5α-Reductase inhibitors increase acute coronary syndrome risk in patients with benign prostate hyperplasia.

BACKGROUND: This study explored the possible association between the use of two typical 5ARIs (finasteride and dutasteride) and the risk of acute coronary syndrome (ACS) in patients with benign prostate hyperplasia (BPH). METHODS: From the claims data of the Taiwan National Health Insurance (NHI) Taiwan, we identified 1843 ACS cases among BPH patients and randomly selected 7330 controls without ACS, with a similar mean age of 73 years. Multivariate logistic regression analysis estimated the odds ratio (OR) and 95 % confidence interval (CI) for the relationship between the 5ARIs medications and ACS risk. RESULTS: We found that BPH patients who had received treatment with both finasteride and dutasteride were at a higher risk of ACS with an OR of 3.47 (95 % CI 1.05-11.5), compared to patients without 5ARIs treatment. Furthermore, the dosage analysis showed that there were no significant associations between ACS risk and uses of a single drug medication regardless the dosages. The ORs for those who took only dutasteride were 1.07 (95 % CI 0.39-2.99) with low dose and 0.73 (95 % CI 0.38-1.44) with high dose. The ORs for those who took only finasteride were 1.30 (95 % CI 0.89-1.92) with low dose and 0.98 (95 % CI 0.19-5.13) with high dose. CONCLUSION: This population-based nested case-control study suggests that 5ARI use may increase ACS risk among patients with BPH when patients were exposed to both finasteride and dutasteride.

Increased subsequent risk of acute coronary syndrome for patients with dermatomyositis/polymyositis: a nationwide population-based retrospective cohort study.

OBJECTIVES: The aim of this study was to explore the possible association between dermatomyositis/polymyositis (DM/PM) and subsequent acute coronary syndrome (ACS) risk. METHOD: We used data from the National Health Insurance (NHI) system of Taiwan to address the research topic. The exposure cohort contained 2029 patients with new diagnoses of DM/PM. Each patient was randomly frequency-matched according to sex and age with four participants from the general population who did not have a history of ACS at the index date (control group). Cox proportional hazard regression analyses were conducted to estimate the relationship between DM/PM and subsequent ACS risk. RESULTS: Among patients with DM/PM, the overall risk for developing subsequent ACS was significantly higher than that of the control group [adjusted hazard ratio (aHR) 1.98, 95% confidence interval (CI) 1.17-3.35]. Further analysis indicated a higher risk in patients who were male, older, or diagnosed with comorbidities. CONCLUSIONS: The findings from this population-based retrospective cohort study suggest that DM/PM is associated with an increased subsequent ACS risk.

Association of tamoxifen use and increased diabetes among Asian women diagnosed with breast cancer.

BACKGROUND: We conducted a population-based cohort study to assess whether tamoxifen treatment is associated with an increased incidence of diabetes. METHODS: Data obtained from the Taiwanese National Health Insurance Research Database were used for a population-based cohort study. The study cohort included 22 257 breast cancer patients diagnosed between 1 January 2000 and 31 December 2004. Among them, 15 210 cases received tamoxifen treatment and 7047 did not. Four subjects without breast cancer were frequency-matched by age and index year as the control group. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariate Cox proportional hazards regression analysis. RESULTS: Breast cancer patients exhibited a 14% higher rate of developing diabetes (adjusted HR=1.14, 95% CI=1.08-1.20) compared with non-breast cancer controls, but the significant difference was limited to tamoxifen users. In addition, tamoxifen users exhibited a significantly increased risk of diabetes compared with non-tamoxifen users among women diagnosed with breast cancer (adjusted HR=1.31, 95% CI=1.19-1.45). Stratification by age groups indicated that both younger and older women diagnosed with breast cancer exhibited a significantly higher risk of diabetes than the normal control subjects did, and tamoxifen users consistently exhibited a significantly higher diabetes risk than non-tamoxifen users or normal control subjects did, regardless of age. Both recent and remote uses of tamoxifen were associated with an increased likelihood of diabetes. CONCLUSIONS: The results of this population-based cohort study suggested that tamoxifen use in breast cancer patients might increase subsequent diabetes risk. The underlying mechanism remains unclear and further larger studies are mandatory to validate our findings.

Association between migraine and irritable bowel syndrome: a population-based retrospective cohort study.

