Cancer Incidence in Physicians: A Taiwan National Population-based Cohort Study.

Cancer has been the leading cause of death in Taiwan since 1982. Physicians have many health-related risk factors which may contribute to cancer, such as rotating night shift, radiation, poor lifestyle, and higher exposure risk to infection and potential carcinogenic drugs. However, the cancer risk in physicians is not clear. In Taiwan's National Health Insurance Research Database, we identified 14,889 physicians as the study cohort and randomly selected 29,778 nonmedical staff patients as the comparison cohort for this national population-based cohort study. Cox proportional-hazard regression was used to compare the cancer risk between physicians and comparisons. Physician subgroups were also analyzed. Physicians had a lower all-cancer risk than did the comparisons (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.76-0.97). In the sex-based analysis, male physicians had a lower all-cancer risk than did male comparisons (HR 0.82, 95% CI 0.73-0.94); and female physicians did not (HR 1.29, 95% CI 0.88-1.91). In the cancer-type analysis, male physicians had a higher risk of prostate cancer (HR 1.72, 95% CI 1.12-2.65) and female physicians had twice the risk of breast cancer (HR 2.00, 95% CI 1.11-3.62) than did comparisons. Cancer risk was not significantly associated with physician specialties. Physicians in Taiwan had a lower all-cancer risk but higher risks for prostate and breast cancer than did the general population. These new epidemiological findings require additional study to clarify possible mechanisms.

New, specific ultrasonographic findings for the diagnosis of pulled elbow.

OBJECTIVE: Among infants and preschool children with complaint of upper extremity immobility, pulled elbow, also known as nursemaid's elbow or radial head subluxation is the most common cause presenting to pediatric emergency departments. However, proper tools to diagnose pulled elbow remain limited. We conducted a study to determine the feasibility of ultrasonography in diagnosing pulled elbow. METHODS: Infants and preschool children presenting to an urban emergency department with the complaint of upper extremity immobility between April and July 2013 were enrolled. The following ultrasonographic information was recorded: (1) whether there was a change in the shape of the supinator muscle, (2) whether there was an annular ligament in place, and (3) whether there was an enlargement of the synovial fringe. We used the affected arms' ultrasonographic images as the study group and opposite arms' ultrasonographic images as the control group. RESULTS: When we diagnosed pulled elbow using ultrasonographic findings (i.e., the annular ligament was not in place), we found the following results: sensitivity, 64.9% (95% CI, 47.5% to 79.8%); specificity, 100.0% (95% CI, 90.5% to 100.0%); positive predictive value, 100.0% (95% CI, 85.8% to 100.0%); and negative predictive, 74.0% (95% CI, 59.7% to 85.4%). CONCLUSION: A pulled elbow can easily be confirmed by ultrasonography when the annular ligament is displaced.

McKittrick-Wheelock syndrome: a rare cause of life-threatening electrolyte disturbances and volume depletion.

BACKGROUND: It is uncommon for emergency physicians to discover a patient with circulatory failure resulting from chronic diarrhea. OBJECTIVES: We describe McKittrick-Wheelock syndrome, a rare disorder characterized by volume and electrolyte depletion and caused by colonic neoplasm. CASE REPORT: The case of a 30-year-old woman who came to the Emergency Department with hypovolemic shock, hyponatremia, and hypokalemia with a background of chronic diarrhea is reported. The hypokalemia and dehydration were refractory to aggressive replacement therapy. Her condition was the result of fluid and electrolyte hypersecretion caused by a colonic adenocarcinoma and colonic polyposis. Surgical removal of the colon and subsequent volume and electrolyte replacement therapy resulted in complete recovery. CONCLUSION: This case is presented to increase awareness among emergency physicians of the rare disorder of McKittrick-Wheelock syndrome.

Efficacy and tolerability of salmeterol/fluticasone propionate versus fluticasone propionate in asthma patients: a randomized, double-blind study.

BACKGROUND: A combination of salmeterol and fluticasone propionate (SAL/FP) has been shown to be effective in the treatment of asthma. We compared the efficacy and tolerability of SAL/FP (50/250 µg) with fluticasone propionate (FP) 250 µg administrated twice daily for 2 weeks in treating patients with mild to moderate asthma. METHODS: This was a randomized, double-blind study in adult patients with symptomatic asthma that was not controlled by 1000 µg/d inhaled corticosteroids (ICS) alone. 48 asthmatics were randomized to receive 2 inhalations of SAL/FP 50/250 µg bis in die (BID) or 2 inhalations of FP 250 µg BID, both delivered via Accuhaler device, for 2 weeks. The primary objective was the mean change from baseline in the mean morning peak expiratory flow (PEF) over the two week period. Other parameters included lung function, daily asthma symptom scores, evening PEF, percentage of days free of rescue medication use and daily rescue medication use. Tolerability was assessed by adverse events spontaneously elicited at clinic visits. RESULTS: 46 patients provided evaluable efficacy for analysis. The morning PEF improved significantly throughout the two weeks of treatment compared with baseline in the SAL/FP group. Mean morning PEF was 23.0 L/min higher in SAL/FP group than in FP group (p = 0.013). The change of forced expiratory volume in one second (FEV1) from baseline was greater in SAL/FP group compared to FP group (p = 0.048). There were similar effects on day-time and night-time symptom scores, percentage symptom free days and nights and usage of salbutamol. 70.8% of the patients receiving SAL/FP were satisfied with the treatment, while only 26.1% of patients receiving FP alone were (p = 0.020). No death or acute exacerbation occurred. CONCLUSION: SAL/FP 50/250 µg was safe and effective, and had a high level of patient satisfaction resulting in significantly greater increases in morning PEF and FEV1 compared to the use of FP 250 µg alone.