Jen-Seng Huang

Transient hyperammonemia related to chemotherapy with continuous infusion of high-dose 5-fluorouracil.

Hyperammonemic encephalopathy has been reported in patients receiving chemotherapy (CT). It is characterized by abrupt alteration in mental status with markedly elevated plasma ammonium levels in the absence of obvious liver disease. This paper reports seven patients who developed transient hyperammonemia during chemotherapy. The regimens all Included continuous infusion of high-dose 5-fluorouracil (5-FU). The onset of hyperammonemic encephalopathy was 1.5–4 days after the start of CT. Five cases had Infection and six had prerenal azotemia at the time of hyperammonemia. After management, plasma ammonium levels all returned to the normal range within 2 days. Except for one persistent coma, status of consciousness cleared completely. The true mechanism of transient hyperammonemia is unclear. The excess production of ammonium due to metabolites of 5-FU added to precipitating factors such as infection, hypovolemia or constipation may be the explanation for transient hyperammonemia In our study.

Omega-3 fatty acid-, micronutrient-, and probiotic-enriched nutrition helps body weight stabilization in head and neck cancer cachexia

OBJECTIVE To evaluate whether an oral nutritional supplement enriched with omega-3 fatty acids, micronutrients, and probiotics affected body weight (BW) changes, serum albumin and prealbumin levels in patients with head and neck cancer (HNC) cachexia. STUDY DESIGN Sixty-eight HNC patients were randomly assigned to receive either an Ethanwell/Ethanzyme (EE) regimen enriched with omega-3 fatty acids, micronutrients, and probiotics, or control (Isocal) for a 3-month period. Analysis of covariance was used to examine the association between BW change and variables. RESULTS Patients with body mass index (BMI) <19 and those receiving the EE regimen consumed fewer daily calories but showed significantly increased BW and maintained higher serum albumin and prealbumin levels than other patients (P<.05). Their BW changes were significantly associated with changes in serum albumin and prealbumin levels. CONCLUSIONS EE regimen improved BW as well as serum albumin and prealbumin levels in HNC patients with BMI <19.

Tumor fever in patients with nasopharyngeal carcinoma: clinical experience of 67 patients.

From 1982 through 1996, 67 patients with nasopharyngeal carcinoma (NPC) proven to have tumor fever (TF) were analyzed. All were in metastatic stage when TF occurred. Forty-five patients (67%) had recurrent disease. Thirty-eight (57%) had fever before metastatic lesions were detected. The metastatic sites were: 84% in bone, 69% in liver, and 19% in lung. Multiple-organ metastases were found in 64% of the patients. Nine patients (13%) had bone-marrow invasion. When TF was present, 22 (33%) patients had other paraneoplastic syndromes, of which leukemoid reaction (LR) was seen most frequently. After the initiation of naproxen or indomethacin, most patients had complete lysis of the fever within 48 hours. Of the six patients receiving chemotherapy as the initial therapy, all of their temperatures returned to normal range after the treatment. Some patients, particularly those with tumor progression, developed TF again when antipyretic drugs were discontinued. The median survival time was 5 months. In conclusion, TF in NPC is usually a manifestation of metastatic disease. Tumor fever often associates with other paraneoplastic syndromes. Naproxen, indomethacin, and systemic chemotherapy all had effectiveness in ameliorating TF. Systemic metastases should be suspected in NPC patients with fever of unknown origin.

