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   2018| September-October  | Volume 51 | Issue 5  
    Online since October 17, 2018

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Improvement of satisfaction in burn patients receiving adjuvant hyperbaric oxygen therapy
Kuan-Liang Chen, Cheng-Jung Wu, Wei-Shih Tseng, Hui-Chieh Lee, Tzu-Pin Tsai, Wen-Shyan Huang
September-October 2018, 51(5):184-191
Background: Hyperbaric oxygen (HBO) therapy is an adjuvant treatment in patients with burns. However, evidence regarding the effectiveness of the HBO therapy for the improvement of patient's satisfaction has seldom been discussed; thus, we share our experience in this topic. Aim and Objectives: This study aimed to evaluate the improvement of burn patients' satisfaction after adjuvant HBO therapy. Materials and Methods: This was a retrospective case–control study involving 35 burn patients admitted to our hospital without a history of chronic pain and burn treatments from 2012 to 2015. Group I consisted of 18 burn patients who received HBO therapy to manage burns. The HBO therapy was administered in the hyperbaric chamber and received 60 min of 100% oxygen at a therapeutic pressure at 50 feet for 20 sessions. Group II consisted of 17 burn patients without a history of HBO therapy. Age, gender, total body surface area (TBSA), scar progression, improvement of visual analogue scale score, satisfaction improvement, and infection rate were documented and analyzed. Results: The mean age of Group I (37.0 ± 9.2) was significantly lower than that of Group II (49.4 ± 17.4) (P = 0.015). The mean improvement pain score in Group I (4.7 ± 1.1) was significantly higher than that of Group II (3.6 ± 0.9) (P = 0.004). The mean satisfaction improvement of Group I (3.4 ± 0.5) was significantly higher than that of Group II (2.9 ± 0.6) (P = 0.009). No significant difference was observed between gender, TBSA, debridement times, skin graft times, skin graft surface, infection rate, length of hospital stay, and progression of scar score in both groups, but there was a positive correlation between HBO therapy and the progression of scar score, so does the infection rate. There is no significant interaction between the two factors (HBO and age) on the improvement of pain score and improvement of satisfaction. Conclusion: Evaluation of the results obtained in the study suggests that the HBO therapy has a significant improvement in the pain relieve and satisfaction improvement after control of age factor in patients with thermal burns.
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Chronic periodontal disease correlated with sezual function in young males
Meng-Han Chou, Chin-Yu Liu, Ming-Hsin Yang, Yu-Ching Chou, Sheng-Tang Wu, Tai-Lung Cha, Chih-Wei Tsao
September-October 2018, 51(5):175-179
Background: In this study, we aimed to identify the association between chronic periodontal disease (CPD) and erectile dysfunction (ED) in a large young population. Patients and Methods: Totally 2191 male participants aged 18–28 years attended the Army Training Center in Taiwan between August 2012 and May 2013. All 1932 included participants filled in the International Index of Erectile Function-5 (IIEF-5) questionnaire and received a comprehensive dental examination to classify whether CPD. Results: There was a statistically significant correlation between the presence of ED and CPD (P < 0.001). Multivariate logistic regression analysis indicated that men with CPD were 1.6 (95% confidence interval = 1.280–2.009, P < 0.001) times more likely to have ED than men without CPD after adjusting confounders. Conclusion: This study demonstrates a link between ED and CPD, and it may be attributed to a combination of psychogenic and organic etiologies, such as systemic inflammation, oxidative stress, and endothelial dysfunction. This study highlights the significance of oral health, which may take a role in sexual function, even in young males. In clinical practice, more comprehensive management strategies to address participants with ED and CPD need to be investigated.
  1,699 248 1
Treatment results in the same surgery method of the high cervical spinal schwannoma
Chien-Yu Ou, Ching-Min Nien, Yu-Hua Huang
September-October 2018, 51(5):180-183
Background: The aim of this study was to explore the outcomes for patients with high cervical spinal schwannoma after microsurgery. Materials and Methods: This retrospective study enrolled ten patients who received high cervical schwannomas microsurgery. The data collected retrospectively include sex, Karnofsky Performance Status (KPS) score before surgery, and KPS score after surgery. Results: The KPS scores of the patients changed from 30 to 90 (average 70) before surgery to KPS scores of 50 to 90 (average 82) upon discharge. The duration of the follow-up in the clinics was 2–192 months (average 44). The mean hospital stay was 7–35 days (average 12.4 days). We used paired t-test and found a significant improvement of the KPS score. Conclusion: High cervical spinal neoplasm is relatively rare and the surgery is technically challenging. Many articles discussed the classification of tumors or surgical approaches, while few studies explored the outcome of the surgery. In this article, the patients with high cervical spinal neoplasm all underwent the same type of surgery. After the surgery, the patients' quality of life had shown significant improvement.
  1,539 196 -
Fishbone-related liver abscess
Hsien-Pin Sun, Chih-Jen Huang
September-October 2018, 51(5):209-212
Liver abscess caused by foreign-body penetration of the alimentary tract is rare. Preoperative diagnosis is difficult as patients are often unaware of the foreign-body ingestion and the unusual characteristic is often being paucisymptomatic until secondary complications occur. We report a patient with fishbone-related liver abscess. Preoperative demonstration of a hyperdense, linear lesion was performed by computed tomography. He was treated successfully after removal of the foreign body and drainage of the abscess.