BACKGROUND AND PURPOSE: Migraine and irritable bowel syndrome (IBS) share many similarities characterized by their epidemiology, periodic pain, lack of definable organic causes, trigger factors, comorbidities and proposed pathophysiology. In this retrospective case-control study, the association between migraine and IBS was investigated using a nationwide population-based database in Taiwan. METHODS: The data were retrieved from the National Health Insurance Research Database (NHIRD) of Taiwan. In all, 14 117 newly diagnosed migraine cases were identified in a subset of the NHIRD and 56 468 migraine-free individuals were randomly selected as the comparison cohort. The multivariate Cox proportional hazards regression model was used to explore the risk of IBS in migraine sufferers after adjusting for demographic characteristics and comorbidities. RESULTS: After adjusting for the covariates, the incidence of IBS was 1.95-fold higher in the migraine cohort than in the comparison cohort (73.87 vs. 30.14 per 10 000 person-years). The adjusted cumulative incidence of IBS was also higher in the migraine group than in the control group in the follow-up years (log-rank test, P < 0.0001). In addition, the risk was most prominent in the youngest group (<30 years old), exhibiting a 3.36-fold increased risk (95% confidence interval 2.44-4.63) of IBS compared with the migraine-free cohort. Moreover, the incidence of IBS in migraine sufferers tended to increase with the frequency of migraine diagnoses. CONCLUSION: The current population-based study demonstrated that migraine is associated with an increased risk of IBS after adjusting for comorbidities, particularly in the young population.

Comparison of therapeutic results in sudden sensorineural hearing loss with/without additional hyperbaric oxygen therapy: a retrospective review of 465 audiologically controlled cases.

OBJECTIVE: To investigate the necessity of routine application of hyperbaric oxygen therapy for sudden sensorineural hearing loss. DESIGN/SETTING AND PARTICIPANTS: A retrospective chart review looked at 465 patients, with 353 of them receiving pharmacologic treatments alone. Among these patients, 76 underwent systemic steroid treatment only (steroid group) and 277 received systemic steroids and dextran (steroid-dextran group). The remaining 112 patients were treated with hyperbaric oxygen in addition to pharmacologic agents (steroid-dextran-hyperbaric oxygen group). MAIN OUTCOME MEASURES: The outcome was determined by comparing the difference of pure-tone thresholds and absolute hearing gains after treatment calculated at each audiometric octave frequency or grouped frequencies of audiograms. On the basis of the severity of initial hearing loss, patients were classified at three scales of hearing impairments measured in decibels hearing level (dBHL): ≦ 70 dBHL, less severe; 71-90 dBHL, severe; and ≧ 91 dBHL, profound. The outcomes of their hearing recovery were classified into three recovery grades: good, fair and poor. RESULTS: In those patients with initial hearing loss >90 dBHL, the addition of hyperbaric oxygen to steroid-dextran gave a significant hearing gain difference (P = 0.030) by showing a greater hearing gain of 24.5 ± 2.7 dB compared with steroid only (12.9 ± 3.7 dB) or steroid-dextran (15.6 ± 2.7 dB). This outcome was confirmed when we compared the outcome using the recovery grading; steroid-dextran-hyperbaric oxygen group showed that more patients with initial profound (≧ 91 dBHL) hearing loss responded to hyperbaric oxygen treatment by exhibiting good and fair recoveries (2% and 70%) as compared with steroid only (0% and 42%) or steroid-dextran (8% and 46%) groups (P = 0.043), while the patients with initial severe (71-90 dBHL) and less severe (≦ 70 dBHL) hearing loss responded to the addition of hyperbaric oxygen treatment with less favourable recoveries. Furthermore, the addition of dextran in steroid-dextran group showed no significant benefit compared with the steroid group (P = 0.435). CONCLUSIONS: When applied as an adjuvant to pharmacologic agents, hyperbaric oxygen benefits patients with initial profound sudden sensorineural hearing loss. Therefore, we recommend the routine application of hyperbaric oxygen in conjunction with pharmacologic agents for those patients. The addition of dextran to steroid has no benefit and cannot be recommended.

Cerebral perfusion in patients with syndrome X: a single photon emission computed tomography study.

OBJECTIVE: To test the hypothesis that syndrome X is a systemic vascular disorder, the authors studied 40 patients with this diagnosis using technetium-99m hexamethylpropylene amine oxime and single photon emission computed tomography (SPECT) brain images. Twenty-three of 25 cases with definite myocardial perfusion defects diagnosed by thallium-201 myocardial perfusion SPECT also had multiple hypoperfusion areas in the brain versus 2 of 15 patients without thallium myocardial defects. The parietal lobes were the most common hypoperfusion areas, and cerebellum was the least common. Syndrome X is a systemic vascular disorder with a high incidence of hypoperfusion lesions of the brain and is usually coincident with myocardial defects.

Effects of butter and soybean oils on solid-phase gastric emptying in patients with functional dyspepsia.

