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Chih-Hsien Wang,
Yi-Chia Lee,
Cheng-Ping Wang, Chien-Chuan Chen,
Jenq-Yuh Ko,
Ming-Lun Han,
Tseng-Cheng Chen,
Pei-Jen Lou,
Tsung-Lin Yang,
Tzu-Yu Hsiao,
Ming-Shiang Wu,
Hsiu-Po Wang,
Ping-Huei Tseng
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ABSTRACT: BACKGROUND: Patients with head and neck squamous cell carcinoma are at high risk for synchronous and/or metachronous esophageal cancer. The present study aimed to evaluate the feasibility and safety of unsedated transnasal endoscopy (TNE) for screening these high-risk patients. PATIENTS AND METHODS: Consecutive high-risk patients including patients with suspicious or diagnosed head and neck cancer or patients with alarming symptoms received screening TNE. All endoscopic procedures, including sequential conventional white-light, narrow-band imaging, and Lugol chromoendoscopy, were done without sedation. All suspicious lesions in the esophagus were biopsied for histological evaluation. The completion rate, procedure time, and significant adverse events of all endoscopic procedures were recorded and analyzed. RESULTS: From May 2007 to August 2011, a total of 500 TNE were carried out in 441 high-risk patients. Among them, 294 patients (66.7%) had diagnosed head and neck squamous cellcarcinoma, and most were hypopharyngeal cancer (n = 186). Esophageal squamous cell carcinomas and high-grade intraepithelial neoplasms were detected in 10.1% and 7.3%, respectively, of the cases. Completion rate of TNE in head and neck cancer was 96.7%; tumor obstruction and stenosis of anastomosis site were the main reasons for incomplete procedures. Mean duration of the endoscopic procedure was 14.6 min. One patient had post-endoscopic epistaxis while another patient had post-biopsy hemoptysis, both of whom were treated conservatively. No procedure-related mortality or significant morbidity occurred. CONCLUSION: Unsedated TNE is safe and feasible for screening synchronous or metachronous esophageal neoplasms in high-risk patients, especially those with head and neck cancer.
Digestive Endoscopy 03/2013; · 1.19 Impact Factor
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ABSTRACT: BACKGROUND & AIMS: The fecal immunochemical test (FIT) can identify patients with advanced colorectal neoplasms, but it also has a high rate of false-negative results. It would be helpful to characterize colorectal neoplasms that are not detected by FIT, to aid in development of new tests. We characterized colorectal neoplasms from patients who had negative results from the FIT. METHODS: We analyzed data from 18,296 subjects who were screened for colorectal cancer by colonoscopy and the FIT at the Health Management Center of National Taiwan University Hospital from September 2005 through September 2010. We identified 4045 subjects with colorectal neoplasms (3385 with non-advanced adenomas, 632 with advanced adenomas, and 28 with cancer). We analyzed the sensitivity of the FIT in identifying these patients, along with information on lesion size, location, and morphology. RESULTS: The FIT identified patients with non-advanced adenoma, advanced adenoma, and cancer with sensitivity values of 10.6% (95% confidence interval [CI], 10.2%-12.3%), 28.0% (95% CI, 24.6%-31.7%), and 78.6% (95% CI, 58.5%-91.0%), respectively. The FIT detected proximal advanced adenomas and nonpolyploid lesions with lower levels of sensitivity than distal advanced adenomas; it had a high