Treatment of frontal sinus osteoma using a craniofacial approach

Osteoma is one of most common benign tumors of the nose and paranasal sinuses, with the frontal sinus being its most frequent location. It may be locally destructive and aggressive with possible intracranial complications. Osteoma of the frontal sinus comprises 57% of all osteomas in the paranasal sinuses. In 1939, Childrey reviewed 3,510 consecutive sinus radiographs taken for any reason and found an incidence of 0.43% of paranasal sinus osteomas. There are many operative approaches for frontal sinus osteomas, such as external frontoethmoidal approach and osteoplastic frontal sinusectomy, both with high recurrence rates. Those traditional operative methods cannot radically eradiate the osteoma grown in the posterior table of the frontal sinus. From July 1991 to June 1992, three patients with symptomatic frontal sinus osteomas were operated by a craniofacial approach. One patient is presented here in detail. A coronal incision is used and is found to be beneficial both in surgical exposure and in reconstruction with a calvarial bone graft. The patient has been followed for 3.5 years without osteoma recurrence.

Massive intratumor hemorrhage in facial plexiform neurofibroma

BACKGROUND

Plexiform neurofibromatosis is a feature of von Recklinghausen's disease. Head and neck lesions may produce varying degrees of cosmetic and functional deformity. However, life-threatening hemorrhage into facial plexiform neurofibromas has not been previously reported.

METHOD

We report two patients with von Recklinghausen's disease who experienced massive hemorrhage into facial neurofibromas, one following a blunt injury and the other without a known initiating event.

RESULTS

Conservative management did not stop the hemorrhage into facial neurofibromas in either instance. Surgical exploration was mandated for hemorrhage control and evacuation of blood clots. Hemostasis was attained by a combination of hypotensive anesthesia and chromic catgut suture ligatures.

CONCLUSIONS

These case reports demonstrate a potentially lethal complication in patients with facial plexiform neurofibroma. Where a competent and experienced interventional neuroradiologist is not available, surgical exploration should be undertaken to control bleeding.

Ethnocultural differences in prevalence of adolescent depression

Data from an ethnically diverse sample of middle school (Grades 6-8) students (n = 5,423) are analyzed for ethnic differences in major depression. The point prevalence of major depression was 8.4% without and 4.3% with impairment. Data were sufficient to calculate prevalences for nine ethnic groups. Prevalences adjusted for impairment ranged from 1.9% for youths of Chinese descent to 6.6% for those of Mexican decent. African and Mexican American youths had significantly higher crude rates of depression without impairment, but only the latter had significantly higher rates of depression with impairment. Multivariate (logistic regression) analyses, adjusting for the effects of age, gender, and socioeconomic status (SES), yielded significant odds ratios for only one group. Mexican American youths were at elevated risk for both depression without (OR = 1.74, p < .05) and depression with impairment (OR = 1.71, p < .05). There was no significant interaction of ethnicity and SES in relation to depression. Females had higher prevalences of depression with and without impairment, as did youths who reported that their SES was somewhat or much worse off than their peers. The data add to growing evidence that Mexican American youths are at increased risk of depression, and that community intervention efforts should specifically target this high-risk group.

Pneumosinus dilatans of the maxillary sinus: a report of two cases

Two cases of the rare condition of pneumosinus dilatans of the maxillary sinus are presented. This is a rare differential diagnosis of a maxillary mass. The precise aetiology and pathogenesis is obscure. Because facial deformity may persist after construction of a naso-antral window alone, direct resection and reconstruction using bone grafts is recommended in addition to the creation of a naso-antral window, if required.