  1,365 194 1
Small cell carcinoma of upper urinary tract: A pooled analysis of survival
Tzong-Shin Tzai, Yuh-Shyan Tsai
September-October 2018, 51(5):192-197
Introduction: Small cell carcinoma (SCC) of upper urinary tract is not common and often associated with poor prognosis. We aimed to analyze the prognostic factors based on the pooled cases published in the literature. Patients and Methods: In addition to 10 cases treated at our hospital since 1990, 52 additional published cases with SCC of renal pelvis and ureter were enrolled into this study. We investigated the following risk factors associated with clinical outcome: age at diagnosis, gender, tumor location, histology, tumor stage, and treatment modality using univariate log-rank test and multivariate Cox analyses. Results: A total of 62 cases were enrolled into the study, including ten added by us. There were 30 cases from renal pelvis, 26 from the ureter, and 6 both sites. The mean age is 65.8 ± 13.0 years, and the median survival is 12 months. Patients with SCC of renal pelvis were significantly younger than did those of the ureter (P = 0.004), as well as higher stage (P = 0.043). Univariate analysis showed that both tumor stage and the presence of radiotherapy were significant predictors of disease-specific overall survival (P = 0.015 and 0.029, respectively), as well as the overall survival (P = 0.035 and 0.036, respectively). Cox's multivariate analysis showed tumor stage is an independent prognostic factor for disease-specific overall survival (hazard ratio, 2.11; 95% confidence interval, 1.08–4.13; P = 0.029). Conclusions: In the current study, tumor stage is significantly associated with disease-specific overall survival. This finding warns us the importance of early diagnosis of SCC.
  1,337 193 -
Burkitt's lymphoma presenting as ovarian mass and ileocecal intussusception in an adult
Chung-Hsiung Liu, Cheng-Lin Wu, Edgar D Sy
September-October 2018, 51(5):201-204
Burkitt's lymphoma (BL) is usually diagnosed in children and young adults. Adults with Burkitt's lymphoma, particularly those with advanced stage disease, present with poorer prognosis compared to children and very rarely as multiorgan tumors. Involvement of the gastrointestinal (GI) tract presents with GI tract symptoms and can cause intussusception. Herein, we report a 42-year-old, chronic schizophrenic woman, presenting with lower GI bleeding secondary to intussusception, and the radiologic study revealed multiple site organs involvement including terminal ileum, cecum, and bilateral ovaries. She underwent optimal cytoreduction procedure, bilateral salpingo-oophorectomy and radical right hemicolectomy with ileocolostomy, and adjuvant multiagents chemotherapy postoperatively with the regimen of CODOX-M/IVAC for four courses without radiologic evidence of tumor recurrence after a 6-year follow-up.
  1,346 178 -
Chest wall pleomorphic liposarcoma combined with lung extraskeletal osteosarcoma
Wan-Yu Hung, Ching-Yuan Cheng, Shyuann-Yuh Lin, Ko-Chin Chen
September-October 2018, 51(5):205-208
Extraskeletal osteosarcoma is extremely rare in human beings, in contrast with liposarcoma, one of the most common types of soft-tissue sarcoma. Lung extraskeletal osteosarcoma was only published in a few case reports, with even less associated with soft-tissue liposarcoma. Within those few reports, no case has mentioned the coexistence of liposarcoma and lung extraskeletal osteosarcoma in the same patient. Herein, we present a very rare case of a patient who suffered a right middle lobe lung extraskeletal osteosarcoma for 20 months, following a complete left chest wall pleomorphic liposarcoma adjuvant therapy. Pleomorphic lipoblast with atypical mitosis was found in previous histology slides; however, typical osteoid was found in the right middle lobe pleura. Unfortunately, although adjuvant chemotherapy with high-dose radiotherapy was arranged immediately, the patient still died in 4 months. According to the literature review, chemotherapy and radiotherapy could induce gene mutation and subsequent transformation of cancer types or mix two cancer types. Since the two tumors can grow rapidly in a short period, the possibilities of cancer recurrence or formation of double primary cancers should not be neglected.
  1,372 150 1
Surgical versus conservative management for suppurative intramural esophageal dissection
Shou-Hei Tseng, Yu-En Chen, Chi-Chih Wang, Frank Cheau-Feng Lin
September-October 2018, 51(5):198-200
Often presented with an insidious onset, intramural esophageal dissection (IED) is a rare disease which has been mostly treated conservatively, though the treatment for infectious cases is still controversial. Two cases are reported here as follows: one was approached surgically by thoracoscopic mediastinotomy and neck debridement and the other was treated conservatively. The latter subsequently developed septic shock and was readmitted with intensive care. Both patients eventually recovered and resumed oral intake without requiring esophagectomy. Comparing these two cases of IED, one with a mucosal perforation and the other without, surgical intervention revealed the advantages of definitive isolation of pathogen and rapid mechanical removal of pus. Surgical risks should be evaluated against the severity, such as the presence of a mucosal perforation and the risk of a protracted clinical course for IED.
  1,297 203 -