Journal of the Formosan Medical Association

Current Status of Human Papillomavirus Vaccines

Barbara Ma, Richard Roden, T.-C. Wu — 2010-07-01

Intra-abdominal Complications of Sarcoidosis

Kristin Loening MacArthur, Faripour Forouhar, George Yung-Hsing Wu — 2010-07-01

Sarcoidosis is an inflammatory disease characterized by non-caseating granulomas in the absence of other autoimmune processes, infectious diseases, or foreign agents. The etiology of sarcoidosis is not completely understood. Several organ systems can be affected, of which the most frequently involved include the lungs and lymph nodes. Intra-abdominal sarcoidosis is less common, but can be found in the absence of pulmonary or lymphatic disease. Intra-abdominal sarcoidosis is most often asymptomatic. However, long-standing unrecognized disease can result in life-threatening complications. The identification, monitoring and prevention of these complications will be discussed, with emphasis on both clinical and histological presentations of intra-abdominal sarcoidosis.

Quality of Life in Taiwanese Breast Cancer Survivors With Breast-conserving Therapy

2010-07-01

Background/Purpose: Breast cancer is the most common female malignancy in Taiwan; however, quality of life (QOL) following breast cancer therapy remains rarely studied. The aim of the present study was to evaluate QOL among Taiwanese breast cancer patients with and without breast-conserving therapy. Methods: A total of 130 women with breast cancer (37 with breast-conserving therapy and 93 with modified radical mastectomy) were enrolled between August, 2004 and December, 2007 in a single center. Patients who underwent breast-conserving therapy were younger, less likely to be married, had a higher educational level, and were at an earlier clinical stage than those who underwent modified radical mastectomy. The traditional Chinese version of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 questionnaires were used as measuring instruments. Structural equation modeling with mean structural analysis, which evaluates configuration invariance and compares groups for latent functional/symptomatic factors, was constructed using a multi-indicators approach. Results: Patients with breast-conserving therapy reported worse global QOL status and role function scores and higher symptomatic scores for fatigue, pain, dyspnea, insomnia, appetite loss, breast and arm problem subscales than those without conserving therapy. In addition, age, marital status, hormone manipulation and postoperative adjuvant therapy were significant confounders for QOL. Measurement invariance was ascertained and the same QOL construct could be applied to Taiwanese subjects with and without breast-conserving therapy. Conclusion: Our study suggests that breast-conserving therapy might be associated with worse perceived QOL for Taiwanese breast cancer survivors.

Self-efficacy Affects Blood Sugar Control Among Adolescents With Type I Diabetes Mellitus

An-Hsuan Chih, Chyi-Feng Jan, San-Ging Shu, Bee-Horng Lue — 2010-07-01

Background/Purpose: Self-management is crucial to diabetes control. To investigate the effectiveness of self-management in reaching target hemoglobin A1c (HbA1c) level, we conducted a study among Taiwanese adolescents with type 1 diabetes mellitus (DM). Methods: Patients aged 12–20 years with type 1 DM participated in an annual integrated DM care clinic at a medical center in Taiwan. All patients completed a questionnaire that included demographic data and self-efficacy measured by the Perceived Diabetes Self-Management Scale (PDSMS) in February 2008. Laboratory tests were also done at the same visit. The target HbA1c was < 7.0% in accordance with the general standard of the American Diabetes Association for patients with type 1 DM. Logistic regression analysis was used to explore the relationship between age, sex, duration of diabetes, PDSMS score, and HbA1c level. Results: Fifty-two patients were enrolled. The mean age was 16.0 ± 2.4 years, and mean HbA1c level was 8.6 ± 1.6%. Pearson correlation analysis showed a positive correlation between body mass index and preprandial blood sugar level (r = 0.297, p < 0.05). Negative correlations were found between PDSMS scores and duration of diabetes (r = −0.365, p < 0.01) as well as HbA1c level (r = −0.295, p < 0.05). Logistic regression analysis demonstrated that sex and PDSMS scores significantly influenced glycemic control. In multivariate logistic regression analysis, patients with higher PDSMS scores were 1.63 times (95% confidence interval = 1.03–2.59) more likely to reach target diabetes control after adjustment for other variables. Male patients also had a higher probability (odds ratio = 19.80, 95% confidence interval = 1.34–291.93) of reaching target diabetes control. Conclusion: This study demonstrates that adolescents with type 1 DM and higher self-efficacy, especially males, have a higher probability of reaching target diabetes control.