Refined frontalis fascial sling with proper lid crease formation for blepharoptosis

Ptosis of the upper eyelid is a complicated problem, and many surgical techniques have been developed for the treatment of ptosis. Frontalis sling with autogenous fascial strip for the correction of severe ptosis with poor levator function is still well accepted. The treatment necessitates an understanding of the etiology of ptosis, detailed history taking, degree of ptosis, the levator function, the anatomic basis of the ptosis and lid crease, and a historic review of surgical procedures. The refinement of our procedure consists of a circular type of frontalis sling with an autogenous fascial strip, harvested from fasciae latae or temporalis fascia, with evenly balanced strength and partial lid resection, including a semilunar segment of skin flap and orbicularis muscle and moderate amount of protruded orbital fat from the orbital septum. The fascial strip is anchored simultaneously to the upper margin of the tarsal plate and incision margin of the pretarsal lid to produce a proper lid crease. This procedure has been successful in the management of 64 lids (46 patients) with a severe degree of ptosis and poor levator function. Satisfactory results have been achieved in 57 lids (89 percent) according to the modified criteria of Berke after an average follow-up period of 18.5 months. Most patients (87.5 percent) have mild lid lag (1 to 3 mm) after the operation, but 58 lids (90.6 percent) achieved a proper lid crease height of 3 to 6 mm.

Optic nerve decompression in fibrous dysplasia: indications, efficacy, and safety

Optic nerve decompression is controversial in posttraumatic visual loss and as a prophylactic therapy in fibrous dysplasia involving the optic canal. It is less controversial for the treatment of optic nerve compression in fibrous dysplasia. Thirteen patients with craniomaxillofacial fibrous dysplasia who underwent 16 optic nerve decompressions at the Chang Gung Craniofacial Centre for both therapeutic (10) and prophylactic (6) indications are reported. One patient sustained a clinically useful improvement in vision in response to two therapeutic decompressions, and another demonstrated marked improvement after therapeutic decompression, with visual acuity improving from 0.4 to 1.0 in the affected eye. No patient underwent a permanent deterioration of vision as a result of either therapeutic or prophylactic decompression. One patient suffered extraocular muscle dysfunction that was corrected with strabismus surgery. A review of the literature clarifies the controversies and allows establishment of indications for optic nerve decompression.

The role of c-Jun N-terminal kinase (JNK) in apoptosis induced by ultraviolet C and gamma radiation. Duration of JNK activation may determine cell death and proliferation

c-Jun N-terminal kinases (JNKs) participate in cellular responses to mitogenic stimuli, environmental stresses, and apoptotic agents. The mechanisms by which JNK integrates with other signaling pathways and regulates the diverse cellular events are unclear. We found JNK, but not p38-mitogen-activated protein kinase (MAPK) or extracellular signal-regulated kinase 2, to be persistently activated in apoptosis induced by gamma radiation, UV-C, and anti-Fas treatment. Direct correlation was found between JNK activation and apoptosis induced by UV-C and gamma radiation; however, JNK induction and apoptosis induced by Fas signaling were not well correlated. Overexpression of activated JNK1 caused cell death in transfected cells, and the expression of a dominant-negative mutant of MAPK kinase 1 or JNK1 (but not a dominant-negative mutant of p38-MAPK or c-Raf) prevented the UV-C- and gamma radiation-induced cell death. The inductions of JNK in T-cell activation and apoptosis were distinguished by the different activation patterns, transient versus persistent, respectively. Co-treatment with a tyrosine phosphatase inhibitor (sodium orthovanadate) and T-cell activation signals (phorbol 12-myristate 13-acetate plus ionomycin) prolonged JNK induction, followed by T-cell apoptosis. Our data revealed the requirement of the JNK pathway in radiation-induced apoptosis and implicated the importance of the duration of JNK activation in determining the cell fates.