false-negative rate in detection of adenomas <15 mm (adjusted odds ratio [aOR], 2.72; 95% CI, 1.76-4.20) and nonpolypoid adenomas (aOR, 2.15; 95% CI, 1.22-3.80), after adjusting for demographic characteristics, colonoscopy findings, and potential confounders. The FIT had produced a higher percentage false-negative results in detection of carcinoma in situ and T1 cancer than T2-T4 cancers (66.7% sensitivity vs. 100%;P =.049). CONCLUSIONS: The FIT produces a high rate of false-negative results for patients with small or nonpolypoid adenomas. Early-stage of cancers are associated with a high rate of false-negative results from the FIT.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 01/2013; · 5.64 Impact Factor
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Chieh-Chang Chen,
Cheng-Hao Tseng,
Jaw-Town Lin, Hsiu-Po Wang,
Ping-Huei Tseng,
Yao-Chun Hsu,
Mei-Jyh Chen,
Yi-Chia Lee,
Chien-Chuan Chen,
Ming-Shiang Wu,
Wen-Hsiung Chang,
Ueng-Cheng Yang,
Chi-Yang Chang,
Yu-Jen Fang,
Jiing-Chyuan Luo,
Chia-Tung Shun,
Shih-Jer Hsu,
Ji-Yuh Lee,
Jyh-Ming Liou
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Jyh-Ming Liou,
Chieh-Chang Chen,
Mei-Jyh Chen, Chien-Chuan Chen,
Chi-Yang Chang,
Yu-Jen Fang,
Ji-Yuh Lee,
Shih-Jer Hsu,
Jiing-Chyuan Luo,
Wen-Hsiung Chang,
Yao-Chun Hsu,
Cheng-Hao Tseng,
Ping-Huei Tseng,
Hsiu-Po Wang,
Ueng-Cheng Yang,
Chia-Tung Shun,
Jaw-Town Lin,
Yi-Chia Lee,
Ming-Shiang Wu
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ABSTRACT: BACKGROUND: Whether sequential treatment can replace triple therapy as the standard treatment for Helicobacter pylori infection is unknown. We compared the efficacy of sequential treatment for 10 days and 14 days with triple therapy for 14 days in first-line treatment. METHODS: For this multicentre, open-label, randomised trial, we recruited patients (≥20 years of age) with H pylori infection from six centres in Taiwan. Using a computer-generated randomisation sequence, we randomly allocated patients (1:1:1; block sizes of six) to either sequential treatment (lansoprazole 30 mg and amoxicillin 1 g for the first 7 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg for another 7 days; with all drugs given twice daily) for either 10 days (S-10) or 14 days (S-14), of 14 days of triple therapy (T-14; lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg for 14 days; with all drugs given twice daily). Investigators were masked to treatment allocation. Our primary outcome was the eradication rate in first-line treatment by intention-to-treat (ITT) and per-protocol (PP) analyses. This trial is registered with ClinicalTrials.gov, number NCT01042184. FINDINGS: Between Dec 28, 2009, and Sept 24, 2011, we enrolled 900 patients: 300 to each group. The eradication rate was 90·7% (95% CI 87·4-94·0; 272 of 300 patients) in the S-14 group, 87·0% (83·2-90·8; 261 of 300 patients) in the S-10 group, and 82·3% (78·0-86·6; 247 of 300 patients) in the T-14 group. Treatment efficacy was better in the S-14 group than it was in the T-14 group in both the ITT analysis (number needed to treat of 12·0 [95% CI 7·2-34·5]; p=0·003) and PP analyses (13·7 [8·3-40], p=0·003). We recorded no significant difference in the occurrence of adverse effects or in compliance between the three groups. INTERPRETATION: Our findings lend support to the use of sequential treatment as the standard first-line treatment for H pylori infection. FUNDING: National Taiwan University Hospital and National Science Council.