A Novel Inspection Protocol to Detect Volatile Compounds in Breast Surgery Electrocautery Smoke

Yu-Wen Lin, Shou-Zen Fan, Kuo-Hui Chang, Chiun-Sheng Huang, Chin-Sheng Tang — 2010-07-01

Background/Purpose: Electrocautery procedures generate malodorous smoke. This study quantified five volatile organic compounds detected in the smoke produced during breast surgery, and elucidated the factors that affect their chemical production. Methods: All samplers were assembled in an acrylic chamber with a Tygon tube attached to the tip of a diathermy pencil. The electrocautery smoke was quantified by gas chromatography/mass spectrometry. Results: In all samples, toluene was identified in concentrations of 2.48–5.50 mg/m3. Higher concentrations were observed during modified radical mastectomy procedures. Patients with high body mass index revealed high toluene concentrations. Longer duration of electrocautery tended to produce more toluene. Conclusion: The sampling protocol enabled acquisition of smoke samples near the source without interrupting surgery. The findings suggest that type of surgery, patient body mass index and duration of electrocautery are factors that can alter production of chemicals.

Clinical Significance of Isolation of Mycobacterium avium Complex From Respiratory Specimens

Meng-Chuan Shen, Susan Shin-Jung Lee, Tsi-Shu Huang, Yung-Ching Liu — 2010-07-01

Background/Purpose: Mycobacterium avium complex (MAC) is frequently considered to be a contaminant or transient colonizer. To the best of our knowledge, there have been very few reports regarding the clinical significance of MAC isolates in respiratory specimens, and the associated disease spectrum in Taiwan. The purpose of this study was to investigate the clinical significance of MAC isolates in respiratory specimens. Methods: We retrospectively reviewed the medical records of patients in a medical center in Southern Taiwan from whom MAC isolates were recovered from respiratory specimens, and analyzed their clinical features, chest imaging findings, treatment and prognosis. We also performed an antibiotic susceptibility test on our MAC isolates. Results: The 64 isolates used in this study were recovered from April to October 2001 from respiratory specimens in 54 patients admitted to Kaohsiung Veterans General Hospital, Taiwan. According to the 2007 criteria of the American Thoracic Society, a total of 12 patients (22.2%) had clinically significant MAC pulmonary disease. Conclusion: Despite the increased frequency of recovering MAC from respiratory specimens, most cases did not meet the criteria of American Thoracic Society for clinically significant nontuberculous pulmonary disease. The minimum inhibitory concentrations of drugs against these MAC isolates might help to guide treatment, but further studies should be done.

Population-based Post-crisis Psychological Distress: An Example From the SARS Outbreak in Taiwan

2010-07-01

Background/Purpose: As a result of the severe acute respiratory syndrome (SARS) pandemic, the World Health Organization placed Taiwan on the travel alert list from May 21 to July 5, 2003. The aim of this study was to explore the post-crisis psychological distress among residents in Taiwan after the SARS epidemic. Methods: The target population consisted of a nationwide representative sample of residents aged ≥ 18 years. Data were collected using computer assisted telephone interview systems by stratified random sampling according to geographic area. The survey (n = 1278) was conducted in November 2003, about 4 months after resolution of the SARS crisis in Taiwan. The maximum deviation of sampling error at the 95% confidence level was ± 2.74%. Psychological distress was measured by a question related to subject's changes in perception of life, plus the five-item Brief Symptom Rating Scale. Multivariate logistic regression was used to examine the correlation of psychological distress. Results: About 9.2% of the participants reported that their perceptions of life became more pessimistic following the SARS crisis. The prevalence of psychiatric morbidity was 11.7%. Major predictors of higher levels of pessimism after the SARS epidemic included demographic factors, perception of SARS and preparedness, knowing people or having personal experiences of SARS-related discrimination, and individual worries and psychiatric morbidity. The correlates of symptomatic cases, as indicated by the five-item Brief Symptom Rating Scale, included age ≥ 50 years, senior high school graduate, and worries about recurrence of SARS. Conclusion: Psychological distress was significantly correlated with demographic factors and perception regarding the SARS epidemic. It is suggested that marketing of mental health education should be segmented according to age and education level, which should enhance crisis communication for newly emerging infectious diseases among community populations.

