Background: Although osmotic demyelination syndrome (ODS) has been well known to be associated with a rapid correction of sodium (Na⁺) in patients with chronic hyponatremia, its risk factors and clinical outcomes have not been examined in Taiwan. Aim: The aim of the study was to analyze the underlying causes and overlooked risk factors in patients with ODS. Methods: We retrospectively collected chronic hyponatremic patients developing ODS and analyzed their clinical characteristics. Results: Fourteen patients (7 males and 7 females) with a mean age of 62.7 ± 17.9 years old were enrolled. Their underlying causes included gastrointestinal illness with poor intake (n = 7), chronic use of diuretics (n = 2), syndrome of inappropriate antidiuretic hormone (n = 2), pneumonia (n = 2), and hypopituitarism (n = 1). Their serum Na⁺ was 107.2 ± 1.2 mmol/L with mild hypokalemia (potassium 3.1 ± 7 mmol/L), hypoalbuminemia (albumin, 3.4 ± 0.6 g/dL), and hypophosphatemia (phosphorus, 2.3 ± 1.0 mg/dL). Their mean Na⁺ correction rate was 8.4 ± 9 mmol/L/day and most patients (60%) developed ODS in first 3 days. Their manifestations included delirium, seizures, unstable gait, aphasia, and drowsy consciousness. Brain magnetic resonance imaging demonstrated that 42.8% had isolated central pontine myelinolysis. Totally, 43% of ODS patients had unfavorable outcome with death and disability. In addition, patients with rapid Na⁺ correction rate (>12 mmol/L/day, n = 4) usually exhibited significant hypokalemia (2.5 ± 0.4 vs. 3.5 ± 0.7 mmol/L, P < 0.05) as compared with those without. Conclusion: Nutritional status and concurrent electrolyte deficiencies such as hypokalemia are major risk factors in patients with ODS. Clinicians should timely recognize these potential risks of ODS and reduce Na⁺ correction rate to avoid catastrophic outcomes.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Drug rash with eosinophilia and systemic symptoms (DRESSs) syndrome is an adverse cutaneous reaction characterized by fever, skin eruption, hematological abnormalities, and internal organ involvement. Although many drugs are known to cause DRESS syndrome, quetiapine-induced DRESS syndrome case is rare. We report a case of a 78-year-old male who developed DRESS syndrome presented with rashes, eosinophilia after taking quetiapine for 2 weeks.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Myoepithelial cells are involved in the development of salivary glands. Many studies propose that these cells can prevent cell proliferation. Aim: This study aimed to investigate the expression of Ki-67, P63, P40, and alpha-smooth muscle actin (α-SMA) in salivary gland carcinomas with or without myoepithelial differentiation. Methods: A panel of myoepithelial markers including P63, P40, α-SMA, and Ki-67 were used for immunohistochemical study in 67 salivary gland carcinomas (33 with and 34 without myoepithelial differentiation). The percentage of positive cells was calculated (in high-power field) from a minimum of 1000 neoplastic cells. SPSS software (version 21) was used. Results: There was no statistically significant difference between Ki-67 expression and the presence or absence of myoepithelial cells (P = 0.6), but Ki-67 expression was related to the age (P = 0.032) and location of carcinomas (P = 0.001). All carcinomas with myoepithelial differentiation exhibited consistent P63+/P40+ staining, whereas polymorphous adenocarcinomas showed P63+/P40− immunophenotype. The expression of Ki-67 in adenoid cystic carcinomas was higher than mucoepidermoid carcinomas (P = 0.020) and polymorphous adenocarcinomas (P = 0.002). Conclusion: In the present study, although the decrease in the number of myoepithelial cells was associated with increased proliferation in adenoid cystic carcinomas, no such relationship was found in the overall assessment between the two groups. This can be justified by the fact that the clinical behavior of salivary carcinomas and their cell proliferation may be affected by factors other than the presence of myoepithelial cells or lack thereof. Ki-67 and P63/P40 expressions may be useful to differentiate adenoid cystic carcinomas from polymorphous adenocarcinomas in small biopsies.