestatic liver disease (ALK-P > or = 2 times of upper normal limit or pathologic evidence of cholangiopathy). They had higher serum levels of ALK-P (p < 0.001) and G-GT (p = 0.004) than 9 non-cholestatic patients. There were no significant differences in survival between these groups. The prescribed initial and maintained prednisolone dosages for our patients to control disease activity were 19 +/- 15 mg and 8 +/- 1 mg, respectively, which were lower than those recommended in Western countries. The remission rate to steroid treatment and relapse rate after discontinuing corticosteroids were 87.5% and 50%, respectively. Compared with Western AIH patients, the AIH patients in Taiwan are older and more likely to develop cholestasis, and need a relatively lower dose of steroid for treatment. Owing to one quarter of the patients already having liver cirrhosis on diagnosis, AIH should be suspected in any Taiwanese patient with cryptogenic hepatitis or cirrhosis.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(12):563-9.
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    ABSTRACT: We describe a case with severely compromised edentulous ridge in the mandible, which previously received marginal resection and radiotherapy due to oral cancer at the mouth floor. Through careful evaluation, the patient had 30 dives of hyperbaric oxygen therapy (HBO) before implant surgery. The edentulous ridge was rehabilitated with 4 endosteal implant fixtures, and palatal mucosa grafting vestibulosulcoplasty. The case had been followed for 4 years with stability of bone and a satisfactory result of rehabilitation.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):548-52.
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    ABSTRACT: Indomethacin, an NSAID capable of inhibiting the effect of both cyclooxygenase and lipooxygenase, has been reported to repress the growth of breast cancer, skin cancer and head & neck cancer, etc. Inhibition in the some cell lines of oral squamous cell carcinoma (OSCC) has also been reported. The purpose of this study was primarily to explore the cellular response of human OSCC lines after indomethacin or retinoic acid (RA) treatment and its correlation to apoptosis phenomenon. Five human OSCC cell lines--KB, SCC15, SCC25, OEC-M1 and OC2--were used for this in vitro study. By direct cell number counting, the cellular response was observed under incremental indomethacin concentrations of 50 microM, 100 microM, 200 microM and 400 microM, in order to select the most appropriate concentration for further study. Then 200 microM indomethacin and all-trans RA at 1 microM were used in the 2nd experiment to explore the intensity of their inhibitory effects individually and potential synergistic inhibition when exerted together. While in the 3rd part, TdT-mediated-dUTP nick-end labeling (TUNEL) method was used for in situ apoptosis assay to see if the apoptosis rate varied with these two agents. All 5 cell lines constantly showed growth suppression with positive dosage effect of indomethacin. Synergistic inhibition by combined treatment of indomethacin and RA was seen in RA responsive lines of SCC15 and SCC25, whereas other RA-resistant clones showed no synergism of this combined treatment. The in situ detection of apoptosis by TUNEL assay revealed a significantly higher ratio of apoptotic cells in the indomethacin/RA treated SCC15 and SCC25 than in controls. The study provides the value of further exploration on the mechanism of how indomethacin inhibiting cancer cell growth and how RA-sensitive OSCC cell lines are synergistically suppressed by conjoint treatment of RA and indomethacin. This study also highlights the value to see how the apoptotic pathway responds differently to the indomethacin/RA treatment.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(12):600-7.
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    ABSTRACT: Autologous cartilage has been widely used as a material for tympanoplasty and mastoid-obliteration surgery. Since it remains vulnerable to an infectious condition, this study aims to evaluate if it can be used for a chronic suppurative cholesteatomatous ear to achieve single-stage tympanoplasty with mastoidectomy and obliteration of the cavity. From January 1988 to August 1998, the records of patients with cholesteatoma who received cartilage-obliteration surgery performed by Dr. Lien were examined for any infection-associated problems within three months after the operation. The Fisher's exact test was used to compare the difference in the incidence of post-operative infection-associated problems between suppurative ears and non-suppurative ears. One hundred and seven surgical procedures performed upon 96 patients were included in this study, with 97 being primary surgical procedures and ten being revision surgery for previous open cavity with cholesteatoma recurrences. The average follow-up was 47.7 months. At time of surgery, there were 59 non-suppurative ears; 48 ears were suppurative and cultured. Granulations were found in the middle ear or mastoid for 42 ears (39.3%). Five ears (4.7%) exhibited infection-associated post-operative problems within three post-operative months. Three cases (5.1%) were non-suppurative ears and two cases (4.2%) were suppurative ears. There was no significant statistical difference when examined with the Fisher's Exact test. In an immunocompetent patient with a cholesteatomatous chronic suppurative ear, autologous cartilage could potentially tolerate an infection condition to serve as a material for mastoid-obliteration in a single-stage surgical procedure.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):523-8.