The Lancet 11/2012; · 38.28 Impact Factor
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Jyh-Ming Liou,
Chieh-Chang Chen,
Chi-Yang Chang,
Mei-Jyh Chen,
Yu-Jen Fang,
Ji-Yuh Lee, Chien-Chuan Chen,
Shih-Jer Hsu,
Yao-Chun Hsu,
Cheng-Hao Tseng,
Ping-Huei Tseng,
Lawrence Chang,
Wen-Hsiung Chang,
Hsiu-Po Wang,
Chia-Tung Shun,
Jeng-Yih Wu,
Yi-Chia Lee,
Jaw-Town Lin,
Ming-Shiang Wu
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ABSTRACT: OBJECTIVES: The efficacy of sequential therapy and the applicability of genotypic resistance to guide the selection of antibiotics in the third-line treatment of Helicobacter pylori have not been reported. We aimed to assess the efficacy of genotypic resistance-guided sequential therapy in third-line treatment. METHODS: Genotypic and phenotypic resistances were determined in patients who failed at least two eradication therapies by PCR with direct sequencing and agar dilution test, respectively. The patients were retreated with sequential therapy containing esomeprazole and amoxicillin for the first 7 days, followed by esomeprazole and metronidazole plus clarithromycin, levofloxacin or tetracycline for another 7 days (all twice daily), according to genotypic resistance determined using gastric biopsy specimens. Eradication status was determined by the (13)C-urea breath test. Trial registered at clinicaltrials.gov (identifier: NCT01032655). RESULTS: The overall eradication rate was 80.7% (109/135, 95% CI 73.3%-86.5%) in the intention-to-treat analysis. The presence of amoxicillin resistance (OR 6.83, 95% CI 1.62-28.86, P = 0.009) and prior sequential therapy (OR 4.77, 95% CI 1.315-17.3, P = 0.017), but not tetracycline resistance (tetracycline group), were associated with treatment failure. The eradication rates in patients who received clarithromycin-, levofloxacin- and tetracycline-based sequential therapies were 78.9% (15/19), 92.2% (47/51) and 71.4% (25/35) in strains susceptible to clarithromycin, levofloxacin and tetracycline, respectively. CONCLUSIONS: A simple molecular method guiding sequential therapy can achieve a high eradication rate in the third-line treatment of refractory H. pylori infection.
Journal of Antimicrobial Chemotherapy 10/2012; · 5.07 Impact Factor
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ABSTRACT: Postoperative ileus is considered an undesirable response to major abdominal surgery that leads to discomfort, complications, morbidity, and the prolongation of hospital stays. Although thoracic epidural analgesia has been introduced to prevent and/or reduce postoperative ileus, it is rarely used as a way to treat postoperative ileus. A 65-year-old man developed paralytic ileus after undergoing a colectomy. Despite conservative and surgical management, postoperative morbidity persisted. A continuous infusion of 0.2% levobupivacaine at a rate of 4 mL/hour was administered for 4 days via a thoracic epidural catheter that had been percutaneously tunneled into the T11-T12 epidural space. With this treatment, daily drainage from a nasogastric tube was gradually decreased and flatus was noted. A week later, the patient could start receiving a liquid diet. Therefore, thoracic epidural analgesia can be used to treat or alleviate paralytic ileus.
Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists. 06/2012; 50(2):78-80.
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ABSTRACT: To determine the prevalence of gastrointestinal (GI) manifestations associated with diabetes mellitus (DM) in a Taiwanese population undergoing bidirectional endoscopies.
Subjects voluntarily undergoing upper endoscopy/colonoscopy as part of a medical examination at the National Taiwan University Hospital were recruited during 2009. Diagnosis of DM included past history of DM, fasting plasma glucose ≥ 126 mg/dL, or glycated hemoglobin (HbA(1c)) ≥ 6.5%. Comparisons were made between diabetic and nondiabetic subjects, subjects with lower and higher HbA(1c) levels, and diabetic subjects with and without complications, respectively, for their GI symptoms, noninvasive GI testing results, and endoscopic findings.
Among 7,770 study subjects, 722 (9.3%) were diagnosed with DM. The overall prevalence of GI symptoms was lower in DM subjects (30.3 vs. 35.4%, P = 0.006). In contrast, the prevalence of erosive esophagitis (34.3 vs. 28.6%, P = 0.002), Barrett's esophagus (0.6 vs. 0.1%, P = 0.001), peptic ulcer disease (14.8 vs. 8.5%, P < 0.001), gastric neoplasms (1.8 vs. 0.7%, P = 0.003), and colonic neoplasms (26.6 vs. 16.5%, P < 0.001) was higher in diabetic subjects. Diagnostic accuracy of immunochemical fecal occult blood test for colonic neoplasms was significantly decreased in DM (70.7 vs. 81.7%, P < 0.001). Higher HbA(1c) levels were associated with a decrease of GI symptoms and an increase of endoscopic abnormalities. Diabetic subjects with complications had a higher prevalence of colonic neoplasms (39.2 vs. 24.5%, P = 0.002) than those without.
DM and higher levels of HbA(1c) were associated with lower prevalence of GI symptoms but higher prevalence of endoscopic abnormalities.