Extended open-tip rhinoplasty with three V-flaps for secondary correction of bilateral cleft lip nasal deformity

Many procedures have been developed to correct the secondary cleft lip nasal deformity, including the depressed nasal tip, flaring nasal aperture, and a very short columella. The forked flap, cartilage graft, or strut and bony graft have been applied for many years. We propose the extended open-tip rhinoplasty with three V-flaps, which we have performed on 12 patients during the past 3 years. An extended incision for the nasal skin flap exposes all deformities to direct vision, makes the advancement and rotation of the nasal skin flap complete, and makes the corrective procedures easy and accurate. A large V-flap (with V-Y advancement for columellar lengthening) and two small V-flaps (with back-cut incisions on the nasal lining) are used to elevate and suspend the alar domes and cartilage to create two symmetrical and piriform apertures, and to ensure adequate columellar length. Columellar lengthening averaged from 2.5 mm preoperatively to 10 mm postoperatively. A protruded nasal tip with two delicate and small dimples over the alar rims, and a piriform aperture of the nasal nares were achieved in our series. No hypertrophic scar, nasal obstruction, or exposure of hairy nares were noted. No cartilage graft or strut and bone graft were required.

The moderating roles of self-esteem and self-construal in reaction to a threat to the self: evidence from the People's Republic of China and the United States

The present research evaluated whether a well-established finding in the U.S.-based self-esteem literature (i.e., a positive relationship between trait self-esteem and self-protection following a threat to the self) was moderated by individuals' self-construal. Participants varying in self-esteem and degree of independent self-construal were studied in 2 different cultures: the United States and the People's Republic of China. Half of the participants received negative individual performance feedback, whereas the remaining half did not. For the U.S. sample (but not the People's Republic of China sample) as a whole, the authors observed a positive relationship between trait self-esteem and self-protection in response to negative feedback. However, the subset of participants from the People's Republic of China with more independent self-construals did exhibit a positive relationship between trait self-esteem and self-protection in response to negative feedback.

The moderating roles of self-esteem and self-construal in reaction to a threat to the self: evidence from the People's Republic of China and the United States

The present research evaluated whether a well-established finding in the U.S.-based self-esteem literature (i.e., a positive relationship between trait self-esteem and self-protection following a threat to the self) was moderated by individuals' self-construal. Participants varying in self-esteem and degree of independent self-construal were studied in 2 different cultures: the United States and the People's Republic of China. Half of the participants received negative individual performance feedback, whereas the remaining half did not. For the U.S. sample (but not the People's Republic of China sample) as a whole, the authors observed a positive relationship between trait self-esteem and self-protection in response to negative feedback. However, the subset of participants from the People's Republic of China with more independent self-construals did exhibit a positive relationship between trait self-esteem and self-protection in response to negative feedback.

Stability of diagnosis in schizophrenia

OBJECTIVE

The authors investigated factors associated with change in diagnosis from schizophrenia to other disorders and from other disorders to schizophrenia, as well as the time elapsed before diagnostic change.

METHODS

Using a longitudinal study design, they examined data collected over a 7-year period at an urban acute care psychiatric hospital. The subjects were 936 inpatients who had been hospitalized at least four times during the study period. Changes to and from a diagnosis of schizophrenia over the 7 years were investigated in relation to demographic variables, socioeconomic factors, and clinical features.

RESULTS

Fifty-six (21.9%) of the 256 subjects with a diagnosis of schizophrenia at the beginning of the study received a different diagnosis during a subsequent hospitalization. Females and subjects of Hispanic origin were more likely to undergo a diagnostic change from schizophrenia. Two hundred twenty-three (32.8%) of the 680 subjects who initially had a diagnosis other than schizophrenia were later diagnosed with schizophrenia. Males and African Americans had significantly higher rates of change to a diagnosis of schizophrenia than females and other ethnic groups. In addition, socio-economic factors and clinical features were associated with a change in diagnosis from another disorder to schizophrenia.

CONCLUSIONS

The diagnosis of schizophrenia, in current practice, is not static. Patients' characteristics interact with longitudinal clinical changes to produce shifts in diagnosis. Longitudinal follow-up is necessary to validate diagnoses.

