Efficacy of submucosal epinephrine injection for the prevention of postpolypectomy bleeding: A meta-analysis of randomized controlled studies.

BACKGROUND: Bleeding is the most common major complication following colonoscopic polypectomy. The purpose of this study is to evaluate whether submucosal epinephrine injections could prevent the occurrence of postpolypectomy bleeding. METHOD: The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for appropriate randomized controlled studies published before April 2015. A meta-analysis was conducted to investigate the preventative effect of submucosal epinephrine injection for overall, early, and delayed postpolypectomy bleeding. RESULTS: The final analysis examined the findings of six studies, with data from 1388 patients. The results demonstrated that prophylactic treatment with epinephrine injection significantly reduced the occurrence of overall (OR = 0.38, 95% CI: 0.21, 0.66; p = 0.0006) and early bleeding (OR = 0.38, 95% CI: 0.20, 0.69; p = 0.002). However, for delayed bleeding complications, epinephrine injections were not found to be any more effective than treatment with saline injection or no injection (OR = 0.45, 95% CI: 0.11, 1.81; p = 0.26). Moreover, for patients with polyps larger than 20 mm, mechanical hemostasis devices (endoloops or clips) were found to be more effective than epinephrine injection in preventing overall bleeding (OR = 0.33, 95% CI: 0.13, 0.87; p = 0.03) and early bleeding (OR = 0.29, 95% CI: 0.08, 1.02; p = 0.05). This was not established for delayed bleeding. CONCLUSION: The routine use of prophylaxis submucosal epinephrine injection is safe and beneficial preventing postpolypectomy bleeding.

Surgical versus percutaneous techniques for peritoneal dialysis catheter placement: A meta-analysis of the outcomes.

BACKGROUND: Peritoneal dialysis (PD) is an effective method of renal replacement therapy for end-stage renal disease patients. The PD catheter could be inserted by surgical (open surgery/laparoscopic-assisted) or percutaneous techniques. However, the efficacy of the techniques, including catheter survival and catheter related complications, is still controversial. METHOD: The dataset was defined by searching PubMed, EMBASE, Google Scholar and the Cochrane database that had been published until July 2014. The meta-analysis was performed using Review Manager Software version 5.2.6. RESULT: The final analysis was conducted on 10 studies (2 randomized controlled studies (RCTs) and 8 retrospective studies), including 1626 patients. The pooled data demonstrate no significant difference in 1-year catheter survival (OR = 1.04, 95% CI = 0.52-2.10, P = 0.90) between surgical and percutaneous groups. However, the sensitivity analysis of the RCTs demonstrated that the incidence of overall infectious (OR = 0.26, 95% CI = 0.11-0.64, P = 0.003) and overall mechanical complications (OR = 0.32, 95% CI = 0.15-0.68, P = 0.003) were significantly lower in the percutaneous groups than the surgical groups. Furthermore, the subgroup analyses revealed no significant difference in the rates of peritonitis, tunnel and exit site infection, leakage, inflow-outflow obstruction, bleeding and hernia by comparing the methods. CONCLUSION: The results showed that the placement modality did not affect 1-year catheter survival. Percutaneous catheter placement is as safe and effective as surgical technique.

Laparoscopic Retrograde Peritoneal Dialysis Catheter Insertion: Technique and Outcomes.

Objective: The study aimed to present technique and outcomes of laparoscopic retrograde peritoneal dialysis catheter insertion in chronic kidney disease (CKD) patients. Material and Method: We retrospectively reviewed 11 complicated CKD patients, who underwent both laparoscopic and laparoscopic retrograde peritoneal dialysis catheter (lap PD, r-lap PD) insertion at HRH Princess Maha Chakri Sirindhorn Medical Center during April 2013 to March, 2016. Technique, outcomes and complications were presented. Results: After a follow-up period of 14 months in patients who underwent lap PD insertion, there was no infection, bleeding complication, or hernia presented. Dialysate leakage after immediate dialysis was found in one r-lap PD insertion patient but healed spontaneously. No catheter removal or revision was observed. Conclusion: The described r-lap PD catheter insertion technique was straightforward, effective and reproducible. Though the sample size was limited, the procedure can used as an alternate in complicated CKD patients.

