Dalin Tzu Chi General Hospital Research Articles

Long-term use of combined conventional medicine and Chinese herbal medicine decreases the mortality risk of patients with lung cancer

BackgroundWe explored the effect of Chinese herbal medicine (CHM) on the long-term survival of lung cancer patients and hazard ratio (HR) and to analyse CHM herbs and formulas for lung cancer treatment. MethodsWe conducted a retrospective cohort study on diagnosed lung cancer patients in 2003–2016 from Taipei and Dalin Tzu Chi General Hospital Cancer Registry Database and from outpatient database from Chinese Medicine and Conventional Medicine Department. We categorised the patients into CHM user and CHM nonuser groups according to the CHM consumption time. After passing the proportional hazard assumption, we used the Cox PH model to calculate the groups’ survival hazard ratio (HR) and examine the statistical difference and effect of CHM on lung cancer survival. ResultsWe classified 2557 lung cancer patients into 1643 CHM nonusers and 228 CHM users. The CHM users had lower mortality than the CHM nonusers. With the multivariable Cox model, we observed that the CHM use was associated with 35% lower risk of mortality (adjusted HR: 0.65; 95% confidence interval: 0.51-0.76). Continuous CHM use of >180 days may further lessen the mortality risk by 64%. Finally, eight herbs and two formulas could significantly lower the mortality. After pairing the eight herbs for analysis, seven combinations could reduce the mortality better than only using one herb. ConclusionCHM users had significantly lower mortality than CHM nonusers. The longer the CHM use, the more the mortality HR declined. Glehnia littoralisF. Schmidt ex Miq., Polyporus umbellatus(Pers.) Fries and Trichosanthes kirilowii Maxim. possess a highly substantial anticancer activity compared with other herbs.

Using Percutaneous Endoscopic Outside-In Technique to Treat Selected Patients with Refractory Discogenic Low Back Pain

Background: Controversy is not uncommon in the diagnosis of discogenic low back pain (DLBP) and in the identification of the location of the pain source for the symptomatic disc in patients with DLBP. Various techniques, from minimally invasive procedures to fusion surgery, are used to treat chronic DLBP, but the clinical outcomes are variable. Percutaneous endoscopic discectomy by transforaminal or interlaminar approach is considered to be an effective method to treat DLBP, but the evidence is limited; the lack of clear evidence may be associated with patient selection and surgical technique. Objectives: The purpose of this study is to evaluate the clinical results of percutaneous endoscopic treatment for annular tear in selected patients with DLBP by using the outside-in technique. Study Design: A prospective study and retrospective observations were performed on 24 consecutive patients with a minimum 2 years of follow-up. This study was approved by the Institutional Review Board (IRB) of Buddhist Dalin Tzu-Chi General Hospital Foundation (IRB number: 10504004) and written informed consent was obtained from all patients. Setting: This research took place within an interventional pain management and spine practice. Methods: Twenty-four consecutive patients with single-level DLBP diagnosed by positive highintensity zone on magnetic resonance imaging, positive provocative discography, and block test underwent a percutaneous endoscopic procedure from January 2014 to December 2015. The transforaminal approach or interlaminar approach was selected according to the location of the annular tear. The torn lesions were visualized directly and treated by puncture and debridement of the inflammatory tissues from the outer annulus fibrosus to the inner nucleus using the outsidein technique. The Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI) score were evaluated before and after surgery. The clinical global outcomes were assessed on the basis of modified MacNab criteria. Results: These patients included 13 men and 11 women with a mean age of 43.8 years (range, 32-55 yrs). There were 15 lesion levels at L4/L5 and 9 lesion levels at L5/S1. Among them, 15 levels were accessed by transforaminal approach and 9 levels by interlaminar approach. No serious complications were observed during the follow-up periods. All except 2 patients experienced significant symptomatic and functional improvements at the 2-year follow-up with a success rate of 91.7%. Limitations: Significant limitations include nonrandom format and small sample size. Future research may focus on controlled prospective studies with larger sample sizes and long-term followup to examine the validity of this protocol. Conclusions: The percutaneous endoscopic procedure provides a safe and effective treatment for selected patients with DLBP. The outside-in technique allows the surgeons to visualize and treat the torn or inflammatory lesions directly, and the success rate is high at 2 years follow-up. Key words: Transforaminal, interlaminar, outside-in technique, endoscopic discectomy, discogenic low back pain