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Evidences show that sugammadex may facilate extubation after surgery. Applying neuromuscular monitoring in general anesthesia may prevent postoperatrive reintubation. However, routine general anesthesia does not always include neuromuscular monitoring. Therefore, we investigated the relationship between the sugammadex use and postoperative reintubation in the absence of neuromuscular monitoring. Methods: We conducted a retrospective analysis of the incidence of postoperative reintubation in the operating room (OR) or postanesthesia care unit following sugammadex use in the absence of neuromuscular monitoring that involved a large number of patients over 4 years (from January 2017 to August 2020). Postoperative reintubation was applied for patients who had peripheric oxygen saturation <90% despite being given 6 L/min oxygen with a face mask. Patients with perioperative neuromuscular monitoring, renal or hepatic failure, electrolyte imbalance, body mass index over 35, incomplete data, and age under 20 years were excluded. All data from the ORs' database and anesthesia records were analyzed. Results: Of 6582 patients receiving sugammadex, 6313 were included in this study. Two confirmed cases of postoperative reintubation were detected, with an incidence of 0.03% (2 of 6,313). As of the type of surgery, a 34 years old male received elective thoracic surgery, and another 66 years old male received elective urological surgery. No long-term pulmonary sequelae were found. Conclusion: This study suggests that the occurrence of postoperative reintubation following sugammadex (2–4 mg/kg) use is rare even in the absence of neuromuscular monitoring. Further large prospective studies are required to validate the findings of this study.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: The aim of the study is to compare the incidence of sudden sensorineural hearing loss (SSNHL) in Northern and Southern Taiwan, areas with different levels of air pollution. Methods: This was a retrospective, cross-sectional, 15-year nationwide study of SSNHL diagnoses between 2000 and 2015 in Taiwan National Health Insurance Research Database. Results: In total, 12,497 patients were included, 5584 in Northern Taiwan and 2532 in Southern Taiwan. In Northern and Southern Taiwan, the mean patients' age was 50.94 ± 16.62 and 50.70 ± 15.86 years, respectively; males (53.56% vs. 53.48%) were more frequently diagnosed than females (46.44% vs. 46.52%). The crude incidence was 41.13/100,000 and 49.45/100,000 in Northern and Southern Taiwan. The increasing trend was significantly higher in Southern than in Northern Taiwan. The maximal difference between Northern and Southern Taiwan, 44.31 versus 77.01/100,000 people/year, occurred in 2012. Mean particulate matter (PM2.5) annual concentration steadily decreased from 25.5 μg/m³ in 2010 to 19.20 μg/m³ in 2015 in Northern Taiwan, 37.10 μg/m³ in 2010 to 26.50 μg/m³ in 2015 in Southern Taiwan, Tainan City area, and 38.20 μg/m³ in 2010 to 25.10 μg/m³ in 2015 in Southern Taiwan, Kaohsiung City area. Cumulative PM2.5 exposure (PM2.5-year) from 2000 to 2015 was 441.1 μg/m³ × year in Northern Taiwan, 563.3 μg/m³ × year in Southern Taiwan – Tainan City area, and 684.3 μg/m³ × year in Southern Taiwan – Kaohsiung City area. Conclusion: SSNHL incidence increased from 2000 to 2015 and was higher in Southern than in Northern Taiwan. Cumulative PM2.5 exposure was higher in Southern than in Northern Taiwan. The relationship between cumulative PM2.5 exposure and SSNHL pathogenesis needs further investigation.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

CIC-DUX4 sarcoma is highly aggressive and rapidly develops lethal metastatic disease and chemoresistance. Its histology is similar to that of Ewing sarcoma and other small round cell sarcomas. Correlation with clinical data, radiological findings, pathological results (including immunohistochemistry and fluorescence in situ hybridization), and/or molecular techniques is necessary. We present the case of a 44-year-old woman who was initially diagnosed as having high-grade undifferentiated round cell sarcoma confirmed to be a CIC-DUX sarcoma by next-generation sequencing.