J.T.C. Chang

Association of HPV infections with second primary tumors in early-staged oral cavity cancer

OBJECTIVE The infection of human papilloma virus (HPV) has been reported in head and neck cancer; however, the clinical significance of HPV infection on the pathogenesis of oral cavity squamous cell carcinoma (OSCC) is still uncertain. MATERIALS AND METHODS The study recruited 103 patients with pathological early-stage OSCC between March 1997 and December 2003 from Chang Gung Memorial Hospital, Taiwan. Tumor specimens were HPV-genotyped by the EasychipVR HPV Blot method. Clinical association study was performed by using chi-square, Kaplan-Meier, and logrank tests. RESULTS Thirty-one patients (30.1%) were positive for HPV infection. The most frequent HPV types were types 16 (16 patients, 51.6%) and 18 (seven patients, 22.6%). HPV infection was not associated with tumor aggressiveness (pathological tumor stage or differentiation status), risk exposure (alcohol, cigarette, or areca quid chewing habit), or the treatment outcome (disease-free survival or overall survival). However, infection with HPV-18 was associated with the occurrence of a second primary cancers (P = 0.033), indicating the infection of HPV in OSCC enhances the susceptibility of developing secondary malignancy. CONCLUSIONS There are 30% of the patients with OSCC infected with HPV, with most high-risk types. HPV-18 infection may enhance the susceptibility of second primary tumors. Large scale of validation study will be needed to confirm this result.

Carbon dioxide insufflation during colonoscopy can significantly decrease post‐interventional abdominal discomfort in deeply sedated patients: A prospective, randomized, double‐blinded, controlled trial

CO2 has been reported to be absorbed from the bowel more rapidly than air, resulting in a discomfort reduction after colonoscopy. Its role in deeply sedated patients is limited. This study was designed to investigate the efficacy and safety of CO2 insufflation during colonoscopy in patients deeply sedated with propofol.

Intensity-Modulated Proton Therapy Reduces Acute Treatment-Related Toxicities for Patients with Nasopharyngeal Cancer: A Case-Control Propensity Score Match Study with Volumetric Modulated Arc Therapy

To evaluate the differences in the treatment-related toxicity between patients with nasopharyngeal cancer treated between IMPT and VMAT. To compare the clinical oncologic outcomes of these two treatment modalities. Intensity-modulated proton therapy reduces acute treatment-related toxicities for patients with nasopharyngeal cancer: A case-control propensity score match study with volumetric modulated arc therapy

Factors associated with healthcare professional's rating of disfigurement and self-perceived body image in female patients with head and neck cancer

The purpose of this study was to determine factors associated with self-perceived body image in female patients with head and neck cancer (HNC), and factors associated with healthcare professionals rating of disfigurement, as well as the correlation between patient and observer ratings. This cross-sectional study recruited 105 women with HNC at a large medical centre. Measures of facial disfigurement and body image, as well as demographic and clinical characteristics, were collected. Multivariate multiple linear regression modelling was used to identify factors associated with healthcare professionals rating of disfigurement and patient self-perceived body image. Disfigurement ratings by healthcare professionals were positively associated with patient self-perceived body image. Medical treatment, cancer stage, radiation dose and cancer site were significantly associated with disfigurement. Medical treatment was an important predictor of perceived body image. These findings indicate a moderate prevalence of disfigurement among women with HNCs. Patients with more disfigurement were more likely to have dissatisfaction with their body image. Nursing professionals need to carefully assess the appearance of women with HNC. Camouflage interventions can be used to help appropriately cope with the disfigurement, and to achieve improved satisfaction with their body image.

The Therapeutic Efficacy of Percutaneous Transhepatic Gallbladder Drainage in Acute Cholecystitis

Introduction: Acute cholecystitis is an acute inflammation of the gallbladder. In 96% of patients, the cystic duct is obstructed with gallstones. This results in a high risk of mortality and morbidity in debilitated and elderly patients. Percutaneous transhepatic gallbladder drainage (PTGBD) combined with intensive antibiotic treatment may allow the patients to receive elective surgery in a better clinical condition. The aim of the present study was to investigate the therapeutic efficacy of PTGBD in debilitated and elderly patients with acute cholecystitis.Patients and Methods: A total of 496 patients with acute cholecystitis were enrolled in this study. Patients who received conservative treatment and who had common bile duct (CBD) stones (evidenced by endoscopic retrograde cholangiopancreatography [ERCP] or magnetic resonance cholangiopancreatography [MRCP]) and Mirizzis syndrome were excluded. PTGBD was performed under ultrasound or computed tomography (CT) guidance in 65 patients. The clinical features, biochemical data, and outcomes were analyzed.Results: Among the 65 patients, 27 patients underwent cholecystectomy after PTGBD and 18 patients (67%) underwent surgery within 28 days. Fourteen (22%) patients died during follow up; they had significantly higher levels of total bilirubin, aspartate amminotransferase (AST), and alkaline phosphatase (ALP), and a higher incidence of sepsis. The clinical and laboratory features were similar between patients with and without surgery after PTGBD. However, patients without surgery had higher rates of sepsis and mortality, which was associated with more comorbidities.Conclusion: Elective surgery after PTGBD may be necessary for debilitated patients with acute cholecystitis. PTGBD together with antibiotics can convert a septic into a non-septic cholecystitis, particularly in elderly and debilitated patients. Surgery alone has a lower mortality rate and may be a better treatment choice for patients with acute cholecystitis who are younger and have fewer comorbidities.

Non-variceal Upper Gastrointestinal Bleeding in the Elderly Patients-A Comparison with Younger Patients

Background: The in-hospital complications and mortality rates of patients with non-variceal upper gastrointestinal bleeding have been reported to be higher in elderly than in younger patients. However, the mortality, the need for surgery and the rebleeding rates of elderly compared with younger patients in the era of therapeutic endoscopy and proton pump inhibitor are unclear.Aim: This study aims to investigate and compare the clinical outcomes of the non-variceal upper gastrointestinal bleeding in the elderly patients with those of the younger patients.Materials and Methods: A total of 205 consecutive patients who were diagnosed with non-variceal upper gastrointestinal bleeding according to chart review from June 2008 to March 2010 were enrolled in this study, including 112 elderly patients (age ≧ 70) and 93 younger patients (age ＜ 70).Result: The frequencies of cardiovascular diseases (40% vs. 14%, P＜0.001), hypertension (68% vs. 39%, P＜0.001), diabetes mellitus (30% vs. 17%, P=0.003 ), ulcerogenic drug use (42% vs.23% P=0.003) and gastric ulcer (66 % vs. 46%, P=0.004) were greater among elderly patients. There was no significant difference in the proportion of high-risk stigmata of recent hemorrhage, amount of blood transfused, rebleeding rate, endoscopy sessions, the need for surgery, or mortality rate between two groups of patients. The length of hospital stay was significantly longer in the elderly patients.Conclusion: Peptic ulcers account for the majority of the in hospital non-variceal upper gastrointestinal bleedings. Among them, gastric ulcers occur more frequently in the elderly patients due to the use of more ulcerogenic drugs. The rate of rebleeding, surgery, or mortality was not statistically different between both groups of patients although the elderly patients tend to have more mortality risk.