Pretreatment serum interleukin‐1β, interleukin‐6, and tumor necrosis factor‐α levels predict the progression of colorectal cancer

The correlations of pretreatment serum concentrations of proinflammatory cytokines such as interleukin (IL)‐1β, IL‐6, and tumor necrosis factor‐α (TNFα) with the clinicopathologic features and progression of colorectal cancer (CRC) were investigated. The pretreatment serum levels of IL‐1β, IL‐6, and TNFα were measured in 164 CRC patients before treatment. The relationships between changes in proinflammatory cytokine and C‐reactive protein (CRP) levels and both clinicopathologic variables and disease progression were examined by univariate and multivariate analysis. Advanced tumor stage was associated with a poorer histologic differentiation, higher CRP level, lower albumin level, and inferior progression‐free survival rate (PFSR). Furthermore, high levels of CRP (>5 mg/L) were associated with proinflammatory cytokine intensity, defined according to the number of proinflammatory cytokines with levels above the median level (IL‐1β ≥10 pg/mL; IL‐6 ≥ 10 pg/mL; and TNFα ≥55 pg/mL). Under different inflammation states, proinflammatory cytokine intensity, in addition to tumor stage, independently predicted PFSR in patients with CRP <5 mg/L, whereas tumor stage was the only independent predictor of PFSR in patients with CRP ≥5 mg/L. Proinflammatory cytokine intensity and the CRP level are clinically relevant for CRC progression. Measurement of IL‐1β, IL‐6, and TNFα serum levels may help identify early cancer progression among patients with CRP <5 mg/L in routine practice.

Antinuclear antibody status and risk of death in children and adolescents

Objectives: The association between the presence of antinuclear antibodies (ANA) and mortality has been rarely reported. The present study explored the value of ANA as a predictor of overall survival in children and adolescents. Methods: Patients younger than 20 years who underwent ANA testing in Chang Gung Memorial Hospital (CGMH) from 2000 to 2008 were enrolled in this study. Mortality was ascertained by using the National Death Registry of Taiwan. Positive ANA titres were categorized as low (1:40 to 1:80), medium (1:160 to 1:320), and high (≥ 1:640). Results: A total of 13 345 subjects (6579 males, 6766 females) were enrolled during the 9-year study period. The overall prevalence of low, medium, and high ANA titres was 20.8% (n = 2774), 6.0% (n = 804), and 2.5% (n = 338), respectively. During 45 140 person-years of follow-up, 146 deaths were identified and the crude mortality rates were 3.8 and 3.0 per 1000 person-years for subjects with positive and negative ANA test results, respectively (p = 0.130). Compared with ANA-negative subjects, the adjusted hazard ratio (HR) for all-cause mortality among those with a high ANA titre was 5.18 [95% confidence interval (CI) 3.13–8.57]. A low-to-medium ANA titre was not associated with increased mortality. Among the 18 deaths in individuals with a high ANA titre, 14 were due to systemic lupus erythematosus (SLE). In comparison, five out of 34 deaths among those with low-to-medium titres of ANA and none of those with negative ANA were related to SLE. Conclusions: Children and adolescents with high ANA titres should receive greater attention and monitoring to prevent unfavourable outcomes because they have a higher mortality risk than those with negative ANA results.

Influenza B-associated rhabdomyolysis in Taiwanese children

Aim:  Influenza B‐associated rhabdomyolysis (IBAR) is an infrequent and little‐known complication of influenza B virus infection in children. Diagnosis is usually made based on clinical history, the presence of influenza in the community and detection of virus in nasopharyngeal specimens. The aim of this study was to describe the clinical and laboratory manifestations, complications and outcomes of IBAR in Taiwanese children.

The Prognostic Value of HER2-Positive Circulating Tumor Cells in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Introduction A meta‐analysis was conducted to determine the prognostic value of HER2‐positive circulating tumor cells (CTCs) in patients with breast cancer. Materials and Methods MedLine, Central, and Embase databases were searched. Inclusion criteria were: (1) randomized controlled trials, 2‐arm prospective studies, and retrospective studies; (2) patients with breast cancer; (3) HER2‐positive CTCs were examined; and (4) hazard ratio (HR) of survival between patients with HER2‐positive and HER2‐negative CTCs was reported. Results Four studies with a total of 550 patients with stage I to IV breast cancer were included. HER2‐positive CTCs were not associated with worse overall survival (OS; HR, 1.489, 95% confidence interval [CI], 0.873‐2.540, P = .144) or progression‐free survival (PFS; HR, 1.543; 95% CI, 0.636‐3.744; P = .338). In patients without metastasis, HER2‐positive CTCs were associated with worse OS (HR, 2.273; 95% CI, 1.340‐3.853; P = .002) and worse PFS (HR, 2.870; 95% CI, 1.298‐6.343; P = .009). There was no significant relationship between HER2‐positive CTCs and survival in subgroups of patients with metastasis. Conclusion HER2‐positive CTCs have prognostic value in patients with breast cancer and without distant metastasis. Micro‐Abstract A meta‐analysis was conducted to determine the prognostic value of HER2‐positive circulating tumor cells (CTCs) in patients with breast cancer. MedLine, Central, and Embase databases were searched. HER2‐positive CTCs were associated with worse overall survival, but not worse progression‐free survival. HER2‐positive CTCs have prognostic value in patients with breast cancer.