Vascular endothelial growth factor-C expression as a biomarker of poor prognosis in esophageal squamous cell carcinoma: a meta-analysis.

BACKGROUND: Vascular endothelial growth factor C (VEGF-C) is involved in the development and progression of tumor angio-/lymphangiogenesis. The purpose of this study is to evaluate whether VEGF-C expression is an indicator of aggressiveness and poor prognosis of esophageal squamous cell carcinoma (ESCC). METHOD: A meta-analysis was conducted to investigate the association between VEGF-C expression with clinicopathological characteristics and survival of ESCC patients. The dataset was defined by searching PubMed, Embase, Google Scholar, and the Cochrane database for appropriate articles published until April 2014. RESULT: The final analysis was made from 9 studies, including 656 ESCC patients. Positive VEGF-C expression was defined by immunohistochemistry (IHC) or mRNA expression analysis. The results demonstrated that VEGF-C expression was significantly associated with advanced-stage disease (odds ratio (OR) = 2.29, 95% confidence interval (CI) = 1.37-3.84, P = 0.002), deeper tumor invasion, lymph node metastasis, and lymphatic invasion. The 5-year survival of VEGF-C expression-negative patients was found to be better than that of VEGF-C expression-positive patients (OR = 0.35, 95% CI = 0.21-0.58, P < 0.0001). However, there was no significant association between the VEGF-C expression levels and either poorer tumor differentiation or vascular invasion. CONCLUSION: The results of the meta-analysis strongly indicate that VEGF-C expression could function as a marker for predicting the aggressiveness and prognosis of ESCC.

Mastalgia: Characteristics and Associated Factors in Thai Women.

OBJECTIVE: This study aimed to identify the clinical presentation, natural history, severity and associatedfactors in Thai women presented with mastalgia. MATERIAL AND METHOD: One hundred and five Thai women with breast pain who visited HRH Princess Maha Chakri Sirindhorn Medical Center were interviewed with breast pain. The data about socio-economic status, sign and symptoms of breast pain, associated factors, mental status and quality of life at first presentation and 6-12 months afterward were collected. RESULTS: In 105 Thai women who present with mastalgia, the pain was associated with menstrual cycle, around 70 percents. Both cyclic and non-cyclic mastalgia patients had similar characteristics as type, intensity and location. There were no diferences in caffeine and high-fat food intake between mild and severe mastalgia. In twenty-seven percent ofpatients who had severe breast pain, the pain affected their work, sleeping and daily entertainment. Though the pain did not influence mental status, it affected some part of quality of life such as apart of bodily pain, socialfunction and mental health. At second follow-up, 80 patients had decreased severity and intensity of pain. The mental status and quality of life evaluations were statistically significant. CONCLUSION: The results showed that most mastalgia was associated with menstruation. Diet showed no definitive association with breast pain severity and severe mastalgia influenced patients' daily activity and quality of life.

The Prevalence and Related Factors of Complementary and Alternative Medicine Used in Thai Breast Cancer Patients.

OBJECTIVE: This study's aim is to identify the prevalence and types of complementary and alternative medicine (CAM) used among Thai breast cancer patients and investigate the factors influencing the use of CAM by these patients. MATERIAL AND METHOD: We interviewed 220 Thai breast cancer patients who visited the HRH Princess Maha Chakri Sirindhorn Medical Center and the Maha Vajiralongkorn Cancer Center during the period from October 2008 to September 2010 and collected data about their socio-economic status, history of cancer treatments and complications, the cancer staging, their Quality of life (QoL) and types and reasons of CAM used. RESULTS: The prevalence of CAM usage in Thai breast cancer patients was 560 in every 1,000 patients. Factors which influenced CAM usage were; the patients' educational level, amount of income per month, the duration of the individuals' breast cancer diagnoses, menopausal status, the type of axillary surgery used in the course of their treatment, the incidences of systemic recurrence and physical components as measured by the SF-36. CONCLUSION: The results have shown that most Thai breast cancer patients used CAM for the treatment of their breast cancer and had used CAM after being diagnosed with breast cancer Healthcare providers should recognize and provide pros and cons to patients and their family if CAM were used during breast cancer treatment.