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    ABSTRACT: To evaluate the effects of sphenopalatine artery electrocautery for the treatment of recurrent posterior epistaxis. Nine patients were enrolled in the study. Seven patients had hypertension, two had diabetes, two received irradiation for nasopharyngeal carcinoma, one had congestive heart failure and one was a heavy drinker. Three patients needed blood transfusion for profound blood loss. The sphenopalatine artery electrocautery was performed transnasally with endoscope. After the sphenopalatine foramen was identified through dissecting the mucosa of middle meatus posteriorly one centimeter from the choana, the neurovascular bundle in the sphenopalatine foramen was cauterized. Most operations can be performed within fifty minutes with minimal blood loss under local anesthesia. One patient developed minor epistaxis 2 months after surgery, and the bleeding was controlled with medical treatment. The other patients had no recurrent epistaxis after surgery. Thus, epistaxis was well controlled in all patients without complications. The follow-up duration was 2 to 14 months after surgery, with a mean duration of 10 months. Transnasal sphenopalatine artery electrocautery is a simple, effective and safe method for the treatment of posterior epistaxis.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):529-33.
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    ABSTRACT: To obtain more information about Guillain-Barré syndrome (GBS) for Taiwanese patients. We retrospectively reviewed the charts for those cases conforming with International Classification of Diseases code (ICD) 357.0, from January 1988 to December 1998. Clinical data such as age, sex, duration of hospitalization, antecedent events, date of onset, initial symptoms, other neurological symptoms and signs, results of lumbar puncture and electrophysiology, respiratory function and mortality, were recorded. We identified 49 cases of typical GBS, with non-specific age distribution. The calibrated male/female ratio was 1.54. The mean age for disease onset was greater for male patients (M: 54.8 years vs. F: 39.5 years), with more cases noted in winter. Upper respiratory tract infection (URI, 53%) was the most common antecedent event, followed, in descending order, by gastrointestinal symptoms (10%), skin lesions (6%) and ear infections (2%). The mean interval between antecedent events and disease onset was 10 +/- 3.1 days. Cranial nerve abnormalities, autonomic dysfunction and respiratory failure were not uncommon. The mortality rate was 6% (3/49). The abnormal findings from motor nerve conduction studies included prolonged distal latencies, reduced conduction velocities, reduced compound muscle action potentials and prolonged F-wave latencies. GBS occurs at all ages, is more prevalent among males, and is related to the season and antecedent infections. Continuous monitoring of autonomic and respiratory function is recommended. The results of motor nerve conduction studies suggest that the nerves fibers are affected at random, with multifocal distribution of the demyelinating lesions. The precise nature of the ataxia was not determined. Further studies are required to distinguish the etiology and expression of ataxia for GBS patients.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):540-7.
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    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):513-4.
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    ABSTRACT: This review article summarizes recent studies on myofascial trigger point (MTrP) to further clarify the mechanism of MTrP. MTrP is the major cause of muscle pain (myofascial pain) in clinical practice. There are multiple MTrP loci in an MTrP region. An MTrP locus contains a sensory component (sensitive locus) and a motor component (active locus). A sensitive locus is the site from which pain, referred pain (ReP), and local twitch response (LTR) can be elicited by needle stimulation. Sensitive loci are probably sensitized nociceptors based on a histological study. They are widely distributed in the whole muscle, but are concentrated in the endplate zone. An active locus is the site from which spontaneous electrical activity (SEA) can be recorded. Active loci are dysfunctional endplates since SEA is essentially the same as endplate noise (EPN) recorded from an abnormal endplate as reported by neurophysiologists. Both ReP and LTRs are mediated through spinal cord mechanisms, demonstrated in both human and animal studies. The pathogenesis of MTrPs appears to be related to the integration in the spinal cord (formation of MTrP circuits) in response to the disturbance of the nerve endings and abnormal contractile mechanism at multiple dysfunctional endplates. Methods usually applied to treat MTrPs include stretch, massage, thermotherapy, electrotherapy, laser therapy, MTrP injection, dry needling, and acupuncture. The mechanism of acupuncture is similar to dry needling or MTrP injection. The new technique of MTrP injection can also be used to treat neurogenic spasticity.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):501-12.