Diabetes care 03/2012; 35(5):1053-60. · 8.09 Impact Factor
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ABSTRACT: Central nervous system dysfunction is a serious complication following cardiac surgery. The prompt and predictable recovery of consciousness (ROC) from anesthesia is essential for neurological evaluations. This retrospective study aimed to determine the factors that were related to ROC time after elective cardiac surgery.
Patients receiving elective cardiac surgery under general anesthesia were included in the analysis. Patient and surgery-related factors were collected through chart review. Cox regression model was used to evaluate the associations between collected variables and ROC time. Backward model selection strategy was further applied to selecting independent factors from significant ones that affected ROC time in the univariate analysis.
A total of 253 patients were recruited in our study. Among significant patient characteristics, higher body mass index (hazard ratio, HR = 1.06) and female gender (HR = 1.72) tended to shorten ROC time, but older age was inclined to prolong it (HR = 0.98). Higher preoperative blood urea nitrogen level also significantly delayed ROC after cardiac surgery (HR = 0.99). Among surgery-related factors, only longer duration of cardiopulmonary bypass significantly increased ROC time after the model selection processes (HR = 0.96). Other factors were not significant after adjustment for these five factors.
This study demonstrated that older age, male gender, lower body mass index, higher preoperative blood urea nitrogen level, and longer bypass duration were independent risk factors of delayed emergence after elective cardiac surgery. These findings provide insights into patient care and anesthetic management for clinicians in related fields.
Journal of the Chinese Medical Association 08/2011; 74(8):345-9. · 0.79 Impact Factor
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ABSTRACT: Imaging-enhanced endoscopy enhances the contrast of the mucosal surface and helps in the diagnosis of gastroesophageal reflux disease. However, whether the increased detection of subtle erosive foci corresponds to the effect of acid suppression remains elusive.
We aim to evaluate the utility of narrow band imaging with and without magnification endoscopy in the prediction of therapeutic response in patients with reflux.
Endoscopic evaluation with conventional white light, narrow band imaging, and narrow band imaging with magnification was performed sequentially in consecutive patients with reflux. All patients received proton pump inhibitor for 14 days. Their therapeutic responses were correlated with the baseline endoscopic findings, including mucosal breaks under standard endoscopy, mucosal brownish changes under narrow band imaging, and increased and/or dilated intrapapillary capillary loops or microerosions under narrow band imaging with magnification.
Of a total of 82 patients, 22 (26.8%) patients were diagnosed with erosive disease under standard endoscopy. Among the remaining 60 (73.2%) patients, 14 (23.3%) and 30 (50%) were considered erosive under narrow band imaging and narrow band imaging with magnification, respectively. Sixty-five (79.3%) patients showed a positive therapeutic response. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting therapeutic response were 33.8%, 100%, 100%, 28.3%, and 47.6%, respectively, for standard endoscopy; 52.3%, 88.2%, 94.4%, 32.6%, and 59.8%, respectively, for narrow band imaging; and 70.8%, 64.7%, 88.4%, 36.6%, and 69.5%, respectively, for narrow band imaging with magnification.
Narrow band imaging with and without magnification endoscopy substantially improve our ability to predict therapeutic response in patients with gastroesophageal reflux.
Journal of clinical gastroenterology 07/2011; 45(6):501-6. · 2.21 Impact Factor
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ABSTRACT: Mutations in KRAS and BRAF genes were associated with treatment failure from EGF receptor inhibitors in colorectal cancer (CRC) patients. However, whether these mutations were associated with survival in patients not treated with EGF receptor inhibitors remained controversial. Moreover, few data were available in Chinese. Therefore, we aimed to evaluate the impact of KRAS and BRAF mutations on the survival of Chinese CRC patients.
CRC patients who underwent surgery between October 2003 and April 2006 were included in this study. They were observed until June 30, 2010 or when death was ascertained by the National Death Registration System. Prospectively collected fresh frozen tumor tissues were used for detection of mutations at codons 12, 13, and 61 of the KRAS gene and exons 11 and 15 of BRAF gene by PCR amplification followed by direct sequencing.
