Luo-Ping Ger

Gender and pain upon movement are associated with the requirements for postoperative patient-controlled iv analgesia: a prospective survey of 2,298 Chinese patients.

PurposeTo investigate prospectively the influence of patient characteristics upon, and the association of postoperative measurements with, the requirements for postoperative morphine and the assessment of resting pain and pain upon movement in Chinese patients.MethodsFrom January 1998 to December 1999, patients receiving patient-controllediv morphine subsequent to general anesthesia and surgery at our institute (Kaohsiung Veterans General Hospital), were enrolled in the study. Demographic data (such as gender, age, weight, height and education level) and postoperative measurements, including pain scores at rest or during movement, sedation scores and morphine consumption, were recorded.ResultsIn total 2,298 patients were recruited. Females consumed significantly less morphine via patient-controlled analgesia (PCA) in the first three postoperative days than was the case for males (P < 0.05). Gender was the strongest predictor for postoperative morphine requirements. Postoperative pain upon movement was another effective predictor for morphine requirement (P < 0.05). Age, body height, body weight, education and operation sites were not associated with morphine consumption.ConclusionGender and postoperative pain upon movement are the major factors influencing morphine requirement for patientcontrollediv morphine analgesia during the first three postoperative days in Chinese patients.RésuméObjectifExaminer prospectivement si les caractéristiques du patient, et l’association des mesures postopératoires des douleurs, influencent les besoins de morphine postopératoire et l’évaluation de la douleur au repos et lors de mouvement chez des malades chinois.MéthodeDe janvier 1998 à décembre 1999, les patients qui ont reçu de la morphine iv auto-contrôlée, à la suite d’une opération sous anesthésie générale au Kaohsiung Veterans General Hospital, ont participé à l’étude. Les données démographiques (sexe, âge, poids, taille et niveau d’instruction) et les mesures postopératoires, incluant les scores de douleur au repos et pendant le mouvement, les scores de sédation et la consommation de morphine, ont été enregistrées.RésultatsNous avons recruté 2 298 patients. Pendant les trois premiers jours postopératoires, les femmes ont utilisé significativement moins de morphine que les hommes (P < 0,05) au moyen de l’analgésie auto-contrôlée (AAC). La variable prédictive la plus significative de la consommation de morphine postopératoire a été le sexe du patient. La douleur postopératoire pendant le mouvement a été un autre prédicteur efficace (P < 0,05). L’âge, la taille, le poids, l’instruction et le type d’opération n’ont pas été significatifs pour la consommation de morphine.ConclusionLe sexe et la douleur postopératoire pendant le mouvement sont les principaux facteurs d’influence des besoins de morphine pour l’analgésie iv auto-contrôlée pendant les trois premiers jours postopératoires chez des sujets chinois.

Helicobacter pylori infection and the risk of gastric malignancy.

OBJECTIVE:This prospective cohort study investigated the impact of Helicobacter pylori infection on the development of various gastric malignancies.METHODS:We prospectively followed up 1,225 dyspeptic Taiwanese who had nonulcer dyspepsia, gastric ulcers, or duodenal ulcers at enrollment. Among them, 618 (50.4%) had H. pylori infection and 607 (49.6%) did not. Patients underwent endoscopy at enrollment and at 1- to 3-yr intervals thereafter.RESULTS:During a mean follow-up of 6.3 yr, gastric adenocarcinoma developed in 7 of the 618 H. pylori-infected patients, but in none of the 607 uninfected patients (1.1% vs 0.0%, P = 0.015). The incidence of gastric lymphoma was 0.2% (1/618) and 0% in H. pylori-infected and uninfected patients. Taken together, the development rate of gastric malignancy in H. pylori-infected patients was significantly higher than that in uninfected patients (1.3% vs 0%, P = 0.007). Among H. pylori-infected subjects, the incidence of gastric malignancy was similar between those receiving and not receiving eradication therapy (1.4% vs 1.2%). Multivariate analysis showed that intestinal metaplasia was the only independent factor predicting subsequent development of gastric malignancy in H. pylori-infected subjects with an odds ratio of 4.5 (95% CI 1.1–19.1).CONCLUSIONS:In this prospective cohort study, all gastric malignancies, including adenocarcinoma and lymphoma, developed in H. pylori-infected patients. The finding implies that H. pylori is a necessary cause of most gastric malignancies. Follow-up for H. pylori-infected patients who have intestinal metaplasia is indicated.

