Pancreatic Tail Cancer with Sole Manifestation of Left Flank Pain: A Very Rare Presentation

Pancreatic cancer is sometimes called a “silent disease” because it often causes no symptoms in the early stage. The symptoms can be quite vague and various depending on the location of cancer in the pancreas. The anatomic site distribution is 78% in the head of the pancreas, 11% in the body, and 11% in the tail. Pancreatic cancer is rarely detected in the early stage, and it is very uncommon to diagnose pancreatic tail cancer during an emergency department visit. The manifestation of pancreatic tail cancer as left flank pain is very rare and has seldom been identified in the literature. We present a case of pancreatic tail cancer with the sole manifestation of dull left flank pain. Having negative findings on an ultrasound study initially, this female patient was misdiagnosed as having possible acute gastritis, urolithiasis or muscle strain after she received gastroendoscopy and colonofiberscopy. Her symptoms persisted for several months and she visited our emergency department due to an acute exacerbation of a persistent dull pain in the left flank area. Radiographic evaluation with computed tomography was performed, and pancreatic tail tumor with multiple metastases was found unexpectedly. We review the literature and discuss this rare presentation of pancreatic tail cancer

Emergency Open Cardiac Massage via Subxyphoid Approach in Ruptured Type A Aortic Dissection

Patient sustained cardiac tamponade caused by rupture of type A aortic dissection may result in sudden death. Pericardiocentesis is a lifesaving procedure; nevertheless, blood may occlude the catheter and fail to relieve the pressure. However, open-chest cardiac massage in resuscitation has been studied in animal models by some medical centers and laboratories with inspiring results. We report a 58-year-old woman who was transferred from a local hospital with the diagnosis of cardiac tamponade caused by ruptured type A aortic dissection. Pulseless electrical activity followed by cardiac arrest occurred thereafter. Successful resuscitation in the emergency department was achieved using open cardiac massage through the sub-xyphoid region by opening a pericardial window. Therefore, in unstable patients with cardiac tamponade due to aortic dissection, this resuscitative procedure is feasible, safe and efficient

Use of sodium bicarbonate for acute dizziness after minor head injury

AbstractObjectiveDizziness after minor head injury (mHI) is common. In some eastern countries, it is treated with 7% sodium bicarbonate solution (SB). This prospective study evaluated the clinical efficacy of SB compared with normal saline (NS).Material and methodsFrom April 2009 to April 2010, we performed a prospective observational study on 228 patients (68% female, 32% male) with acute dizziness after mHI. At the emergency physician’s discretion, intravenous SB (1 mL/kg) in NS (250 mL) or NS (250 mL) was administered to 166 patients and 62 patients, respectively, as empiric antidizziness therapy. Outcome measures were severity of dizziness and treatment response, which were measured by a visual analog scale. Various characteristics were compared between treatment groups. Any continued dizziness of the patients during follow-up was also compared with their pre-injury condition, such as prior psychiatric disorders and the presence of vertigo.ResultsThe SB group had their visual analog scale scores reduced by 25.4% compared with 24.6% in the NS group. Both groups showed a statistically significant reduction in dizziness (p < 0.001); however, the dizziness improvement did not differ significantly between the two treatment groups (p = 0.699). Sixty-four patients (28.1%) suffered from continued dizziness during follow-up (mean period, 22.4 ± 28.9 days). The prevalence of continued dizziness was higher in patients with prior psychiatric disorders, although this was not statistically significant (40% vs. 27.2%, p = 0.276), whereas patients with prior vertigo did not experience a higher dizziness relapse rate (27% vs. 28.2%).ConclusionsSB and NS administrations are both effective individually when treating patients with acute dizziness from mHI; however, both results may be attributable to the placebo effect. Therefore more research is necessary to understand the complex conditions that determine the effects of SB on this disorder

Abnormal glucose tolerance and insulin resistance in polycystic ovary syndrome amongst the Taiwanese population- not correlated with insulin receptor substrate-1 Gly972Arg/Ala513Pro polymorphism

BACKGROUND: Insulin resistance and glucose dysmetabolism in polycystic ovary syndrome (PCOS) are related with the polymorphisms in the genes encoding the insulin receptor substrate (IRS) proteins, especially Gly972Arg/Ala513Pro polymorphism being reported to be associated with type-2 diabetes and PCOS. We intended to assess the prevalence of abnormal glucose tolerance (AGT) and insulin resistance in Taiwanese PCOS women. We also tried to assess whether the particular identity of Gly972Arg/Ala513Pro polymorphic alleles of the IRS-1 gene mutation can be used as an appropriate diagnostic indicator for PCOS. METHODS: We designed a prospective clinical study. Forty-seven Taiwanese Hoklo and Hakka women, diagnosed with PCOS were enrolled in this study as were forty-five healthy Hoklo and Hakka women as the control group. Insulin resistance was evaluated with fasting insulin, fasting glucose/insulin ratio, and homeostasis model assessment index for insulin resistance (HOMA(IR)). The genomic DNA of the subjects was amplified by PCR and digested by restriction fragmented length polymorphism (RFLP) with Bst N1 used for codon 972 and Dra III for codon 513. RESULTS: AGT was found in 46.8% of these PCOS patients and was significantly related to high insulin resistance rather than the low insulin resistance. Those patients with either insulin resistance or AGT comprised the majority of PCOS affected patients (AGT + fasting insulin ≥17: 83%, AGT + glucose/insulin ratio ≥6.5: 85.1%, AGT + HOMA(IR )≥ 2: 87.2%, and AGT + HOMA(IR )≥ 3.8: 72.3%). None of the tested samples revealed any polymorphism due to the absence of any Dra III recognition site or any Bst N1 recognition site in the amplified PCR fragment digested by restriction fragmented length polymorphism. CONCLUSION: There is significantly high prevalence of AGT and insulin resistance in PCOS women, but Gly972Arg and Ala513Pro polymorphic alleles of IRS-1 are rare and are not associated with the elevated risk of PCOS amongst Taiwanese subjects. This is quite different from the similar study in phylogenetically diverged Caucasian subjects