Surgical correction of submucous cleft palate with Furlow palatoplasty

Many surgeons have favored using the pharyngeal flap as the primary treatment for the velopharyngeal insufficiency associated with submucous cleft palate. However, the increasing number of reports of sleep apnea and airway compromise as a result pharyngeal flap surgery support the need to eliminate any unnecessary pharyngeal flap surgery. From 1988 to 1993, 35 Chinese submucous cleft palate patients with velopharyngeal insufficiency received surgery. A Furlow palatoplasty was used in 30 patients (3 to 26 years old). The follow-up duration was 9 months to 5 1/2 years. These patients were selected after a thorough study for velopharyngeal insufficiency including intraoral examination, perceptual speech assessment, videonasopharyngoscopy, and/or multiview videofluoroscopy. The criteria for selection included age, intraoral finding of an obviously anterior inserted levator palatine muscle, size of velopharyngeal gap, pattern of velopharyngeal closure, degree of lateral pharyngeal wall movement, and response to biofeedback speech therapy. In general, younger patients with circular or sagittal pattern closure, a velopharyngeal gap less than 5 mm, or good response to biofeedback speech therapy were considered to be the best candidates for a Furlow palatoplasty. The 5 patients who did not fulfill these criteria and whose velopharyngeal function failed to improve on preoperative biofeedback therapy were treated by pharyngeal flap operation. Twenty-nine patients (96.7 percent) achieved competent velopharyngeal function after the Furlow palatoplasty. The procedure corrected the velopharyngeal insufficiency in 3 patients older than 20 years with a velopharyngeal gap of less than 2 mm. The only patient with an unsatisfactory result was a 26-year old woman who had very prominent action of the musculus uvulae before the surgery. The results show that a Furlow palatoplasty can satisfactorily correct velopharyngeal insufficiency in carefully selected submucous cleft palate patients and thus avoid the serious complications of pharyngeal flap surgery.

Effects of GR 68755 on d-amphetamine-induced changes in mood, cognitive performance, appetite, food preference, and caloric and macronutrient intake in humans

Pre-clinical studies have suggested that 5-HT(3) antagonists such as GR 68755 oppose mesocorticolimbic dopamine release, which may mediate the important effects of d-amphetamine on positive subjective mood, anorexia, and performance. Twenty-six healthy male volunteers received each of the following treatments in a double-blind, randomized, cross-over design separated by a period of four to seven days: (a) d-amphetamine (20mg orally); (b) placebo; (c) GR 68755 (2mg orally); and (d) GR 68755 plus d-amphetamine. Subjects completed subjective measures of mood, hunger, and satiety. Caloric and macronutrient intake were measured using a test meal. Performance and attention were assessed using standardized computerized tasks. GR 68755 enhanced accuracy on the computerized attention task but failed to reverse significantly any of the effects of d-amphetamine. These results suggest that at these doses GR 68755 pre-treatment does not significantly reduce the effects of d-amphetamine.

Hemimandibular hyperplasia

True hemimandibular hyperplasia is an uncommon maxillofacial deformity. Patients with this affliction present clinically with varying degrees of asymmetry characterized by an increase in ramus height, a rotated facial appearance with kinking at the mandibular symphysis, and prominence of the lower border of the mandible. In the advanced form, maxillary and mandibular alveolar bone overgrowth result in a compensatory canting of the occlusal plane and a significant functional malocclusion requiring bimaxillary surgical correction. Nine patients with the above condition were treated with various surgical methods over a 9-year period. The clinical results were satisfying and the long-term results showed good postoperative stability. The pathology of hemimandibular hyperplasia is described and the preexisting nomenclature further defined.