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Breast carcinoma is a leading cause of death among women. Factors such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (HER-2/neu) have important prognostic and predictive value. Aim: The aim of the study is to demonstrate ER, PR, and HER-2/neu expression in breast cancer specimens and to correlate these expressions with other prognostic factors such as tumor size, type, grade, and lymph node status. Methods: This prospective study included 70 cases of female breast carcinoma. Histopathological evaluation of all cases done and tumor size, site, presence, or absence of lymph node was recorded. Typing of tumor, grade, and lymph node status were determined. Immunohistochemical staining for ER, PR, and HER-2/neu of breast lesions was done, and the data were analyzed to find out any correlation of expression of ER, PR, HER-2/neu with the above prognostic factors. Results: The majority of patients were in 41–50 years (44.29%). Most of tumors were 2–5 cm in size and the infiltrating duct carcinoma-not otherwise specified was the commonest type. ER and PR expression decreases (P = 0.02340 and P = 0.02413 respectively), while HER-2/neu expression increases with increase tumor size (P = 0.02289). ER and PR expression were low while Her-2/neu expression was more in higher tumor grade (P = 0.022472, P = 0.04149 and P = 0.03339 respectively). No significant association was identified between ER, PR, HER-2/neu and number of metastatic lymph node. Conclusion: ER, PR, and HER-2/neu status correlates well with histopathological grading and tumor size. However, no significant association is seen with cancer type and lymph node status.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Supraclavicular block is a commonly used block for regional anesthesia in forearm surgeries. The rationale behind this study is to prove that ultrasound (USG)-guided supraclavicular block is sufficient to provide adequate analgesia and eliminates the need for an intercostobrachial (ICB) block for forearm surgeries. Aim: We aimed to find whether there is any additional advantage in performing ICB block along with supraclavicular brachial plexus block in forearm surgeries. Methods: In this study, 110 patients undergoing elective forearm surgeries under USG-guided supraclavicular block were observed. A block solution of 30 ml was made and 20 ml was given as supraclavicular block. Group ICB, received an additional 10 ml ICB nerve block (ICBN) and group Non-ICB who did not receive an additional block. The outcomes assessed were intraoperative and postoperative tourniquet pain scores, hemodynamic changes, the onset of sensory and motor block, sensory and motor scoring, postoperative rescue analgesia time, and patient satisfaction. Data were analyzed using SPSS 25.0 version. Results: The mean intraoperative and postoperative pain scores in the group ICB was 0.76 ± 1.677 and in the non-ICB was 0.69 ± 1.439 and was no significant. Furthermore, there was no statistically significant difference between the immediate and late postoperative pain scores between the two groups. Conclusion: Our study has concluded that a sole USG-guided supraclavicular block provides adequate anesthesia of the operated forearm. Additional blocking of the ICBN does not affect the incidence or course of tourniquet pain.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Acute internal jugular vein thrombosis (IJVT) is a rare vascular disease that can cause lethal complications and manifests with varying neurological symptoms. A 42-year-old woman presented with a progressively worsening headache over the left temporal-occipital area and pain in the left posterior nuchal; ultrasonography and magnetic resonance venography (MRV) revealed a thrombosis with critical stenosis in the left internal jugular vein (IJV). Seven days after treatment with an anticoagulant, she exhibited considerable improvement. Follow-up ultrasonography and three-dimensional computed tomography angiography (CTA) indicated spontaneous IJV recanalization. To avoid implementing inappropriate treatments and prevent adverse outcomes, acute IJVT should be considered as a cause of secondary headaches. To determine the prognosis and secondary prophylaxis strategy (i.e., medical or surgical), recanalization should be detected using color-coded duplex ultrasonography and confirmed using MRV or CTA; these are all safe and minimally invasive procedures.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]