BACKGROUND: To determine whether vegetable fats cause a slower or quicker rate of gastric emptying (GE) than animal fats, we evaluated the effect of animal butter and vegetable soybean oil on solid-phase GE in patients with functional dyspepsia. METHODS: Twenty-seven patients with functional dyspepsia were enrolled in this study. Radionuclide-labeled solid meals were used to evaluate GE. A study meal was composed of 206.8 kcal to 9.2 g protein, 45 g carbohydrate, and 10 g fat (formula 1, with animal butter: 26.2% saturated palmitic acid, 29.1% unsaturated oleic acid, 3.5% linoleic acid, and 0.5% linolenic acid; formula 2, with vegetable soybean oil: 11.0% saturated palmitic acid, 23.4% unsaturated oleic acid, 53.7% linoleic acid, and 7.8% linolenic acid). Each patient received formulas 1 and 2 as study meals on separate days. GE was represented by the gastric retention ratio of the study meal at 90 min (RR90): RR90 = residual radioactivity within the region of interest (ROI) covering the entire stomach at 90 min divided by the initial radioactivity within the ROI at 0 min. RESULTS: The RR90 was 0.648 +/- 0.156 for formula 1 and 0.600 +/- 0.131 for formula 2. There was no significant difference for the RR99 between formulas 1 and 2 (paired Student's t test, p > 0.05). Of the 27 patients, 12 (44.4%) demonstrated an increased RR99 from formula 1 to formula 2, and the RR90 of remaining 15 (55.6%) patient decreased. In addition, neither the patients with increased RR90 nor those with decreased RR90 showed a difference of symptoms between the two study meals. CONCLUSION: Our data suggest that there is no difference between these two types of fat on gastric emptying.

Lung injury related to consuming Sauropus androgynus vegetable.

BACKGROUND: Taking Sauropus androgynus, a Malaysian food, to reduce weight began as a fad in Taiwan in 1994. Some advocates of this fad developed pulmonary dysfunction. The aim of this study is to report the lung injury in patients taking Sauropus androgynus. METHODS: From July 1995 to November 1995, we investigated 104 nonsmoking patients (one male and 103 females) with chest roentgenography, pulmonary function, test, and Technetium 99m-labeled diethylene triamine penta-acetate (Tc-99m DTPA) radioaerosol inhalation lung scintigraphy. RESULTS: Among the 90 patients receiving Tc-99m DTPA inhalation lung scan, 46 (51.1%) patients had increased clearance of Tc-99m DTPA from lung and 20 (22.2%) patients had inhomogeneous deposition of the submicronic radioaerosol. Eighteen (18/100) patients had obstructive ventilatory impairment in pulmonary function test. Analyzing the results, we found that the patients with respiratory symptoms (n = 42) took more vegetables (p = 0.016), had increased clearance of Tc-99m DTPA (p = 0.010) and had lower FEV1 (p = 0.001), FEV1/FVC (p < 0.001), FEF25-75 (p = 0.001), VC (p = 0.002) and DLCO (p = 0.009) than the patients without respiratory symptoms (n = 62). FEV1 and FEV1/FVC were significantly reduced in patients with severe impairment of alveolar permeability. The cumulative dosage and duration of exposure were significantly associated with the reduction of FEV1 and FEV1/FVC. CONCLUSION: The lung injury after taking Sauropus androgynus involves alveoli and/or small airways and is manifest as obstructive ventilatory impairment with inhomogeneous aerosol distribution and increased lung epithelial permeability.

The effect of coffee on gastric emptying.

The effect of coffee on gastric emptying was addressed in a scintigraphic liquid-phase gastric emptying study in patients with non-ulcer dyspepsia. Ninety-three subjects (56 males, 37 females; mean age 40 years, range 17-77 years) diagnosed as having non-ulcer dyspepsia were enrolled in the study. The baseline study was to drink 500 ml of 5% glucose water and the coffee study was to drink 500 ml of 5% glucose water containing 4 g of regular instant coffee. The two studies were performed on separate days. Fifteen of the 93 subjects were chosen at random to undergo repeated coffee studies for evaluation of reproducibility. Overall the 93 subjects showed accelerated gastric emptying, as measured by half emptying time (T1/2) with coffee compared with baseline (35.7 +/- 10.5 vs 45.0 +/- 23.1 min, P < 0.001). However, 68 (73.2%) subjects showed accelerated emptying (-14.8 +/- 19.5 min), while 25 (26.8%) subjects showed delayed emptying (5.9 +/- 4.5 min) after ingestion of coffee. There was no significant difference in the change in gastric emptying with coffee in duplicate measurements from the 15 subjects who had two coffee studies (P = 0.082). We conclude that coffee accelerates liquid-phase gastric emptying in the majority of patients with non-ulcer dyspepsia.