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    ABSTRACT: Direct stent implantation without predilatation is considered a promising new technique that may reduce procedural time, radiation exposure, ischemic time and cost, but little information is available concerning the long-term outcome. The aim of this study was to investigate the long-term clinical outcome of successful direct stenting without predilatation. We prospectively undertook a clinical follow-up program (minimum 8 months) in a consecutive series of 101 patients (113 lesions) who were successfully treated with direct stenting without predilatation. Clinical follow-up was obtained in all 101 patients at a mean period of 12.8 months (range 8 to 18.9). Stress test results were available in 94 patients (94%). During the follow-up period, 23 patients (23%) had one or more events, which included death in 2 patients (2%), target vessel revascularization in 14 (14%), myocardial infarction in 1 (1%) and positive stress test results or recurrence of symptoms (Canadian Cardiovascular Society I to II) treated medically in 6 (6%). Cumulative event-free survival at 8 and 18 months were 80% and 72%, respectively. Long-term clinical event rate was not significantly different among the clinical presentations, lesion types, or stent types. Angiographic follow-up was performed in 43 (43%) patients with 45 lesions. Restenosis (defined as 50% diameter stenosis) was observed in 14 of the lesions (31%). Direct stenting without predilatation is an effective method of coronary intervention in terms of low long-term clinical event rate.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(11):517-22.
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    ABSTRACT: Antacids were usually co-prescribed with non-steroidal anti-inflammatory drugs (NSAIDs), although no broad evidences were available as to the effects of antacids in preventing NSAID-associated gastropathy. We performed a survey of national insurance claims for outpatient services in Taiwan to determine the extent of this co-therapy nationwide. The National Health Insurance Research Database supplied the sampling datasets for analysis. They represented 0.2% of the entire claims for outpatient medical services in 1999. Co-prescribing was assessed as NSAIDs and antacids on the same prescription. The selection and grouping of NSAIDs followed the guidelines of the Anatomical Therapeutic Chemical (ATC) Classification System recommended by the World Health Organization. Only the oral drugs prescribed on regular visits were taken into account. In totally 425,442 prescriptions with 1,825,604 items of drugs, non-aspirin NSAIDs were present in 108,818 (25.6%) prescriptions and antacids in 235,252 (55.3%) prescriptions respectively. Furthermore, antacids were present in 71.3% of prescriptions that contained NSAIDs and in 49.8% of prescriptions that did not contain NSAIDs (p < 0.001). Significant association of NSAIDs and antacids existed in different specialties of prescribing physicians, but the co-prescription rate (antacids in NSAIDs prescriptions) varied from the highest of 92.8% in the neurosurgery to the lowest of 49.8% in the pediatrics. Significant association of NSAIDs and antacids also existed at different levels of health care facilities, where the co-prescription rates were 80.9% at medical centers, 83.5% at regional hospitals, 87.4% at local hospitals, and 66.6% at primary care units. The subgroup of oxicams was more frequently co-prescribed with antacids than other subgroups (odds ratio = 1.51, p = 0.001). Concomitant prescription of oral non-aspirin NSAIDs and antacids was indeed a popular practice in Taiwan. Beside their effects in alleviating the NSAID-associated dyspepsia, the role of antacids in preventing NSAID-associated peptic ulcers or in masking the warning symptoms of these ulcers demands further evaluation.
    Zhonghua yi xue za zhi = Chinese medical journal; Free China ed 12/2002; 65(12):588-93.