Twist Expression of Nasopharyngeal Carcinoma Predicts Pre-vertebral Space Invasion and Survival Outcome

BackgroundThe purpose of this study was to explore Twist expression in nasopharyngeal carcinoma and to investigate the prognostic impact of Twist expression on survival rates in patients with nasopharyngeal carcinoma. MethodsWe utilized Western blotting to investigate the expression of Twist, vimentin, and E-cadherin in NPC cell lines. Additionally, a retrospective review of case notes from the Dalin Tzu Chi General Hospital archives was performed. We analyzed the relationship between Twist expression of tissue specimen, TNM staging, and survival rates by using immunohistochemical staining. All nasopharyngeal carcinoma patients were included. We used Pearson's chi-square and Fisher's exact tests to analyze the correlation between Twist expression of tissue specimen and TNM staging and clinical features. Kaplan-Meier survival curves were constructed and survival analysis was completed using Cox proportional hazard models. Receiver operating characteristic (ROC) curve was also examined in order to validate the ability of Twist expression to predict outcomes. ResultsA total of 48 patients with newly diagnosed NPC were enrolled in this study. Nineteen patients (40%) in this series were found to have Twist overexpression. Twist overexpression in NPC patients was associated with pre-vertebral space invasion (P = 0.032). Patients with Twist overexpression were found to have a poor overall survival rate compared with others (P = 0.01, respectively), but not metastasis free-survival rate (P = 0.126). There was a trend toward significance between Twist expression and advanced T classification (P = 0.094 respectively). Multivariate analysis showed that Twist overexpression was associated with poor survival rate (hazard ratio 5, 95% confidence interval 1.07-27; P = 0.041). The receiver operating characteristic (ROC) curves for predicting outcomes revealed that Twist expression (area under curve = 0.735) was superior to T classification (area under curve = 0.718) and clinical stage (area under curve = 0.598). ConclusionsTwist may be a useful molecular marker for nasopharyngeal carcinoma and indicator for overall survival. Patients with Twist expression should be treated more aggressively.

Predicting insulin resistance using the triglyceride-to-high-density lipoprotein cholesterol ratio in Taiwanese adults

BackgroundThe triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) has been advocated as a simple clinical indicator of insulin resistance. Thresholds of TG/HDL-C appeared to depend on ethnicity. However, no studies have specifically compared the accuracy of TG/HDL-C with and without other clinical and demographic factors in predicting insulin resistance in Taiwanese adults. The aim of the present investigation was to use TG/HDL-C and other clinical available factors to predict insulin resistance in Taiwanese adults.MethodsA total of 812 subjects were recruited from at the time of their general health examination at the Buddhist Dalin Tzu Chi General Hospital, Taiwan. Demographic information and clinical characteristics were obtained. Insulin resistance was defined by the homeostasis model assessment for insulin resistance (HOMA-IR). Simple and multiple logistic regression analyses were used to obtain probabilities of insulin resistance (HOMA-IR > 2) using TG/HDL-C with (Model 2) and without (Model 1) other clinical variables. A receiver operating characteristic (ROC) analysis was conducted to evaluate the ability of the two models to correctly discriminate between subjects of low and elevated HOMA-IR.ResultsFemale sex, greater waist circumferences, and higher ALT levels were significantly associated with the risk of elevated HOMA-IR in addition to TG/HDL-C in the multiple logistic regression (Model 2). The area under the ROC curve (AUC) of Model 2 was 0.71 [95% CI = 0.67-0.75] and was significantly higher (P = 0.007) than the AUC 0.66 [95% CI = 0.62-0.71] of Model 1.ConclusionsThe diagnostic accuracy of insulin resistance, defined by HOMA-IR, using TG/HDL-C can be significantly enhanced by including three additional clinically available factors - sex, waist circumferences, and ALT levels.