Functional expression of subunit IV of Rhodobacter sphaeroides cytochrome b-c1 complex and reconstitution of recombinant protein with three-subunit core complex

Subunit IV of Rhodobacter sphaeroides cytochrome b-c1 complex was over-expressed in Escherichia coli JM109 cells as a glutathione S-transferase fusion protein (GST-RSIV) using the expression vector, pGEX/RSIV. Maximum yield of soluble active recombinant fusion protein was obtained from cells harvested 3 h after induction of growth at 37 degrees C in LB medium. Subunit IV was released from the fusion protein by proteolytic cleavage with thrombin. When subjected to SDS-polyacrylamide gel electrophoresis, isolated recombinant subunit IV of R. sphaeroides cytochrome b-c1 complex. Although the isolated recombinant subunit IV is soluble in aqueous solution, it is in a highly aggregated form, with an apparent molecular mass of over 1000 kDa. The addition of detergent deaggregates the isolated protein, suggesting that the recombinant protein exists as a hydrophobic aggregation in aqueous solution. When the three-subunit core cytochrome b-c1 complex, purified from RS delta IV-adapted chromatophores containing a fraction of the wild type cytochrome b-c1 complex activity, was reacted with varying amounts of recombinant subunit IV, the activity increased as the subunit IV concentration increased. Maximum activity restoration was reached when 1 mol of subunit IV/mol of three-subunit core complex was used. The reconstituted cytochrome b-c1 complex is similar to the wild-type complex in molecular size, apparent Km for Q2H2, and inhibitor sensitivity, indicating that recombinant subunit IV is properly assembled into the active cytochrome b-c1 complex. A tryptophan residue in subunit IV was found to be involved in the interaction with the three-subunit core complex.

Persistent activation of c-Jun N-terminal kinase 1 (JNK1) in gamma radiation-induced apoptosis

The c-Jun N-terminal kinases (JNK) are activated by various stimuli, including UV light, interleukin-1, tumor necrosis factor-alpha (TNF-alpha), and CD28 costimulation. Induction of JNK by TNF-alpha, a strong apoptosis inducer, implies a possible role of JNK in the regulation of programmed cell death. Present studies show that lethal doses of gamma radiation (GR) induced JNK activities at the early phase of apoptosis in Jurkat T-cells. We demonstrate that JNK1 was activated by either the T-cell activation signals, anti-CD28 monoclonal antibody plus phorbol 12-myristate 13-acetate (PMA), or the apoptosis-inducing treatment, GR; however, the induction patterns were different. In contrast to the rapid and transient JNK1 activation caused by CD28 signaling plus PMA, GR induced a delayed and persistent JNK1 activation. This implies a distinct regulatory mechanism and specific function of JNK1 in irradiated cells. The nuclear and cytosolic JNK1 activities were simultaneously increased in the irradiated cells without an evident change in the protein levels. The abilities of GR to induce JNK1 activation and DNA fragmentation were correlated. Peripheral blood lymphocytes were more sensitive to GR than Jurkat cells in JNK1 induction. The responsiveness of JNK1 to GR suggests the involvement of JNK1 in the initiation of the apoptosis process.

Unusual complications of the Le Fort I osteotomy

In this report we describe three very different and interesting complications of the Le Fort I osteotomy. The first case is of a unilateral third nerve palsy developing as a result of a carotid-cavernous fistula and false aneurysm of the internal carotid artery. The second complication to be reported is total unilateral blindness. The third case is one of total avulsion of a lateral segment of the palate in a patient with a complete bilateral cleft of the primary and secondary palates. All complications were the result of a Le Fort I osteotomy performed for correction of midface hypoplasia secondary to congenital cleft lip and palate. The literature is reviewed, and the pathomechanics of each injury are hypothesized.

Skull morphology affected by different sleep positions in infancy

In infancy, prior to cranial suture and fontanel calcification, the craniofacial skeleton can be easily deformed by an externally exerted force. In this study, the relationship between the sleep position and skull morphology was investigated. A group of 81 cleft lip and/or palate infants without other systemic anomalies was first seen in the craniofacial center at approximately 1 month of age. The sleep position of each infant was recorded as supine, prone, or mixed type. The body and skull growth were longitudinally measured at 1, 3, and 6 months of age. Infants sleeping in the supine sleep position tended to have a wider head width, shorter head length, and a larger cephalic index by 6 months of age. The opposite phenomena were observed in the prone sleep group. The mixed sleep group tended to have head width, head length, and cephalic index between those of the supine sleep group and the prone sleep group. During the first 3 months of life, the sleep position could mold the skull primarily in the dimension of head width. In conclusion, the supine sleep position may promote brachycephaly and the prone sleep position dolichocephaly.