When to discharge patients with bleeding peptic ulcers : a prospective study of residual risk of rebleeding

BACKGROUND From January 1993 to December 1994, we conducted a prospective study to investigate the evolutionary change of rebleeding risk in bleeding peptic ulcers. To obviate possible confounding factors that would influence decision making for discharge of patients, subjects with coexistent acute illnesses, systemic bleeding disorders, alcoholism, and use of nonsteroidal anti-inflammatory drugs were excluded. METHODS Emergency endoscopies were performed in patients with hematemesis or a melena within 24 hours of admission. Ulcer lesions were divided into six categories according to endoscopic findings. The residual risks of rebleeding of each type of ulcers were calculated for 10 days, and the critical point of acceptable rebleeding risk after discharge was set at 3%. RESULTS Three hundred ninety-two patients with bleeding peptic ulcers completed the study. The ulcers, characterized by clean bases, red or black spots, adherent clots, nonbleeding visible vessels without local therapy, nonbleeding visible vessels with local therapy, and bleeding visible vessels with local therapy took 0, 3, 3, 4, 4, and 3 days, respectively, to decrease rebleeding risk to below the critical point. All episodes of fatal rebleeding (n = 4) occurred within 24 hours after admission. CONCLUSIONS Patients with clean-based ulcers can be discharged in the first day of admission. The optimal duration required for hospitalization of patients with ulcers characterized by nonbleeding visible vessels at initial endoscopy is 4 days. The remaining patients with ulcers marked by other bleeding stigmata may be discharged after a 3-day observation.

Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-cesarean analgesia

Purpose: To determine the minimum effective dose of dexamethasone in preventing nausea and vomiting associated with epidural morphine for post-Cesarean analgesia.Method: One hundred and eighty parturients (n=45 in each of four groups) requiring epidural morphine for post-Cesarean analgesia were enrolled in this randomized, double-blinded, placebo-controlled study. At the end of surgery, parturients received either dexamethasone, at doses of 10 mg, 5 mg, 2.5 mg, or salineiv. Three milligrams epidural morphine were given to all parturients for postoperative analgesia. The incidence of PONV and side effects were estimated for 24 hr after delivery by blinded, trained nurse anesthetists.Results: Parturients who received dexamethasone, either 10 mg or 5 mg were different from those who received saline alone in the following parameters: the total incidence of nausea and vomiting, incidence of >4 vomiting episodes, number the of parturients requiring rescue antiemetics, and the total number of parturients with no vomiting and/or no antiemetic medication (P<0.05 toP<0.01). The differences between dexamethasone 10 mg and 5 mg were not significant. Dexamethasone 2.5 mg was partially effective.Conclusion: Dexamethasone, 5 mgiv, is suggested as the minimum effective dose in preventing nausea and vomiting associated with epidural morphine for post-Cesarean analgesia.RésuméObjectif: Déterminer la dose efficace minimale de dexaméthasone à utiliser pour prévenir les nausées et les vomissements liés à l’administration épidurale de morphine comme analgésie post-césarienne.Méthode: Cent quatre-vingt parturientes (n=45 dans chacun des quatre groupes), nécessitant une analgésie épidurale post-césarienne avec morphine, ont participé à l’étude randomisée et à double insu contre placebo. Elles ont reçu, à la fin de l’opération, soit 10 mg, 5 mg ou 2,5 mg de dexaméthasone, soit une solution saléeiv. Toutes ont reçu 3 mg de morphine comme analgésie postopératoire épidurale. L’incidence des NVPO et des effets secondaires a été évaluée pendant vingt-quatre heures après l’accouchement par des infirmières impartiales diplômées en anesthésie.Résultats: Les parturientes qui ont reçu 10 mg ou 5 mg de dexaméthasone ont présenté des caractéristiques différentes de celles qui ont reçu le placebo pour les paramètres suivants: l’incidence totale de nausées et de vomissements, l’incidence d’épisodes de vomissements >4, le nombre de patientes qui ont eu besoin d’antiémétiques de secours et le nombre total de parturientes sans vomissements et/ou sans médication antiémétique (P<0,05àP<0,01). Aucune différence significative n’était liée aux doses de 10 mg et de 5 mg de dexaméthasone. La dexaméthasone à 2,5 mg n’a été que partiellement efficace.Conclusion: La dexaméthasone, administrée en doses de 5 mgiv, est suggérée comme la dose efficace minimale pour prévenir les nausées et les vomissements associés à l’analgésie épidurale post-césarienne avec de la morphine.