Impact of total vaginal mesh surgery for pelvic organ prolapse on female sexual function

Objective To evaluate the short-term impact of surgical repair with total transvaginal mesh (TVM) on sexual function among women with pelvic organ prolapse (POP). Methods Twenty-seven sexually active women who underwent total TVM procedures for symptomatic POP at Buddhist Dalin Tzu Chi General Hospital between 2007 and 2010 were included in the retrospective study. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP-Q) system, urodynamic studies, and a personal interview to evaluate urinary and sexual symptoms via the urogenital distress inventory (UDI-6), incontinence impact questionnaire (IIQ-7), and female sexual function index (FSFI). Results The mean patient age was 51.4 years (range 36–68 years) and the mean parity was 2.7 (range 0–4). Regarding POP-Q parameters, there were significant improvements at points Aa, Ba, C, Ap, and Bp after surgery ( P < 0.001). Similarly, the UDI-6 and IIQ-7 scores significantly dropped postoperatively ( P < 0.01). After surgery, the scores for the dyspareunia and the lubrication domains of FSFI worsened significantly ( P < 0.05). There was no significant change in other domains (desire, arousal, orgasm, satisfaction, and total score; P > 0.05). Two-thirds (66.7%) of women had a lower total FSFI score postoperatively. Conclusion TVM surgery was found to contribute successfully to the anatomic correction of POP, but individual domains of sexual function sometimes worsened.

Umbilical Hernia Due to Enlarged Paraumbilical Vein

*Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan; College of Medicine, Tzu Chi University, Hualien, § aiwan; Department of Medical Image, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan; Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan

Free Tissue Transfers for Limb Salvage in Patients with End-Stage Renal Disease on Dialysis

Microvascular surgery plays a major role in the reconstructive process of limb salvage. However, microsurgery in the patient with renal disease is still considered a high-risk procedure. Some authors have even recommended immediate amputation because of poor long-term survival in patients with renal failure and lower limb ischemia. A retrospective review of all patients with end-stage renal disease on hemodialysis who underwent free flap surgery at Dalin Tzu Chi General Hospital was included in the study. Data were collected over a 5-year period, between June of 2005 and June of 2009. A total of 20 patients were included in the study, of which 11 were men and nine were women. The average age of the patients was 63 years. All had a history of diabetes mellitus with peripheral vascular disease. Seven of the 20 patients had undergone prior vascular intervention. The total flap survival rate was 95 percent. Four patients eventually required major limb amputation because of progressive infection at the recipient site. There were no further major limb amputations in these patients during the long-term follow-up. The total limb salvage rate was 80 percent. The average follow-up was 30 months. The authors' present approach shows that the results of limb salvage in this particular group of patients are not as discouraging as previously reported. In the description of patients with renal disease, the authors suggest that they not be described as one entity but that they be divided into subgroups so that this better reflects the risk of surgery and the success of limb salvage.

Targeting Withdrawal Time to 6 Minutes can Increase Polyp Detection During Colonoscopy

Objective To investigate whether increasing the withdrawal time of the endoscope to 6 minutes during colonoscopy can improve the polyp detection rate by an individual endoscopist. Materials and Methods We reviewed the procedural data from routine colonoscopies performed in the physical examination department at Buddhist Dalin Tzu Chi General Hospital by a single endoscopist. Two-hundred and sixty-six consecutive patients who underwent colonoscopy from July to December 2006 constituted the “before” group (group 1). A second group of 266 consecutive patients who underwent colonoscopies from July through December 2007 served as the “after” group (group 2). In group 2, the endoscopist attempted to prolong withdrawal of the colonoscope to 6 minutes. The rate of polyp detection was then compared between the two groups. Results The withdrawal time was 4.2±1.1 minutes in group 1 and 5.7±1.6 minutes in group 2, respectively ( p<0.001). More patients in group 2 had at least one polyp than those in group 1 (55.4% vs. 42.4%, respectively; p = 0.004). More patients in group 2 also had at least one adenoma than patients in group 1 (33.9% vs. 23.7%, respectively; p=0.010). In addition, more adenomas were detected in group 2 than in group 1 (126 vs. 85, respectively; p = 0.038). Conclusion Using proper inspection techniques, increasing the amount of time spent using the colonoscope could significantly increase detection rates of polyps and adenomas.