DC-SIGN (CD209) Promoter −336 A/G (rs4804803) Polymorphism Associated with Susceptibility of Kawasaki Disease

Kawasaki disease (KD) is characterized by systemic vasculitis of unknown etiology. High-dose intravenous immunoglobulin (IVIG) is the most effective therapy for KD to reduce the prevalence of coronary artery lesion (CAL) formation. Recently, the α2, 6 sialylated IgG was reported to interact with a lectin receptor, specific intracellular adhesion molecule-3 grabbing nonintegrin homolog-related 1 (SIGN-R1) in mice and dendritic cell-specific intercellular adhesion molecule-3 grabbing nonintegrin (DC-SIGN) in human, and to trigger an anti-inflammatory cascade. This study was conducted to investigate whether the polymorphism of DC-SIGN (CD209) promoter −336 A/G (rs4804803) is responsible for susceptibility and CAL formation in KD patients using Custom TaqMan SNP Genotyping Assays. A total of 521 subjects (278 KD patients and 243 controls) were investigated to identify an SNP of rs4804803, and they were studied and showed a significant association between the genotypes and allele frequency of rs4804803 in control subjects and KD patients (P = 0.004 under the dominant model). However, the promoter variant of DC-SIGN gene was not associated with the occurrence of IVIG resistance, CAL formation in KD. The G allele of DC-SIGN promoter −336 (rs4804803) is a risk allele in the development of KD

CD40 Gene Polymorphisms Associated with Susceptibility and Coronary Artery Lesions of Kawasaki Disease in the Taiwanese Population

Background. Kawasaki disease (KD) is characterized by systemic vasculitis of unknown etiology. Our previous studies showed expression of CD40 ligand on CD4+ T cells correlated to the coronary artery lesion (CAL) and disease progress in KD. Other studies from Japan suggested the role of CD40L in the pathogenesis of CAL, and this might help explain the excessive number of males affected with KD but cannot be reproduced by Taiwanese population. This study was conducted to investigate the CD40 polymorphism in KD and CAL formation. Methods. A total of 950 subjects (381 KD patients and 569 controls) were investigated to identify 2 tagging single-nucleotide polymorphisms (tSNPs) of CD40 (rs4810485 and rs1535045) by using the TaqMan allelic discrimination assay. Results. A significant association was noted with regards to CD40 tSNPs (rs1535045) between controls and KD patients (P = 0.0405, dominant model). In KD patients, polymorphisms of CD40 (rs4810485) showed significant association with CAL formation (P = 0.0436, recessive model). Haplotype analysis did not yield more significant results between polymorphisms of CD40 and susceptibility/disease activity of KD. Conclusions. This study showed for the first time that polymorphisms of CD40 are associated with susceptibility to KD and CAL formation, in the Taiwanese population

ITPKC Single Nucleotide Polymorphism Associated with the Kawasaki Disease in a Taiwanese Population

Kawasaki disease (KD) is characterized by systemic vasculitis with unknown etiology. Previous studies from Japan indicated that a gene polymorphism of ITPKC (rs28493229) is responsible for susceptibility to KD. We collected DNA samples from 1,531 Taiwanese subjects (341 KD patients and 1,190 controls) for genotyping ITPKC. In this study, no significant association was noted for the ITPKC polymorphism (rs28493229) between the controls and KD patients, although the CC genotype was overrepresented. We further combined our data with previously published case/control KD studies in the Taiwanese population and performed a meta-analysis. A significant association between rs28493229 and KD was found (Odds Ratio:1.36, 95% Confidence Interval 1.12–1.66). Importantly, a significant association was obtained between rs28493229 and KD patients with aneurysm formation (P = 0.001, under the recessive model). Taken together, our results indicated that C-allele of ITPKC SNP rs28493229 is associated with the susceptibility and aneurysm formation in KD patients in a Taiwanese population

Removing Infragravity‐Wave‐Induced Noise from Ocean‐Bottom Seismographs (OBS) Data Deployed Offshore of Taiwan

Vertical ocean‐bottom seismograph (OBS) data at frequencies below 0.05 Hz are contaminated by noise induced by infragravity waves. We constructed the transfer function between pressure and velocity data from OBSs deployed in Taiwan waters to remove the wave pressure‐induced noise from seismic recordings. Data were analyzed from five portable broadband OBSs deployed each for 10 months at water depths from 1740 to 4600 m and from a cabled, shallow‐buried seismograph (EOS1) installed on the seafloor at 300 m depth. Removing long‐period noise from these OBS data improves the identification of teleseismic phases such as P, S, SS, Pdiff, and PKIKP that are otherwise ambiguous or unidentifiable. For EOS1, infragravity‐wave signals completely mask the P and S waveforms in the 10–50 s period band suitable for centroid moment tensor (CMT) solutions for most of the local events. Application of the transfer functions to predict and remove wave deformation yielded clean prominent P and S waveforms at these periods and aided in the CMT determination for small events jointly with land stations. The relative amplitudes of the wavenumber‐normalized transfer function for some of the OBSs are mostly determined by the thickness of the sediment at the OBS site