Intravenous glutamine appears to reduce the severity of symptomatic platinum-induced neuropathy: a prospective randomized study.

Abstract The purpose of this study is to evaluate the efficacy of intravenous (IV) glutamine or calcium/magnesium (Ca/Mg) infusion against platinum-induced neuropathy. Patients undergoing platinum-based (oxaliplatin or cisplatin) therapy were randomized to receive IV glutamine or Ca/Mg infusion during four cycles of chemotherapy, from the fifth cycle of therapy to the eighth cycle. The total neuropathy score (TNS) was evaluated at the end of the fourth course of chemotherapy (as baseline) and at the end of the eighth cycle (as end-of treatment). The intent-to-treat analysis of the end point included 29 patients in the glutamine arm and 26 patients in the Ca/Mg arm. The mean TNS of both cohorts increased significantly. The baseline and end-of-treatment TNSs between the two groups were not statistically different. Patients with symptoms at baseline (N = 29) had significantly lower scores at the end of the study in the glutamine group (P = 0.045). Besides, glutamine group patients who initially had only sensory symptoms (N = 23) also had significantly lower scores at the studys end (P = 0.035). Neither IV glutamine nor Ca/Mg infusion prevented further worsening of platinum-induced neuropathy. However, IV glutamine apparently reduced the severity of symptomatic platinum-induced neuropathy.

Chemoradiotherapy in elderly patients with advanced head and neck cancer under intensive nutritional support.

To evaluate treatment tolerance, toxicities and survival in elderly patients with advanced head and neck cancer who received inpatient‐based intensive nutritional support with concurrent chemoradiotherapy in comparison with younger patients undergoing the same treatment.

Phase I dose escalation study of oxaliplatin combined with oral tegafur-uracil and leucovorin in patients with advanced gastric cancer.

Our aim was to determine the dose-limiting toxicities (DLTs), maximum tolerated dose (MTD) and recommended dose of oxaliplatin combined with oral tegafur–uracil and leucovorin. Twenty-eight chemo-naïve patients with advanced gastric cancer were enrolled. Oxaliplatin (55, 70, 85, 100 and 115 mg/m2) was given as a 2-h infusion on days 1 and 15. Oral tegafur–uracil (300 mg/m2 per day) and leucovorin (60 mg/day) were given 3 times a day from days 1 to 21 (28-day cycle). DLTs were defined as grade IV hematologic toxicity or grade III non-hematologic toxicity. The MTD for oxaliplatin was 100 mg/m2. The most common DLT was diarrhea. Major grade III/IV toxicities included vomiting, diarrhea, renal dysfunction, leukopenia and thrombocytopenia. There were two treatment-related deaths. Intent-to-treat response was graded as partial response in 13 patients (46.4%; 95% confidence interval 26.74–66.12%), stable disease in nine and disease progression in five. As of June 2004, 17 patients had died. The median time to treatment failure, time to progression and overall survival were 124, 308 and 434 days, respectively. The recommended dose for the phase II study is oxaliplatin 100 mg/m2 biweekly with oral tegafur–uracil (300 mg/m2 per day) and leucovorin (60 mg/day) 3 times a day for 21 days.