Waist Circumference and Cecal Intubation Time

1Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan; 2Division of Endocrinology and Metabolism, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan; 3School of Medicine, Buddhist Tzu Chi University, Hwalien, Taiwan. Correspondence: Yu-Hsi Hsieh, MD, Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, No 2, Min-Sheng Road, Dalin Town, Chia-Yi 622, Taiwan, ROC. E-mail: [email protected]

New Continuous Negative-Pressure and Irrigation Treatment for Infected Wounds and Intractable Ulcers

Sir: We read with great interest the article by Kiyokawa et al. entitled “New Continuous Negative-Pressure and Irrigation Treatment for Infected Wounds and Intractable Ulcers.”1 We found this idea to be very innovative and used it in a couple of our patients with sternal wound infection. We would like to suggest one minor modification. The first problem that we encountered was that sometimes the fluid for irrigation was elevated accidentally above the required level. This resulted in pooling of the irrigation fluid inside the wound and leakage of the vacuum-assisted closure dressing, as the vacuum-assisted closure system cannot drain it in time. The second problem was that if one used the vacuum-assisted closure vacuum pump (Kinetic Concepts, Inc., San Antonio, Texas), with the increased irrigation fluid, there is increased drainage through the vacuum-assisted closure system, resulting in an increased demand for the canister used in the pump, leading to increased costs, as the canister had to be replaced more often. We solved both problems by adding an underwater chest drain to the wound. This assisted with drainage and also decreased the demand on the need to change the vacuum-assisted closure canister. Again, we congratulate the authors on such an interesting idea. Sou-Hsin Chien, M.D. Wei Hwa Jimmy Tan, M.D. Honda Hsu, M.B.Ch.B. Division of Plastic Surgery Dalin Tzu Chi General Hospital Dalin, Chia-Yi, Taiwan

Long pediatric colonoscope versus intermediate length adult colonoscope for colonoscopy

Controversy exists on how the length and diameter of colonoscopes affect the quality of colonoscopy. The aim of this study was to compare a long pediatric colonoscope with an intermediate length adult colonoscope with regards to completion rate and cecal intubation time. Whether either scope may be more efficient in any subgroups was also investigated. Asymptomatic patients admitted to the physical check-up department of Buddhist Dalin Tzu Chi General Hospital were included. A single endoscopist performed all of the colonoscopic examinations under sedation. Consecutive patients were randomized to undergo colonoscopy with either intermediate length adult colonoscope (CF-240I) or long pediatric colonoscope (PCF-240L). The success rate and time required to reach cecum were compared between the two groups. Between April 2005 and February 2006, a total of 918 patients were enrolled. Incomplete colonoscopy occurred in 21 (2.3%) cases (14 in the CF-240I group and seven in the PCF-240L group, P > 0.1). The overall cecal mean insertion time was 6.00 +/- 3.66 min. There was no significant difference between the CF-240I and PCF 240L groups with regard to the cecal intubation rate (96.9% vs 98.5%, P = 0.18), the need for abdominal pressure (71.7% vs 73.4%, P = 0.55) and change of position (13.5% vs 11.5%, P = 0.37). However, the cecal intubation time was shorter in the CF-240I group (5.75 +/- 3.18 vs 6.26 +/- 3.30 min, P = 0.02). Subgroup analysis by sex, age, and body mass index showed comparable outcomes between the two groups except that the cecal intubation times were significantly shorter in the CF-240I group when only men (4.78 +/- 2.57 vs 5.50 +/- 2.93 min, P < 0.01) or those younger than 50 years (5.50 +/- 2.90 vs 6.25 +/- 3.68 min, P = 0.02) were considered. Cecal intubation time is shorter in patients examined with an intermediate length adult colonoscope, mainly in the subgroups of men and those younger than 50 years of age.