Dexamethasone for preventing nausea and vomiting associated with epidural morphine: a dose-ranging study.

We conducted a dose-ranging study of dexamethasone for preventing nausea and vomiting within the first 24 h after the administration of epidural morphine. Two hundred twenty-five women (n = 45 in each of the five groups) undergoing simple abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. When the incision closure was completed, patients received IV dexamethasone, 10 mg, 5 mg, or 2.5 mg; IV droperidol 1.25 mg; or saline 2 mL. All patients received epidural morphine 3 mg for postoperative analgesia. We found that patients who received dexamethasone 5 mg or 10 mg or droperidol 1.25 mg were significantly different from those who received saline alone in the following variables: the total incidence of nausea and vomiting, the incidence of more than four vomiting episodes, the number of patients requiring rescue antiemetics, the total number of patients with no vomiting and/or no antiemetic medication (P < 0.05 to P < 0.01). The differences among dexamethasone 10 mg and 5 mg and droperidol 1.25 mg were not significant. Dexamethasone 2.5 mg was ineffective. In conclusion, because dexamethasone 5 mg was as effective as 10 mg as an antiemetic, we recommend the smaller dose for preventing nausea and vomiting associated with epidural morphine.

The Interleukin‐1 RN Polymorphism and Helicobacter pylori Infection in the Development of Duodenal Ulcer

Background.  The host genetic factors that determine the clinical outcomes for Helicobacter pylori‐infected individuals remain unclear.

Sauropus androgynus-constrictive obliterative bronchitis/bronchiolitis — histopathological study of pneumonectomy and biopsy specimens with emphasis on the inflammatory process and disease progression

Aims: 

The effect of education and clinical practice on knowledge enlightenment to and attitudes toward the use of analgesics for cancer pain among physicians and medical students.

BACKGROUND Insufficient education and limited clinical practice on the part of physicians may contribute to the undertreatment of cancer pain in Taiwan. To address these concerns, a survey among physicians and fifth-year medical students relevant to cancer pain management (CPM) was carried out in a medical school and its principal teaching hospital. METHODS A questionnaire on CPM was sent to 97 physicians and 78 fifth-year medical students (equivalent to the third-year medical students in the United States). The same questionnaire was delivered again to these 78 fifth-year medical students after they had completed a modified curriculum of anesthesiology with a 4-hour course on introduction to clinical pharmacology of CPM. RESULTS The physicians knowledgeable on pain (physicians of anesthesiology, hematology-oncology, or radiation oncology), physicians unfamiliar with pain (outside of anesthesiology, hematology-oncology, or radiation oncology), and the 5th-yr medical students took similar negative attitudes (24-92%, 33-89%, and 23-94%) toward the optimal use of analgesics for CPM. As compared, the mean score on knowledge of prescribing opioids of pain-knowledgeable physicians was 3.60, the highest of all as against 2.61 of other physicians and 2.54 of 5th-yr medical students. On attitudes toward prescribing opioids, both pain-knowledgeable physicians and other physicians scored a higher means, respectively of 3.52 and 2.91 as opposed to 2.68 of 5th-yr medical students, the lowest of all. However, seniority or length of clinical practice did not improve knowledge or affect attitudes toward CPM. In addition, this 4-hour course did enable the 5th-yr medical students to take a more positive attitude toward and become more knowledgeable on CPM than pain-knowledgeable physicians, as a comparison was made. CONCLUSIONS The effect of accumulation of clinical experience and seniority of clinical practice on CPM was limited among general physicians, except for clinical specialty on anesthesiology, hematology-oncology, or radiation oncology. In Taiwan, the knowledge of and positive attitude toward CPM could only be conveyed to physicians through undergraduate, post graduate or on-job education.