Effect of coffee on solid-phase gastric emptying in patients with non-ulcer dyspepsia.

The purpose of this study was to evaluate the effect of coffee on solid phase gastric emptying in patients with non-ulcer dyspepsia (NUD). Twenty-one NUD patients with an endoscopic negative finding or superficial gastritis were included in this study. Radionuclide labeled solid meals were used to assess the gastric emptying times (GET) of the stomach. A control meal was composed of radionuclide solid meal and 500ml 5% of glucose water. The study meal was made from addition of 4g of instant coffee into the control meal. Of the 21 total cases, 1 demonstrated prolonged GET, 6 had shortened GET, and the other 14 showed no significant difference in GET. There were no statistically significant differences (p > 0.05) between the control and the study meal after coffee intake. Our data suggests that there may be some ingredient in coffee that promotes gastric motility, but this effect is counteracted by intestinal feedback, and the net effect is not significant.

Comparison of the effect of 8-methoxypsoralen (8-MOP) plus UVA (PUVA) on human melanocytes in vitiligo vulgaris and in vitro.

In this study, we examined the various effects of PUVA treatment on cultured human melanocytes, and it revealed that 1) the higher the dose of PUVA treatment, the more significant the inhibition of cell DNA and protein synthesis; 2) the higher the dose of PUVA treatment, the more significant the depletion of epidermal growth factor receptor (EGFR) expression; 3) PUVA treatment at 124 mJoule/cm2 depleted the vitiligo-associated melanocyte antigens (VAMA) immediately after irradiation, and both the VAMA and EGFR expression progressively recovered at 24 or 72 h after PUVA; 4) PUVA treatment stimulated tyrosinase activity, but not in a dose-dependent fashion. In vitiligo vulgaris, PUVA treatment may stimulate the regrowth of melanocytes from hair follicles, but deplete the epidermal Langerhans cells in depigmented lesion of patients with stable vitiligo. Comparing the above results obtained from in vivo and in vitro studies, it reveals significantly different biologic responses. Although the precise therapeutic mechanism of PUVA treatment in vitiligo is still not well known, it is proposed that 1) PUVA treatment may stimulate the other components of skin, such as keratinocytes, to release inflammatory mediators and some of them may act as melanocyte growth-stimulatory factors (MGSF), which further enhance the proliferation of remaining melanocytes in hair follicle; and 2) PUVA treatment may deplete the VAMA expression on cell membrane of melanocytes and also deplete epidermal Langerhans cells, which may result in blocking the progressing of antibody-dependent cell-mediated cytotoxicity to melanocytes in vitiligo.

Depletion and repopulation of Langerhans cells in nonsegmental type vitiligo.

The role of Langerhans cells in the pathogenesis of nonsegmental type vitiligo is still unknown. In this study, biopsies were taken from 26 patients at various stages of nonsegmental type vitiligo and morphometrically observed to investigate the kinetics of Langerhans cells in patients at various stages of the disease. A marked depletion of OKT6-positive and ATPase-positive epidermal dendritic cells was noted in patients with active nonsegmental type vitiligo. A repopulation of both OKT6-positive and ATPase-positive epidermal dendritic cells was noted in patients with stable nonsegmental type vitiligo. Profound depletion of epidermal OKT6-positive and ATPase-positive dendritic cells was noted in patients with repigmenting nonsegmental type vitiligo receiving treatments involving topical use of 0.05% Fluocinonide cream or PUVA photochemotherapy. Transmission electron microscopy confirmed the absence of epidermal dendritic cells (Langerhans cells and intermediate cells) in patients with active and repigmenting nonsegmental type vitiligo. In active nonsegmental type vitiligo, two possible explanations are proposed for the depletion of OKT6-positive and ATPase-positive epidermal dendritic cells (presumptive Langerhans cells): 1) the cells are destroyed by cytotoxic factors released during the course of destruction of melanocytes in active vitiligo, and/or 2) they leave the epidermis and migrate to regional lymph nodes to present certain antigens which are released from certain destroyed epidermal cells (keratinocytes or melanocytes) during the course of active vitiligo. The repopulated epidermal Langerhans cells may result from phenotypically transformed dermal dendritic cells in the depigmented lesions of patients with stable vitiligo. Since various therapies which result in repigmentation deplete the density of epidermal Langerhans cells markedly, it is suggested that depletion of epidermal Langerhans cells in stable vitiligo may aid in repigmentation. It is also proposed that the repopulated epidermal Langerhans cells may play a role in inhibiting the proliferation of epidermal melanocytes in depigmented lesions of stable vitiligo, thus various methods of treatment which deplete the Langerhans cells may eventually aid in the repigmentation of nonsegmental type vitiligo.