Biological prognostic factors for disease free survival in breast cancer patients treated with adjuvant anthracycline chemotherapy

Previous studies on variable stiffness colonoscopes showed mixed results. Different methods of activating the variable stiffness function were used and might explain part of the controversy. To determine the most efficient way of activating the variable stiffness function, this study compared 3 methods (no activation, regular activation, activation on an as-needed basis) using 1 single type of pediatric variable stiffness colonoscope.Asymptomatic patients admitted for physical check-up at the Buddhist Dalin Tzu Chi General Hospital were included. A single endoscopist performed all of the colonoscopic examinations of patients under sedation using a variable stiffness pediatric colonoscope. Consecutive patients were randomized to undergo colonoscopy using 3 different methods of activating the variable stiffness function: no activation (“no” group), regular activation at descending colon (“regular” group), and activation on an as-needed basis (“as-needed” group). Completion rate, cecal intubation time, and use of adjunct measures were evaluated and compared among the 3 groups. Subgroup analysis by gender was also performed.Between January and July 2006, a total of 250 patients were enrolled. The completion rates of the examinations were 97.6%, 91.7% and 96.4% in the “no”, “regular” and “as-needed” groups, respectively (p = 0.17). The cecal intubation times were 5.6 ± 2.6 minutes, 5.6 ± 2.7 minutes and 6.2 ± 2.3 minutes, respectively (p = 0.22). Multivariate logistic regression analysis showed that activation of the variable stiffness function regularly (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.28, 0.98; p = 0.04) or on an as-needed basis (OR, 0.52; 95% CI, 0.28, 0.97; p = 0.04) were independent factors that were related with less use of abdominal pressure. When only women were considered, the completion rate was lower in the “regular” group (98.0%, 86.8% and 96.5%, p = 0.04). The use of abdominal pressure was more in the “no” group than the other 2 groups (56%, 34% and 33%, p = 0.03). When only men were considered, the cecal intubation time was longer in the “as-needed” group (4.6 ± 1.4, 4.6 ± 1.8 and 5.8 ± 2.5 minutes, p = 0.02). The other outcomes were similar in both genders.The 3 different methods did not result in significantly different completion rates or cecal intubation times. However, activation of the variable stiffness function decreased the need for abdominal pressure. When males and females were considered separately, activation of the variable stiffness function on an as-needed basis in females was the only useful setting.

Comparing Different Methods of Activating the Variable Stiffness Function of a Pediatric Variable Stiffness Colonoscope

Previous studies on variable stiffness colonoscopes showed mixed results. Different methods of activating the variable stiffness function were used and might explain part of the controversy. To determine the most efficient way of activating the variable stiffness function, this study compared 3 methods (no activation, regular activation, activation on an as-needed basis) using 1 single type of pediatric variable stiffness colonoscope. Asymptomatic patients admitted for physical check-up at the Buddhist Dalin Tzu Chi General Hospital were included. A single endoscopist performed all of the colonoscopic examinations of patients under sedation using a variable stiffness pediatric colonoscope. Consecutive patients were randomized to undergo colonoscopy using 3 different methods of activating the variable stiffness function: no activation ("no" group), regular activation at descending colon ("regular" group), and activation on an as-needed basis ("as-needed" group). Completion rate, cecal intubation time, and use of adjunct measures were evaluated and compared among the 3 groups. Subgroup analysis by gender was also performed. Between January and July 2006, a total of 250 patients were enrolled. The completion rates of the examinations were 97.6%, 91.7% and 96.4% in the no, regular and as-needed groups, respectively (p = 0.17). The cecal intubation times were 5.6 +/- 2.6 minutes, 5.6 +/- 2.7 minutes and 6.2 +/- 2.3 minutes, respectively (p = 0.22). Multivariate logistic regression analysis showed that activation of the variable stiffness function regularly (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.28, 0.98; p = 0.04) or on an as-needed basis (OR, 0.52; 95% CI, 0.28, 0.97; p = 0.04) were independent factors that were related with less use of abdominal pressure. When only women were considered, the completion rate was lower in the regular group (98.0%, 86.8% and 96.5%, p = 0.04). The use of abdominal pressure was more in the no group than the other 2 groups (56%, 34% and 33%, p = 0.03). When only men were considered, the cecal intubation time was longer in the as-needed group (4.6 +/- 1.4, 4.6 +/- 1.8 and 5.8 +/- 2.5 minutes, p = 0.02). The other outcomes were similar in both genders. The 3 different methods did not result in significantly different completion rates or cecal intubation times. However, activation of the variable stiffness function decreased the need for abdominal pressure. When males and females were considered separately, activation of the variable stiffness function on an as-needed basis in females was the only useful setting.

