Guidance on home blood pressure monitoring: A statement of the HOPE Asia Network

Hypertension is an important modifiable cardiovascular risk factor and a leading cause of death throughout Asia. Effective prevention and control of hypertension in the region remain a significant challenge despite the availability of several regional and international guidelines. Out‐of‐office measurement of blood pressure (BP), including home BP monitoring (HBPM), is an important hypertension management tool. Home BP is better than office BP for predicting cardiovascular risk and HBPM should be considered for all patients with office BP ≥ 130/85 mm Hg. It is important that HBPM is undertaken using a validated device and patients are educated about how to perform HBPM correctly. During antihypertensive therapy, monitoring of home BP control and variability is essential, especially in the morning. This is because HBPM can facilitate the choice of individualized optimal therapy. The evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for HBPM in Asia.     

Postincisional local anaesthetic infiltration of the rectus muscle decreases early pain and morphine consumption after abdominal hysterectomy

We conducted a randomized, double-blind study to evaluate the degree to which selective infiltration of the rectus muscle may influence pain and morphine requirements after major intra-abdominal surgery 6 h postoperatively. One hundred Chinese patients presenting for elective total abdominal hysterectomy received a standard general anaesthetic and were randomly divided into two groups to receive intramuscular injection of 0.4 ml kg⁻¹ of either bupivacaine 0.5 or 0.9% saline (maximum to 20 ml) to the rectus muscle wound at the end of surgery. The mean hourly pain (visual analogue score (VAS)) was statistically significant at 0–2 and 4 h while mean hourly morphine consumption was statistically significant at 1, 2 and 4 h postoperatively between the two groups (P<0.05). Total morphine consumption at 6 h postoperative was significantly reduced from 21.7 mg (mean) and 20 mg (median) in the saline group to 12.8 mg (mean) and 12 mg (median) in the bupivacaine group respectively (P<0.05). These results indicate that the rectus muscle is an important origin, and injury and spasm of this muscle potential mechanisms, of pain in the early postoperative period after abdominal hysterectomy.     

Provocation tests in doppler ultrasonography for carpal tunnel syndrome

Introduction: Doppler ultrasonography (DU) has recently been shown to be useful in imaging carpal tunnel syndrome (CTS). In this study, we aim to characterize the changes seen after exercise and electrical stimulation. Methods: Five patients with CTS were recruited with 5 age‐matched subjects. DU was used to visualize the median nerve, flexor tendon, and bone at base line and after 1 minute of: (a) median nerve motor stimulation, (b) median nerve sensory stimulation, (c) abductor pollicis brevis contraction, and (d) adductor digiti minimi contraction. Results: Blood flow in the median nerve was greater after APB exercise. Furthermore, blood flow in the median nerve was greater in cases than controls after APB exercise. At baseline, blood flow in the flexor tendon was greater in cases than controls. Conclusions: While limited by sample size, this study demonstrates that exercise of median innervated muscles may be useful in enhancing diagnostic utility of DU for CTS. Muscle Nerve, 2013     

Quality of Life After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: An Asian Perspective

Background

Data on quality of life (QOL) after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is scarce in the Asian population. This study assesses QOL outcomes after CRS and HIPEC in an Asian cancer center.

Methods

Patients who completed CRS + HIPEC 6–18 months ago (27 patients) were enrolled in the study. QOL was measured via the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaires. The scores were compared with a group of 393 disease-free cancer patients, not on active treatment, who had ECOG scores of either 0 or 1. The 1-sample t test was used to compare differences in QOL scores between the 2 groups.

Results

A total of 27 patients were analyzed, of which 22 (81 %) were females. Median age was 51 years (15–59 years). CRS + HIPEC were performed for ovarian cancer in 15 patients (55 %), appendiceal carcinoma in 5 patients (19 %), and colorectal carcinoma in 4 patients (15 %). The median intraoperative peritoneal carcinomatosis index (PCI) score was 15 (2–31) while the completeness of CC score was 0 and 1 in 25 and 2 patients, respectively. The median duration after CRS + HIPEC was 10 months (6–16 months). Global health status and functional and symptom scores were largely similar between patients after CRS + HIPEC and the control group. Cognitive functioning scores and fatigue scores were significantly better in the group after CRS + HIPEC (p = 0.014 and 0.04).

Conclusions

QOL after CRS and HIPEC can be equivalent to that of well-functioning, disease-free cancer patients.     

Trends in Post‐Mastectomy Reconstruction in an Asian Population: A 12‐Year Institutional Review

Post‐mastectomy breast reconstruction is an integral component of breast cancer treatment. It is often perceived that women in Asian countries have a lower rate of post‐mastectomy reconstruction than Western populations. This study describes trends in timing and types of breast reconstruction performed in the largest healthcare provider in Singapore, over a period of 12 years. It also reports on the oncological outcomes and surgical safety. A retrospective review of all patients who underwent post‐mastectomy reconstruction from January 2001 to December 2012 at the National Cancer Centre Singapore and Singapore General Hospital was performed. Six hundred and twenty post‐mastectomy reconstructions were performed in 579 patients. The proportion of reconstructions increased from 4% in 2001 to 18% in 2012. Younger patients (<50 years old) and those with early stage cancer were more likely to undergo reconstruction. Immediate breast reconstruction was favored by more than 90% of patients. Postoperatively, 9% developed acute surgical complications that were treated surgically; 6% had additional surgery for late complications. Only 4% had delay of adjuvant chemotherapy. At median follow‐up of 63 months (range 3–166), loco‐regional recurrence was 4%, and distant metastases 8%. Post‐mastectomy reconstruction for breast cancer is increasingly performed in our institution. Both younger age and lower stage disease were associated with choice for reconstruction in our study. Low rates of delay to adjuvant therapy were noted, and it may safely be offered to suitable women undergoing mastectomy.