Among the 314 patients, KRAS and BRAF mutations were detected in 65 (20.7%) and 12 (3.8%) patients, respectively. KRAS mutations appeared to occur more frequently in females than males (p = 0.039) and in non-smokers (p = 0.039). KRAS and BRAF mutations were significantly associated with the proximal location of cancer (p = 0.017 and 0.001, respectively). In the univariate analysis, KRAS and BRAF mutations were not associated with survival. However, BRAF mutations were associated with a significantly worse overall survival (hazard ratio = 3.91, 95% confidence interval 1.31 to 11.66, p = 0.014) in the multivariate Cox proportional hazard model after adjustment for all direct clincopathological variables.
BRAF mutations, but not KRAS mutations, were associated with a worse outcome in Chinese CRC patients.
International Journal of Colorectal Disease 05/2011; 26(11):1387-95. · 2.38 Impact Factor
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ABSTRACT: Current techniques of peripheral nerve block have major limitations, including lack of differentiation between motor and sensory fibers and potential toxicity of local anesthetics. Recent studies have suggested that a nociceptive-selective nerve block can be achieved via a transient receptor potential vanilloid type 1 activator (capsaicin) along with local anesthetics. We hypothesized that the combination of potent transient receptor potential vanilloid type 1 agonist resiniferatoxin (RTX) and selected antidepressants (amitriptyline, doxepin, and fluoxetine, also potent sodium channel blockers) would produce prolonged and predominantly sensory nerve block.
Rats were anesthetized with isoflurane, and 0.2 mL of amitriptyline, doxepin, or fluoxetine was deposited next to the surgically exposed sciatic nerves (n = 8 per group). Some animals received a second injection containing RTX (n = 8 per group). The effect of nerve block was assessed by neurobehavioral tests of the motor function (extensor postural thrust) and the nocifensive reaction (mechanical pinch).
A single application of RTX produced nociceptive-selective sciatic nerve block, whereas antidepressants produced nociceptive and motor block. The combined administration of RTX and antidepressant resulted in a predominantly nociceptive nerve block. Compared with antidepressants or RTX alone, the combination prolonged the nociceptive nerve block more than the motor block.
The combined application of RTX and antidepressants produced a markedly prolonged nociceptive peripheral nerve block in rat sciatic nerves compared with either agent alone. However, the 2-drug regimen also elicited prolonged blockade of the motor function, although disproportionately less compared with the nociceptive modality, suggesting the existence of nontransient receptor potential vanilloid type 1-mediated mechanisms. The mechanisms through which RTX affects nociceptive signal transduction/transmission have yet to be fully elucidated.
Anesthesia and analgesia 07/2010; 111(1):207-13. · 3.08 Impact Factor
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ABSTRACT: The efficacy of a levofloxacin-based regimen as the first-line treatment and a clarithromycin-based regimen as the second-line treatment for Helicobacter pylori infection remains unknown. The aim of this study was to assess the eradication rates of these two regimens using different administration sequences.
Eligible patients were randomised to receive LAL: levofloxacin (750 mg once a day), amoxicillin (1000 mg twice a day) and lansoprazole (30 mg twice a day) for 7 days, or CAL: clarithromycin (500 mg twice a day), amoxicillin (1000 mg twice a day) and lansoprazole (30 mg twice a day) for 7 days. Patients with positive [(13)C]urea breath test after treatment were retreated with the rescue regimen in a crossover manner for 10 days.
When used as first-line treatment (n=432), the eradication rates of LAL (n=217) and CAL (n=215) were 74.2 and 83.7% (p=0.015) in the intent-to-treat (ITT) analysis, and 80.1 and 87.4% (p=0.046) in the per-protocol (PP) analysis, respectively. When used as second-line treatment, the eradication rates of LAL (n=26) and CAL (n=40) were 76.9 and 60% (p=0.154) in the ITT analysis, and 80 and 61.5% (p=0.120) in the PP analysis, respectively. The overall eradication rates of CAL followed by LAL were better than the reverse sequence in both the ITT analysis (93% vs 85.3%, p=0.01) and the PP analysis (97.6% vs 92.5%, p=0.019). The eradication rate was significantly lower in the presence of levofloxacin resistance in the LAL group (50% vs 84.4%, p=0.018) and clarithromycin resistance in the CAL group (44.4% vs 90.7%, p=0.002).