Surgical complications of the Le Fort I osteotomy--a retrospective review of 146 cases

A retrospective review of 146 cases with Le Fort I osteotomy performed between 1981 and 1990 is presented. A complication of 6.1% was recorded. These complications include intraoperative hemorrhage, trigeminal nerve injury, oronasal fistula and dental injury. Although the Le Fort I osteotomy has proven to be relatively safe, improvements in technique will further reduce the incidence and the severity of complications.

[Postoperative evaluation in mandibular prognathism treated by bilateral sagittal split osteotomy]

The present study was undertaken to evaluate the postoperative relapse from the period of unwiring to 1 year postoperatively and its correlation to the amount of mandibular setback and change in vertical dimension after mandibular bilateral sagittal split osteotomy. Twenty-seven patients were evaluated cephalometrically by the time preoperatively, 6 weeks, 6 months and 1 year postoperatively. It was found that 1) the average amount of mandibular setback at pogonion point, 6 weeks postoperatively, is 7.6mm backward and 1.9mm downward, 2) the average amount of horizontal relapse at pogonion point, 6 months and 1 year postoperatively, are 1.9mm and 2.3mm respectively. 86% of the horizontal relapse, 1 year postoperatively, occurs in the first 6 months after removal of intermaxillary fixation, 3) the average amount of vertical relapse at pogonion point, 6 months and 1 year postoperatively, are 0.9mm and 1.1mm upward. 82% of the vertical relapse, 1 year postoperatively, occurs in the first 6 months after removal of intermaxillary fixation, 4) the amount of 1 year postoperatively horizontal relapse is significantly correlated both with the amount of horizontal mandibular set back and vertical downward change (r = 0.58, 0.67, p < 0.001), whereas the amount of vertical relapse is with the vertical downward change only, but horizontal setback isn't.

Polyotia

Polyotia is an extremely rare congenital anomaly of the external ear. Only four case reports are documented in the literature. A 13-month-old child with a mirror-image duplication of the left auricle was operated on in a one-stage corrective procedure. The duplicated portion of the affected ear was positioned anteriorly and measured approximately two-thirds the size of the posterior, normally oriented portion. There were two fully developed conchae and one fully developed and one partially developed anthelix and lobule. The entire complex had a single external auditory meatus and no tragus. There were no other congenital anomalies, and the child was developmentally normal. The technique for surgical correction is described, and a review of the literature is presented.

A signature of the oxygenase intermediate in catalysis by ribulose-bisphosphate carboxylase/oxygenase as provided by a site-directed mutant

An uncharacterized minor transient product, observed in our earlier studies of substrate turnover by the E48Q mutant of Rhodospirillum rubrum ribulose-bisphosphate carboxylase/oxygenase (Lee, E. H., Harpel, M. R., Chen, Y.-R., and Hartman, F. C. (1993) J. Biol. Chem. 268, 26583-26591), becomes a major product when it is trapped and stabilized with borate as an additive to the reaction mixture. Chemical characterization establishes this novel product as D-glycero-2,3-pentodiulose 1,5-bisphosphate, thereby demonstrating oxidation of the C-3 hydroxyl of D-ribulose 1,5-bisphosphate to a carbonyl. As the formation of the novel oxidation product is oxygen-dependent and generates hydrogen peroxide, its precursor must be a peroxy derivative of ribulose bisphosphate. Thus, discovery of the dicarbonyl bisphosphate lends direct support to the long standing, but heretofore unproven, postulate that the normal pathway for oxidative cleavage of ribulose bisphosphate by the wild-type enzyme entails a peroxy intermediate. Our results also suggest that stabilization of the peroxy intermediate by the wild-type enzyme promotes carbon-carbon scission as opposed to elimination of hydrogen peroxide.