Utilization of Emergency Department in Patients With Non-urgent Medical Problems: Patient Preference and Emergency Department Convenience

Jeffrey Che-Hung Tsai, Yia-Wun Liang, William S. Pearson — 2010-07-01

Background/Purpose: We investigated the factors associated with emergency department (ED) use among patients with non-urgent medical problems, with a focus on convenience and preference to use the ED instead of primary care clinics. Methods: A five-level triage system was adopted by research nurses to decide each patient's triage level and the maximum time to physician interview. Patients who had a maximum time to physician interview of more than 60 minutes were assumed to be non-urgent in this study. Results: More than half of ED visits were considered to be non-urgent. Non-urgent patients were more likely to be unmarried, government employees, visit the ED due to trauma, have a history of chronic illness, and present in the day time or at the weekend. ED visits were also more likely to occur in patients who took less than 15 minutes to reach the ED, chose the ED for its convenience, agreed that they could have chosen another facility for their visit, did not agree that the ED was convenient for receiving medical care. Multivariate logistic regression showed that marital status, time of presentation, time needed to get to the ED, and occupation were associated with non-urgent ED visits. Conclusion: Preference for using EDs for medical care and their convenience might contribute to non-urgent ED visits. A five-level triage system reliably stratified patients with different admission rates and utilization of medical resources, and could be helpful for reserving limited medical resources for more urgent patients.

Creating a Platform to Bridge Service and Research for Early Psychosis

Chen-Chung Liu, Hai-Gwo Hwu, Yen-Nan Chiu, Meng-Chuan Lai, Huai-Hsuan Tseng — 2010-07-01

Early identification of subjects at risk of developing psychosis is the key to early intervention. A prospective study on the psychopathological progress from prodromal state to full-blown psychosis was initiated in Taiwan in 2006. However, the clinical entity of our interests is ill-defined; therefore, recruitment of at risk subjects to participate in studies requires innovation. In November 2006, the study team launched a special clinic for cognitive and perceptual disturbance. In the first year, 142 subjects, mostly aged 16–30 year olds, made an appointment for this special clinic. More than 20 tentative diagnoses were made. Seventy-six subjects with a gradient of clinical severity were eligible for enrollment, and 68 gave informed consent to participate in the research. It seems that setting up a special clinic to provide a service for at risk subjects, combined with certain campaigns, could facilitate their engagement in a longitudinal prospective study for early psychosis.

Giant Cell (Temporal) Arteritis With Anterior Ischemic Optic Neuropathy: A Biopsy-proven Case in Taiwan

Cheng-Kuo Cheng, Chin-Cheng Lee, Kai-Han Huang, Tzu-En Wu, Pai-Huei Peng — 2010-07-01

Giant cell arteritis with arteritic anterior ischemic optic neuropathy has rarely been diagnosed in Taiwan. Recently, we encountered a 76-year-old Taiwanese patient who presented with right visual impairment and marked pale swelling of his right disc. He also suffered body weight loss, general malaise and many typical manifestations of giant cell arteritis, such as jaw claudication, a tender, non-pulsating engorgement of his temporal arteries, and a highly elevated erythrocyte sedimentation rate and C-reactive protein level. Biopsy of his right superficial temporal artery revealed a granulomatous inflammation with multinucleated giant cell infiltration. This was a biopsy-proven case of giant cell arteritis with arteritic anterior ischemic optic neuropathy and indicated that although rare, this disease could occur in patients in Taiwan.