CAL achieved a higher eradication rate than LAL as the first-line treatment, but not as the second-line treatment. The strategy of using CAL as the initial treatment and LAL as the rescue regimen achieved higher eradication rates than the reverse sequence.
Gut 05/2010; 59(5):572-8. · 10.11 Impact Factor
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ABSTRACT: Ganglion impar block is an uncommon procedure that has been performed traditional with fluoroscopy. One approach is the trans-sacrococcygeal approach. Sometimes this can be difficult because the sacrococcygeal joint (SCJ) cannot be readily seen on anteroposterior (AP) and lateral fluoroscopy. This technical report describes the feasibility of ultrasound in assisting ganglion impar blocks.
We performed ganglion impar block using ultrasound as the primary imaging tool, with fluoroscopic confirmation in 15 patients. We used a linear array transducer (5-12 MHz) to obtain sonographic transverse and longitudinal views at the sacral cornua; we identified the first cleft below the sacral hiatus as the SCJ. Then we inserted a 23-gauge (7 cm in length) needle into the SCJ under sonographic guidance. Then we confirmed proper needle depth by lateral fluoroscopy and injection of contrast agent.
In all 15 procedures, we accurately located and passed the needle into the patients' SCJs under real time sonographic guidance.
In cases where the cleft cannot be readily seen on AP and lateral fluoroscopy, we have found ultrasound to be of assistance. Ultrasound does not replace fluoroscopy, because lateral fluoroscopy is still required to establish safe depth, and correct site of injection. However, ultrasound can be helpful when fluoroscopy alone is insufficient.
Pain Medicine 03/2010; 11(3):390-4. · 2.35 Impact Factor
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ABSTRACT: Overexpression of IGF-II and IGF-binding protein (IGFBP)-2 has been reported in several cancers.
We aimed to assess the roles of plasma IGF-II and IGFBP-2 levels as diagnostic and prognostic biomarkers and the impact of loss of imprinting (LOI) of IGF-II on the survival of colorectal cancer (CRC).
We conducted a case control and prospective cohort study for diagnostic and prognostic values, respectively.
Plasma levels of IGF-II and IGFBP-2 were measured in 162 patients with CRC before surgery, in paired 15 patients after curative surgery, in 24 patients with advanced colon polyps, and in 114 healthy controls between 2003 and 2006 in National Taiwan University Hospital.
The area under the curve values of using IGFBP-2 as a diagnostic marker for advanced colon polyp and CRC were 0.654 [95% confidence interval (CI) = 0.547-0.76; P = 0.017] and 0.815 (95% CI = 0.766-0.864; P < 0.001), respectively. The sensitivity and specificity for diagnosing CRC were 80.2 and 64%, respectively, if the cutoff value of IGFBP-2 was 377 ng/ml. In the multivariate Cox proportional hazards regression model, higher IGFBP-2 levels were associated with increased risk of mortality [hazard ratio (HR) = 2.46; P = 0.017], whereas higher IGF-II levels were associated with reduced risk of mortality (HR = 0.42; P = 0.044). LOI of IGF-II was associated with increased risk of mortality (HR = 7.91; P = 0.014) in patients with stage IV disease.
IGFBP-2 is a potential diagnostic and prognostic biomarker of CRC. LOI of IGF-II is significantly associated with poor prognosis in patients with stage IV disease.
The Journal of clinical endocrinology and metabolism 02/2010; 95(4):1717-25. · 6.50 Impact Factor
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ABSTRACT: Methemoglobinemia occasionally causes cyanosis particularly in congenital methemoglobinemia. Avoidance of exposure to oxidizing agents is important for patients with congenital methemoglobinemia because of their deficient enzymatic pathways and decreased oxygen-carrying capacity. Here, we present a patient with preoperatively undiagnosed congenital methemoglobinemia who underwent uterine myomectomy under general anesthesia. The patient was a 35-year-old woman who displayed a low pulse oximetry reading of 91% prior to induction of anesthesia. Methemoglobinemia was first suspected intraoperatively because of a mismatch of SpO2 of finger pulse oximetry and SaO2 of arterial blood, and was later confirmed by multiple-wavelength CO-oximetry. The pathophysiology, etiology, clinical manifestations, anesthetic considerations, and treatment options of methemoglobinemia are discussed.