Assessment of Growth From Foot Length in Taiwanese Neonates

BACKGROUND Previous studies have demonstrated a positive correlation between foot length (FL) and birth body weight (BBW), birth body length (BBL), and head circumference (HC). However, there is no data on birth FL in Taiwan. The aim of this study was to evaluate FL measurement in Taiwanese neonates as a method of estimating other anthropometric indices. METHODS In this retrospective study, we enrolled 256 babies born at our hospital and Kaohsiung Veterans General Hospital from 2003-2005. Medical records were reviewed for sex, BBW, BBL, HC, gestational age, and birth FL. Ill newborns, small-for-gestational-age babies, or those with poor birth footprints were excluded. FL at birth was measured from the center of the back of the heel to the tip of the big toe. Linear regression analysis was used to investigate the relation of FL to BBW and BBL. The intraclass correlation coefficient was used to assess inter-rater reliability. RESULTS A total of 256 babies were reviewed. There were 136 male and 120 female neonates. The gestational age was 38.5+/-1.3 (mean+/-standard deviation) weeks, ranging from 35-42 weeks. The BBW was 3137+/-396g. The BBL was 51.1+/-2.1 cm. The HC was 33.5+/-1.7 cm. The FL was 7.4+/-0.46 cm. The regression equation for BBW (y) on FL (x) was as follows: y=486.2+360.4x (p<0.001, r=0.421). The regression equation for BBL (y) on FL (x) was as follows: y=40.1+1.45x (p<0.001, r= 0.305). The regression equation for HC (y) on FL (x) was as follows: y=14.8+2.53x (p<0.001, r=0.423). FL showed excellent reliability, with an intraclass correlation coefficient of 0.965 (p<0.001). CONCLUSION Our study demonstrated a significant degree of correlation between FL and BBW, BBL and HC. However, it did not reliably estimate BBW, BBL, or HC-the three anthropometric indices were weakly correlated (r<0.5) with FL.

Reappraisal of the Prostaglandin E1 Dose for Early Newborns with Patent Ductus Arteriosus-Dependent Pulmonary Circulation

OBJECTIVES The usual initial dose of prostaglandin E1 (PGE1) for ductal-dependent congenital heart disease (CHD) is 50-100 ng/kg/minute. The aim of this study was to review our experience of a low initial dose of PGE1 treatment in early newborns with congenital heart disease and patent ductus arteriosus (PDA)-dependent pulmonary flow. METHODS We reviewed the clinical data of 33 newborns with CHD and PDA-dependent pulmonary circulation who were admitted from January 2005 to December 2010. Clinical parameters were collected, including, PGE1 dosage, oxygenation condition, vital signs, and other related clinical parameters during admission. Echocardiography was employed to assess the status of the PDA as clinically indicated. RESULTS Thirty-three newborns, including 17 males and 16 females, with CHD and PDA-dependent pulmonary circulation were enrolled in the study. Their mean age was 2.9 ± 5.1 (within the range of 1-26) days with a median of 1.0 day. Among the 33 cases, 25 were diagnosed with pulmonary atresia and eight with critical pulmonary stenosis. Twenty-five of our patients were treated with the initial low-dosage regimen of 20.0 ± 7.4 ng/kg/minute in our neonatal intensive care unit. None of these 25 patients with had significant apnea necessitating intubation and none had hypotension, fever, convulsion or cortical hyperostosis. Three of the eight patients who were treated with high-dose PGE1 (39 ± 13.2 ng/kg/minute) before referral to our unit had apnea and intubation after PGE1 use. All patients had adequate PDA patency with a low maintenance dose of 10.5 ± 5.3 ng/kg/minute before operation under our protocol. CONCLUSION In our experience, adequate PDA flows in early newborns with CHD and PDA-dependent pulmonary circulation could be achieved at a much lower dose than recommended in the literature. The lower dose of PGE1 also causes much fewer complications, such as apnea, fever, and hypotension. For early newborns with CHD and PDA-dependent pulmonary circulation, treatment with a lower initial dose of PGE1 of 20 ng/kg/minute and a maintenance dose of 10 ng/kg/minute is recommended.