A Cost-Utility Analysis Comparing Standard Axillary Lymph Node Dissection with Sentinel Lymph Node Biopsy in Patients with Early Stage Breast Cancer in Thailand.

OBJECTIVES: In Thailand, axillary lymph node dissection (ALND) is the dominant form of treatment for breast cancer, even though the treatment often leaves patients with some degree of arm morbidity. Sentinel lymph node biopsy (SNB) is widely accepted globally as a preferable alternative procedure because of its lower rates of associated morbidity. This study compared the cost-utility of SNB and ALND in patients with early stage breast cancer in Thailand. METHODS: A decision tree with a 5-year time horizon was developed. Outcomes that were relevant to SNB and ALND were included, along with locoregional recurrence of cancer and lymphedema scenarios. The model parameters were derived from a meta-analysis of international clinical trials and other relevant literature. The resources and cost data were derived from the medical records of tertiary hospitals. Health utilities were measured by using the standard gamble technique. A sensitivity analysis was performed using a set of plausible parameters. RESULTS: The incremental cost-effectiveness ratio (ICER) in the base-case analysis showed that SNB was more cost-effective than ALND. ICERs were -275,140 and -470,600 Thailand baht/quality-adjusted life-year gained from the provider perspective and the societal perspective, respectively. The most sensitive parameter was the utility score of patients with early stage breast cancer who had received breast-conserving therapy with lymphedema; the sensitivity and specificity of SNB had no impact on the ICER. CONCLUSIONS: The study confirmed that SNB was an economically viable alternative treatment to ALND. In developing countries, where resources are limited, nationwide implementation of SNB warrants widespread support from relevant stakeholders, including medical personnel and policymakers.

Development and validation of the body image scale among Thai breast cancer patients.

OBJECTIVE: To examine the psychometric property of the Thai version of the Body Image Scale (BIS) in breast cancer patients in Thailand. MATERIAL AND METHOD: The authors conducted a cross-culture translation of the BIS into the Thai language and administered it to 242 breast cancer patients who had surgery and had completed chemo-radiation for more than one year. RESULTS: The present study confirmed a good reliability and validity of Thai version of BIS. The questionnaire has high internal and external consistency; Cronbach's alpha was above 0.8 and test-retest reliability was more than 0.7. Content validity was confirmed by expert opinion and cognitive interview with breast cancer patients. Construct validity was examined though factor analysis showed a single-factor solution which excludes one item from the original 10-item scale. Discriminant validity which confirmed by different score between mastectomy and breast conserving surgery group and good response prevalence also supported the clinical validity of the test. CONCLUSION: Thai version of the BIS showed a good psychometric property and can be used as a patient-physician communication and quality of life evaluation tool after breast cancer treatment in Thai women.

The technique and outcome of peritoneal dialysis catheter revision.

OBJECTIVE: Tenchkhoff catheter malposition is a significant cause of technical failure in patients with peritoneal dialysis (PD). Many surgical revised techniques have been reported including wire manipulation and laparoscopy. The objective of the present study was to report the outcome of surgical revised technique for catheter malposition in patients with PD. MATERIAL AND METHOD: The data of one hundred and twenty three patients with peritoneal dialysis at the HRH Princess Maha Chakri Sirindhorn Medical Center were reviewed. The Tenchkhoff catheters were revised in ten patients who had delayed outflow drainage and failed with nonsurgical treatment. The outcome of catheter placement and revision were reported. RESULTS: The longest catheter survival time in the authors' patient was 71 months. The Tenchkhoff catheters were revised successfully in ten patients. The positions of exit sites were not changed. The immediate postoperative complication was not found. The second revision of Tenchkhoff catheter was performed in three patients. Five patients died from other causes not related to the catheter malposition, one patient was referred to another hospital, and four patients had still undergone CAPD. CONCLUSION: The authors catheter-revised technique is safe, simple, straightforward and no special instrument needed therefore it is suitable to be practiced in Thailand.