Acta Anaesthesiologica Taiwanica 09/2009; 47(3):143-6.
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ABSTRACT: Elevated extracellular calcium ion has been shown to shift the voltage dependence of Na+- and K+-ion channels rightward, making the nerve less excitable. We hypothesized that calcium chloride (CaCl2) when used as an adjuvant prolongs and intensifies the block by local anesthetics (LAs). We investigated the effects of LAs combined with calcium in rat sciatic nerve blockade and in cultured rat GH3 cells expressing Na+ channels. Furthermore, we tested for histologic changes due to CaCl2.
We anesthetized rats with sevoflurane, exposed the sciatic nerves, and injected 0.2 mL of 1% lidocaine or 0.1% bupivacaine, alone or coadministered with 0.625%, 1.25%, 2.5%, or 5% CaCl2 (n = 8-10 per group). We assessed the complete-block time and complete-recovery time of proprioception, motor function, and nocifensive reaction. To elucidate the mechanism of nerve block, we performed electrophysiology experiments in cultured rat GH3 cells. Sciatic nerves were harvested at day 7 and stained with hemotoxylin/eosin.
The addition of CaCl2 overall prolonged the duration of blockade by lidocaine or bupivacaine. Adding 10 mM CaCl2 to 300 microM lidocaine caused a right shift of the steady-state Na+-channel inactivation curve, indicating that the CaCl2 reduced the potency of lidocaine. Rat sciatic nerves treated with 1% lidocaine coadministered with 5% CaCl2 showed microscopic signs of neurotoxicity.
The mechanism of prolonged nerve block of CaCl2 coadministered with LAs seems to be a raised threshold for nerve excitation. Major histopathologic changes at higher concentrations of CaCl2 are evident, and therefore, clinical application as an adjuvant to LAs seems unlikely.
Regional anesthesia and pain medicine 08/2009; 34(4):333-9. · 4.16 Impact Factor
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ABSTRACT: Colonoscopy is the most effective screening tool for colorectal cancer. In Taiwan, colonoscopy is used much less than sigmoidoscopy for screening because sedation significantly increases the cost and is not readily available, and unsedated colonoscopy is considered to be poorly tolerated. However, unsedated colonoscopy has been shown to be well accepted and may improve the cost-effectiveness and access to colonoscopic screening.
To compare the feasibility of unsedated colonoscopy and sigmoidoscopy for primary screening and to analyze factors associated with acceptance of the procedures and need for sedation.
Single center, prospective.
National Taiwan University Medical Center. POPULATION AND INTERVENTIONS: A consecutive series of 261 subjects without history of colonoscopy or sigmoidoscopy who underwent unsedated colonoscopy (n = 176) or sigmoidoscopy (n = 85) for primary screening.
Pain scores, acceptance, and need for sedation.
No significant differences in pain, acceptance, and need for sedation were found between the colonoscopy and sigmoidoscopy groups. Only 9.6% in the colonoscopy group and 10.1% in the sigmoidoscopy group considered sedation necessary. Multivariate analyses revealed that the examinee's sex and the endoscopist, but not the type of endoscopic examination, were associated with the severity of pain and need for sedation.
Nonrandomized study design.
Unsedated colonoscopy for primary screening is well accepted in nine tenths of examinees who accept this option and is similar to sigmoidoscopy in pain, acceptance, and need for sedation. Primary screening with unsedated colonoscopy is feasible, as with sigmoidoscopy.
Gastrointestinal endoscopy 07/2009; 70(4):724-31. · 6.71 Impact Factor
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ABSTRACT: Evidence from Japanese studies suggests that nonpolypoid colorectal neoplasia (NP-CRN) tends to be more pathologically advanced than polypoid neoplasia. However, data are limited regarding the prevalence of NP-CRN in an average-risk population. In addition, the diagnostic yield of the fecal occult blood test (FOBT) in relation to different types of colorectal neoplasms remains unclear. We prospectively investigated the prevalence and characteristics of polypoid and nonpolypoid colorectal lesions in an asymptomatic and average-risk Chinese population.