Identification of amino acid residues involved in structural and ubiquinone-binding functions of subunit IV of the cytochrome bc1 complex from Rhodobacter sphaeroides

Previous studies established that subunit IV of the cytochrome bc1 complex from Rhodobacter sphaeroides is involved in structural and ubiquinone-binding functions of the complex. To identify regions or amino acid residues responsible for these functions, deletion, insertion, and substitution mutations at various regions of subunit IV were generated and characterized. Mutational effects on the structural role of subunit IV are indicated by a delay in photosynthetic growth and by a decrease in the cytochrome bc1 complex activity in chromatophores upon detergent treatment. An effect on the ubiquinone-binding function of subunit IV is suggested by an increase in the apparent Km for 2,3-dimethoxy-5-methyl-6-geranyl-1,4-benzoquinol (Q2H2) of the complex. RSIV delta (2-5), in which residues 2-5 are deleted, had photosynthetic growth behavior, tolerance to detergent treatment, and an apparent Km for Q2H2 of its cytochrome bc1 complex similar to those of wild-type or complement cells, indicating that amino acid residues 2-5 are not essential for subunit IV function. RSIV delta (2-11), with residues 2-11 missing, showed a 24-h delay in photosynthetic growth and a 65% inactivation of the cytochrome bc1 complex upon dodecyl maltoside solubilization. However, its apparent Km for Q2H2 was the same as in wild-type cells, indicating that deletion of amino acid residues 6-11 results in loss of the structural but not the ubiquinone-binding function of subunit IV. RSIV delta (113-124), which has 13 amino acid residues deleted from the C terminus, had photosynthetic growth behavior, tolerance to detergent treatment, and ubiquinone-binding kinetics similar to those of wild-type or complement cells, indicating that residues 113-124 are not essential. Point mutants RSIV(W79L) and RSIV(W79F), in which tryptophan 79 was replaced with leucine or phenylalanine, showed a 24-h delay in photosynthetic growth, a decrease of 75% of the cytochrome bc1 complex activity in chromatophores upon detergent solubilization, and a 4-fold increase in the apparent Km for Q2H2, indicating that Trp-79 is essential for the structural and ubiquinone-binding functions of subunit IV.

A clinical study of colorectal cancer accompanied by cancer of other organs

BACKGROUND

The incidence of double primary neoplasms has increased in recent decades. The etiologies and epidemiologies of double primary neoplasms are under investigation, and relationships between some cancers are well established. A group of patients with double primary cancers was studied to determine the relationships between certain cancers.

METHODS

From November 1982 to September 1993, 48 patients with colorectal cancer accompanied by cancer of another organ (double primary cancers) were treated here. The male-to-female ratio was 31 to 17. According to Warren's definitions, the patients were classified into two groups: synchronous and metachronous. Data collection was done on the basis of locations, pathological staging and interval between cancers.

RESULTS

Among the 48 patients, extracolonic cancers were mainly found in the cervix (8), stomach (7), prostate (5), lung (5), urinary bladder (4), and breast (4). In the female patients, 88.2% (15/17) of extracolonic cancers were in the female reproductive organs. In male patients, 45% (14/31) of extracolonic cancers were GI tract neoplasms, and 35.5% (11/31) were cancers of the GU tract. Nearly half of the patients expired within two years after diagnosis of the second primary cancer.

CONCLUSIONS

Cancers of the cervix, stomach, prostate, lung, urinary bladder and breast may have some etiologic factors in common with that of colorectuim. Thus, attention should be paid to these sites during the period of post-operative follow-up of the first primary cancer.