Neck mass with epithelial papillae: A diagnostic pitfall in aspiration cytology

Otolaryngology–Head and Neck SurgeryVolume 137, Issue 6 p. 979-980 Case Report Neck mass with epithelial papillae: A diagnostic pitfall in aspiration cytology Cheng-Chuan Su MD, Corresponding Author Cheng-Chuan Su MD [email protected] Department of Clinical Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan Department of Pathology, Tzu Chi University, Hualien, TaiwanReprint requests: Cheng-Chuan Su, MD, Department of Clinical Pathology, Buddhist Dalin Tzu Chi General Hospital, 2, Minsheng Road, Dalin Town, Chiayi County 622, Taiwan. E-mail address: [email protected].Search for more papers by this authorHsu-Chueh Ho MD, Hsu-Chueh Ho MD Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, TaiwanSearch for more papers by this author Cheng-Chuan Su MD, Corresponding Author Cheng-Chuan Su MD [email protected] Department of Clinical Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan Department of Anatomic Pathology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan Department of Pathology, Tzu Chi University, Hualien, TaiwanReprint requests: Cheng-Chuan Su, MD, Department of Clinical Pathology, Buddhist Dalin Tzu Chi General Hospital, 2, Minsheng Road, Dalin Town, Chiayi County 622, Taiwan. E-mail address: [email protected].Search for more papers by this authorHsu-Chueh Ho MD, Hsu-Chueh Ho MD Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, TaiwanSearch for more papers by this author First published: 17 May 2016 https://doi.org/10.1016/j.otohns.2007.08.018 Cheng-Chuan Su: , corresponding author, submission and full access to all study data, study design, cytology study; Hsu-Chueh Ho, clinical study, literature research; all authors, approval of final version. Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume137, Issue6December 2007Pages 979-980 RelatedInformation

Factors that predict cecal insertion time during sedated colonoscopy: The role of waist circumference

Various factors have been closely linked to the cecal insertion time. These factors include age, sex, body mass index, quality of bowel preparation, doctor's technique, a history of prior hysterectomy, diverticulosis, and constipation. Waist circumference is better than body mass index in assessing abdominal obesity and therefore may be better than body mass index in predicting cecal insertion time. The aim of this study was to evaluate the factors influencing cecal insertion time and the impact of waist circumference. This prospective study was conducted between August 2004 and June 2005 in Buddhist Dalin Tzu Chi General Hospital. Asymptomatic patients admitted to our physical check-up department were enrolled. A single endoscopist performed all colonoscopies under sedation with a single-handed method. Age, sex, body mass index, waist circumference, history of hysterectomy, constipation, bowel cleansing status, and diverticulosis were analyzed. A total of 1022 patients were enrolled. Among them, 996 (97.5%) completed the colonoscopic examinations (472 men and 524 women). The mean +/- SD insertion time was 307 +/- 166 s for men and 403 +/- 195 s for women (P < 0.01). Female sex, poor bowel preparation, smaller waist circumference, lower body mass index and older age were associated with longer insertion time. Waist circumference was better than body mass index in predicting cecal insertion time. Female sex, poor bowel preparation, smaller waist circumference, lower body mass index and older age were associated with a longer insertion time. Waist circumference was a better predictor than body mass index in assessing cecal insertion time.

Seizures Complicating Bacterial Meningitis

The clinical data of 116 patients, 1 month to <5 years of age, admitted for bacterial meningitis, and grouped according to those with and without seizures during hospitalization, were compared in a study at Buddhist Dalin Tzu Chi General Hospital, Chang Gung Memorial Hospital and other centers in Taiwan.