The study included 12,731 asymptomatic Chinese subjects (8372 of whom were average-risk subjects) who underwent screening colonoscopy. The prevalence, histopathologic findings, and topographic distribution of polypoid and nonpolypoid colorectal lesions were determined and analyzed. The diagnostic yield of FOBT, in relation to lesion morphology, also was assessed.
NP-CRN was detected in 552 (4.3%) asymptomatic and 348 (4.2%) average-risk subjects. The prevalence of depressed NP-CRN was 0.18% in both asymptomatic and average-risk subjects. A higher proportion of smaller-sized but high-grade dysplasia and invasive carcinoma beyond the submucosal layer was noted for depressed NP-CRN compared with flat NP-CRN or polypoid neoplasia. The diagnostic yield of FOBT was comparable in depressed lesions and their polypoid counterparts.
The prevalence of NP-CRN is substantial in both asymptomatic and average-risk Chinese individuals. Some subcategories of NP-CRN in this population tend to have more advanced pathologic characteristics. These findings may lead to modification of screening and prevention strategies for colorectal cancer.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 05/2009; 7(4):463-70. · 5.64 Impact Factor
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ABSTRACT: Gabapentin, an anticonvulsant with analgesic effect, has been reported to be an activator of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels. In this study, we tested the effect of intrathecal ZD7288, an HCN channel inhibitor, and its interaction with intrathecal gabapentin in the rat formalin test.
Male Sprague-Dawley rats (250-300 g) with an intrathecal catheter were intraplantarly injected with formalin (5% formaldehyde, 50 microl) in the right hindpaw. Ten minutes before formalin injection, gabapentin (100 or 200 microg) was given intrathecally. ZD7288 (50 microg) was administered intrathecally 10 min before paw formalin injection or intrathecal gabapentin. The paw flinch numbers in 1 min were counted at the first minute and every 5 min for 1 h after formalin injection.
Biphasic flinching responses were induced by formalin and monitored at 0-9 min (phase 1) and 10-60 min (phase 2) after formalin injection. Gabapentin (100 and 200 microg), given intrathecally 10 min before formalin injection, attenuated the flinching response during phase 2 of the formalin test. ZD7288 (50 microg), given intrathecally 10 min before formalin injection or intrathecal gabapentin injection, did not attenuate the formalin-induced flinching response or reverse gabapentin-induced analgesia.
Our data suggest that activation of spinal or dorsal root ganglion HCN channels or both is not involved in formalin-induced pain, and intrathecal gabapentin does not act as an HCN channel activator to achieve its antinociceptive effect in the formalin test.
European Journal of Anaesthesiology 04/2009; 26(10):821-4. · 2.23 Impact Factor
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ABSTRACT: Although evidence suggests that gastroesophageal reflux disease (GERD) may interrupt sleep, the effects of symptomatic and endoscopically diagnosed GERD remain elusive because the patient population is heterogeneous. Accordingly, we designed a cross-sectional study to assess their association.
Consecutive participants in a routine health examination were enrolled. Definition and severity of erosive esophagitis were assessed using the Los Angeles classification system. Demographic data, reflux symptoms, sleep quality and duration, exercise amount, alcohol consumption, and smoking habits were recorded. Factors affecting sleep quality and sleep duration were revealed by a polytomous logistic regression analysis.
A total of 3663 participants were recruited. Subjects with reflux symptoms, female gender, higher body mass index, and regular use of hypnotics had poorer sleep quality. Exercise was associated with better sleep quality. Either symptomatically or endoscopically, GERD did not disturb sleep duration. Among the 3158 asymptomatic patients, those with erosive esophagitis were more likely to have poor sleep quality. The risk increased with the severity of erosive changes (p = 0.03).
The present study highlights the adverse effect of gastroesophageal reflux on sleep, even in the absence of reflux symptoms. This finding has therapeutic implications in patients with silent erosive disease, and future trials are warranted.
Journal of the Formosan Medical Association 02/2009; 108(1):53-60. · 1.13 Impact Factor
